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García-González S, Aboul-Hosn Centenero S, Baumann P, Fita-Esteban I, Hernández-Alfaro F, Weyer N. Prospective, multi-centric, international, single-arm, cohort study to assess a synthetic polyamide suture material in oral surgery to close the mucosa - MUCODA study. J Dent 2024; 145:104922. [PMID: 38490322 DOI: 10.1016/j.jdent.2024.104922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The aim was to collect different clinical parameters systematically and proactively regarding safety, effectiveness, and performance of a nylon monofilament suture under routine clinical practice for oral surgery. METHODS The study design was prospective, bicentric, international, single-armed, and observational. A non-absorbable suture was applied to close the mucosa after different dental surgical interventions. Main objective was the incidence of combined postoperative complications until suture removal. The 95 % Confidence Interval (Agresti-Coull method) was used to prove the non-inferiority with a pre-specified upper margin of 21.9 %. Secondary variables were intraoperative suture handling, patient pain and satisfaction, wound healing, aesthetic appearance, and bacterial contamination. RESULTS 105 patients were enrolled. Complication rate was low (1.9 %), 2 swellings occurred. Pain was present for 1.61 days ± 1.42 after various dental interventions with an average pain level of 20.98 ± 22.60 (VAS). Patients with impacted third molar extraction showed the longest pain duration (6 days) combined with the highest mean pain level of 35.33 ± 30.45 (VAS). Intraoperative suture handling was very good to excellent. Suture removal was done after an average duration of 7.56 ± 2.09 days. Patient's satisfaction was high, and an excellent wound healing was reported by the dentists. Aesthetic appearance only performed in implant patients was rated by oral surgeons with an average of 96.19 ± 3.79 points [min. 80 - max. 100] at 5 months postoperatively. Thread bacterial analysis showed that F. nucleatum was the most present species. CONCLUSIONS Our findings indicate that the non-absorbable, nylon-based monofilament suture used is safe and quite suitable for oral mucosal closure after various dental surgical interventions such as tooth extraction, implant placement and impacted third molar extraction. CLINICAL SIGNIFICANCE This study showed the safe use of a non-absorbable, nylon-based monofilament suture for different oral surgical interventions under daily routine clinical practice.
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Affiliation(s)
- S García-González
- Department of Oral Surgery, International University of Catalonia, Carrer de Josep Trueta, 08195 Sant Cugat del Vallès, Barcelona, Spain.
| | - S Aboul-Hosn Centenero
- Department of Oral Surgery, International University of Catalonia, Carrer de Josep Trueta, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - P Baumann
- Department of Medical Scientific Affairs, Aesculap AG, Am Aesculap Platz 78532 Tuttlingen, Germany
| | - I Fita-Esteban
- Department of Medical Scientific Affairs, B. Braun Surgical, S.A.U., Carretera de Terrassa 121 08191 Rubí, Barcelona, Spain
| | - F Hernández-Alfaro
- Department of Oral Surgery, International University of Catalonia, Carrer de Josep Trueta, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - N Weyer
- Praxisklinik für MKG, Ästhetische und Plastische Chirurgie, Schwerpunkt Implantologie, Fabrikstraße 10/1, 73728 Esslingen am Neckar, Germany
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Acar AH. Can natural language processing serve as a consultant in oral surgery? J Stomatol Oral Maxillofac Surg 2024; 125:101724. [PMID: 38052322 DOI: 10.1016/j.jormas.2023.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE In this comprehensive evaluation, ten experienced oral surgeon experts posed a total of twenty oral surgery-related questions, including dental implant and tooth extractions, to three distinct Natural Language Processing (NLP)-based chatbot platforms: ChatGPT, Microsoft Bing, and Google Bard. The study aimed to assess the effectiveness of these chatbots in responding to specialized medical questions. MATERIALS AND METHODS Two primary evaluation metrics were employed: a Likert Scale (LS) for measuring the accuracy and completeness of responses and a Global Quality Scale (GQS) for evaluating the clarity of responses. Statistical analyses, including one-way analysis of variance (ANOVA) and Post Hoc Tukey, were conducted to assess and compare the performance of the chatbots as rated by the experts. RESULTS The results of the study revealed significant differences in the performance of the chatbots. ChatGPT statistically achieved a better mean LS score of 1.4000±0.15986 than Microsoft Bing (1.8750±0.18143) and Google Bards (2.0500±0.12472) (P < 0.001). Additionally, ChatGPT statistically achieved a higher GQS score of 4.4200±0.30111 than Microsoft Bing (3.7550±0.28621) and Google Bards (3.5250±0.22392) (P < 0.001). CONCLUSIONS These findings showed the substantial advantage of ChatGPT in effectively addressing oral surgery-related questions with superior accuracy, completeness, and clarity. The study highlights the potential of advanced NLP platforms to enhance information retrieval and communication within the field of oral surgery, reinforcing the utility of such technologies in medical and surgical domains.
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Affiliation(s)
- Ahmet Hüseyin Acar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul Medeniyet University, Istanbul, Turkey.
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Grillo R, Quinta Reis BA, Lima BC, Peral Ferreira Pinto LA, Cruz Meira JB, Melhem-Elias F. The butterfly effect in oral and maxillofacial surgery: Understanding and applying chaos theory and complex systems principles. J Craniomaxillofac Surg 2024; 52:652-658. [PMID: 38582679 DOI: 10.1016/j.jcms.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024] Open
Abstract
The present paper provides a historical context for chaos theory, originating in the 1960s with Edward Norton Lorenz's efforts to predict weather patterns. It introduces chaos theory, fractal geometry, nonlinear dynamics, and the butterfly effect, highlighting their exploration of complex systems. The authors aim to bridge the gap between chaos theory and oral and maxillofacial surgery (OMFS) through a literature review, exploring its applications and emphasizing the prevention of minor deviations in OMFS to avoid significant consequences. A comprehensive literature review was conducted on PubMed, Web of Science, and Google Scholar databases. The selection process adhered to the PRISMA-ScR guidelines and Leiden Manifesto principles. Articles focusing on chaos theory principles in health sciences, published in the last two decades, were included. The review encompassed 37 articles after screening 386 works. It revealed applications in outcome variation, surgical planning, simulations, decision-making, and emerging technologies. Potential applications include predicting infections, malignancies, dental fractures, and improving decision-making through disease prediction systems. Emerging technologies, despite criticisms, indicate advancements in AI integration, contributing to enhanced diagnostic accuracy and personalized treatment strategies. Chaos theory, a distinct scientific framework, holds potential to revolutionize OMFS. Its integration with advanced techniques promises personalized, less traumatic surgeries and improved patient care. The interdisciplinary synergy of chaos theory and emerging technologies presents a future in which OMFS practices become more efficient, less traumatic, and achieve a level of precision never seen before.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília-DF, Brazil.
| | | | - Bernardo Correia Lima
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Department of Oral and Maxillofacial Surgery and Diagnosis, Hospital da Boca, Santa Casa da Misericórdia do Rio de Janeiro, RJ, Brazil
| | | | - Josete Barbosa Cruz Meira
- Department of Biomaterials and Oral Biology, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| | - Fernando Melhem-Elias
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil
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Bragaglia M, Sciarretta F, Filetici P, Lettieri-Barbato D, Dassatti L, Nicoletti F, Sibilia D, Aquilano K, Nanni F. Soybean Oil-Based 3D Printed Mesh Designed for Guided Bone Regeneration (GBR) in Oral Surgery. Macromol Biosci 2024; 24:e2300458. [PMID: 38198834 DOI: 10.1002/mabi.202300458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/22/2023] [Indexed: 01/12/2024]
Abstract
This study aims to obtain a cyto-compatible 3D printable bio-resin for the manufacturing of meshes designed from acquired real patients' bone defect to be used in future for guided bone regeneration (GBR), achieving the goal of personalized medicine, decreasing surgical, recovery time, and patient discomfort. To this purpose, a biobased, biocompatible, and photo-curable resin made of acrylated epoxidized soybean oil (AESO) diluted with soybean oil (SO) is developed and 3D printed using a commercial digital light processing (DLP) 3D printer. 3D printed samples show good thermal properties, allowing for thermally-based sterilization process and mechanical properties typical of crosslinked natural oils (i.e., E = 12 MPa, UTS = 1.5 MPa), suitable for the GBR application in the oral surgery. The AESO-SO bio-resin proves to be cytocompatible, allowing for fibroblast cells proliferation (viability at 72 h > 97%), without inducing severe inflammatory response when co-cultured with macrophages, as demonstrated by cytokine antibody arrays, that is anyway resolved in the first 24 h. Moreover, accelerated degradation tests prove that the bio-resin is biodegradable in hydrolytic environments.
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Affiliation(s)
- Mario Bragaglia
- Department of Enterprise Engineering, University of Rome "Tor Vergata", Via del Politecnico 1, Rome, 00133, Italy
| | | | - Pierfrancesco Filetici
- Multispecialty Department of Oral Surgery - Periodontology and Implant-Prosthodontic Rehabilitation, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, 00168, Italy
| | | | - Leonardo Dassatti
- Multispecialty Department of Oral Surgery - Periodontology and Implant-Prosthodontic Rehabilitation, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, 00168, Italy
| | - Fabrizio Nicoletti
- Multispecialty Department of Oral Surgery - Periodontology and Implant-Prosthodontic Rehabilitation, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, 00168, Italy
| | - Diego Sibilia
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy
| | - Katia Aquilano
- Department of Biology, University of Rome "Tor Vergata", Via della Ricerca scientifica 1, Rome, 00133, Italy
| | - Francesca Nanni
- Department of Enterprise Engineering, University of Rome "Tor Vergata", Via del Politecnico 1, Rome, 00133, Italy
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Al-Ani AJ, Taher HJ, Alalawi AS. Histological evaluation of the surgical margins of oral soft tissue incisions using a dual-wavelength diode laser and an Er, Cr:YSGG laser; an ex vivo study. J Appl Oral Sci 2024; 32:e20230419. [PMID: 38655987 DOI: 10.1590/1678-7757-2023-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/01/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE This study compared a dual-wavelength diode laser and an Er, Cr:YSGG laser in oral soft tissue incisions to determine the most effective and safest laser system at the histopathological level. METHODOLOGY The (810 and 980 nm) dual-wavelength diode laser was used at 1.5 W and 2.5 W (CW) power settings, and the (2780 nm) Er, Cr:YSGG laser was used at 2.5 W and 3.5 W (PW) power settings. Both laser systems were used to incise the tissues of freshly dissected sheep tongue pieces to obtain the following histopathological criteria: epithelial tissue changes, connective tissue changes, and lateral thermal damage extent by optical microscopy. RESULTS The epithelial and connective tissue damage scores were significantly higher in the dual-wavelength diode laser groups than in the Er, Cr:YSGG laser groups (P<0.001), and there was a significant difference between some groups. The extent of lateral thermal damage was also significantly higher in the diode laser groups than in the Er, Cr: YSGG laser groups (P<0.001), and there was a significant difference between groups. Group 2 (2.5 W) of the diode laser was the highest for all three criteria, while group 3 (2.5 W) of the Er, Cr:YSGG laser was the lowest. CONCLUSION The Er, Cr:YSGG laser with an output power of 2.5 W is, histologically, the most effective and safest laser for oral soft tissue incision. The dual-wavelength diode laser causes more damage than the Er, Cr:YSGG laser, but it can be used with a low output power and 1 mm safety distance in excisional biopsy.
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Affiliation(s)
- Alaa Jamal Al-Ani
- University of Baghdad, Institute of Laser for Postgraduate Studies, Medical and Biological Applications Branch, Baghdad, Iraq
| | - Hanan J Taher
- University of Baghdad, Institute of Laser for Postgraduate Studies, Photonics Units, Baghdad, Iraq
| | - Ammar Saleh Alalawi
- Al-Emamein Al-Kadhemein Medical city, Laser/Dentistry (oral surgery), Baghdad, Iraq
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Dawiec G, Niemczyk W, Wiench R, Niemczyk S, Skaba D. Introduction to Amniotic Membranes in Maxillofacial Surgery-A Scoping Review. Medicina (Kaunas) 2024; 60:663. [PMID: 38674309 PMCID: PMC11051762 DOI: 10.3390/medicina60040663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Background: Amniotic membrane (AM) holds significant promise in various medical fields due to its unique properties and minimal ethical concerns. This study aims to explore the diverse applications of the human amniotic membrane (HAM) in maxillofacial surgery. Methodology: A comprehensive search was conducted on databases, namely Google Scholar, PubMed, and Scopus, from January 1985 to March 2024. Articles in English, Polish, and Spanish were included, focusing on keywords related to amniotic membrane and oral surgery. Results: Various preservation methods for HAM were identified, namely fresh, decellularized, cryopreserved, lyophilized, and air-dried formats. Clinical studies demonstrated the efficacy of HAM in repairing oral mucosal defects, vestibuloplasty, oronasal fistula closure, cleft palate treatment, bone defect repair, and medication-related osteonecrosis of the jaw (MRONJ). Surgeon evaluations highlighted the ease of handling but noted challenges in suturing and stability during application. Conclusions: Amniotic membranes offer a versatile and effective option in maxillofacial surgery, promoting wound healing, reducing inflammation, and providing a scaffold for tissue regeneration. Further research, including randomized trials and comparative studies, is warranted to validate the efficacy and optimize the utilization of HAM in clinical practice.
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Affiliation(s)
- Grzegorz Dawiec
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Faculty of Medical Sciences, ul. Medyków 16, 40-752 Katowice, Poland
- Outpatient Clinic for Dental Surgery in Zabrze, University Dental Centre, Silesian Medical University Ltd. in Katowice, Pl. Akademicki 17, 41-902 Bytom, Poland
- Private Dental Practice NZOZ Stomatologia-Dawiec s.c., Ul. Witczaka 49/15, 41-902 Bytom, Poland
| | - Wojciech Niemczyk
- Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Pl. Traugutta 2, 41-800 Zabrze, Poland; (R.W.); (D.S.)
| | - Rafał Wiench
- Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Pl. Traugutta 2, 41-800 Zabrze, Poland; (R.W.); (D.S.)
| | - Stanisław Niemczyk
- Municipal Hospital No. 4 in Gliwice, Zygmunta Starego 20, 44-100 Gliwice, Poland;
| | - Dariusz Skaba
- Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Pl. Traugutta 2, 41-800 Zabrze, Poland; (R.W.); (D.S.)
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Kaba YN, Demirbas AE, Topan C, Asan CY, Kahraman B. Which method is successful in closure of acute oroantral communication? A retrospective study. Med Oral Patol Oral Cir Bucal 2024; 29:e95-e102. [PMID: 38150602 PMCID: PMC10765340 DOI: 10.4317/medoral.26084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND This study's purpose is to retrospectively evaluate the success of surgical methods used in treating Oroantral Communication (OAC). MATERIAL AND METHODS This study was designed as a retrospective cohort study on patients who developed OAC after surgery maxillary posterior region. The records of patients previously treated with OAC were scanned through the hospital registry software. A data set was created by recording patients' age, gender, systemic disease, etiological reasons, and surgical methods. The primary predictor variable was the surgical method used to treat OAC. Other variables were age, gender, systemic disease and etiological reasons. The primary outcome was oroantral fistula development after the first surgical intervention. The patients who were positive in clinical examination and Valsalva test on control days were considered unsuccessful. One-way analysis of variance and Kruskal-Wallis tests were used for quantitative variables in more than two groups. Pearson chi-square test was used to compare categorical data. RESULTS This retrospective cohort study was completed with 605 patients who met the study criteria among 95,883 patients who underwent surgery in the maxillary posterior region. The incidence of OAC was 0.63%. The patients consisted of 238 female and 367 male patients. The mean age was 41.06±14.48 years. Buccal flap and Buccal Fat Pad methods were used most frequently in the treatment. While treatment was completed with the first surgical intervention in 592 (97.85%) patients, OAF developed in 13 (2.15%) patients. No statistically significant relation existed between surgical technique and OAF development (p>0.005). The success rate of the Buccal Flap method was 98.7%, and the Buccal Fat Pad method was 95.8%. CONCLUSIONS The results of this study showed that noninvasive methods in openings smaller than 5 mm and surgical treatment methods in openings larger than 5 mm have a high success rate with the limitations of present study.
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Affiliation(s)
- Y-N Kaba
- Erciyes University, Faculty of Dentistry Departments of Oral and Maxillofacial Surgery, Kayseri, Türkiye
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Karlsson K, Trullenque-Eriksson A, Tomasi C, Derks J. Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:244-284. [PMID: 36217689 DOI: 10.1111/jcpe.13732] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. MATERIALS AND METHODS Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). RESULTS Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. CONCLUSIONS Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Fiorino A, Staderini E, Diana R, Rengo C, Gallenzi P. New Conservative Approach for the Management of Recurrent Sublingual Ranula-A Case Report. Int J Environ Res Public Health 2023; 20:2398. [PMID: 36767764 PMCID: PMC9915898 DOI: 10.3390/ijerph20032398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Ranula is a rare and benign extravasation mucocele that is clinically characterized by asymptomatic sublingual or submandibular masses. Surgical excision is considered the most effective treatment approach, but it has been associated with high invasiveness and several complications (hemorrhage, damage to Wharton's duct, and lingual nerve injury). Over the past decade, more conservative therapies have been rapidly disseminated into clinical practice to seek a more effective and less traumatic approach for young patients. In this report, an 8-year-old female with an asymptomatic, recurrent sublingual ranula was treated using a conservative approach with marsupialization and an intracystic injection of a plaque remover (Hybenx® gel). After incision of the cystic dome, Hybenx® gel was applied into the cystic lumen for 20 seconds and then aspirated; next, the area was rinsed thoroughly with sterile saline solution before suturing. Ultrasound re-evaluation at 10 months and intraoral clinical examination at 24 months confirmed the absence of relapse. Our results support the hypothesis that marsupialization combined with intracystic injection of Hybenx® gel could be an encouraging conservative treatment alternative for recurrent sublingual ranula in children. Further randomized controlled trials are needed to test this hypothesis.
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Affiliation(s)
- Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, 80131 Naples, Italy
| | - Edoardo Staderini
- Postgraduate School of Orthodontics, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Rosalba Diana
- Postgraduate School of Orthodontics, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Carlo Rengo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Patrizia Gallenzi
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, 80131 Naples, Italy
- UOC Odontoiatria Generale e Ortodonzia, Dipartimento di Testa-Collo e Organi di Senso, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
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Landart C, Barbay V, Chamouni P, Trost O. Management of patients with inherited bleeding disorders in oral surgery: A 13-year experience. J Stomatol Oral Maxillofac Surg 2022; 123:e405-e410. [PMID: 35150908 DOI: 10.1016/j.jormas.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The management of patients with inherited bleeding disorders in oral surgery requires the systematic evaluation of bleeding risk and the setting up of an adequate treatment protocol by the referring haematologist, defining a replacement therapy and a recommended length of hospital stay. The purpose of this study was to determine the bleeding risk associated with oral surgery for each type of inherited bleeding disorder and to evaluate the efficacy of the treatment protocols set up in our tertiary care center. MATERIALS AND METHODS We included all patients with an inherited bleeding disorder, managed in our oral and maxillofacial surgery department with a treatment protocol set up by our local Haemophilia Treatment Centre for an oral surgical procedure. RESULTS Between January 2006 and December 2018, 295 treatment protocols were set up for the management of patients with haemorrhagic risk in oral surgical procedures. Of these, 203 were scheduled to take place in our department. A total of 180 oral surgical procedures for 147 patients were included. The incidence of bleeding complications in our study was 4.44% (8 out of 180) with a significantly higher risk in patients with haemophilia, the mean time to onset of bleeding was 11 days. DISCUSSION The use of a treatment protocol for the management of patients with inherited bleeding disorders in oral surgery seems effective. Our rate of bleeding complications was comparable to data in the literature, and often lower.
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Affiliation(s)
- Cécile Landart
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen Normandy University, 1 rue de Germont, Rouen F-76000, France
| | - Virginie Barbay
- Haemophilia Treatment Centre, Laboratory of Hematology, Rouen University Hospital, Rouen Normandy University, 1 rue de Germont, Rouen F-76000, France
| | - Pierre Chamouni
- Haemophilia Treatment Centre, Laboratory of Hematology, Rouen University Hospital, Rouen Normandy University, 1 rue de Germont, Rouen F-76000, France
| | - Olivier Trost
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen Normandy University, 1 rue de Germont, Rouen F-76000, France; Inserm, Rouen Normandy University, Sorbonne University, University of Paris 13, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris F-75006, France; Laboratory of Anatomy, Rouen Faculty of Medicine, Rouen Normandy University, 22 boulevard Léon-Gambetta, Rouen F-75006, France.
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Francisco I, Antonarakis GS, Caramelo F, Paula AB, Marto CM, Carrilho E, Fernandes MH, Vale F. Current Treatment of Cleft Patients in Europe from a Provider Perspective: A Cross-Sectional Survey. Int J Environ Res Public Health 2022; 19:ijerph191710638. [PMID: 36078357 PMCID: PMC9518109 DOI: 10.3390/ijerph191710638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 05/27/2023]
Abstract
The latest Eurocleft study reported several discrepancies in cleft care. Since then, no critical assessment has been performed. This study aimed to better understand the main strengths and inefficiencies of cleft care within Europe. The Google documents platform was used to create an online survey to investigate several aspects, i.e., provider characteristics, patient profile, services offered, and treatment protocols and complications. Descriptive statistics were calculated. The association between categorical variables was performed using Fisher's exact test. The significance level chosen was 0.05. A total of 69 individuals from 23 European countries completed the survey. Centralized care was the preferred system, and the majority of the countries have an association for cleft patients and professionals (53.6%). The largest percentage of patients was seen in the university hospital environment (Fisher's exact test p < 0.001). The majority of responders (98.6%) reported that an orthodontist was involved in cleft treatment, and 56.5% of them spend 76-100% of their time treating these patients. Despite cleft care having been reconfigured in Europe, a better consensus among the various centers regarding provider characteristics, services offered, and treatment protocols is still required. There is a need for better coordination between clinicians and national/international regulatory bodies.
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Affiliation(s)
- Inês Francisco
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Gregory S. Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Francisco Caramelo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
| | - Anabela Baptista Paula
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Carlos Miguel Marto
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Eunice Carrilho
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Maria Helena Fernandes
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/REQUIMTE, University of Porto, 4160-007 Porto, Portugal
| | - Francisco Vale
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
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12
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Aboulhassan MA, Aly TM, Akram Khodir MM, Moussa HM, Hussein MA. Quantitative Evaluation of Palatal Lengthening After Cleft Palate Repair When a Buccal Flap Is Routinely Combined With Furlow's Z-Plasty. Ann Plast Surg 2022; 88:288-292. [PMID: 34393194 DOI: 10.1097/sap.0000000000002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of a buccinator myomucosal flap in combination with Furlow's Z-plasty during primary and secondary palatal repairs has been proposed by many authors to overcome some of the limitations of Furlow's technique. However, there have been no studies that quantitatively measured the effective palatal lengthening when the buccal flap is added. PATIENTS AND METHODS The buccal flap is routinely used during primary palate repair in order to fill the gap between the hard palate and reoriented palatal muscle sling. The soft palatal length was measured in the midline from the posterior edge of the hard palate to the base of the uvula. All patients were measured before starting the surgery and just after palatal closure in the standard position for cleft palate repair. RESULTS Seventy-three patients with cleft palate who were candidates for primary repair were included. The mean age at the time of operation was 11.4 ± 3.5 months. The mean preoperative palatal length was 21.36 ± 3.529 mm, whereas the mean postoperative palatal length was 29.64 ± 4.171) mm. The mean palatal length change was 8.29 ± 2.514 mm (P < 0.000). CONCLUSIONS The Combined use of a buccinator myomucosal flap with modified Furlow's Z-plasty in primary cleft palate repair has proven effective for palatal lengthening and achieved tensionless closure without the need for relaxing incision. It also provided a pliable soft tissue attachment of the palatal muscles to the hard palate allowing for better muscle function and mobility.
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Affiliation(s)
- Mamdouh Ahmed Aboulhassan
- From the Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University, Cairo
| | | | | | | | - Mohammed Ahmed Hussein
- From the Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University, Cairo
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13
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Philips R, Topf MC, Vimawala S, Luginbuhl A, Curry JM, Cognetti DM. Risk factors for gastrostomy tube dependence in transoral robotic surgery patients. Am J Otolaryngol 2022; 43:103175. [PMID: 34418824 DOI: 10.1016/j.amjoto.2021.103175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/26/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. METHODS Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year. RESULTS A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28-28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37-41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis. CONCLUSIONS Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.
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Affiliation(s)
- Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA.
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232, USA
| | - Swar Vimawala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
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14
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Herrick KR, Terrio JM, Herrick C. Medical Clearance for Common Dental Procedures. Am Fam Physician 2021; 104:476-483. [PMID: 34783493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical consultations before dental procedures present opportunities to integrate cross-disciplinary preventive care and improve patient health. This article presents recommendations related to patients with certain medical conditions who are planning to undergo common dental procedures, such as cleanings, extractions, restorations, endodontic procedures, abscess drainage, and mucosal biopsies. Specifically, prophylactic antibiotics are not recommended for preventing prosthetic joint infections or infectious endocarditis except in certain circumstances. Anticoagulation and antiplatelet therapies typically should not be suspended for common dental treatments. Elective dental care should be avoided for six weeks after myocardial infarction or bare-metal stent placement or for six months after drug-eluting stent placement. It is important that any history of antiresorptive or antiangiogenic therapies be communicated to the dentist. Ascites is not an indication for initiating prophylactic antibiotics before dental treatment, and acetaminophen is the analgesic of choice for patients with liver dysfunction or cirrhosis who abstain from alcohol. Nephrotoxic medications should be avoided in patients with chronic kidney disease, and the consultation should include the patient's glomerular filtration rate. Although patients undergoing chemotherapy may receive routine dental care, it should be postponed when possible in those currently undergoing head and neck radiation therapy. A detailed history of head and neck radiation therapy should be provided to the dentist. Multimodal, nonnarcotic analgesia is recommended for managing acute dental pain.
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15
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Katz A, Gidumal S, Mayland E, Genden E. Management of pedicle ossification following free flap reconstruction: A case report. Am J Otolaryngol 2021; 42:102990. [PMID: 33621765 DOI: 10.1016/j.amjoto.2021.102990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Heterotopic ossification of a vascular pedicle is an uncommon, but established, phenomenon occasionally seen incidentally on post-operative imaging after fibular free flap reconstruction. Symptomatic cases of pedicle ossification, however, are much rarer, with very few cases requiring operative intervention. We present the largest case of pedicle ossification recorded to date, review the literature on symptomatic pedicle ossification, and describe our experience with the surgical management and outcomes of this complication in symptomatic patients. PRESENTATION OF CASE A 60-year-old man with a 7 cm neck mass and neck pain presents six months after fibular free flap reconstruction of an osteonecrotic mandible. CT demonstrates heterotopic ossification of the free flap vascular pedicle. The patient underwent surgical resection of the ossification with preservation of the pedicle and had an uncomplicated post-operative course with resolution of symptoms. DISCUSSION While pedicle ossification following fibula free flap surgery appears to be a somewhat common occurrence in the literature, clinically significant and symptomatic cases are rare. Symptomatic pedicle ossification may require secondary surgical intervention if large, painful, or disfiguring. Although there are surgical techniques described which may decrease the incidence of postoperative ossification, the rarity of symptomatic cases may not justify the additional surgical risks created by subperiosteal dissection. CONCLUSION Here, we present what appears to be the largest case of pedicle ossification in the literature. We believe this case may aid in the understanding of pedicle ossification and contribute towards a standard treatment protocol in the prevention and treatment of clinically relevant pedicle ossification.
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Affiliation(s)
- Abigail Katz
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Sunder Gidumal
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States of America
| | - Erica Mayland
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States of America
| | - Eric Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States of America
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16
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Cameron N, Balsiger R, Prueter J, Kadakia S. Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle. Am J Otolaryngol 2021; 42:102944. [PMID: 33592553 DOI: 10.1016/j.amjoto.2021.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.
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Affiliation(s)
- Nicholas Cameron
- Department of Otolaryngology-Head and Neck Surgery, Kettering Health Network, Dayton, OH, United States of America.
| | - Robert Balsiger
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, United States of America.
| | - James Prueter
- Department of Otolaryngology-Head and Neck Surgery, Southwest Ohio ENT, Dayton, OH, United States of America
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Premier Health Comprehensive Head and Neck Oncology and Reconstruction Program, 30 E Apple St, Suite 2200, Dayton, OH 45409, United States of America.
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17
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Tsai YT, Lai CH, Huang TH, Hsieh CC, Huang EI, Lee YC, Yeh HK, Tsai MS, Chang GH, Hsu CM. Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study. Medicine (Baltimore) 2020; 99:e23860. [PMID: 33350779 PMCID: PMC7769301 DOI: 10.1097/md.0000000000023860] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023] Open
Abstract
Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | - Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | | | | | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung
| | - Hsuan-Keng Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery
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18
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Echlin K, Whitehouse H, Schwaiger M, Nicholas R, Fallico N, Atherton DD. A Cadaveric Study of the Buccal Fat Pad: Implications for Closure of Palatal Fistulae and Donor-Site Morbidity. Plast Reconstr Surg 2020; 146:1331-1339. [PMID: 33234964 DOI: 10.1097/prs.0000000000007351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND For the cleft surgeon, palatal fistulae after cleft palate repair remain a difficult problem, with a paucity of local tissue options to aid closure. Small clinical series have described the use of the buccal fat pad flap to repair palatal fistulae; however, there is no literature detailing the anatomical coverage of the flap. This study delineates the anatomy of the buccal fat pad flap to guide surgeons in patient selection and examines the residual buccal fat after flap harvest to provide new information with regard to possible effects on the donor site. METHODS Buccal fat pad flaps were raised in 30 hemicadavers. The reach of the flap across the midline, anteriorly and posteriorly, was recorded. In 18 hemicadavers, the entire buccal fat pad was then exposed to determine the effects of flap harvest on movement and volume of the residual fat. RESULTS All buccal fat pad flaps provided coverage from the soft palate to the posterior third of the hard palate and all across the midline. Approximately three-fourths of flaps would cover the mid hard palate. The flap constitutes 36 percent of the total buccal fat pad on average, and a series of retaining ligaments were identified that may prevent overresection. CONCLUSIONS The buccal fat pad flap is a useful tool for coverage of fistulae in the soft palate to the posterior third of the hard palate. In most cases, it will also reach the middle third; however, it is not suitable for more anterior defects. On average, two-thirds of the buccal fat pad remains within the cheek after flap harvest, which may protect against unwanted alteration in aesthetics.
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Affiliation(s)
- Kezia Echlin
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Harry Whitehouse
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Michael Schwaiger
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Rebecca Nicholas
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Nefer Fallico
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Duncan D Atherton
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
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19
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Abstract
The complex tissue engineering/regenerative medicine now represents a therapeutic reality applicable to various organic substrates, with the aim of repairing deficient tissues and restoring normal organ function. Among the possible specialized uses, in the dental field, the treatment of periodontal, pre- and peri-implant bone defects should be mentioned. Nowadays, in oral surgery, there are many surgical methods that can be used, despite that the literature still seems controversial regarding the actual advantages of their use. Surely, this work will bring to light the current clinical-surgical orientations and the different perspectives.
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Affiliation(s)
- Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
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20
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Roof SA, Perez ER, Villavisanis DF, Khan MN, Ferrandino RM, Chouake RJ, Pacheco CW, Yao M, Teng MS, Genden EM, Miles BA. 2-Octyl cyanoacrylate to prevent salivary fistula formation following oral cavity microvascular reconstruction: A prospective trial. Am J Otolaryngol 2020; 41:102552. [PMID: 32505990 DOI: 10.1016/j.amjoto.2020.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Salivary fistulas remain a significant problem in patients undergoing major head and neck reconstructive surgery. Surgical sealants have become increasingly used in cutaneous and non-cutaneous wound closure, providing a barrier to fluids/gases and promoting healing. The purpose of this study was to determine the efficacy of a common surgical sealant, 2-Octyl Cyanoacrylate (2-OCA, Dermabond®), in the prevention of salivary fistulas following free flap reconstruction of the oral cavity. METHODS In this non-randomized, single arm prospective trial, patients undergoing free flap reconstruction of gravity-dependent oral cavity defects were recruited. Application of 2-OCA was performed along flap inset suture lines at the time of surgery. Prospectively collected trial data were propensity score matched to a control cohort to compare outcomes. Data collected include demographics, medical co-morbidities, previous treatments, primary tumor site, and subsites reconstructed. The primary outcome measure was rate of salivary fistula formation. Secondary outcomes were time to development of leak and percentage of patients tolerating oral feeding at one month post-operatively. RESULTS In the 46 propensity score matched pairs, eight (17.4%) out of 46 patients in the 2-OCA prospective cohort and seven (15.2%) out of 46 patients in the control cohort developed postoperative salivary fistulas within the one-month study interval (p = 1.00). The average time to postoperative leak in the 2-OCA group was 12.5 days versus 7.1 days in the control cohort (p = 0.10). In the 2-OCA group, 30 (65.2%) patients were tolerating regular diet at one month post-operatively compared to 33 (71.7%) in the control cohort (p = 0.65). CONCLUSION Salivary fistula rates after application of a 2-OCA surgical sealant were not improved compared to a control cohort in this single institutional trial. There are several surgical sealants available, each with varying elasticity and adhesiveness. Future studies are needed to identify surgical sealants that are able to provide sufficient strength and adhesion to seal closures and combat corrosive saliva, but elastic enough to handle motion related tension during swallowing and post-operative movements in the head and neck.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
| | - Enrique R Perez
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | | | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Rocco M Ferrandino
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Robert J Chouake
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caitlin W Pacheco
- Department of Otolaryngology Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, CA, USA
| | - Mike Yao
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Marita S Teng
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Eric M Genden
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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Rodríguez Sánchez F, Arteagoitia I, Teughels W, Rodríguez Andrés C, Quirynen M. Antibiotic dosage prescribed in oral implant surgery: A meta-analysis of cross-sectional surveys. PLoS One 2020; 15:e0236981. [PMID: 32810135 PMCID: PMC7446810 DOI: 10.1371/journal.pone.0236981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to assess the dosage and types of antibiotics prescribed in oral implant surgery, compare them among the different subpopulations (country and prescription regimens) and against the evidence-based recommended dosage: a 2-gram single preoperative dose of amoxicillin. A meta-analysis of cross-sectional surveys was conducted, which reports the overall dosage (and type) of antibiotics prescribed in combination with implant placement. PubMed, Cochrane, Science, Direct, and EMBASE via OVID were searched until April 2019. Three reviewers independently undertook data extraction and risk of bias assessment. The outcome variable was set on the average of prophylactic antibiotics prescribed per oral implant surgery. Overall, 726 participants from five cross-sectional surveys, representing five different countries were finally included. Amoxicillin was the most prescribed antibiotic. On average, 10,724 mg of antibiotics were prescribed per implant surgery. This average was significantly (p<0.001) higher than 2,000 mg. Overall, amoxicillin doses were significantly higher than 2,000 mg (9,700 mg, p<0.001). All prescribed amoxicillin regimens independently contained more than 2,000 mg, including those comprising only preoperative amoxicillin (2,175 mg, p = 0.006). Exclusive preoperative antibiotic regimens were the only subgroup with prescription dosages below this threshold (p = 0.091). Significant variations in antibiotic prescriptions were found among different countries and antibiotic regimens (p<0.001). In conclusion, the average dose of antibiotics prescribed per oral implant surgery was larger than the evidence-based recommended dose in healthy patients and straightforward conditions. In addition, variations in the average antibiotic dosages were found among different countries and prescription regimens.
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Affiliation(s)
- Fabio Rodríguez Sánchez
- Department of Preventive Medicine and Public Health, University of the Basque Country, Bilbao, Spain
- Department of Oral Health Sciences, Section Periodontology, Catholic University of Leuven & University Hospitals Leuven, Leuven, Belgium
- * E-mail:
| | - Iciar Arteagoitia
- Department of Stomatology, University of the Basque Country, Bilbao, Spain
- Bioruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Wim Teughels
- Department of Oral Health Sciences, Section Periodontology, Catholic University of Leuven & University Hospitals Leuven, Leuven, Belgium
| | - Carlos Rodríguez Andrés
- Department of Preventive Medicine and Public Health, University of the Basque Country, Bilbao, Spain
| | - Marc Quirynen
- Department of Oral Health Sciences, Section Periodontology, Catholic University of Leuven & University Hospitals Leuven, Leuven, Belgium
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Kurata S, Mishima G, Sekino M, Sato S, Pinkham M, Tatkov S, Ayuse T. A study on respiratory management in acute postoperative period by nasal high flow for patients undergoing surgery under general anesthesia. Medicine (Baltimore) 2020; 99:e21537. [PMID: 32756204 PMCID: PMC7402890 DOI: 10.1097/md.0000000000021537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022] Open
Abstract
In head and neck surgery where the oropharyngeal area is the operative field, postoperative respiratory depression and upper airway obstruction are common. Therefore, supplemental oxygen is administered to prevent severe postoperative early hypoxemia. However, a high concentration of oxygen increases the likelihood of secondary complications, such as carbon dioxide (CO2) narcosis. Nasal high-flow (NHF) therapy generates high flows (≤60 L/min) of heated and humidified gas delivered via nasal cannula and provides respiratory support by generating positive airway pressure, clearance of dead space and reduction of work of breathing. This study aims to determine whether the postoperative hypoxemia and hypercapnia can be prevented by NHF without the requirement of supplemental oxygen. The study will recruit adult patients undergoing planned oral surgery under general anesthesia at Nagasaki University Hospital. It is a randomized parallel group comparative study with 3 groups: NHF with room air only and no supplemental oxygen, no respiratory support, and face mask oxygen administration. The study protocol will begin at the time that the patient is returned to the general ward and will finish 3 hours later. The primary endpoint is the time-weighted average of transcutaneous O2 over the 180 minutes and secondary endpoints are the time-weighted average of transcutaneous CO2 (tcpCO2), SpO2, and respiratory rate, incidence rate of marked hypercapnia (tcpCO2 ≥60 mm Hg for 5 minutes or longer), incidence rate of moderate hypercapnia (tcpCO2 ≥50 mm Hg for 5 minutes or longer) and the percentage of time that SpO2 is <90%. Included also is a group in which the postoperative management is performed only by spontaneous breathing without performing respiratory support such as oxygen administration, to investigate the efficacy and necessity of conventional oxygen administration. This exploratory study will investigate the use of NHF without supplemental oxygen as an effective respiratory support during the acute postoperative period. TRIAL REGISTRATION:: The study was registered the jRCTs072200018. URL https://jrct.niph.go.jp/latest-detail/jRCTs072200018.
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Affiliation(s)
| | | | | | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | | | | | - Takao Ayuse
- Department of Dental Anesthesiology
- Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Bußmann L, Laban S, Wittekindt C, Stromberger C, Tribius S, Möckelmann N, Böttcher A, Betz CS, Klussmann JP, Budach V, Muenscher A, Busch CJ. Comparative effectiveness trial of transoral head and neck surgery followed by adjuvant radio(chemo)therapy versus primary radiochemotherapy for oropharyngeal cancer (TopROC). BMC Cancer 2020; 20:701. [PMID: 32727416 PMCID: PMC7389683 DOI: 10.1186/s12885-020-07127-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/01/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND For loco-regionally advanced, but transorally resectable oropharyngeal cancer (OPSCC), the current standard of care includes surgical resection and risk-adapted adjuvant (chemo) radiotherapy, or definite chemoradiation with or without salvage surgery. While transoral surgery for OPSCC has increased over the last decade for example in the United States due to transoral robotic surgery, this treatment approach has a long history in Germany. In contrast to Anglo-Saxon countries, transoral surgical approaches have been used frequently in Germany to treat patients with oro-, hypopharyngeal and laryngeal cancer. Transoral laser microsurgery (TLM) has had a long tradition since its introduction in the early 70s. To date, the different therapeutic approaches to transorally resectable OPSCC have not been directly compared to each other in a randomized trial concerning disease control and survival. The goal of this study is to compare initial transoral surgery to definitive chemoradiation for resectable OPSCC, especially with regards to local and regional control. METHODS TopROC is a prospective, two-arm, open label, multicenter, randomized, and controlled comparative effectiveness study. Eligible patients are ≥18 years old with treatment-naïve, histologically proven OPSCC (T1, N2a-c, M0; T2, N1-2c, M0; T3, N0-2c, M0 UICC vers. 7) which are amenable to transoral resection. Two hundred eighty patients will be randomly assigned (1:1) to surgical treatment (arm A) or chemoradiation (arm B). Standard of care treatment will be performed according to daily routine practice. Arm A consists of transoral surgical resection with neck dissection followed by risk-adapted adjuvant therapy. Patients treated in arm B receive standard chemoradiation, residual tumor may be subject to salvage surgery. Follow-up visits for 3 years are planned. Primary endpoint is time to local or locoregional failure (LRF). Secondary endpoints include overall and disease free survival, toxicity, and patient reported outcomes. Approximately 20 centers will be involved in Germany. This trial is supported by the German Cancer Aid and accompanied by a scientific support program. DISCUSSION This study will shed light on an urgently-needed randomized comparison of the strategy of primary chemoradiation vs. primary surgical approach. As a comparative effectiveness trial, it is designed to provide data based on two established regimens in daily clinical routine. TRIAL REGISTRATION NCT03691441 Registered 1 October 2018 - Retrospectively registered.
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Affiliation(s)
- Lara Bußmann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simon Laban
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Gießen, Gießen, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Silke Tribius
- Hermann-Holthusen-Institut for Radiation Oncology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Nikolaus Möckelmann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Arne Böttcher
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christian Stephan Betz
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Adrian Muenscher
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Chia-Jung Busch
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Buck LS, Frey H, Davis M, Robbins M, Spankovich C, Narisetty V, Carron JD. Characteristics and considerations for children with ankyloglossia undergoing frenulectomy for dysphagia and aspiration. Am J Otolaryngol 2020; 41:102393. [PMID: 31932026 DOI: 10.1016/j.amjoto.2020.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to analyze the basic demographics of patients who underwent frenulectomy at our institution as well as additional considerations regarding age, location of procedure, and possible effects on aspiration. METHODS A retrospective chart review was performed based on CPT codes for frenulectomy and basic demographic data was collected. Other information such as presenting symptoms, type of ankyloglossia, location of the procedure, and modified barium swallow study (MBSS) information were also obtained. RESULTS A total of 226 (66.4% male) patients underwent frenulectomy in the study time frame. Younger patients underwent frenulectomy for feeding symptoms (average age 6.5 months) and older children typically presented with speech related symptoms (average age 3.8 years). Of patients who had MBSS before and after the procedure, 5/11 (43%) had improvement of their aspiration after frenulectomy. CONCLUSIONS Symptomatic ankyloglossia is more common in boys. Two age groups typically present for frenulectomy, infants for feeding difficulties and toddlers/preschoolers for speech related difficulties. Children with aspiration may benefit from frenulectomy, though aspiration is unlikely to resolve if other comorbidities are present. Proper evaluation and documentation of anatomy and functional tongue movement is important for future studies and decision-making regarding frenulectomy.
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Affiliation(s)
- Lauren S Buck
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hudson Frey
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Morgan Davis
- Department of Otolaryngology - Head and Neck Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Michael Robbins
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Christopher Spankovich
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Vamsi Narisetty
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jeffrey D Carron
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA.
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Lin AY, Yarholar LM. Plastic Surgery Innovation with 3D Printing for Craniomaxillofacial Operations. Mo Med 2020; 117:136-142. [PMID: 32308239 PMCID: PMC7144700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Plastic Surgery restores unique human qualities such as appearance, speech (palate), hands, to improve interaction with others and quality of life. Three-dimensional printing technology can be applied to Plastic Surgery craniomaxillofacial operations to change the bony skeleton of the skull, face, and jaws. Three-dimensional printing for patient-specific applications have four types: Type I contour models, Type II guides, Type III splints, Type IV implants. Plastic Surgery innovation in 3D printing clinical applications are described here and https://www.slucare.edu/newsroom/kmov-science-of-healing-faces-of-childhood.php.
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Affiliation(s)
- Alexander Y Lin
- Alexander Y. Lin, MD, and Lauren M. Yarholar, MD are in the Division of Plastic Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri and at SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Lauren M Yarholar
- Alexander Y. Lin, MD, and Lauren M. Yarholar, MD are in the Division of Plastic Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri and at SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
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Mahmood H, Siddique I, McKechnie A. Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery. Ann R Coll Surg Engl 2020; 102:9-13. [PMID: 31755732 PMCID: PMC6937600 DOI: 10.1308/rcsann.2019.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION An increasing number of patients are taking oral antiplatelet agents. As a result, there is an important patient safety concern in relation to the potential risk of bleeding complications following major oral and maxillofacial surgery. Surgeons are increasingly likely to be faced with a dilemma of either continuing antiplatelet therapy and risking serious haemorrhage or withholding therapy and risking fatal thromboembolic complications. While there are national recommendations for patients taking oral antiplatelet drugs undergoing invasive minor oral surgery, there are still no evidence-based guidelines for the management of these patients undergoing major oral and maxillofacial surgery. METHODS MEDLINE and EMBASE databases were searched to retrieve all relevant articles published to 31 December 2017. FINDINGS A brief outline of the commonly used antiplatelet agents including their pharmacology and therapeutic indications is discussed, together with the haemorrhagic and thromboembolic risks of continuing or altering the antiplatelet regimen in the perioperative period. Finally, a protocol for the management of oral and maxillofacial patients on antiplatelet agents is presented. CONCLUSIONS Most current evidence to guide decision making is based upon non-randomised observational studies, which attempts to provide the safest possible management of patients on antiplatelet therapy. Large randomised clinical trials are lacking.
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Affiliation(s)
- H Mahmood
- Department of Oral & Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - I Siddique
- Department of Oral & Maxillofacial Surgery, Bradford Royal Infirmary, Bradford, UK
| | - A McKechnie
- Department of Oral & Maxillofacial Surgery, Leeds Dental Institute, Leeds, UK
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Thakur S, Singh A, Diwana VK, Rani A, Thakur NS. Dynamic changes in nasal symmetry after presurgical nasoalveolar molding in infants with complete unilateral cleft lip and palate. Afr J Paediatr Surg 2020; 17:1-4. [PMID: 33106444 PMCID: PMC7818664 DOI: 10.4103/ajps.ajps_5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/26/2018] [Accepted: 05/28/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Presurgical nasoalveolar molding (PNAM) technique gave a new perspective to presurgical infant orthopedics. Nasal reconstruction presents a challenge for the plastic surgeons in case of patients with unilateral cleft lip and palate (UCLP). PNAM facilitates the reshaping of the nasal cartilage and molding of maxillary arch preoperatively. This therapy not only aids the surgical repair of lip but also enhances the overall postsurgical results with negligible postoperative scar. AIM The aim of the study was to analyze nasal changes before and after PNAM in patients with complete UCLP. MATERIALS AND METHODS This was a retrospective review of 22 ULCP patients who underwent PNAM before lip surgeries. A series of standard basilar view photographs in 1:1 ratio were taken, and linear measurements were done directly on the photographs. RESULTS After PNAM therapy, there was highly significant increase in the nostril height, nostril dome height, and columella length (P < 0.001*) and highly significant reduction in the nostril width and nasal basal width (P < 0.001*). CONCLUSION Significant improvement in the nasal symmetry was found after PNAM therapy in patients with complete UCLP.
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Affiliation(s)
- Seema Thakur
- Department of Peditric and Preventive Dentistry, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Anjali Singh
- Department of Peditric and Preventive Dentistry, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Vijay Kumar Diwana
- Department of Plastic Surgery, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Alka Rani
- Department of Oral Pathology, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Narbir Singh Thakur
- Department of Oral Pathology, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Figliuzzi MM, Altilia M, Altilia S, Romeo C, Leonzio F. New proposal of flap drawing for the extraction of the third mandibular molar semi-included. Cogswell triangular flap modified and transposed. Ann Ital Chir 2020; 91:93-99. [PMID: 32180573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The study proposes a new flap drawing derived from the modification of a triangular Cogswell flap to treat a semi-included third molar. MATERIAL AND METHOD Two groups of patients underwent surgery: in the study group the new flap proposal was carried out whilst in the control group the triangular Cogswell flap was used. The gingival tissue and the periosteum were detached and the extraction technique was standardised for all the cases. RESULTS At 7 days and at 14 days from the operation, the results showed a statistically significant difference in the increase in primary intention healing in the study group whereas no statistically significant difference was encountered between using the innovative flap or the triangular Cogswell flap in terms of swelling. DISCUSSION The patients who underwent the innovative flap operation presented an increased percentage of primary intention healing compared to the patients who underwent the baseline method. As known from the international literature, a correct operational conduct aims at reducing surgical trauma as much as possible in order to limit the immediate and delayed consequences of surgery. Nevertheless the lengthening of healing times also leads to an increase of probability that post-operative complications and worse quality of life for the patients arise. CONCLUSION The Cogswell triangular flap modified and translated represents a new method available to the oral surgeon, useful in soft tissue management for the extraction of semi-included third mandibular molars. Simple to carry out, it promotes primary intention healing with absence of an increase in complications such as swelling²6¯³0. KEY WORDS Cogswell triangular flap, Mandibular molar, Oral surgery.
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Pesis M, Bar-Droma E, Ilgiyaev A, Givol N. Deep Neck Infections Are Life Threatening Infections of Dental Origin: a Presentation and Management of Selected Cases. Isr Med Assoc J 2019; 21:806-811. [PMID: 31814344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Untreated dental caries or even dental manipulations, such as a tooth extraction, might cause direct spread of an odontogenic infection and consequently the development of life-threatening conditions such as deep neck infections (DNI). The most common source of DNI is of odontogenic origin (38.8-49%). Abscess formation or cellulitis can lead to life-threatening complications, despite new diagnostic imaging technology and widespread availability of antibiotics. OBJECTIVES To demonstrate the dangers of DNI, which can create life-threatening situations. METHODS Five cases of DNI of odontogenic origin, which were referred to the oral and maxillofacial surgery unit, are presented. RESULTS Clinical manifestations included trismus, dysphagia, dysphonia, dyspnea, and infection symptoms. In all cases, computed tomography confirmed diagnosis and extent of abscess. Complications included mediastinitis, respiratory distress, osteomyelitis of the jaws, and in rare cases the mandibular condyle. Treatment included securing the airway, immediate surgical drainage, removal of the infection source, and antibiotic therapy. All patients were discharged in stable and improved condition. CONCLUSIONS DNI treatment on an emergency basis requires proper diagnosis and effective management. To confirm diagnosis and prevent serious complications, it is essential for physicians to recognize the spaces of the head and neck that are likely to be affected by DNI.
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Affiliation(s)
- Michael Pesis
- Department of Oral and Maxillofacial Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eitan Bar-Droma
- Department of Oral and Maxillofacial Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anatoliy Ilgiyaev
- Department of Oral and Maxillofacial Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Navot Givol
- Department of Oral and Maxillofacial Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Yadav S, Markiewicz MR, Allareddy V. Dentoalveolar Distraction Osteogenesis for Rapid Maxillary Canine Retraction: An Overview of Technique, Treatment, and Outcomes. Oral Maxillofac Surg Clin North Am 2019; 32:83-88. [PMID: 31685346 DOI: 10.1016/j.coms.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients and orthodontists seek to reduce treatment time in braces. Rapid canine retraction through dentoalveolar distraction osteogenesis is one of several treatment approaches to reduce treatment in braces. This article provides an overview of technique of dentoalveolar distraction osteogenesis to accomplish rapid canine retraction and associated outcomes. When this treatment protocol is implemented well, rapid canine retraction is achieved predictably with minimal side effects. Although current evidence suggests that adverse sequelae, such as root resorptions and pulp devitalization, are rare, prospective clinical studies that are adequately powered and documenting long-term follow-up of these outcomes are lacking.
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Affiliation(s)
- Sumit Yadav
- Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Michael R Markiewicz
- Department of Oral & Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, 112 Squire Hall, Buffalo, NY 14214, USA
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 138AD (MC841), Chicago, IL 60612-7211, USA.
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Alonso Arroyo V, Sánchez Abuín A, Gómez Beltrán OD, Molina Vázquez ME. [Multilayer repair of palatal fistula with an interpositional collagen matrix]. Cir Pediatr 2019; 32:207-211. [PMID: 31626407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Palatal fistula after the repair of cleft palate appears in 7.7-35% of patients. We present two cases of palatal fistula, detailing a multi-layer repair with an interpositional collagen graft. MATERIAL AND METHODS Patient 1: girl with a cleft palate operated using a Furlow technique. A reintervention was performed due to a Pittsburgh type III fistula. Patient 2: male with cleft palate operated using a Furlow technique. A reintervention was performed due to a type V fistula. RESULTS We used a multilayer repair with a local rotational flap and the interposition of a collagen matrix between the nasal and oral layers. The suture was reinforced with a fibrin hemostatic adhesive. No recurrence of the fistula after 2 years. CONCLUSIONS The three-layer closure is simple, safe, effective and avoids refistulizations. Interpositional grafts of a resorbable collagen membrane provide a "scaffold" for tissue growth, revascularization and epithelialization of the mucosa.
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Piroli A, Cutilli T, Lupi E, Marinangeli F, Varrassi G, Paladini A. Different Solutions for Damaged Nasotracheal Tube during Maxillofacial Surgery: A Case Series. Adv Ther 2019; 36:1812-1816. [PMID: 31065994 DOI: 10.1007/s12325-019-00968-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/19/2022]
Abstract
Difficult airway management and intraoperative tube damage are important problems during maxillofacial surgery. Damage occurs frequently during the surgery, and the anesthesiologist must be ready to find a quick and safe solution. Replacing the damaged endotracheal tube involves additional difficulties, and various factors must be evaluated. We present two cases of nasotracheal tube (NTT) damage suffered during maxillofacial surgery. The different intraoperative conditions led us to decide for the replacement of NTT in one case and for conservative action in the other. The purpose of this article is to highlight the difficulties that the anesthesiologist may have in deciding quickly what is the best approach in case the endotracheal tube is damaged during maxillofacial surgery and possibly try to provide a rapid and safe solution for the situation.
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Affiliation(s)
- Alba Piroli
- Department of MeSVA, University of L'Aquila, L'Aquila, Italy
| | - Tommaso Cutilli
- Department of MeSVA, University of L'Aquila, L'Aquila, Italy
| | - Ettore Lupi
- San Salvatore Teaching Hospital of L'Aquila, L'Aquila, Italy
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Liang Y, Yang Y, Wu Y. Correction of labial tubercle defect in repaired bilateral cleft lips using bilateral vermilion musculomucosal sliding flaps: Case series. Medicine (Baltimore) 2019; 98:e16161. [PMID: 31335670 PMCID: PMC6709140 DOI: 10.1097/md.0000000000016161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/25/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Insignifificant, asymmetrical or lack of labial tubercle often occurs after cleft lip surgery due to improper treatment of vermilion tissue. Especially in the cases of bilateral cleft lip, because of short front lip and insuffificient vermilion tissue, the median vermilion depression often occurs after surgery, forming a "whistling" deformity. The object of this study is to verify the outcomes of patients with median labial tubercle detects after treatment with bilateral vermilion musculomucosal sliding flflaps (VMSF). PATIENT CONCERNS Six patients with median labial tubercle defect after bilateral cleft lip repair from March 2015 to May 2017 were enrolled in our department and subjected to bilateral lip deformity correction under general anesthesia. DIAGNOSES Secondary deformity of bilateral cleft lip forming a "whistling" deformity were diagnosed in all the patients. INTERVENTIONS Bilateral VMSF were designed and used to reconstruct the median labial tubercles by sliding downward so as to eliminate the whistling deformity. OUTCOMES During the 10 to 37 months of follow-up, the reconstructed vermilion tubercles had stable morphology showing no whistling deformity and the overall lip shapes were satisfactory. LESSONS Reconstructing MVTD and eliminating whistling deformity using the scar tissues that need to be removed previously on the vermilion musculomucosa has achieved stable and satisfactory results and is worthy of clinical application.
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Guedes AA, Pereira FL, Machado EG, Salgado Filho MF, Chaves LFM, Araújo FDP. Delayed trigeminocardiac reflex after maxillofacial surgery: case report. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 30665670 PMCID: PMC9391851 DOI: 10.1016/j.bjane.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Case report Discussion Conclusion
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Affiliation(s)
- Alexandre Almeida Guedes
- Universidade Federal de Juiz de Fora (UFJF), CET-SBA do Hospital Universitário, Juiz de Fora, MG, Brasil; Faculdade de Medicina de Barbacena, Barbacena, MG, Brasil
| | - Felipe Ladeira Pereira
- Hospital Geral de Juiz de Fora, Juiz de Fora, MG, Brasil; Hospital Regional de Barbacena José Américo-Rede Fhemig, Barbacena, MG, Brasil
| | - Eric Guimarães Machado
- Hospital de Traumatologia e Ortopedia Dona Lindu, Paraíba do Sul, RJ, Brasil; Secretaria de Estado de Defesa Social de Minas Gerais, Juiz de Fora, MG, Brasil
| | - Marcello Fonseca Salgado Filho
- Curso de Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Santa Casa de Juiz de Fora, Residência de Anestesiologia, Juiz de Fora, MG, Brasil; Universidade Presidente Antônio Carlos, Juiz de Fora, MG, Brasil
| | - Leandro Fellet Miranda Chaves
- Universidade Federal de Juiz de Fora (UFJF), CET-SBA do Hospital Universitário, Juiz de Fora, MG, Brasil; Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, MG, Brasil; Hospital Albert Sabin, Juiz de Fora, MG, Brasil
| | - Fernando de Paiva Araújo
- Universidade Federal de Juiz de Fora (UFJF), CET-SBA do Hospital Universitário, Juiz de Fora, MG, Brasil; Hospital Monte Sinai, Juiz de Fora, MG, Brasil.
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Abstract
Root resection and hemisection is a treatment option for furcated molars, and the prognosis of this technique has been well documented. The aim of the present paper is to systematically review studies examining the survival and/or failure rate of root resection and hemisection and to determine the factors behind the variability in the outcome reported. A Medline (PubMed), Embase, and Google Scholar search was undertaken, looking for articles published up to September 2016. A total of 1,012 publications were screened. Two reviewers analyzed the articles and extracted the data. Case series studies required a minimum of 5 cases, and all levels of evidence were accepted. A total of 22 studies met the inclusion criteria. Survival rate and follow-up times differed widely: survival rate ranged from 40.3% to 100% and follow-up from 6 months to 23 years. Half of the studies had a survival rate > 90% with a follow-up period ranging from 5 to 23 years. Therefore, root resection and hemisection are associated with high survival rates, making it a reliable option for treatment of furcated molars that should be considered before every extraction and implant placement. In a great number of studies, incomplete information was found concerning case selection and endodontic, restorative, and maintenance therapy, which makes one question the obtained results and the occasional reports of low survival rates. These concerns should encourage more detailed, long-term clinical trials, with respect to each phase requirement for the procedure, for a better assessment of survival rate.
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Affiliation(s)
- Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology, Stanford Sleep Surgery Fellowship, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94304, USA.
| | - Robert Wayne Riley
- Division of Sleep Surgery, Department of Otolaryngology, Stanford Sleep Surgery Fellowship, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94304, USA
| | - Anthony Pogrel
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - Christian Guilleminault
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063, USA
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Katna R, Kalyani N, Deshpande A. Free thyroid transfer to anterolateral thigh for prevention of radiation induced hypothyroidism: An initial experience. Am J Otolaryngol 2019; 40:160-163. [PMID: 30594401 DOI: 10.1016/j.amjoto.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 11/17/2022]
Abstract
AIM Radiation induced hypothyroidism (RIHT) is one of the commonest late side effects of radiation therapy and is seen in more than half of patients and affects quality of life significantly. We report our initial experience on feasibility of free microvascular transfer of thyroid gland out of radiation field to prevent development of RIHT. MATERIAL AND METHODS A prospective pilot study was undertaken during August 2017 to May 2018. Six Patients with stage III/IV patients of oral cavity cancers who required wide excision/composite resections with microvascular free flap (ALT) reconstruction and adjuvant radiation therapy were enrolled. A written informed consent was obtained from all patients prior to the procedure. RESULTS The mean age of cohort was 51 years with tongue most common site of primary cancer. The free transfer of thyroid gland to anterolateral thigh was done using microvascular technique. The mean additional time for procedure was 51 min. All patients had successful transfer with no associated immediate complications. Patients were followed up with Tc99 scan, USG Doppler and biochemical assay at routine intervals in peri and postoperative period to assess the anatomical and physiological function of the transferred gland. At median follow up of 8 months, 5 patients were euthyroid and remaining one had biochemical hypothyroidism. All patients had functional thyroid gland in anetrolateral thigh. Five patient were alive, one patient died due to disease. CONCLUSION This is a small and early feasibility study for free thyroid gland transfer and validates the previously published data. The selected group of patients who have high chances of developing RIHT may benefit from this strategy. Further validation of the technique may be explored in a larger cohort.
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Affiliation(s)
- Rakesh Katna
- Jaslok Hospital and Research Centre, Pedder Road, Mumbai, India; Bombay Hospital and Research Centre, Marine Lines, Mumbai, India
| | - Nikhil Kalyani
- Jaslok Hospital and Research Centre, Pedder Road, Mumbai, India.
| | - Akshay Deshpande
- Jaslok Hospital and Research Centre, Pedder Road, Mumbai, India; Bombay Hospital and Research Centre, Marine Lines, Mumbai, India
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Arslan Zİ, Türkyılmaz N. Which nostril should be used for nasotracheal intubation with Airtraq NT®: the right or left? A randomized clinical trial. Turk J Med Sci 2019; 49:116-122. [PMID: 30762320 PMCID: PMC7350855 DOI: 10.3906/sag-1803-177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/aim Nasotracheal Airtraq is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Materials and methods After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18 and 70 years of age undergoing elective maxillofascial, oral, and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomized into the right and left nostril groups. Results Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (P < 0.001). 90° counterclockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (P < 0.001 vs P = 0.03). Cuff inflation maneuver also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NT without the need of Magill forceps. We recommend the use of the 90° counterclockwise rotation, external laryngeal pressure, and head flexion maneuvers to direct the tube into the vocal cords first. On the other hand, cuff inflation maneuver must also be kept in mind.
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Liu SYC. Sleep Surgery: From Reconstruction to Restoration and Re-education. Atlas Oral Maxillofac Surg Clin North Am 2019; 27:xi. [PMID: 30717929 DOI: 10.1016/j.cxom.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stanley Yung-Chuan Liu
- Assistant Professor, Division of Sleep Surgery, Department of Otolaryngology, Co-director, Stanford Sleep Surgery Fellowship, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94304, USA.
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40
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Maccheroni M, Fillios M. Replication of Ancient Egyptian Oral Surgical Procedures Using Stone and Bronze Hand Drills. J Hist Dent 2019; 67:31-39. [PMID: 32189637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
For over a hundred years researchers have disputed whether ancient Egyptians performed the oral surgical procedure of drilling holes in jaws, presumably in an attempt to relieve pressure and pain due to periapical infections. To date (although it has been indirectly suggested) there have been no published attempts to reproduce the disputed holes identified in the Egyptian mandibles with tools fabricated from stone and bronze, the materials that were available to ancient Egyptian artisans. This paper presents an abbreviated assessment of oral surgery in ancient Egypt regarding these procedures, with an attempt to reproduce these procedures on fresh pig and embalmed cadaver jaws as proxies for vital human bone, using hand drills that were fabricated of bronze and chet. The experiment confirms that the procedure could be effectively performed with basic hand tools. In comparison to fresh pig mandible the embalming process hardens cadaver bone. Redesign of drill handles would increase efficiency.
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Affiliation(s)
- Michael Maccheroni
- Honorary Research Officer, University of New England, Archeomaterials Science Hu Armidale, NSW 2350, Australia
| | - Melanie Fillios
- Lecturer and MA Coordinator, Archaeology & Paleoanthropology, University of New England Armidale, NSW 2350, Australia
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41
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Gandhi S, Mehta V, Suri RK. Unusual array of neural communications in the infratemporal fossa: Useful for skull base surgery. Morphologie 2018; 102:302-305. [PMID: 30249474 DOI: 10.1016/j.morpho.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
Variations in the branching pattern of the mandibular nerve frequently accounts for failure to obtain adequate local anesthesia in routine oral and dental procedures, and also for unexpected injury to the nerves during surgery. The knowledge of the neurovascular relationships of the infratemporal region is relevant in odontostomatology practice. In this article we present a rare case of atypical communication between the inferior alveolar nerve and lingual nerve and the mylohyoid and lingual nerves. Further, the clinical implications of these communications on the development of the supplementary innervation and their possible role in anesthesia is discussed in detail. The communication between mylohyoid and lingual nerve was found in this case near the submandibular ganglion after the lingual nerve passes in close relation to third molar tooth, which makes it more susceptible to injury during third molar extractions. The communicating branch between the mylohyoid nerve and lingual nerve may also innervate the tongue, and surgeons should be aware of this variation to avoid post- operative complcations after oral surgeries. Thus the precise anatomy of structures of infratemporal region and its variations may prove beneficial to clinicians, especially to oral and maxillofacial surgeons.
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Affiliation(s)
- S Gandhi
- Department of Anatomy, Lady Hardinge Medical College, New Delhi, India
| | - V Mehta
- Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - R K Suri
- Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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42
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Upadhyaya C, Paunju N, Chaurasia N, Srii R. A Large Dermoid Cyst in the Floor of the Mouth. Kathmandu Univ Med J (KUMJ) 2018; 16:348-350. [PMID: 31729352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The dermoid cyst in the floor of mouth is considered to bea rare condition which comprises only 1.6 to 6.5% of all body dermoid cysts. Dermoid cyst in the floor of mouth may be congenital or acquired. The congenital form results from defective embryonic development and the acquired form may be due to traumatic or iatrogenic causes; and as a result of the occlusion of a sebaceous gland duct. We report an unusual case of huge dermoid cyst in the floor of the mouth in a 12 year old male who presented with progressively increasing swelling below his tongue and reviewed the relevant literature.
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Affiliation(s)
- C Upadhyaya
- Department of Oral and Maxillofacial Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | - N Paunju
- Department of Oral and Maxillofacial Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | - N Chaurasia
- Department of Oral and Maxillofacial Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | - R Srii
- Department of Oral Histology and Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
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43
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Fletcher P, Tarnow DP. Circumferential Occlusal Access Procedure (COAP): Novel Minimally Invasive Surgical Approach for Treatment of Peri-Implantitis- A Case Series. Compend Contin Educ Dent 2018; 39:626-635. [PMID: 30299112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Treatment of peri-implantitis is typically most successful when a full-thickness surgical flap is elevated to access the contaminated implant surface and the bone loss that has occurred. This approach, however, can be problematic. Primary flap approximation can be challenging after a regenerative procedure, especially with a shallow vestibule, thin mucosa, or minimal zone of keratinized tissue. Incomplete wound closure and soft-tissue dehiscence can lead to membrane and graft exposure. In medicine, minimally invasive techniques have been developed and are being used in an increasing variety of procedures. This article will present the circumferential occlusal access procedure (COAP), a minimally invasive, flapless surgical technique designed to access and detoxify a contaminated implant surface and facilitate bone repair or regeneration while reducing the potential for membrane exposure and recession.
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Affiliation(s)
- Paul Fletcher
- Associate Clinical Professor, Division of Periodontics, Columbia University College of Dental Medicine, New York, New York; Private Practice, New York, New York
| | - Dennis P Tarnow
- Clinical Professor, Director of Implant Education, Division of Periodontics, Columbia University College of Dental Medicine, New York, New York; Private Practice, New York, New York
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Abstract
BACKGROUND A glomus tumor is a rare neoplasm usually found in the dermis or subcutaneous tissue of the extremities. It is rare for the glomus tumor to occur on the head and face. Only 26 glomus tumors of the oral region and affected bone have been reported in the English-language literature (Table 1). We report a case of a glomus tumor at the mandible. As a new point, the glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible. CASE PRESENTATION The patient was a 44-year-old Japanese man who complained swelling of the right mandible. Radiographic examination showed a multilocular radiolucency area in the left mandible. Radiographic findings on our case resembled those of a common benign tumor. The lesion occupied to the premolar and molar area and revealed that the tumor resorbed the roots of the teeth. The lesion was removed surgically with the buccal cortical bone and buccal mucosa in contact with the mass of the tumor. The mass fully excised intraorally under general anesthesia, and the inferior alveolar nerve in contact with the mass was preserved. The specimen was pathologically diagnosed as a glomus tumor. Immunohistochemical staining was positive for vimentin, muscle-specific actin/HHF35, and calponin. A hairline-shaped area of positive staining for type IV collagen surrounding the tumor cells was also observed. In contrast, staining for alpha-SMA, cytokeratin (AE1/AE3), cytokeratin (CAM5.2), CK19, CD31, CD34, CD68, p63, S-100, Factor VIII, and desmin was all negative. The Ki-67 labeling index was almost 1%. A recurrent tumor was again detected in the site below the primary tumor at an 8-year follow-up, and it was surgically removed. The patient has had no symptoms of recurrence in 2 years after the second operation. CONCLUSION The glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible. The immunohistochemical features of the tumor were consistent with those described in previous reports. It is important to completely remove the Glomus tumor.
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Affiliation(s)
- Kazuto Kurohara
- Department of Oral and Maxillofacial Surgery, Graduate School, Mie University, 174, Edobashi 2-chome, Tsu-shi, Mie 514-8507 Japan
- Department of Maxillofacial Surgery, Division of Maxillofacial and Neck Reconstruction, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuyuki Michi
- Department of Maxillofacial Surgery, Division of Maxillofacial and Neck Reconstruction, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Akane Yukimori
- Department of Oral Pathology, Division of Oral Health Sciences, Graduate school of Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Yamaguchi
- Department of Maxillofacial Surgery, Division of Maxillofacial and Neck Reconstruction, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
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45
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Lewis JR, Lewis K. Veterinary Oral and Maxillofacial Surgery Receives Well-Deserved Attention. J Vet Dent 2018; 35:166. [PMID: 30168376 DOI: 10.1177/0898756418795908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Michael D Turner
- Division of Oral & Maxillofacial Surgery, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA.
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Chen JX, Zenga J, Emerick K, Deschler D. Sublingual gland excision for the surgical management of plunging ranula. Am J Otolaryngol 2018; 39:497-500. [PMID: 30017374 DOI: 10.1016/j.amjoto.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/26/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. METHODS This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. RESULTS Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. CONCLUSION Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States
| | - Joseph Zenga
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States.
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48
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Andrade GS, de Souza Carvalho ACG, Magalhães TG, Cetira Filho EL, Cavalcante RB, Nogueira RLM. Expansive renal osteitis fibrosa: a case report. Oral Maxillofac Surg 2018; 22:323-327. [PMID: 29725779 DOI: 10.1007/s10006-018-0697-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
Hyperparathyroidism (HPT) is an endocrine metabolic disorder characterized by increased secretion of parathyroid hormone. Untreated secondary HPT leads to renal osteodystrophy (ROD). Facial skeletal abnormalities in patients with ROD are rare. The purpose of this paper is to report a conservative surgical approach of exuberant osteitis fibrosa lesions in patient with chronic kidney disease. A 24-year-old female was referred to maxillofacial surgery department with giants ROD affecting palate, maxilla, and mandible, resulting in esthetic and functional impairment. The pathogeneses and multidisciplinary management of ROD are discussed with a brief literature review. Eight years after the conservative treatment of exuberant jaw lesions, no noticeable bone changes were observed in the patient. A multidisciplinary therapy is essential for correct diagnosis of ROD and optimal multimodality treatment. The conservative management was an efficient alternative for the success of the case reported.
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Affiliation(s)
| | | | | | - Edson Luiz Cetira Filho
- Division of Oral and Maxillofacial Surgery, IJF Hospital - Institute Dr. José Frota, Barão do Rio Branco street, 1816 - Center, Fortaleza, Ceará, 60025-061, Brazil.
| | - Roberta Barroso Cavalcante
- Department of Oral and Maxillofacial Pathology, Fortaleza University School of Dentistry, Fortaleza, Brazil
| | - Renato Luiz Maia Nogueira
- Department of Oral Surgery, Discipline of Oral and Maxillofacial Surgery and Stomatology, Federal University of Ceará School of Dentistry, Fortaleza, Ceará, Brazil
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49
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Abstract
OBJECTIVE Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. STUDY DESIGN Multicenter prospective observational study. SETTING University hospital. SUBJECTS AND METHODS This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. RESULTS Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). CONCLUSION Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.
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Affiliation(s)
- Jin Pyeong Kim
- 1 Department of Otolaryngology, Gyeongsang National University, Changwon, South Korea
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Dong Kun Lee
- 3 Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Jeong Hwan Moon
- 4 Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, South Korea
| | - Jung Je Park
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- 5 Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Seung Hoon Woo
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- 5 Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
- 6 Beckman Laser Institute, University of California, Irvine, California, USA
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50
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Li J. Emergency department management of dental trauma: recommendations for improved outcomes in pediatric patients. Pediatr Emerg Med Pract 2018; 15:1-24. [PMID: 30020737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
Nearly 50% of children will experience dental trauma by the age of 4 years. Timely and effective care is important in the management of dental injuries, as several studies have shown poor outcomes with delayed treatment. The current evidence in the management of dental injuries is primarily from a dentist's perspective, with limited evidence specific to management in the emergency department. The goal of pediatric dental injury management is dictated largely by whether the dentition is primary or permanent. This issue provides a systematic emergency medicine-based approach to address pediatric dental injuries, along with a review of basic dental procedures that will lead to improved dental outcomes.
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Affiliation(s)
- Joyce Li
- Physician in Medicine, Boston Children's Hospital, Division of Emergency Medicine; Assistant Professor, Harvard Medical School, Division of Pediatrics and Emergency Medicine, Boston, MA
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