Risk factors for surgical site infection in cervico-facial oncological surgery

IntroductionInfection after head and neck oncological surgery is relatively frequent, and is associated with significant morbidity and mortality.AimThe primary objective of this prospective study was to determine risk factors for Surgical Site Infection (SSI) in major head and neck cancer surgery.Patients and methodsA population of 137 head and neck cancer patients, of the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal), was prospectively studied in order to ascertain the correlation between 31 known risk factors and the presence of SSI.ResultsThe rate of SSI was 10.9%, with all of the infections being of the deep incisional type. A discriminant analysis and multiple logistic regression methods identified pre-surgical tracheostomy (p < 0.001), previous surgery (p = 0.001) and length of pre-operative hospital stay (p < 0.001) as the most significant risk factors for surgical site infections.ConclusionIn order to minimize the risk of post-operative SSI in the context of head and neck cancer patients, particular attention should be paid to patients submitted to tracheostomy before surgery, to those submitted to previous oncological surgery, and to patients who are forced to remain in the hospital for prolonged periods of time before surgery.     

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03 ± 26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%–69.5%], 44.2% of patients were decannulated [95%CI 33.96%–54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%–23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%–19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p = 0.34), decannulation (RR1.35, p = 0.27), complications (RR0.75, p = 0.09) and time to decannulation (SMD 0.46, p = 0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p = 0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.     

Evaluating the additional effects of arthrocentesis on the condylar pathways of temporomandibular joint in patients with internal derangement treated with stabilizing splint

ObjectivesThe purpose of this investigation is to find out the differences in the condylar pathways of the temporomandibular joint (TMJ) in patients treated with stabilizing splint and arthrocentesis accompanied by stabilizing splint in 6 months period.Study designForty patients who were assigned a clinical diagnosis of internal derangement of the TMJ were included in this study. Full arch stabilizing splints were made for all patients. Patients were divided into two groups; group A (patients who underwent arthrocentesis), group B (patients who did not underwent arthrocentesis). Computerized axiography was performed for each group before therapy (T₀), on the 3^rd month (T₁), after arthrocentesis (T_A) (for group A) and on 6th month (T₂). Curve parameters were recorded in three-dimension; X axis (posteroanterior), Y axis (mediolateral), Z axis (superoinferior). Also the distance from the starting point of the movement on sagittal plane (S) was calculated.ResultsThere was a significant increase in the value of Z (p = 0.014) and S (p = 0.038) in mediotrusion movement in group A. Also, there was a significant increase in the value of Z (p = 0.007) in protrusion/retrusion movement, value of Z (p = 0.019) and S value (p = 0.002) in mediotrusion movement and value of Y in open/close movement in group B.ConclusionsNo positive effects on condylar pathways of an additional arthrocentesis to splint therapy alone in patients with internal derangement were found in this study.     

The effect of a single 75 mg preoperative dose of pregabalin on postoperative pain in rhinoplasty: A double-blinded,placebo-controlled randomized clinical trial

The goal of this study was to evaluate the effect of a single preoperative dose of 75 mg of pregabalin on postoperative pain in rhinoplasty. Volunteers with a physical status of ASA I were included in our study after informed written consent. This was a randomized, double-blinded, placebo-controlled clinical trial. All pregabalin and placebo capsules were given to patients orally 1 h prior to surgery. A standard open rhinoplasty procedure was performed on all patients. All patients underwent the same general anesthesia and postoperative analgesic protocol, with the only difference between the two studied groups being the use of a single dose of pregabalin prior to surgery. Finally, pain intensity was measured at 2, 4, 6, 12, and 24 h after surgery, using a horizontal visual analogue scale (VAS), and was analyzed statistically. 128 volunteers — 33 men (25.8%) and 95 women (74.2%) — with a mean age of 26.23 ± 7.16 were included in this study. Pain intensity scores were consistently lower in patients who received pregabalin preoperatively (p = 0.002); however, the incidence of nausea, drowsiness, difficulty in concentrating, dry mouth, and constipation showed no differences between the two study groups (p > 0.05). In conclusion, the administration of pregabalin should be added to the perioperative protocol whenever appropriate.     

Comparison of postoperative complications in early versus delayed tracheostomy decannulation in patients undergoing oral cancer surgery with microvascular reconstruction

The purpose of this study was to determine the relationship of early and delayed tracheostomy decannulation protocols on the length of stay, time to oral feeding and incidence of postoperative complications in patients undergoing microvascular reconstruction for oral cancer.A review of all patients who underwent surgical management of oral squamous cell carcinoma (OSCC) over the study period from 01/07/2017 to 31/06/2021 was performed. Patients who underwent elective tracheostomy as part of their microvascular reconstruction were included. Two cohorts were identified based on distinct postoperative tracheostomy decannulation protocols; early (Within 7 days) and delayed (≥7 days). Time to oral feeding, length of stay and complication rates was determined for both groups for statistical analysis.A total of 103 patients with OSCC were included in the study. The overall complication rate was 35.9% and were more likely in node positive patients (53.7% vs 23.2%; p = 0.003) and in cases where the geniohyoid muscle complex was disrupted during tumour resection (66.7% vs 31.9%; p = 0.026). Early decannulation was significantly associated with shorter length of hospital stay (10 days vs 15 days) and earlier removal of nasogastric feeding tubes (7 vs 10 days). There was no difference in the overall complication rate between the two groups (33.3% vs 37.5%; p = 0.833).Early decannulation in appropriately selected patients is recommended as it significantly reduces the length of hospital stay and aids in early resumption of oral intake. Furthermore, this approach is not associated with increased rates of complications.     

Stability of lingual plate osteotomy in orthognathic surgery for patients with severe facial asymmetry: A retrospective analysis with 1-year follow-up

This study aimed to evaluate the stability of lingual plate osteotomy after sagittal split ramus osteotomy (SSRO) in patients with severe facial asymmetry. It included 20 patients undergoing lingual plate osteotomy between January 2011 and January 2017. Cephalometric X-ray imaging and three-dimensional computed tomography (3DCT) were performed before the operation and then 1 day and 1 year after the operation. The relapse rate and postoperative complications were assessed. The operation time was compared between lingual plate osteotomy and transoral angle osteotomy.Specific values measured on cephalometric X-ray and 3DCT images showed significant changes 1 day after the operation, with 47.9% correction occurring in the occlusal plane angle (mean ± SD = 1.74 ± 0.84°, p < 0.05). However, no significant differences were found between measurements taken 1 day and 1 year after the operation, with a 5% change seen in the occlusal plane angle (mean ± SD = 0.1 ± 0.24°, p = 0.61), suggesting that the surgical outcomes can be well maintained for at least 1 year after surgery.Three patients experienced numbness postoperatively but recovered within 1 year. The operation time for lingual plate osteotomy was shorter than that for transoral angle osteotomy. Our findings indicate that lingual plate osteotomy after SSRO is stable, effective, and safe in patients with severe facial asymmetry.     

The prognostic implications of comorbidity and risk factors for (post)operative complications,days spent in the intensive care unit (ICU), and length of hospitalization in patients with oral squamous cell carcinoma: A prospective study

BackgroundThis study aimed to investigate the prognostic implications of comorbidity/risk factors in a cohort of patients with OSCC.MethodsThe prospective study included patients with biopsy-proven primary OSCC. The impact of potential predictors on (post)operative complications, days spent in the ICU, and length of hospitalization was analyzed using both univariate and multivariate analysis.ResultsUsing a microvascular free flap (p = 0.009) and tobacco abuse (p = 0.005) had statistically significant impacts on postoperative complications in univariate, but not in multivariate, analysis. The duration of anesthesia (p < 0.001), type of neck dissection (p = 0.014), reconstruction type (p < 0.001), and red blood cell transfusion during operation (p = 0.007) had statistically significant impacts on spending ≥ 3 days in ICU in univariate analysis, with reconstruction type (p = 0.022) and red blood cell transfusion during operation (p = 0.034) having similar impacts in multivariate analysis. The duration of anesthesia (p < 0.001), pT (p = 0.009), type of neck dissection (p = 0.046), reconstruction type (p < 0.001), and microvascular free flap (p < 0.001) had a statistically significant impacts on length of hospitalization in univariate analysis, with reconstruction type (p < 0.001) also having a significant impact in multivariate analysis.ConclusionNone of the investigated variables showed a significant effect on the prediction of (post)operative complications according to the Clavien-Dindo classification. The type of reconstruction proved to be a valid predictor for the time spent in ICU as well as for the overall length of hospitalization. Red blood cell transfusion during operation further predicted the time spent in ICU after operation. Both variables should be taken into account when performing a comprehensive planning of the patients’ hospitalization.     

Bimaxillary surgery in Class III malocclusion: Soft and hard tissue changes

The aim of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement and mandibular setback surgery with sagittal split osteotomy in Class III skeletal deformity by using lateral cephalograms taken before and after the operation.The material consisted of 31 patient (15 female, 16 male cases, mean age was 26.7 ± 2.5 years) with Class III skeletal deformity. All patients were treated by Le Fort I maxillary advancement and mandibular setback surgery with sagittal split osteotomy. Lateral cephalograms were taken before and 1.4 ± 0.3 years after surgery. Wilcoxon test was used to compare the pre- and post-surgical measurements. Pearson correlation test was used to compare the relationships between the skeletal, dental and facial soft tissue changes.In the maxilla, the APOINTAP (the anteroposterior position of A point) and ITIPAP (the anteroposterior position of upper incisor) showed significant protractions (?3.19 ± 3.63, and ?3.19 ± 4.52, p < 0.01). In the mandible, the L1TIPAP (the anteroposterior position of lower incisor, ?3.20 ± 5.83, p < 0.01), L1TIPSI (the superoinferior position of lower incisor, ?2.43 ± 10.31, p < 0.05), BPOINTSP (the superoinferior position of B point, ?2.28 ± 12.51, p < 0.05) and BPOINTAP (the anteroposterior position of B point, ?3.19 ± 9.31, p < 0.01) showed significant retractions and upper positions after bimaxillary surgery. The insignificant decrease in soft tissue Pog–Vert distance was correlated the significant upper position of B point and lower incisor (r: 0.851, p < 0.001 and r: 0.842, p < 0.001).     

Skeletal stability after mandibular advancement in bilateral sagittal split osteotomies during adolescence

Bilateral sagittal split osteotomy (BSSO) is the most frequently performed surgery for correcting mandibular retrognathia. Few studies have reported the use of BSSO in young patients, as growth may cause relapse. The aim of the present study was to determine the amount of relapse after performing BSSO in patients aged less than 18 years. Patients who had a mandibular advancement by BSSO surgery between January 2003 and June 2008 were evaluated. Eighteen patients were treated before the age of 18 years and compared with patients treated at 20–24 years of age. Cephalometric radiographs were used to determine the amount of relapse. For patients aged less than 18 years, the mean horizontal relapse after 1 year was 0.5 mm, (10.9% of perioperative advancement). For patients aged 20–24 years, the mean relapse was 0.9 mm, (16.4% of perioperative advancement). There were no significant differences between the age groups (p > 0.05). In conclusion, the BSSO procedure is a relatively stable procedure, even during adolescence.     

Antimicrobial prophylaxis in open reduction and internal fixation of compound mandibular fractures: a collaborative regional audit of outcome

We conducted a regional 2-stage prospective audit involving 5 different maxillofacial units in the Yorkshire region of the UK to evaluate the effectiveness of perioperative antimicrobial prophylaxis in the treatment of mandibular fractures. In the first stage (145 patients) we surveyed current practice concerning antimicrobial prophylaxis and found out the current infection rate after open reduction and internal fixation (ORIF) of mandibular fractures. In the second stage (157 patients) we implemented a common antimicrobial protocol in all units and recorded the infection rates using the new regimen. In the first stage a wide range of antimicrobial prophylaxis was used in different units. The agreed perioperative antimicrobial protocol in the second stage was to begin amoxicillin or clarithromycin and metronidazole intravenously on admission and include 2 postoperative doses. The infection rates were 10.3% and 8.9%, respectively, and the difference between the two groups was not significant (χ² = 0.051, df = 1, p = 0.83). The infection rate in the Yorkshire region was similar to results from other centres. We recommend short perioperative antimicrobial prophylaxis with a maximum of 2 postoperative doses after ORIF of mandibular fractures.     

A retrospective analysis of the complication rate after SARPE in 111 cases,and its relationship to patient age at surgery

PurposeSurgically assisted rapid palatal expansion (SARPE) is a well-known surgical intervention for treating maxillary transverse deficiencies (MTDs). This investigation aimed to evaluate the complication rate after SARPE, and its relationship to patient age.Materials and methodsBased on multivariate analyses, the complication rate after SARPE and its association with increasing age in 111 patients with MTD was evaluated. In every case the following variables were evaluated: age, gender, concomitant surgery, expander appliance, perioperative and dental complications, pain score, neurosensory disturbances (NSDs), postoperative excessive haemorrhage, length of hospital stay, infection, oronasal communication, palatal ulceration, asymmetrical maxillary expansion, mal- or non-union of the bone, lacrimation, and mechanical failure.ResultsOverall, 58 (52.25%) patients had minor-to-severe complications. The most common complications were NSDs (27.03%) and postoperative pain (13.51%). Multivariate analysis showed that the frequency of dental complications (mean age 35.9; SD = 10.5140; p = 0.00211), NSDs in general (mean age 30; SD = 9.9827; p = 0.01571), NSDs lasting more than 4 weeks (mean age 30,9583; SD = 10.6260; p = 0.01051), and NSDs lasting more than 1 year (mean age 36.2; SD = 8.7579; p = 0.02011) increased significantly with patient age.ConclusionDetailed data analysis revealed a limited number of severe, long-term complications after SARPE. However, careful patient selection is recommended in elderly cases.     

Impact of thermocycling on surface roughness,microhardness and optical properties of three different lithium disilicate ceramics

ObjectivesThis investigation was carried out to examine the influence of thermocycling aging on the surface roughness (R_a, µm), color parameters (L*, a*, b*), lightness change (ΔL*), chroma change (ΔC*_ab), color change (ΔE), and microhardness (VH) of three lithium disilicate ceramics.Materials and methodsForty-five specimens were prepared from three lithium disilicate materials (n = 15)—e.max CAD (EC), e.max Press (EP), and GC Initial LiSi Press (LP) ceramics—with dimensions of 6.0 × 1.2 × 16.0 ± 0.2 mm following the manufacturers’ instructions. All specimens were exposed to 5000 thermal cycles with bath temperatures ranging between 5 °C and 55 °C. Data of surface roughness, color parameters, and microhardness were obtained using an optical profiler, a spectrophotometer, and a Vickers hardness tester, respectively. One-way ANOVA, a post-hoc Tukey’s test, and a paired sample t-test were implemented for statistical analysis (p ≤ 0.05).ResultsFor surface roughness, insignificant differences were reported between the materials either before or after thermocycling (p > 0.05) while each material displayed a significant increase after being subjected to thermocycling (p < 0.05). For color parameters, LP showed significantly lower L* and b* after thermocycling while EC presented a significant reduction in a* in comparison with other materials (p < 0.05). EP showed a significant decrease in ΔL*, ΔC*_ab and ΔE compared with other materials (p < 0.05). Regarding microhardness, LP showed significantly increase value in comparison with other materials (p < 0.05).ConclusionsThermocycling had a major impact on the surface roughness, microhardness and optical characteristics of the tested materials. E.max Press displayed less changes in (ΔL*), (ΔC*_ab) and (ΔE), while GC LiSi Press had better behavior in terms of microhardness.     

Association between gender,estrogen receptors genes and anxiety levels in patients undergoing orthognathic surgery

Orthognathic surgery is a procedure that is performed for the correction of dentofacial deformities and can lead to a change in an individual's anxiety levels. Anxiety is a multifactorial condition in which hormones and genes play an important role. This study aimed to evaluate if gender and genetic polymorphisms in estrogen receptor alpha (ESR1) and beta (ESR2) are associated with anxiety levels in patients undergoing orthognathic surgery. In this longitudinal observational study, 44 patients were included. Anxiety level assessments were performed at three time periods: 2 days before the surgical procedure and 1 and 6 months postoperatively, using the State-Trait Anxiety Inventory Scale. Gender, age, and facial profile were also evaluated. Additionally, a saliva sample from each individual was collected for the genotypic evaluation of ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) using real time polymerase chain reaction. Data were analyzed with a significance level of 0.05. There was a decrease in trait-anxiety and state-anxiety when comparing the preoperative measurements with those obtained 1 and 6 months postoperatively (p < 0.05). Females were more anxious than males at each time point during the study (p < 0.05). The genetic polymorphism rs9340799 in ESR1 was associated with state-anxiety during the preoperative period (p = 0.046). In conclusion, an individual's gender and genetic polymorphism in ESR1 are associated with anxiety in orthognathic surgery patients.     

High through-put sequencing analysis of changes in oral flora in rats before and after zoledronate administration

The aim of this study was to compare the changes in the oral flora of Sprague-Dawley rats before intraperitoneal injection of zoledronic acid, 6 weeks and 12 weeks after injection. Clinically, some antibiotics effectively treat patients with medicine-related osteonecrosis of the jaws (MRONJ), but the effect of broad-spectrum antibiotics for osteomyelitis of the jaw is not obvious. We therefore speculated that MRONJ may have some dominant bacteria. We used 12 healthy rats for the experiment. One rat was used for haematoxylin and eosin staining, three were used for gene analysis, three for signal molecule research, and five for 16SrDNA high-pass sequencing to compare the changes of flora before intraperitoneal injection of zoledronic acid, and 6 and 12 weeks after injection once every three days. Alpha and beta analysis was used for sequencing data. Analysis of the flora showed that the alpha diversity of the bacteria of rats injected with zoledronic acid was significantly higher than it was before injection (p < 0.05). At the phylum level, Bacteroidetes at 6 and 12 weeks of injection were significantly higher than those before injection (p < 0.05). At the genus level, the proportions of Novophingobium, Dubosiella, Mannheimia, Prevotella, Brevundimonas, and Bacteroides were higher than they were before injection (p < 0.05). The proportions of Lactobacillus, Mannheimia, Brevundimonas, Bacteroides, Roseovarius, Salegentibacter, Marinobacter, and Granulicatella in rats injected for 12 weeks were higher than those before injection (p < 0.05). Zoledronic acid can change the structure of oral flora in SD rats, in which Bacteroides increased and Actinomycetes decreased.     

Radiographic evaluation in three dimensions of condylar fractures with closed treatment in children and adolescents

The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes.The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1–2 years of follow-up.In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% — including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1–2 years.Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.     

Head posture and pharyngeal airway volume changes after bimaxillary surgery for mandibular prognathism

PurposeThe purpose of this study was to evaluate head posture and the pharyngeal airway volume changes using 3D imaging after bimaxillary surgery in mandibular prognathism patients by null hypothesis.Materials and methodsCone-beam computed tomography (CBCT) scans were obtained for 25 mandibular prognathism patients before bimaxillary surgery (T1) and 6 months after surgery (T2). The head posture of each patient was assessed by measuring cranio-cervical angle on a midsagittal plane passing through the anterior nasal spine at T1 and T2. Additionally, the volume of each subject's pharyngeal airway was measured using InVivoDental 3D imaging software.ResultsThe cranio-cervical angle increased significantly 6 months after bimaxillary surgery (p < 0.01). The total volume of the pharyngeal airway slightly decreased (p > 0.05) at the same timepoints, while naso- and oro-pharyngeal airway volume decreased significantly (p < 0.05, p < 0.05). There was significant relationship between the changes of head posture and those of total airway volume (p < 0.05).ConclusionThe null hypothesis was rejected. Bimaxillary surgery resulted in significant head flexion and a slight decrease in total pharyngeal airway volume.     

Piezosurgery for orbital decompression surgery in thyroid associated orbitopathy

The purpose of this study was to assess a piezosurgical device as a novel tool for bony orbital decompression surgery.At a multidisciplinary orbital center, 62 surgeries were performed in 40 patients with thyroid associated orbitopathy (TAO). Within this retrospective case-series, we analyzed the medical records of these consecutive unselected patients. The reduction of proptosis was the main outcome measure.Indications for a two (n = 27, 44%) or three wall (35, 56%) decompression surgery were proptosis (n = 50 orbits, 81%) and optic neuropathy (n = 12, 19%). Piezosurgery enabled precise bone cuts without intraoperative complications. Proptosis decreased from 23.6 ± 2.8 mm (SD) by 3 mm (95% CI: −3.6 to −2.5 mm) after surgery and stayed stable at 3 months (−3 mm, 95% CI: −3.61 to −2.5 mm, p < 0.001, respectively). The effect was higher in those with preoperatively higher values (>24 mm versus ≤24 mm: −3.4 mm versus −2.81 mm before discharge from hospital and −4.1 mm versus −2.1 mm at 3 months: p < 0.001, respectively). After a mean long-term follow-up period of 14.6 ± 10.4 months proptosis decreased by further −0.7 ± 2.0 mm (p < 0.001). Signs of optic nerve compression improved after surgery. Infraorbital hypesthesia was present in 11 of 21 (52%) orbits 3 months after surgery.The piezosurgical device is a useful tool for orbital decompression surgery in TAO. By cutting bone selectively, it is precise and reduces the invasiveness of surgery. Nevertheless, no improvement in outcome or reduction in morbidity over conventional techniques has been shown so far.     

Surgical treatment of sagittal synostosis by extended strip craniectomy: Cranial index,nasofrontal angle,reoperation rate,and a review of the literature

BackgroundSagittal synostosis is the most common non-syndromic single suture craniosynostosis. Different techniques of surgical correction, including extended strip craniectomy (ESC), have been used to treat this condition. The aim of this study is to evaluate radiologic changes and rate of symptomatic restenosis after ESC in a large group of patients less than 12 months of age with non-syndromic sagittal synostosis.MethodsA retrospective study of patients from 1990 to 2012 was performed comparing cranial index (CI) and nasofrontal angle (NFA) before and after surgical correction by ESC. Also, the frequency of subsequent reoperations for symptomatic restricted head growth was determined.ResultsA total of 238 patients underwent ESC. Follow-up information was available for 182 patients. The average age at the time of the operation was 4.5 months and the mean duration of follow-up was 49.6 months. The average post procedure radiologic follow-up (22 patients) was 40.7 months.ConclusionsThe mean CI increased from 0.68 to 0.75 (p < 0.001) after ESC. Also, mean NFA increased from 127 to 133° (p < 0.001). Five patients (2.7%) required a second operation due to symptomatic cranial growth restriction. Reoperation occurred at an average of 26.5 months after the initial procedure. The most common symptom reported was headache.ESC is effective in treating non-syndromic sagittal synostosis. It significantly improved NFA without the need for direct frontal bone resection or frontal orbital osteotomy and significantly increased CI without adjunctive helmet treatment. Patients should be followed for at least 5 years after surgical correction as symptomatic restenosis, although rare, can occur.     

Alterations of upper airway volume caused by Le Fort III osteodistraction in children

PurposeThe aim of the study was to assess changes in the upper respiratory tract and sleep quality in patients who were suffering from midfacial hypoplasia and treated with the movement of underdeveloped middle segment of the face with an Le Fort III osteotomy and distraction.MethodsIn this study patients aged 7–19, suffering from Crouzon syndrome, Apert syndrome, or other craniosynostosis were treated with Le Fort III osteotomy and midface distraction. Patients were subjected to radiological examination and polysomnography before and after the treatment. Typical anthropometric points were identified on lateral cephalograms, and were used to take linear and angular measurements. The surface and the volume of the upper respiratory tract were measured with the Dolphin Imaging software. Apnoea Hypopnea Index (AHI) was used to assess the sleep quality.ResultsIn all 18 patients the analysis showed statistically significant changes of the AHI and in the linear, angular and volumetric measurements. Mean change of the volume of the upper respiratory tract was 12,4 ± 11,3cm3(p = 0,0001) and of the surface was 615 ± 521 mm² (p = 0,0000000002). Mean improvement of AHI was 9 ± 6,2 (p = 0,00006). In three cases patients had tracheostomy prior to operation and none of them required tracheostomy after the operation.ConclusionsThe use of distraction osteogenesis of the middle segment of the face combined with Le Fort III osteotomy results in dilation of the upper respiratory tract at the nasopharyngeal level and at the soft palate level resulting in elimination of sleep and respiration disorders. Further studies with polysomnography are necessary, as well as observation of patients over time and monitoring of treatment stability.     

Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p = 0.04), and in the MDAS between before and immediately after extraction (p = 0.02), and between immediately after and 7 days after extraction (p = <0.001). The DFS also differed between before and immediately after extraction (p = 0.002), and between immediately and 7 days after extraction (p < 0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.