Three Dimensional CT Reconstruction for the Evaluation and Surgical Planning of Mid Face Fractures: A 100 Case Study

Background  

3D CT reconstruction is increasingly becoming a valuable tool in maxillofacial trauma. The aim of this study is to evaluate the role of three dimensional computed tomography as compare to conventional radiography in diagnosis and management of mid face fractures.     

The taper of cast post preparation measured using innovative image processing technique

Background  

No documentation in the literature about taper of cast posts. This study was conducted to measure the degree of cast posts taper, and to evaluate its suitability based on the anatomy aspects of the common candidate teeth for post reconstruction.     

Auricular Reconstruction of Congenital Microtia Using Autogenous Costal Cartilage: Report of 27 Cases

Background  

Total auricular reconstruction in congenital lobule type microtia is one of the most challenging problems faced by a reconstructive surgeon as it demands precise surgical technique combined with artistic creativity. Ear reconstruction requires carefully planned procedures.     

Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction

Purpose

Ablative oncological surgery to treat head-and-neck cancer often triggers a requirement for jaw reconstruction. Modern surgical procedures using free microvascular flaps afford acceptable outcomes in terms of restoration of bony and soft tissue defects. A fibula free flap is often the preferred flap, as the bone length is considerable and a two-surgeon approach is possible. Dental implants play important roles in functional rehabilitation. Our aim was to evaluate the survival of dental implants placed in reconstructed areas after transfer of fibula tissue to the jaw.

Erfahrungen in der chirurgischen Versorgung von Gesichtshautbasaliomen und plastischen Rekonstruktionsverfahren

Background

No recurrences and optimal aesthetic outcomes after R0 resection and plastic reconstruction of the face are the goals in the surgical treatment of basal cell carcinoma. The aim of this study was to evaluate recurrence rates and to evaluate different reconstructive techniques.

Patients and methods

This study included 205 follow-up patients undergoing R0 resection of primary basal cell carcinoma and facial skin reconstruction between 1998 and 2002; data were analyzed retrospectively.

Results

The most frequent locations of basal cell carcinoma were the nasal (40.5%) and orbital (22.9%) regions. The rate of recurrence after 2.5 years (6 months–5 years) was 7.3%. Local flaps, full-thickness skin grafts, and sliding flaps were usually performed; indications for split-thickness skin grafts were rare. Disturbances of sensation were found in only 3.6% of the sliding flaps and in 11.7% of the local flaps, but 22.7% in full-thickness and 38.7% in split-thickness skin grafts. The aesthetic outcome, evaluated by clinical inspection and a patient satisfaction score, was classified as “unobtrusive” and “good or excellent” for 88.4% of local flaps, 92.6% of sliding flaps, but only for 66.4% of full-thickness and 54% of split-thickness skin grafts.

Conclusion

Local flaps and sliding flaps result in better aesthetic and neurological outcomes after reconstruction of facial skin regions. Skin grafts have their indications as an alternative procedure in cases of critical indications for flaps.     

A Simple and Cost Effective Template for Central Segment Reconstruction of Mandible with Free Fibula Flap

Purpose  

A variety of templates are being used for mandible reconstruction with free flaps. We describe a simple and cost effective method using a ‘K’ wire template for the central segment reconstruction of the mandible with free fibula flap.     

The effect of voxel size on image reconstruction in cone-beam computed tomography

Objectives  

This study evaluated the effects of changing the voxel size on the resolution and noise of cone-beam computed tomography (CBCT) reconstruction images.     

Evaluation of the Perioperative Use of 0.2% Chlorhexidine Gluconate for the Prevention of Alveolar Osteitis After the Extraction of Impacted Mandibular Third Molars: A Clinical Study

Purpose  

To clinically evaluate the perioperative use of 0.2% chlorhexidine gluconate for the prevention of alveolar osteitis, to assess the patient compliance to chlorhexidine and to prepare a comprehensive treatment plan to prevent alveolar osteitis after removal of an impacted third molar extraction.     

Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps: A Case Series

Introduction

Reconstruction of the nasal clefts is a challenging task considering the nasal anatomic complexity and their possible association with craniofacial defects. The reconstruction of these defects needs extensive amounts of soft tissue that warrant the use of forehead flaps. Often presence of cranial defects and low hairline compromise the amount of tissue available for reconstruction warrenting tissue expansion.

Aim

To evaluate the efficacy of tissue expansion in reconstruction of congenital nasal clefts.

Subjects and Methods

9 patients with congenital nasal clefts involving multiple sub units were taken up for nasal reconstruction with expanded forehead flaps. The average amount of expansion needed was 200 ml. The reconstruction was performed in 3 stages.

Results

Expanded forehead flaps proved to be best modality for reconstruction providing the skin cover needed for ala, columella and dorsum with minimal scarring at the donor site.

Conclusion

Expansion of the forehead flap is a viable option for multiple sub unit reconstruction in congenital nasal cleft deformities.     

The Versatility of Temporalis Myofascial Flap in Maxillo-Facial Reconstruction: A Clinical Study

Objectives  

This clinical study was conducted in the department of Oral & Maxillofacial Surgery, at our institute, to study the versatility of temporalis myofascial flap in maxillofacial reconstruction.     

Patient Satisfaction with Hyaluronic Acid Fillers for Improvement of the Nasolabial Folds in Type IV &; V Skin

Introduction  

Soft tissue augmentation by hyaluronic acid filler injections has become the most commonly done cosmetic procedure in the last 10 years. These are now being widely used for improvement of the nasolabial folds. The present study was done to evaluate the patient satisfaction after these injections.     

One‐piece zirconia oral implants for single‐tooth replacement: Three‐year results from a long‐term prospective cohort study

Aim

This 3‐year report of a prospective long‐term cohort investigation aimed to evaluate the clinical and radiographic outcomes of a one‐piece zirconia oral implant for single‐tooth replacement.

Materials and Methods

Sixty‐five patients received a 1‐stage implant surgery with immediate temporization. Standardized radiographs were taken at implant insertion, after 1 year, and after 3 years to monitor peri‐implant bone levels. A univariate analysis of the association of different baseline parameters on marginal bone loss from implant insertion to 36 months was performed. Soft‐tissue parameters were evaluated at prosthesis insertion, after 6 months, after 1 year, and at the 3‐year follow‐up.

Results

After 3 years, six posterior site implants were lost, giving a cumulative survival rate of 90.8%. The mean marginal bone loss was 1.45 mm; 35% of the implants lost at least 2 mm bone, and 22% more than 3 mm. The univariate analysis did not identify any parameter associated with marginal bone loss. Probing depth, clinical attachment level, and bleeding index increased over 3 years, and plaque index decreased.

Conclusions

The low survival rate of the presented ceramic implant and especially the high frequency of advanced bone loss are noticeable but remain unexplained.     

Use of Nasolabial Flap in Intra and Extraoral Reconstruction: Our Experience with 40 Cases

Purpose

This article represents the use of inferiorly based nasolabial flap in reconstruction of various intraoral and extraoral defects.

Patients and Methods

Nasolabial flaps were performed in 40 patients, for reconstruction of buccal mucosa, gingivobuccal sulcus, commissure, lower lip, floor of mouth, upper lip and lower alveolar defects.

Results

The most common defect site in the oral cavity was the buccal mucosa. Partial flap necrosis occurred in five patients. Out of 40 cases of carcinoma of lip, commissure and floor of the mouth, all the patients had good speech after complete healing of the wound. None of the patients who had lip or commissure reconstruction developed drooling of saliva due to lip incompetence.

Conclusion

The inferiorly based nasolabial flap provides reliable coverage of intermediate-sized oral cavity defects when used alone. Minimal donor morbidity is associated with its use. It is especially useful in elderly patients with facial skin laxity and where esthetics is not a major concern.     

Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

Background

The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications.

Material and Methods

Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes.

Results

The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion.

Conclusions

A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations. Key words:Free flap, complications, oral cancer, risk factors, reconstruction.     

Adapting the German version of the dental environment stress questionnaire

Aims

To develop a German version of the Dental Environment Stress (DES) questionnaire, and to evaluate its reliability and validity.

Methods

The original English DES questionnaire was translated into German using a forward–backward translation process. To evaluate construct stability, a subgroup of dental students (n = 43) completed the DES twice (interval: 1 week). To evaluate how the DES responds to anticipated changes in stress, all dental students' (n = 64) DES scores and saliva cortisol levels administered from a clinical study were compared between holiday and term time. Furthermore, the Depression, Anxiety and Stress Scale (DASS) and a stress self-assessment were used to determine the validity of the DES. Reliability analyses were calculated using Kendall's tau correlations. To estimate reliability strength, correlation coefficients and intraclass correlations (ICCs) were used.

Results

Regarding construct stability, 24 of 25 DES items had at least moderate correlations, and most items showed strong correlations. Correlations for the seven subdomains were good (range: 0.778–1.000). The same was true for the total DES score (ICC: 0.944). Correlations for response to term-time stress were weaker and more varied. Validity analyses revealed fair correlations between the DES and students' self-assessment (Pearson's r = .592) and DASS score (Pearson's r = .392), suggesting satisfactory validity. Stress levels were quite similar between baseline and follow-up.

Conclusion

The German DES is a reliable tool for evaluating stress in dental students. Because it can be used to identify individual stressors in various categories, it might enable the detection of specific stress situations in educational situations and facilitate solutions (adjustment of curricula, tailored consulting services).     

Mandibular Reconstruction: Overview

Introduction

Mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques.

Purpose

This article reviews the history of oromandibular reconstruction, biomechanics of mandible, summarizes the reconstruction options available for mandible with defect classification, goals in reconstruction, the various donor sites, current reconstructive options, dental rehabilitation and persistent associated problems.

Summary

Oromandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts and current reconstructive options. The ideal reconstruction would provide a solid arch to articulate with the upper jaw, restoring swallowing speech, mastication, and esthetics. Autogenous vascularized bone grafts in combination with microsurgical techniques have revolutionized mandibular reconstruction in oral cancer surgery. Current trends in mandibular reconstruction aim to achieve reestablishment of a viable mandible of proper form and maxillary mandibular relationship while decreasing the need for invasive autogenous graft procurement. However the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection, timing of surgery and method of reconstruction.

     

“Transport Distraction Osteogenesis for Reconstruction of Mandibular Defects”: Our Experience

Introduction  

Mandibular defects usually involve a combination of osseous and soft tissue deficiency and are among the most challenging problems in maxillofacial surgery, many options are available for mandibular reconstruction. One of the options discussed in literature recently being distraction osteogenesis.     

A clinical,randomized study on the influence of dental whitening on Streptococcus mutans population

Background

Dental whitening with peroxides has been popularized through the at‐home technique, which employs low concentrations of peroxide applied in individual trays. However, there are few clinical trials reporting the effects of its continuous use on oral microbiota. Thus, the purpose of the present clinical, randomized study was to evaluate the influence of at‐home whitening treatment on Streptococcus mutans in saliva, buccal mucosa, and subgingival and supragingival plaque.

Methods

Thirty volunteers were randomly divided into two study groups (N = 15) according to the whitening therapy: G CP, whitening using 10% carbamide peroxide 4 h daily for 21 days; and G HP, whitening using 6% hydrogen peroxide 1.5 h daily for 21 days. Samples from the predetermined locations were collected at three evaluation periods: T1, before; T2, immediately after; and T3, 30 days after the beginning of the treatment. The microbiological evaluation was made using conventional and molecular methods.

Results

Student's t‐test demonstrated a statistically significant decrease in S. mutans population in the subgingival and supragingival plaque for HP samples between T1 and T2 no difference was found between T1 and T3 regardless of the location and the whitening product used (α = 0.05).

Conclusions

Although HP reduced S. mutans during treatment, the levels returned to baseline when assessed 30 days after the treatment.     

Comparison of two- and three-dimensional filtering methods to improve image quality in multiplanar reconstruction of cone-beam computed tomography

Objectives  

Two- and three-dimensional (2D and 3D, respectively) filtering methods were examined to improve the accuracy of bone morphology depicted in dental cone-beam computed tomography (CBCT) images. An attempt to improve multiplanar reconstruction (MPR) image quality was carried out by reducing the image noise.     

Long‐term Schneiderian membrane thickness changes following zygomatic implant placement: A retrospective radiographic analysis using cone beam computed tomography

Objectives

The purpose of this retrospective study was to evaluate the long‐term changes in the thickness of Schneiderian membranes after zygomatic implant placement using cone beam computed tomography (CBCT).

Material and methods

Twenty‐five consecutive patients were included in this study. All the patients underwent bilateral zygomatic implant placement. Schneiderian membrane thickness (SMT) in 49 maxillary sinuses (one sinus was not included because of early loss of the zygomatic implants) was measured using CBCT before and at least 1 year after zygomatic implant placement. Ostium patency of each sinus was also evaluated and recorded.

Results

In total, 84 zygomatic implants and 30 regular implants were placed in included patients. Two unilateral maxillary zygomatic implants in one patient were removed 2 months after implant placement. The SMT increased from 1.03 mm (inter‐quartile range: 1.57 mm) to 1.33 mm (inter‐quartile range: 1.98 mm) after a median follow‐up time of 23.00 months (inter‐quartile range: 14 months), and the difference was statistically significant. Before zygomatic implant insertion, 24.5% (12/49) of sinuses had SMT greater than 2 mm, whereas this value was 28.6% (14/49) after zygomatic implant placement. The percentage of sinuses observed with ostium patency also increased from 2.0% (1/49) to 12.2% (6/49).

Conclusions

Chronic Schneiderian membrane thickening could result from zygomatic implant insertion. Intensive postoperative care and clinical and radiographic monitoring are recommended after zygomatic implant placement.