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1.
Ahmed Al-Dam Clarissa Precht Armelle Barbe Carsten Kohlmeier Henning Hanken Johannes Wikner Gerhard Schön Max Heiland Alexandre T. Assaf 《Journal of cranio-maxillo-facial surgery》2018,46(8):1379-1384
Purpose
The purpose of this clinical study was to evaluate the sensitivity and specificity of cervical sentinel lymph node biopsy after mapping with indocyanine green fluorescence (ICG) for imaging early-stage oral cancer.Patients and methods
A sentinel lymph node biopsy (SLNB) was performed during a selective neck dissection (SND) in 20 patients with oral squamous cell carcinoma (OSCC, cT1 or cT2, N0 status). The sentinel lymph nodes (SLN) were identified using an infrared video camera after ICG injection. Lymph nodes were examined histologically. The endpoint of this study was to investigate the rate of false-negative results in SLNB.Results
Sentinel lymph nodes could be detected after 8.1 min (range 1–22 min). In eight out of 20 cases, lymph node metastases were found during histopathological evaluation of the neck dissection specimen. In four cases a metastasis could be found in the detected SLN (sensitivity 50%). In the other four cases metastases were found in different lymph nodes. Specificity was 100%, positive predictive value 100%, and negative predictive value 75%.Conclusion
In this study, reliability of sentinel lymph node biopsy after ICG imaging could not be verified, as there were false-negative results in 50% of the cases. Therefore, SND can still be recommended as for patients with cT1 or cT2 OSCC, and a N0 neck status. 相似文献2.
C.G.U. Riese J.-A. Karstadt A. Schramm S. Güleryüz G. Dressel K.J. Lorenz B. Klemenz A. Sailer S. Seitz F. Wilde 《Journal of cranio-maxillo-facial surgery》2018,46(10):1748-1752
Purpose
This study investigates the possibility and sensibility of using sentinel node biopsy (SNB) during surgery for oropharyngeal carcinomas with clinically and radiographically unremarkable cervical lymph nodes.Materials and methods
A total of 36 patients who were treated for early oral and oropharyngeal carcinoma and unremarkable cervical lymph nodes were included in this study. After lymphoscintigraphy for detecting sentinel lymph nodes (SLN), the SLN were excised first. Thereafter elective neck dissection was performed. Histopathological and immunochemical examinations were used to examine the SLN and all other lymph nodes.Results
The preoperative SLN detection rate was 97.2% (35 of 36). SLN in level V were detected in four patients (11.1%). Metastases were found in 33.3% of the patients (12 of 36). All metastases were in the marked SLN. No skip metastases could be detected. A specificity of 100% and a sensitivity of 94.4% were identified for the SNB.Conclusion
The study confirms that SNB is a precise diagnostic procedure for assessing the nodal status of cervical lymph nodes. Further studies are needed to determine whether SNB without elective neck dissection for clinically and radiologically unremarkable cervical lymph nodes can become a reliable course of treatment for carcinomas of the head and neck region. 相似文献3.
Yoldez Houcine Emna Romdhane Ahlem Blel Meriem Ksentini Raoudha Aloui Rim Lahiani Nadia Znaidi Mamia Ben Salah Soumaya Rammeh 《Journal of cranio-maxillo-facial surgery》2018,46(7):1117-1120
Purpose
Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas.Materials and methods
This was a retrospective study carried out over a 6-year period (January 2011 to December 2016) and conducted at the Cytology Unit in our Pathology Department (Charles Nicolle Hospital, Tunisia). The measures of diagnostic accuracy of FNAC in the diagnosis of cervical lymph node lymphomas were calculated taking histopathology as the gold standard.Results
A total of 937 FNA samples were obtained from 851 patients. The diagnosis of lymphoma was obtained in 65 cases (6.9%). Cytological diagnoses of lymphoma were as follows: 28 (44%) Hodgkin lymphoma, 17 (25%) high-grade lymphoma, 15 (23%) low-grade lymphoma, and 5 (8%) “suggestive of lymphoma.” FNAC of cervical lymph nodes had a sensitivity of 95.5%, specificity of 98.7%, positive predictive value (PPV) of 97.7%, and negative predictive value (NPP) of 97.5%.Conclusion
The present study demonstrated that cytology is capable to detect nodes suspicious for the presence of lymphoma precisely, in terms of low- or high-grade lymphoma, which is a relevant and very achievable first step in the management of patients with cervical lymph node lymphoma. 相似文献4.
V. Rempel A.F. Safi U. Drebber H.J. Nickenig J. Neugebauer J.E. Zöller M. Kreppel 《Journal of cranio-maxillo-facial surgery》2018,46(9):1659-1663
Background
This study aims at investigating the prognostic significance of lymph node ratio (LNR) in a cohort of patients with oral squamous cell carcinomas (OSCC), treated with neoadjuvant radiochemotherapy followed by radical surgery.Methods
The study included 171 treatment-naive patients with biopsy-proven primary OSCC, being reviewed retrospectively. All patients received a concomitant neoadjuvant radiochemotherapy (RCT) followed by radical surgery of the primary tumor and neck dissection based on the pretreatment staging results. The Kaplan–Meier survival analysis method was used to estimate the events of interest for overall survival (OS). Prognostic factors were identified through univariate and multivariate analysis.Results
The 5-year overall survival rate for all patients was 48 %. In univariate analysis, patient's age and data compiled from the histopathological examination as margin status, extracapsular spread, ypT, ypN, ypUICC, number of positive lymph nodes and lymph node ratio (LNR) had a statistically significant impact on overall survival. Multivariate analysis revealed an independent significant impact of patient age, ypT, margin status and LNR on OS. ypN showed no statistical significant impact on OS.Conclusion
Our results show that LNR is an important predictor for OS in patients with OSCC that were treated with neoadjuvant radiochemotherapy and radical surgery. 相似文献5.
Ali-Farid Safi Martin Kauke Andrea Grandoch Hans-Joachim Nickenig Joachim Zöller Matthias Kreppel 《Journal of cranio-maxillo-facial surgery》2018,46(6):1007-1012
Purpose
Lymph node ratio (LNR) essentially improves assessment of prognosis and therapeutic decision making for patients with oral squamous cell carcinoma, as it considers both the number of positive lymph nodes and the number of dissected lymph nodes. Mandibular infiltration by oral squamous cell carcinoma is a vital clinicopathological feature, significantly worsens prognosis. However, to the best of our knowledge, data on the influence of LNR on prognosis for patients with OSCC and mandibular infiltration are not available.Materials and methods
A retrospective chart review of 89 patients with treatment-naive oral squamous cell carcinoma and histopathologically proven mandibular infiltration (pT4a) was performed. Exclusion criteria were primarily curative intended surgery (radical tumor resection, neck dissection and segmental mandibulectomy) with negative resection margins. Exclusion criteria were neoadjuvant chemoradiotherapy, erosive infiltration of the mandible, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months, and inadequate information to correctly determine clinicopathological characteristics.Results
We observed a significant correlation on univariate analysis between locoregional recurrence and pathologic N classification (p = 0.004), perineural invasion (p = 0.005) and lymph node ratio (p < 0.001). On multivariate analysis, lymph node ratio (p = 0.028) was shown to be an independent indicator for locoregional recurrence.Conclusion
LNR predicted locoregional recurrence better than the conventional nodal staging system and therefore might serve as a more precise risk stratification tool. LNR >7% led to a 11.419-fold higher risk for locoregional recurrence of patients with mandibular infiltration due to OSCC. 相似文献6.
Matthias Zirk Ali-Farid Safi Johannes Buller Hans-Joachim Nickenig Timo Dreiseidler Max Zinser Uta Drebber Joachim E. Zöller Matthias Kreppel 《Journal of cranio-maxillo-facial surgery》2018,46(2):195-200
Background
Recently, lymph node ratio (LNR) has been recognized as an important prognosticator for oral squamous cell carcinoma (OSCC). However, its relevance for the specific subsite floor of mouth (FOM) has not been investigated. This study was conducted to elucidate the prognostic significance of LNR for the subsite FOM among other prognostic factors.Methods
A retrospective study of 155 patients with FOM SCC who received primary curative resection and neck dissection was conducted. We analyzed the impact of LNR among other clinicopathologic variables on overall survival (OS) in univariate and multivariate analysis.Results
In univariate analysis, patients detected with LNR ≤ 0.07 (cutoff-point: 0.07) showed an 85% 5-year OS rate, whereas for patients with LNR > 0.07 the OS rate reached 25% after 5-years (p < 0.001). The 5-year DFS rate was 72% for patients with LNR ≤ 0.07; on the contrary, patients with LNR > 0.07 the 5-year DFS rate was 17% (p < 0.001). LNR was detected as an independent predictor of OS in multivariate analysis (p = 0.032) for the subsite FOM.Conclusion
We concluded that LNR is an important predictor of prognosis in patients with FOM SCC, LNR should be considered in the choice of adjuvant treatment for these patients. 相似文献7.
Kai Qian Kai Guo Xiaoke Zheng Wenyu Sun Tuanqi Sun Lili Chen Ding Ma Yi Wu Qinghai Ji Zhuoying Wang 《Journal of cranio-maxillo-facial surgery》2019,47(1):47-52
Purpose
To evaluate whether elective neck dissection (END) was beneficial for cN0 patients with salivary gland carcinoma.Materials and methods
The rates of regional failure-free survival and disease-free survival were calculated using Kaplan–Meier methods and Cox models. The risk factors for occult lymph node metastasis (OLNM) in cN0 patients undergoing END was analyzed using logistic regression. A nomogram was formulated to calculate the estimated probability of OLNM.Results
Neck dissection was performed in 84 patients (43.3%). OLNM was detected in eight of the patients who underwent END. During the follow-up period, regional recurrences involving cervical lymph nodes were found in 10 patients. Cox model analysis revealed that neck dissection was not related to regional failure-free survival and disease-free survival. Logistic regression analysis revealed that older age, neural symptoms, and positive adjacent lymph nodes were associated with OLNM. A nomogram comprising age, neural symptoms, and adjacent lymph nodes was developed to predict the risk of OLNM.Conclusion
The incidence of OLNM was low in cN0 patients after detailed preoperative evaluations. There was no strong evidence supporting END as a conventional therapy in cN0 patients with salivary cancers. Our nomogram is a simple and practical instrument for strengthening the prediction of OLNM. 相似文献8.
Jonathan C. Simmonds Anju K. Patel Nicholas S. Mader Andrew R. Scott 《Journal of cranio-maxillo-facial surgery》2018,46(3):498-503
Objectives
To examine the frequency of partial glossectomy performed for the indication of macroglossia in children within the United States, assessing for differences in rates of intervention across various demographics.To identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay and cost of admission following tongue reduction surgery.Study Design
Retrospective cross-sectional study.Setting
The Kids' Inpatient Database 2003, 2006, 2009, and 2012.Subjects
Patients under age 5 diagnosed with macroglossia who underwent partial glossectomy.Methods
Demographics were analyzed and cross tabulations, linear regression modeling, and multivariate analysis were performed.Results
During the four-years studied, partial glossectomy was performed in 196 children under age 5 with macroglossia. A disproportionately higher rate of intervention was seen in white children (p = 0.001), patients undergoing surgery in the mid-west (p < 0.001) and patients in the highest socioeconomic quartile (p = 0.015). Most patients underwent glossectomy in their second year of life. The average length of stay in patients who underwent partial glossectomy for macroglossia was 9.59 days (Range 1–211 days, median 3.45 days) and the average cost was $56,602 (median $16,330).Conclusion
Partial glossectomy for macroglossia is typically performed prior to age 2 in the United States. A higher rate of intervention is seen in white children, those who have surgery in the mid-west and affluent children even when controlling for confounding variables.Level of evidence
III. 相似文献9.
Statement of problem
Lack of an accepted definition for the ascending ramus of the mandible means no common reference point is available for clinical or research dialogue.Purpose
The purpose of this review was to determine whether the ascending ramus has been defined, by using a search of published studies.Material and methods
PubMed was searched, using terms “ascending ramus” and “mandible.”Results
The search found no acceptable definition of the ascending ramus of the mandible.Conclusions
An acceptable definition for the ascending ramus of the mandible is lacking, and one is proposed here. 相似文献10.
Ioannis Iatrou Nadia Theologie-Lygidakis Ourania Schoinohoriti Fotios Tzermpos Anastassios I. Mylonas 《Journal of cranio-maxillo-facial surgery》2018,46(2):213-221
Background
The rarity of Ewing's sarcoma (ES) in the maxillofacial region of children, coupled with the technical challenge of resection and associated functional and cosmetic impairment has resulted in deficient data regarding the optimal local control of the disease.Objective
To describe our experience in the management of primary maxillofacial ES in children, focusing on the therapeutic modalities for local control of the disease.Study design
Single institution observational study.Methods
This is a single institution review of patients, treated between 2007 and 2016.Results
Six primary maxillofacial ES were treated according to the EURO-EWING 99 protocol, consisting of a uniform chemotherapy regimen, combined selectively with surgery and radiotherapy as local treatment. Patients' mean age was 9.42 years (range 6–12.5 years). One patient initially suffered from metastasis and succumbed to the disease; another refused further treatment following chemotherapy and was lost to follow-up. Four patients underwent surgery and adjuvant radiotherapy successfully. At a mean follow-up of 3.78 years relapse-free and overall survival rates were 60% and 80% respectively. The aesthetic and functional outcome was satisfactory in all treated patients.Conclusions
In eligible cases the combination of chemotherapy with surgery and adjuvant radiotherapy results in optimal oncological and functional outcome for children with ES of the maxillofacial region. Metastasis and poor response to chemotherapy are the most important adverse prognostic factors. 相似文献11.
Francesco Ricotta Laura Cercenelli Salvatore Battaglia Barbara Bortolani Gabriella Savastio Emanuela Marcelli Claudio Marchetti Achille Tarsitano 《Journal of cranio-maxillo-facial surgery》2018,46(12):2240-2247
Introduction
In the present study, our aim was to confirm the role of navigation-guided surgery in reducing the percentage of positive margins in advanced malignant pathologies of the mid-face, by introducing a new volumetric virtual planning method for resection.Materials and methods
Twenty-eight patients were included in this study. Eighteen patients requiring surgery to treat malignant midface tumors were prospectively selected and stratified into two different study groups. Patients enrolled in the Reference Points Resection group (RPR – 10 patients) underwent resection planning using the anatomical landmarks on CT scan; patients enrolled in the Volume Resection group (VR – 8 patients) underwent resection using the new volumetric virtual planning method. The remaining 10 patients (Control group) were treated without the use of a navigation system.Results
In total, 127 margins were pathologically assessed in the RPR group, 75 in the VR group, and 85 in the control group. In the control group, 16% of the margins were positive, while in the RPR group the value was 9%, and in the VR group 1%.Conclusions
The volumetric tumor resection planning associated to the navigation-guide resection appeared to be an improvement in terms of control of surgical margins in advanced tumors involving the mid-face. 相似文献12.
Ramzi M. Alameddine Jeffrey Z. Tsao Audrey C. Ko Bradford W. Lee Don O. Kikkawa Bobby S. Korn 《Journal of cranio-maxillo-facial surgery》2018,46(8):1247-1251
Background
Wide surgical access to the orbital floor and medial wall is often impaired by the course of the inferior oblique muscle. There is no current consensus on the optimal surgical approach for exposure, and techniques involving inferior oblique division are generally shunned for concern of possible complications.Objective
To determine the safety and outcomes of inferior oblique division and reattachment for surgical access to the orbital floor and medial wall during orbital fracture repair.Methods
Retrospective, single-center, review of 85 patients that underwent orbital floor, medial wall or combined fracture repair with division and reattachment of the inferior oblique near its origin. Measured characteristics include surgical approach, type of surgery, time to surgery, pre- and post-operative diplopia, enophthalmos, and complications.Results
Forty-five patients (52.9%) with no pre-operative diplopia were followed up for a mean of six months. Of these, six patients (13.3%) developed post-operative binocular diplopia that resolved in all patients on an average of three months (range 2–6 months). No patients developed torsional diplopia. One patient developed a hematoma two years later attributable to capsular contraction around the implant.Conclusion
Division and reattachment of the inferior oblique muscle is a safe method that allows for panoramic surgical visualization of the inferior and medial orbit. 相似文献13.
Sang-Ha Oh Hyeokjae Kwon Sun Je Kim Hyunwoo Kyung Young Joon Seo Dae Hyun Lew Seung Han Song 《Journal of cranio-maxillo-facial surgery》2018,46(6):1032-1036
Background
Skin texture and color are important considerations during the reconstruction of facial defects, and anatomical borders should be preserved. Therefore, a local flap is a better option. In these cases, the authors repaired facial defects using a bilateral interdigitated VY flap.Objective
We aim to present a modified bilateral Pacman flap technique for the reconstruction of round and oval facial defects.Materials and Methods
We performed a retrospective chart review of 25 patients (26 cases) who underwent bilateral interdigitated Pacman flap repair of round and oval facial defects after Mohs surgery for skin cancer from January 2012 to December 2017. The defect sizes ranged from 0.7 to 8.4 cm2 (mean 3.1 cm2).Results
All defects were covered successfully and the flaps survived in all cases. One patient had partial flap necrosis that resolved spontaneously. No flap contraction, distortion, or severe scar formation was observed in any patient during the 12-month follow-up period.Conclusion
The bilateral interdigitated Pacman flap can cover round and oval facial defects without distortion or central dog-ear deformity. This method is a useful option for facial restoration in selected cases. 相似文献14.
Kathleen M. Ross Jason S. Mehr Rebecca D. Greeley Lindsay A. Montoya Prathit A. Kulkarni Sonya Frontin Trevor J. Weigle Helen Giles Barbara E. Montana 《Journal of the American Dental Association (1939)》2018,149(3):191-201
Background
In October and November 2014, the New Jersey Department of Health received reports of 3 patients who developed Enterococcus faecalis endocarditis after undergoing surgical procedures at the same oral surgery practice in New Jersey. Bacterial endocarditis is an uncommon but life-threatening condition; 3 patients with enterococcal endocarditis associated with a single oral surgery practice is unusual. An investigation was initiated because of the potential ongoing public health risk.Methods
Public health officials conducted retrospective surveillance to identify additional patients with endocarditis associated with the practice. They interviewed patients using a standardized questionnaire. An investigative public health team inspected the office environment, interviewed staff, and reviewed medical records.Results
Public health officials identified 15 confirmed patients with enterococcal endocarditis of those patients who underwent procedures from December 2012 through August 2014. Among these patients, 12 (80%) underwent cardiac surgery. One (7%) patient died from complications of endocarditis and subsequent cardiac surgery. Breaches of recommended infection prevention practices were identified that might have resulted in transmission of enterococci during the administration of intravenous sedation, including failure to perform hand hygiene and failure to maintain aseptic technique when performing procedures and handling medications.Conclusions
This investigation highlights the importance of adhering to infection prevention recommendations in dental care settings. No additional patients with endocarditis were identified after infection prevention and control recommendations were implemented.Practical Implications
Infection prevention training should be emphasized at all levels of professional dental training. All dental health care personnel establishing intravenous treatment and administering intravenous medications should be trained in safe injection practices. 相似文献15.
Jochen Weitz Klaus-Dietrich Wolff Marco Rainer Kesting Christopher-Philipp Nobis 《Journal of cranio-maxillo-facial surgery》2018,46(11):1975-1978
Introduction
The authors developed a semi-standardised resection and cutting guide for mandibular reconstruction with free fibula flap based on data of mandible sizes and angles.Methods
After analyzing the angles and lengths of mandibular angles and segments on computer tomography, a partly-adjustable resection guide for the mandible and cutting guide for the fibula were designed.Results
After testing and optimizing the guides on plastic models and cadavers, the guides were successfully used for mandible resection and reconstruction with free fibula flap in 8 patients with segmental mandibulectomy. Application of the cutting and resection guides and functional results like occlusion and aesthetic appearence were satisfactory in all cases.Conclusions
The developed semi-standardised device is a helpful instrument for facilitating reconstruction of segmental mandibular defects with free fibula flaps. No extensive preoperative preparation and 3D printing is necessary which can avoid additional costs for virtual planning. Especially for lower budget health systems this can be an alternative to virtual planning. 相似文献16.
Daniel Kruber Thomas Hierl Hans-Martin Doerfler Heike Huempfner-Hierl Matthias Krause 《Journal of cranio-maxillo-facial surgery》2018,46(7):1159-1161
Introduction
Polydioxanone (PDS) sheets are commonly used in the treatment of orbital wall fractures. A potential drawback of PDS is that it may be difficult to adapt to the anatomy of the orbital walls. Therefore a study was conceived to test the feasibility of preforming PDS sheets.Material and methods
PDS sheet material was water-heated and preformed using a template based on a statistical anatomical model. Then the deformed sheet was cooled, stored and compared to the original model to investigate post-deformation changes.Results
PDS sheet material could easily be deformed using a mould. No significant post-cooling shape changes were noticed.Conclusions
PDS sheet material can be preformed into complex geometric shapes. This could be a benefit in the treatment of orbital wall fractures. 相似文献17.
Raymond A. Kuthy Susan C. McKernan Mark Pooley M. Bridget Zimmerman 《Journal of the American Dental Association (1939)》2018,149(4):308-316
Background
In this study, the authors used observational data from 2014 to evaluate the association between the number of general dentists and several community characteristics.Methods
The authors collected community-level characteristics from secondary sources for all 947 Iowa incorporated communities to study their relationships with the mean number of general dentists per 1,000 population per square mile (population density), the dependent variable. The authors used zero-inflated negative binomial models to examine the association between the dependent and predictor variables.Results
Only 22.8% of communities had a dentist. Urban, young, well-educated, fluoridated communities with at least 1 elementary school had the highest estimated mean concentration of dentists. Isolated communities with older, less educated adults and lacking fluoridation and an elementary school had the fewest dentists.Conclusions
Although population is an important determinant for where a dentist practices, other variables such as urbanization, demographic characteristics, fluoridation status, and presence of at least 1 elementary school are also predictors of the number of dentists in a community.Practical Implications
These findings provide dental students and young practitioners useful information by highlighting community characteristics that are associated with office locations. 相似文献18.
Nicolas Graillon Nathalie Degardin Jean Marc Foletti Magali Seiler Marine Alessandrini Audrey Gallucci 《Journal of cranio-maxillo-facial surgery》2018,46(10):1772-1776
Background
Secondary alveolar bone grafting in patients with clefts lip and palate is usually performed with iliac crest bone harvesting, however using bone substitute allow to avoid harvesting morbidity. The purpose of our study was to assess if the use of a bioactive glass ceramic is an acceptable alternative to iliac crest bone harvesting in alveolar clefts treatment.Methods
A prospective study including all patients who have benefited of alveolar grafting by GlassBONE? (Noraker, France), a synthetic resorbable bioactive glass 45S5 ceramic was conducted. The patients underwent clinical assessments and imaging check-up by dental panoramic radiography and CBCT.Results
Fifty-eight graftings were performed. The mean age at the time of the graft was 7.6 years. Hospitalization, social eviction and antalgic consumption were reduced. Bone continuity was achieved in 63.8% of the cases. Bilateral cleft and dental agenesia increased grafting failure. In the subgroup of 25 patients with isolated unilateral cleft without dental agenesis, 80% had bone continuity at one year. We noted 10.3% of alveolar fistula recurrence.Conclusion
The use of GlassBONE? in alveolar grafts simplifies the surgery procedure and the postoperative management, and ensures satisfactory mucosal healing, tooth eruption and bone continuity in two thirds of the followed grafts. 相似文献19.
Camilla Baserga Olindo Massarelli Alessandro Remigio Bolzoni Diego Sergio Rossi Giada Anna Beltramini Alessandro Baj Aldo Bruno Giannì 《Journal of cranio-maxillo-facial surgery》2018,46(9):1674-1678