Complications and loss of free flaps after reconstructions for oral cancer

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005–2010. The patients’ clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n = 86, 45%) and the anterolateral thigh free flap (ALTFF) (n = 48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n = 25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41–50 years (p = 0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p = 0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.     

Otitis media with effusion in Nigerian children with cleft palate: incidence and risk factors

Otitis media with effusion is common in children with cleft palate, and the aim of this study was to find out its incidence and risk factors in Nigerians. We prospectively studied 84 patients (42 with cleft palate and 42 control subjects); 27 were male and 15 female, who were age and sex matched with control subjects. The extent and size of the clefts were measured using a dental cast and Vernier calipers, and the otitis media was diagnosed with otoscopy and tympanometry. The mean (SD) age of the groups was 11 (7) months (range 1–33). Twelve children in the cleft group had otitis media compared with three in the control group. Infants and boys were more likely to be affected. There was a significant association between age (p = 0.02), sex (p = 0.01), and size of cleft (p = 0.00). However, only the size of the cleft was confirmed to be an independent predictor, with children who had extremely wide clefts being more likely to develop otitis media than those with narrow clefts (OR = 8.71, 95%CI = 1.07 to 70.5).We conclude that the incidence of otitis media with effusion was higher among children with cleft palate than among those who did not have a cleft. Infants had a higher incidence than older children, and boys had a higher incidence than girls. Age, sex, and the size of the palatal cleft were significantly associated with otitis media, but not the extent of clefting.     

Applying artificial intelligence to assess the impact of orthognathic treatment on facial attractiveness and estimated age

This observational study aimed to use artificial intelligence to describe the impact of orthognathic treatment on facial attractiveness and age appearance. Pre- and post-treatment photographs (n = 2164) of 146 consecutive orthognathic patients were collected for this longitudinal retrospective single-centre study. Every image was annotated with patient-related data (age; sex; malocclusion; performed surgery). For every image, facial attractiveness (score: 0–100) and apparent age were established with dedicated convolutional neural networks trained on >0.5 million images for age estimation and with >17 million ratings for attractiveness. Results for pre- and post-treatment photographs were averaged for every patient separately, and apparent age compared to real age (appearance). Changes in appearance and facial attractiveness were statistically examined. Analyses were performed on the entire sample and subgroups (sex; malocclusion; performed surgery). According to the algorithms, most patients’ appearance improved with treatment (66.4%), resulting in younger appearance of nearly 1 year [mean change: ?0.93 years (95% confidence interval (CI): ?1.50; ?0.36); p = 0.002), especially after profile-altering surgery. Orthognathic treatment had similarly a beneficial effect on attractiveness in 74.7% [mean difference: 1.22 (95% CI: 0.81; 1.63); p < 0.001], especially after lower jaw surgery. This investigation illustrates that artificial intelligence might be considered to score facial attractiveness and apparent age in orthognathic patients.     

Risk factors associated with post-loading implant loss of removable and fixed implant-supported prostheses in edentulous jaws

Purpose

This study analyzed risk factors for post-loading implant loss in cases of implant-supported prostheses applied to edentulous jaws of Japanese patients.

Solid malignant metastases in the jaw bones

Metastatic tumours to the jaw bones are rare, and usually develop during the final stages of cancer. Some, such as those of lung, breast, and kidney, are more likely to metastasise to the jaw. We have therefore analysed the clinical and epidemiological characteristics of patients with metastatic tumours. We retrieved the notes of 4 478 patients with metastatic tumours to the jawbones who were treated in the Clinical Hospital Centre Dubrava in Zagreb, Croatia, during the 15 years 2002-17 and made a retrospective analysis of patients’ age, sex, site of primary tumour, site and clinical presentation of the metastases, time interval since diagnosis of the primary tumour and oral metastases, and time interval from diagnosis of oral metastases to death. Of the 10 who were diagnosed with metastases to the jaw, there were four male and six female patients (mean age 57 (range 51-84) years) and the most common primary tumours were kidney (n = 5), lung (n = 2), breast (n = 1), colon (n = 1) and unknown (n = 1). The mandible was more often affected (n = 7) than the maxilla (n = 3), and the most common histological type was adenocarcinoma (n = 6). The primary tumour in most of the patients (n = 7) was diagnosed before the oral metastatic lesion. A metastasis in the jaw was the first sign of metastatic tumour in three patients, and in one case the metastasis and the primary tumour were diagnosed at the same time. Most of the patients had some oral problems. The time intervals from diagnosis of an oral metastasis to death varied from one month - five years. Because of the rarity of the presentation, the diagnosis of an oral metastatic lesion remains challenging, so metastases in the jaw should be suspected in every patient with such cancers and lesions in the jaw.     

Retroseptal transconjunctival approach for fractures of the zygomaticomaxillary complex: a retrospective study

We designed a retrospective study to evaluate the efficacy of retroseptal transconjunctival approaches in the management of fractures of the zygomaticomaxillary complex (ZMC). The patients were from a single institution, and had had three-point fixation of fractures of the ZMC between 2008 and 2016. A total of 77 patients (56 men and 21 women with a mean (range) age of 28 (18–54) years), were divided into two groups. Group I (n = 51) had had reduction and fixation of the infraorbital rim using a retroseptal transconjunctival approach. In group II (n = 26) the same approach had been used with lateral canthotomy and inferior canthlolysis for both the infraorbital rim and the zygomaticofrontal region. We analysed the association of both approaches with the outcomes of reduction, fixation, and complications. Suboptimal results were found in 13 patients in group I and one in group II (p = 0.017). There were also three patients with trichiasis and two with entropion in group I, and one each of both complications in group II. There was only one patient with a malopposed lateral canthus in group II. All 26 patients in group II had no perceptible scar along the extended line of incision. The risk of a suboptimal outcome was reduced by 20% (relative risk = 0.8) in group II. The retroseptal transconjunctival approach with lateral canthotomy and inferior cantholysis is safe, aesthetic, and effective in the management of fractures of the ZMC.     

Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling

The effects of bilateral sagittal split ramus osteotomy (BSSRO) on the temporomandibular joint (TMJ) are still not well understood. The aim of this study was to compare the morphological differences among unaffected subjects on the one hand, and patients with facial asymmetry before and after BSSRO on the other. Ten Chinese patients (preoperative and postoperative groups, mean (SD) age 25 (5) years) diagnosed with facial asymmetry and 10 unaffected subjects (control group, mean (SD) age 27 (5) years) were recruited prospectively. The 3-dimensional morphological measurements made on 3-dimensional models in each group were assessed by analysis-of-variance (ANOVA) and Student’s t test, and probabilities of <0.05 were accepted as significant. The horizontal condylar angle (HCA), coronal condylar angle (CCA), sagittal ramus angle (SRA), medial joint space (MJS), lateral joint space (LJS), and superior joint space (SJS) differed significantly between the preoperative and control groups (HCA: p = 0.000, CCA: p = 0.000, SRA(left/undeviated side): p = 0.002, MJS(left/undeviated side): p = 0.000, MJS(right/deviated side): p = 0.007, LJS(right/deviated side): p = 0.000, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.000). The SRA, MJS, LJS, and SJS differed significantly between the preoperative and postoperative groups (SRA(left/undeviated side): p = 0.012, MJS(left/undeviated side): p = 0.002, LJS(right/deviated side): p = 0.021, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.001), And the SRA, MJS, and LJS in the preoperative group differed significantly between the deviated and undeviated side (SRA: p = 0.006; MJS: p = 0.003; LJS: p = 0.011). However, there were no significant differences in the postoperative and control groups between the deviated and undeviated sides. BSSRO improved the asymmetrical morphology of the TMJ and alleviated the symptoms.     

Risk factors in securing successful surgical resection of oral squamous cell carcinoma

The purpose of this retrospective study was to analyze the factors that had a significant effect on securing a successful surgical resection (surgical margin) in oral cancer surgery. One hundred forty-eight consecutive patients who underwent planned radical resection of oral squamous cell carcinoma (SCC) were analyzed. Successful resection was judged if pathological examination of the surgical specimen revealed a clear surgical margin (no SCC within 5 mm, n = 116), while an unsuccessful resection was judged if there was a close and involved surgical margin (SCC within 5 mm, n = 21; and SCC at margin, n = 11). Univariate analyses showed that gender, age, and T-classification had significant influence on successful surgical resection. The results of multivariate logistic regression analysis showed that age (odds ratio [OR] = 1.042, 95% CI = 1.001-1.084), T-classification (OR = 1.656, 95% CI = 1.060-2.587), and the presence of preoperative treatment (OR = 2.868, 95% CI = 1.047-7.85) had significant effects on successful surgical resection. The results of this study suggested that successful resection of oral SCC was difficult in patients with either older age or advanced (T4) tumor. It is also suggested that preoperative therapy had a positive effect on securing a pathologically clear surgical margin.     

Warthin’s tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population

There is little information in the English-language literature regarding Warthin’s tumour (WT) in the eastern-Chinese population. A large retrospective study (1084 primary tumours over a period of 18 years) was carried out to investigate the clinicopathological features (patients’ gender, age and tumour location) of these tumours in this population. A total of 994 (91.7%) patients were male and 90 (8.3%) were female, with a male/female ratio of 11:1. The mean age was 56.48 years (range 20–89 years), with a peak incidence in the fifth to seventh decade (82.1%). The favorite primary site of the tumour was the parotid gland (n = 1055), followed by intra-/peri-parotid lymph nodes (n = 13), upper neck (n = 10), submandibular gland (n = 4) and upper lip (n = 1). Multifocal WTs arose in 9.5% (103 patients) of cases whereas bilateral multifocal WTs were found in 0.65% (seven patients). In 24 (2.2%) patients, WT were found to coexist with other different types of neoplasm synchronously. The most common subtype of metaplasia was the squamous metaplasia (166/250, 66.4%). The usual treatment measure is (bilateral) superficial parotidectomy and the patients should be followed long term, in view of possible metachronous WT, even after prolonged time intervals.     

Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People’s Hospital and divided into experimental (n = 89) or control (n = 151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. Only two patients developed transoral salivary fistulas in the experimental group, while in the control group there were 14 (9%). The incidence of fistulas in the experimental group was significantly lower than that in the control group (p = 0.035). Regression analysis showed that there was a significant correlation between the groups and the incidence of salivary fistulas (p = 0.032). The two-step suture technique is safe, effective, and easy to learn, and could reduce the incidence of postoperative salivary fistulas.     

Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients

The aim of this study was to identify the risk factors associated with sinus membrane perforation and the effect of sinus membrane perforation and other risk factors on graft success and postoperative sinusitis. Sinus membrane perforation, graft failure, and postoperative sinusitis were tested for an association with age, sex, operator experience, side of the operation, residual bone height, presence of septa, presence of a mucous retention cyst, and smoking (χ² test). Logistic regression analysis was used to model the odds ratio (OR) with corresponding risk factors. One hundred and twenty patients were included in this study. A total of 22 (18.3%) perforations occurred. A residual bone height of 3–6 mm (OR 6.808, P = 0.002) and presence of septa (OR 4.023, P = 0.025) were identified as significant risk factors. Twenty-eight (23.3%) sinus grafts were classified as failed. Membrane perforation (OR 16.819, P < 0.005) and residual bone height of 3–6 mm (OR 5.363, P = 0.01) were identified as significant risk factors for graft failure. None of the risk factors investigated in this study was significantly associated with postoperative sinusitis. These results suggest that the presence of septa and a residual bone height of 3–6 mm are associated with an increased risk of sinus membrane perforation, and that sinus membrane perforation has a negative effect on graft success.     

Oral medicine psychiatric liaison clinic: study of 1202 patients attending over an 18-year period

Patients with orofacial pain and discomfort often suffer from psychiatric disorders. However, few studies involving a large sample have examined the diagnostic results of patients with orofacial pain or discomfort in relation to psychiatric disorders. The purpose of this study was to summarize and clarify the characteristics and demographic data of 1202 patients attending the psychiatric liaison clinic at Aichi Gakuin University Hospital. Psychiatric diagnosis was performed by psychiatrists for all patients, based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Among the 1202 patients, 992 (82.5%) were female. The average age of the patients was 57.2 ± 15.0 years. The predominant broad categories of orofacial pain and discomfort seen were burning mouth syndrome (n = 484, 40.3%), persistent idiopathic facial pain (n = 258, 21.5%), and oral dysesthesia (n = 215, 17.9%). The predominant broad categories of psychiatric diagnoses seen were somatic symptoms and related disorders (n = 934, 77.7%) and depressive disorders (n = 76, 6.3%). Among the 934 patients with somatic symptoms and related disorders, 678 had a somatic symptom disorder with predominant pain. The results confirmed that most patients with orofacial pain and discomfort were middle-aged and elderly women suffering from a somatic symptom disorder with predominant pain.     

Thirty years of submental intubation: a review

Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n = 887), followed by orthognathic surgery (5.8%, n = 59), skull base surgery (2.8%, n = 29), and rhinoplasty and rhytidectomy (1.5%, n = 15). The complication rate was relatively low: 91.0% of patients (n = 929) were complication-free. The most common complication was infection, occurring in 3.5% (n = 36) of the total number of patients, followed by scarring (1.2%, n = 12) and formation of an orocutaneous or salivary fistula (1.1%, n = 11). In summary, submental intubation is a good alternative airway with minimal complications.     

Precise osteotomies for mandibular distraction in infants with Robin sequence using virtual surgical planning

Mandibular distraction osteogenesis (MDO) has become the first-line operation in many centers for the management of obstructive sleep apnea (OSA) in infants with (Pierre) Robin sequence (RS) not relieved by non-surgical approaches. Preoperative virtual surgical planning (VSP) may improve precision and decrease complications for this operation. This article reports a retrospective study of RS infants who underwent MDO for OSA using preoperative VSP and three-dimensionally printed cutting guides performed by one surgeon. Seventeen subjects who had MDO at a mean age of 87 ± 96 days were included. Maxillofacial computed tomography scans were obtained 15 ± 7 days prior to MDO. Osteotomy designs included linear (n = 4, 23.5%), inverted-L (n = 11, 64.7%), and multi-angular (n = 2, 11.8%). Cutting guides were used successfully and osteotomies were created as planned in all cases. Devices were removed 67 ± 15.6 days after placement. Bone formation in the distraction gap was seen in all cases at device removal. All patients had successful airway outcomes. There were no major and four minor complications during the follow-up period of 458 ± 267 days. In conclusion, MDO is a successful procedure for the management of OSA associated with RS in infants, and VSP facilitates its precise design and execution.     

Review of HaNDLE-on-QoL: a database of published papers that use questionnaires to report quality of life in patients with cancer of the head and neck

HaNDLE-on-QoL (Head And Neck Database Listing Evidence on QoL) is a searchable database that comprises abstracts of papers that have used questionnaires to report on quality of life (QoL) in patients with cancer of the head and neck. It can be searched by title, first author, year of publication, words used in the abstract, site of cancer, study design, and questionnaires used. The aim of this paper was to summarise its contents. In May 2017 we searched the website using the criteria above. It contained 1498 papers (including 149 reviews), and the number is increasing each year. Most studies concerned a combination of subsites in the head and neck (n = 871); 180 focused specifically on oral sites, and 109 on the larynx. The commonest topics were swallowing (n = 353), speech (n = 299), pain (n = 292), emotions (n = 226), and depression (n = 193). Nearly all the papers concerned function or predictors of health-related QoL (HRQoL), but 98 were clinical or randomised controlled trials. The site included over 250 questionnaires of which the most common were the European Organisation for Research and Treatment of Cancer C30 (EORTC-C30, n = 369), the EORTC-head and neck 35 (EORTC H&N35, n = 353), and the University of Washington Quality of Life (UWQoL) (n = 276). HaNDLE-on-QoL highlights the complexity of QoL after treatment and the diversity and range of the studies. It is a useful point of reference for those involved in clinical practice or research.     

Grafts of autogenous coronoid process to reconstruct the mandibular condyle in children with unilateral ankylosis of the temporomandibular joint: long-term effects on mandibular growth

Injury to the mandibular condyle in children usually leads to malocclusion and disharmony of facial growth. Our aim was to study the facial growth after reconstruction of the mandibular condyle using autogenous coronoid process grafts in children with unilateral ankylosis of the temporomandibular joint (TMJ). We followed up 10 growing patients with unilateral bony ankylosis of the TMJ who had been admitted to the West China Hospital of Stomatology, Sichuan University (Chengdu, China) between 1 January 2008 and 31 December 2012. There were three boys and seven girls, age range 5–12 years at the time of operation. In each case, patients were treated by gap arthroplasty, reconstruction of the condyle with an ipsilateral coronoid process, and interposition of the pedicled temporalis fascial flap during one operation. The mean (range) postoperative follow up was 4.73 (3–6) years. Postoperative panoramic radiographs were taken, and the growth of the mandibular height and length on the affected side was measured and compared with the healthy side. All patients had an uneventful, normal recovery. The mean (range) maximal mouth opening at the end of follow up was 35.6 (32–41) mm. Both the height of the ramus and the length of the mandible continued to grow after successful treatment of the ankylosis (using autogenous coronoid process grafts for reconstruction of the condyle) but the deficit in growth was not completely made up. The final height of the ramus on the affected side (at the end of follow up) had increased by 25% (p = 0.012) and the final length of the mandible on the affected side by 26% (p = 0.010) compared with immediately after operation. For comparison of the rate of growth, the increased height of the ramus of the affected side was 47% lower (p = 0.003), while the increased length of the mandible on the affected side was 27% shorter (p = 0.008) compared with the healthy side. The mandible on the affected side continued to grow after successful treatment of the ankylosis, but the growth deficit was not made up completely. The rate of growth of the affected mandible seemed to be less than on the undisturbed side even after treatment of the ankylosis.     

Subjective perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy at a district general hospital

Our aim was to assess patients’ perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy (BSSO) at a district general hospital. Patients who had BSSO between August 2013 and August 2014 (n = 46) were asked to score their perception of numbness between 0–10 (0 = normal sensation. 10 = complete loss of sensation/total numbness) one day postoperatively and then weekly for seven weeks, and at three months, 6 months, and one year. Data was collected on score sheets and by regular contact by telephone. Of the 46 operated on, 31 were female and 15 male. Data were available one year postoperatively for 43 patients. Ten of the 92 sides were reported as feeling normal on day 1 postoperatively, three-quarters as feeling normal at six months, and 79 at one year. On multivariate analysis there was no significant difference in postoperative sensation at one year between sides operated on by the registrar (left) and consultant (right) operated (p = 0.76). Our results compared favourably with the limited data available in similarly designed studies.     

Effect of ionizing radiation on properties of restorative materials

Objective

To evaluate the effect of ionizing radiation from high energy X-ray on properties of restorative materials.

Longitudinal study on risk indicators for peri-implantitis using survival-time analysis

Purpose

The purpose of this study was to evaluate the incidence of peri-implantitis and to identify potential associated risk indicators.

Tuberculosis: the great imitator in the head and neck - our experience of 24 cases in 22 years

This retrospective study covered over two decades, during which an individual head and neck surgeon treated 24 patients with cervicofacial lymphadenitis that was related to both Mycobacterium tuberculosis complex (n = 17, made up of M tuberculosis (n = 16) and M bovis (n = 1)), and non-tuberculous mycobacteria. The seven cases of non-tuberculous mycobacteria were caused by M avium complex (n = 3), M malmoense (n = 3), and M kansaii (n = 1). By using a tailored management approach, at times selective combined surgical and antimycobacterial treatment, he achieved a success rate of 23/24 cases, with only one recurrence and no major complications. The results suggest that patients with tuberculosis confined to the head and neck rarely develop constitutional symptoms, so the absence of such symptoms may not exclude tuberculosis. There was also a good correlation between predictive variables (immune state, inflammatory markers on admission, causative mycobacterium, and the antimycobacterial regimen used) and time spent under follow-up at the head and neck outpatient clinic.