Journal of Cranio-Maxillo-Facial Surgery

Editorial Board

2012-06-01

Bisphosphonate-related osteonecrosis of the jaws – Characteristics, risk factors, clinical features, localization and impact on oncological treatment

2011-06-15

Abstract: Introduction: Osteonecrosis of the jaw (ONJ) is a serious side-effect of intravenous nitrogen-containing bisphosphonate therapy frequently used in the treatment of malignant diseases. Despite numerous case series published so far studies with detailed investigations into risk factors, the precise localization of ONJ and impact of ONJ on the oncological treatment remain sparse.Patients and methods: This single-centre study collated medical records (2003–2009) of all patients that suffered from ONJ within the Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany. In total, 126 patients fulfilled the case criteria of ONJ and were examined clinically. The complete medical history including detailed questionnaires was collected of 66 patients, focussing in particular on the identification of underlying risk factors, clinical features, ONJ localization as well as the impact on the oncological treatment.Results: The majority of ONJ cases occurred in patients suffering from malignant diseases (n=117; 92.8%), in particular breast cancer (n=57; 45.2%), multiple myeloma (n=37; 29.4%) and prostate cancer (n=13; 10.3%), all received nitrogen-containing bisphosphonates intravenously. ONJ was also diagnosed in 9 patients (7.1%) suffering from osteoporosis or rheumatoid arthritis. The most prevalent clinical feature was exposed necrotic bone (93.9%) in the oral cavity which was accompanied in 78.8% of cases by pain. A predilection for the mandible and in particular for molar and premolar regions in both jaws was shown. Although no recommendation concerning the oncologic treatment was made, the manifestation of ONJ resulted (in a significant proportion of the patients) in a change of medication and schedule. The most frequent co-medications were steroids and anti-angiogenetic drugs, such as thalidomide.Discussion: The predilection for mandibular molar and premolar regions, and the infectious conditions that often precede the onset of ONJ support recent pathogenesis theories stating that local inflammation and associated pH-changes may trigger the release and activation of nitrogen-containing bisphosphonates ultimately resulting in necrosis.Conclusion: The development of ONJ has a multi-factorial aetiology and the clinical presentation can vary markedly. ONJ cannot only impair the quality of life but also the treatment of the underlying disease.

Guided bone regeneration in pig calvarial bone defects using autologous mesenchymal stem/progenitor cells – A comparison of different tissue sources

2011-07-04

Abstract: Due to donor side morbidity and the absence of osteogenic properties in bone substitutes, there is a growing need for an alternative to traditional bone grafting within the scope of tissue engineering. This animal study was conducted to compare the in vivo osteogenic potential of adipose-derived (AD), periosteum-derived (PD) and bone marrow-derived (BM) mesenchymal stem/progenitor cells (MSC). Autologous mesenchymal stem/progenitor cells of named tissue origin were induced into osteogenic differentiation following in vitro cell expansion. Ex vivo cultivated cells were seeded on a collagen scaffold and subsequently added to freshly created monocortical calvarial bone defects in 21 domestic pigs. Pure collagen scaffold served as a control defect. The animals were sacrificed at specific time points and de novo bone formation was quantitatively analyzed by histomorphometry. Bone volume/total defect volume (BV/TV) and the mineralization rate of newly formed bone were compared among the groups. In the early stages of wound healing, up to 30 days, the test defects did not show better bone regeneration than those in the control defect, but the bone healing process in the test defects was accelerated in the later stage compared to those in the control defect. All the test defects showed complete osseous healing after 90 days compared to those in the control defect. During the observation period, no significant differences in BV/TV and mineralization of newly formed bone among the test defects were observed. Irrespective of the tissue sources of MSC, the speed and pattern of osseous healing after cell transplantations into monocortical bone defects were comparable. Our results indicate that the efficiency of autologous AD-MSC, PD-MSC and BM-MSC transplantation following ex vivo cell expansion is not significantly different for the guided regeneration of bone defects.

Effects of Choukroun’s platelet-rich fibrin on bone regeneration in combination with deproteinized bovine bone mineral in maxillary sinus augmentation: A histological and histomorphometric study

2011-06-13

Abstract: Purpose: The potential effect of Choukroun’s platelet-rich fibrin (PRF) in combination with allograft on promoting bone regeneration has been discussed in previous publications. This study aims to evaluate an influence of PRF on bone regeneration in sinus augmentation in combination with a xenograft, deproteinised bovine bone.Materials and methods: Eleven sinuses from 10 patients with posterior maxillary bone atrophy were selected for the study. As a test group, six sinus floor elevations were grafted with a Bio-Oss and PRF mixture, and as control group, five sinuses were treated with Bio-Oss alone. Clinical and radiographic examinations were performed pre- and postoperatively. After 6 months of sinus augmentation, bone biopsies were obtained from the grafted posterior maxilla, and un-decalcified ground sections were prepared. Bone characteristics were evaluated using histological observation and histomorphometric analyses.Results: No adverse effect was observed in any case within the follow-up period of 6 months after sinus augmentation. Histological observation showed similar morphological characteristics for both the PRF and control groups. The percentage of new bone formation in the PRF group was about 1.4 times of that in control (18.35%±5.62% vs. 12.95%±5.33%), while the percentage of residual bone substitute in the control group was about 1.5 times higher as that in the PRF group (28.54%±12.01% vs. 19.16%±6.89%). The percentage of contact length between newly formed bone and bone substitute in the PRF group was 21.45%±14.57% vs. 18.57%±5.39% in the control. No significant statistical differences between the two groups were found in these observed parameters.Conclusions: Our preliminary result demonstrated neither an advantage nor disadvantage of the application of PRF in combination with deproteinised bovine bone mineral in sinus augmentation after a healing period of 6 months.

Squamous cell carcinoma and piercing of the tongue – A case report

2011-06-23

Abstract: Tongue piercings can be associated with local and systemic complications. Local complications occur frequently immediately after the surgery but also long-term local effects can cause problems such as speech and swallowing difficulties. Aspiration, transmission of infectious diseases, hypersensitivity reaction belong to the systemic complications. In the presented paper an unusual case of cancer development in a 26-year-old man who had a metal piercing inserted for 5 years in the right anterior third of the tongue. Despite of intense concommitant chemoradiotherapy the patient died 18 months from the first symptoms. In prevention of various complications it would be the best solution spread information about the risks of the tongue piercing especially within teenage population.

Effects of autogenous growth factors on heterotopic bone formation of osteogenic cells in small animal model

2011-07-04

Abstract: Aims: This study used a new approach to investigate the effective concentrations of growth factors released from platelet concentrate (PC) on the bone formation capacity of osteogenically differentiated rat bone marrow stromal cells (rBMSCs).Materials and methods: Rat BMSCs and whole blood were harvested from 40 adult male Spraque-Dawly rats. Rat BMSCs were expanded in an osteogenic medium and seeded on inert collagenous bovine bone matrix (ICBM). Growth factors released from degranulated PC (GFs) containing TGF-β1 1 (25ng/ml)–10ng (250ng/ml) and rhBMP-2 400ng (10μg/ml) were suspended in 40μl platelet poor plasma (PPP) and applied on the ICBM–rBMSC constructs or ICBM only, respectively. The constructs were then transplanted in autologous hosts for 4 weeks. Concurrently, osteoblastic differentiation of rBMSCs on ICBM–rBMSC–PPP constructs was characterized in vitro.Results: Rat BMSCs in osteogenic medium exhibited phenotypes of mature osteoblasts. The amount of newly formed bone among groups of ICBM–rBMSC–PPP with and without GFs was not significantly different (p>0.05) and was significantly lower than a group of ICBM–PPP–BMP-2 (p<0.05).Conclusions: Autogenous GFs had no effect on the capacity of rBMSCs to form new bone. The ability to measure the bone formation capacity of transplanted autologous cells and growth factors in a small animal model was demonstrated.

Complications in helmet therapy

2011-07-11

Abstract: Objective: Helmet therapy is an established method to correct positional head deformity in early infancy. Side effects such as skin erythema or pressure sores are well known for helmet therapy, but not yet adequately discussed in current literature.Patients and methods: Retrospectively, all patient-sheets of infants treated by individual orthotic therapy in the years 2007 and 2008 were sighted and complications were noted. Complications were classified and sorted by their frequency and descriptive statistics was performed. The treatment to cure complications was recorded and success in complication control was analysed.Results: Altogether, 410 patients fit the inclusion criteria for this investigation. Complications were apportioned into pressure sores, local ethanol erythema, unsatisfying fit of the helmet or loss of the helmet, skin infection, failed correction of head deformity, and subcutaneous abscess in one case. Non-compliance is to be noticed in a high number, but mainly occurred towards the end of the treatment period.Conclusion: Helmet therapy represents a safe therapeutic tool for the correction of positional cranial deformity. Complications have to be clear in number and severity for parental elucidation. Most complications can easily be avoided or eliminated by proper instruction of the parents.Highlights: ► This study tracks complications and adverse effects of the therapy with individual moulding helmets. ► Complications are separated into six individual events, frequency and dispensation are collected ► A solid basis for parental elucidation prior to helmet therapy is generated.

Trigonocephaly: Results after surgical correction of nonsyndromatic isolated metopic suture synostosis in 54 cases

2011-07-04

Abstract: Children with nonsyndromatic isolated metopic suture synostosis suffer from a significant deformity of the supraorbital ridges, the temporal regions and hypotelorism. We retrospectively analyzed 54 consecutive cases of isolated nonsyndromatic metopic synostosis treated over a 14-year-period. The data were evaluated using patients’ clinical records, skull radiographs in two planes, CT-scans, MRI scans and pre-/post-operative photographs. Surgery with standardized fronto-orbital advancement was performed at a median age of 11.5 months. Follow-up ranged from 4.5 months to 177.4 months, with an average of 51.9 months. The average blood loss was less than 255ml and the average post-operative length of stay was 5 days. Not a single major complication was observed except for uncomplicated dural tears in six cases. According to the classification of Whitaker, results were considered good to excellent (Category I and II) in all except one case (Category IV). As the current techniques have been standardized for routine use, surgical risks are reasonably low with no mortality or permanent morbidity. We think that the treatment of single metopic synostosis is safe with very low reoperation rates and short length of hospital stay. Overall, our results showed acceptable minor complication rates and generally satisfactory aesthetic outcomes.

Triple dumbbell-shaped jugular foramen schwannomas

2011-07-06

Abstract: Purpose: Triple dumbbell-shaped jugular foremen schwannomas (DSJFSs) have high cervical extension according to Bulsara’s classification. One-stage, single-discipline, total removal of triple DSJFSs is not always possible due to their both intracranial and cervical extensions. We evaluated our experience in one-stage resection of triple DSJFSs by using a combined neurosurgical and head and neck approach.Methods: Between October 2004 and May 2009, eight patients with triple DSJFSs were treated surgically at our institute. The clinical and radiological features, operative procedures and outcomes are retrospectively reviewed.Results: Total tumour removal was achieved in seven patients and near total in one. New cranial nerve (CN) paresis occurred after surgery in one patient and worsening of preoperative CN deficits was noted in three. Two patients experienced cerebrospinal fluid leakage and one of them had a repeated operation with closure of the dural deficit. Follow-up period ranged from 23 to 60 months (mean 38 months). All CN dysfunction had improved considerably at the last follow-up examination. There have been no clinical or radiological signs of tumour recurrence.Conclusions: One-stage total resection of triple DSJFSs can be achieved by a multidisciplinary cranial base team composed of neurosurgeons and head and neck surgeons via a craniocervical approach.

Manifestation of an ameloblastic carcinoma ten years after follicular cyst enucleation in the mandibular ramus

2011-07-08

Abstract: Ameloblastic carcinoma (AC) is a rare tumour which can emerge de novo or from an ameloblastoma. To our knowledge, malignant transformation from an odontogenic cyst into an AC has not been documented yet. This case report describes the manifestation of an AC 10 years after enucleation of a histologically confirmed follicular cyst in the angle of the mandible.

Clinical survey of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria (Axis II) for TMD: Preliminary study

Young-Kyun Kim, Su-Gwan Kim, Jae-Hyung Im, Pil-Young Yun — 2011-07-11

Abstract: Purpose: The purpose of this study was to investigate the nonspecific physical and psychological symptoms in patients who suffered from temporomandibular joint disorder (TMD) using the Research Diagnosis Criteria (Axis II) for TMD diagnosis (RDC/TMD).Study design: A total of 317 patients were included (M: 75, F: 242). The signs and symptoms of physical, psychological and behavioral factors were evaluated using questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method and diagnosed by the same investigator. Patients were divided into 3 different groups such as: the osteoarthritis group (group 1), the internal derangement (group 2) and the myofascial pain dysfunction syndrome group (MPDS, group 3).Results: In the analysis of depression and vegetative symptoms, patients in the internal derangement group revealed a high ratio of ‘normal’. In patients with MPDS, they appeared to suffer highly. According to nonspecific physical symptoms, there have been tendencies of a higher ratio of ‘severe’ patients with MPDS. In subjects aged 25 years or younger, the internal derangement group was the greatest, while the osteoarthritis group was the greatest for subjects over 40-years old. In the evaluation of depression and vegetative symptoms, the internal derangement group showed a relative normal value while the MPDS group showed a serious extent in comparison.Conclusion: According to the result of this study, MPDS group showed more severe depressive and nonspecific physical symptoms than internal derangement group. When making TMD diagnosis and treatment, it is thought to be important to analyze psychometric properties and nonspecific physical symptoms.

Modified internal mandibular distraction osteogenesis in the treatment of micrognathia secondary to temporomandibular joint ankylosis: 4-Year follow-up of a case

Hongtao Shang, Yang Xue, Yanpu Liu, Jinlong Zhao, Lisheng He — 2011-07-11

Abstract: Micrognathia and obstructive sleep apnoea syndrome (OSAS) are problems subsequent to temporomandibular joint ankylosis (TMJa) in growing patients. For patients with micrognathia and OSAS secondary to TMJa, it is important to restore proper mandibular form and dimension, achieve occlusal stability and recover satisfactory joint movement.We report a 4-year follow-up of a patient with micrognathia and OSAS secondary to bilateral TMJa. The treatment of this patient involved (1) a modified internal mandibular distraction osteogenesis without altering the pre-existing occlusion; (2) TMJ arthroplasty in which the dislocated disc was found and repositioned and the shape of the glenoid fossa and articular head was formed without removing bone in vertical dimension; (3) passive mouth-opening exercise with an individualized occlusal pad postoperatively for one month; and (4) orthodontic treatment for the occlusal disturbance and active mouth-opening exercise for one year. After the treatment the micrognathia was corrected; the oropharyngeal airway was increased significantly; mouth-opening increased to 40mm intraoperatively was maintained at 36.66mm 4 years after surgery. Satisfactory occlusion was achieved after orthodontic treatment. Through the 4-year follow-up, no signs of reankylosis were found. In conclusion, this new clinical protocol is a safe, effective and quick way to treat micrognathia and OSAS secondary to TMJa.

Identification of the Fra-1 transcription factor in healing skin flaps transplants: A potential role as a negative regulator of VEGF release from keratinocytes

2011-08-16

Abstract: The molecular mechanisms underlying successful myocutaneous skin flap integration, as well as the ischemic loss of transplanted tissue on surgery, remain largely unknown. In this study we used a mouse model of caudally based skin flaps to determine molecular patterns of acute transplant re-integration. Gene chip-based transcriptional analysis revealed an up-regulation of the transcription factor Fra-1 in murine skin flap tissue. Epidermal keratinocytes at the wound margins represented a dominant cellular source of Fra-1 in mice. Moreover, Fra-1 protein showed a clear nuclear localization. In addition, Fra-1 protein was also present in nuclei of wound margin keratinocytes located near the suture line in human skin flaps. In vitro studies using the human keratinocyte cell line HaCaT showed that epidermal growth factor (EGF) was a potent inducer of Fra-1 expression in keratinocytes. Ablation of Fral-1 protein using a specific Fra-1 small interfering (si)RNA markedly increased the EGF-induced vascular endothelial growth factor (VEGF) expression from keratinocytes. These data suggest the involvement of an injury-induced Fra-1 transcription factor as a regulator of keratinocyte gene expression, which might act as an antagonistic player to restrict epithelial-driven angiogenic responses during normal skin flap integration.

The evaluation of the nasal morphologic changes after bimaxillary surgery in skeletal class III maloccusion by using the superimposition of cone-beam computed tomography (CBCT) volumes

2011-07-05

Abstract: Background: The purpose of this study was to evaluate nasal morphologic and maxillary skeletal changes occurring after bimaxillary surgery in skeletal class III patients, using a new method entailing superimposition of cone-beam computed tomography (CBCT) volumes.Materials & methods: The subjects consisted of 30 adults (15 males and 15 females) who had presented with skeletal class III deformities. The subjects underwent Le Fort I advancement and impaction osteotomy and mandibular setback surgery. For closure of the maxillary vestibular incision, alar cinch suture and V-Y closure were performed. The pre- and post-operative CBCT data were superimposed and evaluated by voxel-by-voxel registration.Results: After surgery, the nasolabial angle, nasal tip angle, nasal tip inclination and columellar angle showed significant increases (P < 0.01). The nasal tip protrusion and nasal height, meanwhile, had significantly decreased (P < 0.01), and the alar base width had increased (P < 0.01). The columellar length and nostril axis angle also had decreased, but the nostril area did not show any significant change.Conclusions: After surgery, as the maxilla had been moved upward and forward, the nasal tip was shifted antero-superiorly and the alar base width and nostrils were widened. CBCT superimposition, enabling 3D assessment of nasal morphologic changes, can be an effective tool for simultaneous measurement of skeletal and soft-tissue changes.

Correlation between clinical findings and CT-measured displacement in patients with fractures of the zygomaticomaxillary complex

2011-07-06

Abstract: Background: This prospective clinical study aimed to analyse the influence of displacement on duration and severity of symptoms of fractures of the zygomaticomaxillary complex.Methods: 47 patients, who received surgical treatment of zygomaticomaxillary complex fractures at the Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena were examined preoperatively, 1, 3 and 10 days as well as 6 months post-operation for ophthalmologic, occlusal and neurosensory changes.Results: Preoperatively, periorbital haematoma and ooedema were present in 76.6% and 31.9% of the patients, which increased until day 1 post-op and decreased until the end of hospital stay. Preoperative diplopia was present in 83.0% of the patients and resolved postoperatively in all but 3 cases, in whom it persisted until end of the study. Occlusal disturbances and limited mouth opening were present in 21.3% of the patients and resolved by end of the study in all but 2 cases. Neither ophthalmologic nor occlusal changes correlated with the degree of displacement. Postoperatively no significant differences were detectable among the groups. In 44.8% of the patients neurosensory disturbances persisted until end of the follow-up. In the non-displaced fracture group none of the patients suffered from neurosensory disturbances at the 6-month follow-up.Conclusion: Although the degree of displacement has a significant impact on the incidence of sensory disturbances preoperatively, postoperatively no differences were observed between displaced and non-displaced fractures.

Oral health-related quality of life and depression/anxiety in long-term recurrence-free patients after treatment for advanced oral squamous cell cancer

2011-07-06

Abstract: This report focuses on the association between oral health-related quality of life (OHRQoL) and depression/anxiety of a homogeneous group of cancer patients who were recurrence-free for 8 years after treatment for advanced oral squamous cell.Participants were 24 patients (mean age 55 years, 75% men) treated with neoadjuvant concurrent radiochemotherapy followed by surgery with a mean recurrence-free period of 95 months (from 39 to 164 months). The OHRQoL (OHIP) and the anxiety/depression (HADS) were assessed twice (1 year between t1 and t2).OHRQoL was impaired in this group (mean OHIP score 65 units). In cross-lagged correlation analysis, the correlation between OHRQoL to t1 and depression to t2 was significant and greater than the non-significant correlation for depression to t1 and OHRQoL to t2 indicating that OHRQoL predicts depression better than vice versa. However, the difference in the correlation coefficients was not significant (ZPF-test). The same was true for OHRQoL and anxiety.The OHRQoL measured with the OHIP was impaired in comparison to the normal population. In the limitations of the study design and bearing the small sample size in mind, the results give evidence that OHRQoL predicts psychological outcomes, namely depression and anxiety, better than vice versa.

Melanotic neuroectodermal tumour of infancy: Report of two cases and review of the literature

Spomenka Manojlović, Mišo Virag, Ivica Lukšić, Danko Müller — 2011-07-07

Abstract: Melanotic neuroectodermal tumour of infancy (MNTI) is an uncommon tumour affecting predominantly the craniofacial bones of the newborn infants. The neural crest origin of the tumour has been confirmed. MNTI is generally accepted as a benign tumour despite of its rapid and locally infiltrative growth. Recurrence rate varies between 10% and 60%, and malignant behaviour has been reported in 6.5% of MNTIs. Systematic review of the literature revealed 445 MNTIs published between 1918 and 2010. We present additional two cases of MNTI from our Department, typical in all terms, which equals a total number of 447 reported cases. One of our cases revealed histological features consistent with malignant behaviour, but at present, 18 months after the surgical excision, there is no evidence of recurrence. Biological behaviour of MNTI cannot be predicted by gross or histologic characteristics, thus early diagnosis and careful follow-up after the complete surgical excision is required.

Treatment and complications of mandibular fractures: A 10-year analysis

Bart van den Bergh, Martijn W. Heymans, Freya Duvekot, Tymour Forouzanfar — 2011-07-06

Abstract: The surgical treatment and complications of patients with mandibular fractures in Amsterdam over a period of 10 years are analysed. Between January 2000 and January 2009 225 patients were surgically treated for a mandibular fracture (mean age of 32.6 (SD±14.6) years). A total of 426 fracture lines were identified. Of 213 dentate patients 29 patients were treated primarily with intermaxillary fixation (IMF). IMF combined with osteosynthesis was performed on 99 patients. Seventy-nine patients received IMF only per-operatively to make open reduction and internal fixation (ORIF) possible. Of 12 edentulous patients three patients were treated with Gunning splints. Nine patients were treated by manual reduction and internal fixation. A total of 1965 screws and 442 plates were used. Sixty (26.7%) patients presented with complications, including (transient) hyposensibility of the lip and chin (34 patients), dysocclusion (15 patients), infected osteosynthesis material (six patients) and temporomandibular dysfunction (five patients). Four patients needed surgical retreatment for correction of a dysocclusion. The results of this report are partly in line with other studies and provide important data for improving the treatment of the fractured mandible.

Upper airway distress due to an oropharyngeal infantile myofibroma

2011-07-06

Abstract: Infantile myofibroma is an uncommon fibrous tumour of infancy, usually present at birth. It is a rare cause of child airway obstruction, with only one neonatal case reported. We report an eight months age case which was referred to our Unit for increasing respiratory distress. CT scan showed a well defined margins mass measuring 7×5×5cm arising from the left parapharyngeal space and occupying the oropharynx. We performed a complete surgical resection through a transoral approach with no events during the surgery. The patient has been followed-up by the first author for five years with no signs of recurrence or sequelaes.

Atypical meningioma presenting as a nasal mass-multidisciplinary management

Scharukh Jalisi — 2011-08-16

Abstract: Objective: To report a case of recurrent extracranial atypical meningioma successfully managed by a multidisciplinary team.Methods: Case report and literature review concerning successful management of recurrent extracranial meningioma based on pathology and extent of resection.Results: A 48-year-old woman who presented with a nasal mass, anosmia and headaches. Physical exam and imaging showed recurrent meningioma involving the entire anterior frontal meninges extending into the frontal bone and down into the nasal cavity via the anterior ethmoid. Combined modality surgical intervention was successful and the patient recovered suffering no neurological sequelae.Conclusion: This is a very rare presentation of meningioma that the craniomaxillofacial surgeon should consider when formulating a differential diagnosis for a nasal mass. Long-term surveillance is crucial as recurrence can have devastating consequences. Aggressive multidisciplinary care is needed to prevent future recurrences and to improve survival.

Effect of self-setting α-tricalcium phosphate between segments for bone healing and hypoaesthesia in lower lip after sagittal split ramus osteotomy

2011-08-16

Abstract: Aims: The aim of this study was to evaluate hypoaesthesia of the lower lip and bone formation using self-setting α-tricalcium phosphate (Biopex®) between the proximal and distal segments following sagittal split ramus osteotomy (SSRO) with bent absorbable plate fixation.Subjects and methods: The subjects were 40 patients (80 sides) who underwent bilateral SSRO setback surgery. They were divided into a Biopex® group (40 sides) and a control group (40 sides). The Biopex® was inserted into the anterior part of the gap between the segments in the Biopex® group. Trigeminal nerve hypoaesthesia in the region of the lower lip was assessed bilaterally using the trigeminal somatosensory-evoked potential (TSEP) method. Ramus square, ramus length, and ramus width, the square of the Biopex® at the horizontal plane under the mandibular foramen were assessed preoperatively, immediately after surgery, and 1year postoperatively by computed tomography (CT).Results: The mean measurable period and standard deviation were 9.3±15.7weeks in the control group, 5.3±8.3weeks in the Biopex® group, and there was no significant difference. Ramus square after 1year was significantly larger than that prior to surgery and new bone formation was found between the segments in both groups (P<0.05). In the Biopex® group, the square of the Biopex® after 1year was significantly smaller than that immediately after surgery (P<0.05).Conclusion: This study suggested that inserting Biopex® in the gap between the proximal and distal segments was useful for new bone formation and it did not prevent the recovery of lower lip hypoaesthesia after SSRO with bent absorbable plate fixation.

Sinonasal carcinoma associated with inverted papilloma: a report of 16 cases

2011-08-22

Abstract: Objectives: To analyse the characteristics and outcome of patients with carcinoma associated with inverted papilloma, and find predictors of associated malignancy.Methods: The medical records of 228 patients who were diagnosed with IP between January 1990 and December 2010 were retrospectively reviewed. Out of 228 patients, 16 were also diagnosed with carcinoma. We evaluated their clinical characteristics, treatment modalities, and survival outcomes.Results: The incidence of carcinoma associated with IP was 7.0%. Fourteen were synchronous carcinomas and two were metachronous. Tumours arising inside the frontal sinus or the frontoethmoidal recess were more likely to be associated with carcinoma. Patients who had a stage of T2 or less had a much better outcome than those who had a stage of T3 or greater (disease-free period, 84.8months vs. 5.7months, p<0.001).Conclusion: Tumours originating in the frontal sinus or frontoethmoidal recess have a tendency to be associated with carcinoma. As most (87.5%) of the carcinomas were diagnosed at the same time as the inverted papilloma, complete histological examination of the whole excised tumour is warranted because early diagnosis and treatment is essential as T2 and lower stage carcinomas had a strikingly better prognosis than T3 and higher stage carcinomas.

EACMFS Prizes & Awards

2012-06-01

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2012-06-01