Department Of Cranio-Maxillofacial Surgery Research Articles

Disabling hearing loss after Lefort I osteotomies in patients with history of Eustachian tube dysfunction: An unknown complication

IntroductionThe aim of this study was to determine the predisposing factors of this deafness after orthognathic surgery for a population with no history of cleft palate. Material and methodsAll patients with significant auditory symptoms after orthognathic surgery performed in the department of Craniomaxillofacial surgery in the Croix Rousse Hospital, Lyon, France, since 2012 were included in the study. The exclusion criterion was a history of cleft palate. Bone movements performed during orthognathic surgery were analyzed. An audiometric assessment, including Pure Tone Audiometry and tympanometry, was performed at day 30 (D30), day 60 (D60) and day 90 (D90). ResultsSix patients were included in the study. All patients were women with a mean age of 33.5 years and suffered from class III skeletal deformities. The average hearing loss was 40 dB at D30, 20 dB at D60 and 5 dB at D90 with sometimes differences between the two ears. Five patients had a type C tympanogram suggesting Eustachian tube dysfunction and one patient had a type B tympanogram. All patients benefited from maxillary advancement of 5 mm on average. DiscussionThis study allows to conclude that female patients with a history of allergy or catarrhal tubal deafness are at risk of deafness after orthognathic surgery. These patients must be informed of this complication before surgery and be reassured about its reversibility.

Myoepithelial Carcinoma Arising in a Salivary Duct Cyst of the Parotid Gland: Case Presentation

Cystic lesions observed in parotid glands are relatively rare and comprise 2-5% of all parotid primaries. A salivary duct cyst (SDC) is a true cyst representing 10% of all salivary gland cysts. The risk of malignant transformation of SDC's epithelium is extremely rare. In the literature, only three cases of carcinoma ex SDC of the parotid gland are described. This report presents the first in the literature case of myoepithelial carcinoma (MECA) arising from a parotid SDC. A 75-year-old male patient was referred to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Cracow, Poland due to a cystic tumor arising from the right parotid gland. Superficial parotidectomy with facial nerve preservation was performed. Histological examination confirmed a rare case of MECA emerging from the SDC. The immunohistochemical profile of MECA ex SDC was presented. During 6 months of the follow-up, local recurrence or distant metastasis was not observed.

Reciprocating Rasp for Use in Mandibular Anterior Subapical Osteotomy.

The article describes a reciprocating rasp used in the mandibular anterior subapical osteotomy. Over the past 2 years, reciprocating rasp osteotomy was introduced in the Oral and Craniomaxillofacial Surgery Department of Shanghai Ninth People's Hospital. No complication such as bleeding, wound infection, or tissue necrosis has been encountered. The use of reciprocating rasp avoids iatrogenic damage to adjacent structures and reduces the time spent operating mandibular anterior subapical osteotomy. Therefore, it is recommended for mandibular anterior subapical osteotomy.

Primary basaloid squamous cell carcinoma of the parotid gland mimicking metastasis of basal cell carcinoma of the contralateral periorbital region: case report

Basaloid squamous cell carcinoma (BSCC) in the head and neck area is extremely rare. World Health Organization defined BSCC as a high-grade variant of squamous cell carcinoma composed both of basaloid and squamous components. Due to its histologic similarity to other parotid gland malignancies it can be easily misdiagnosed. We report first case of BSCC arising from parotid gland in Europe and second in the world literature. A 72-year-old female patient was referred to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Poland due to the tumor arising from the right parotid gland. Patient had history of multiple excisions of recurrent basal cell carcinoma (BCC) of the left periorbital region. We performed total parotidectomy with facial nerve preservation. Postoperative radiotherapy (PORT) was carried out, and the patient received 70 Gy in 30 fractions on the parotid gland area due to the fact that the tumor adhered to the facial nerve trunk and branches, additionally 60 Gy on the neck area in I, II and III levels. To distinguish the tumor of the parotid gland from the possible metastasis from BCC of the left medial canthal region previous histopathological slides were also reexamined and compared with histopathological examination of removed parotid gland tumor. Histological examination confirmed a rare case of BSCC arising from the parotid gland. 14 months of the follow up did not show local recurrence or distant metastasis.

Clinical characteristics of oral lichen planus and its causal context with dental restorative materials and oral health-related quality of life

BackgroundThe aim of this study was to investigate the influence of clinical characteristics and dental restorative materials on oral health-related quality of life in patients with oral lichen planus. In particular, the influences of amalgam and metals were investigated.MethodsA total of 112 patients with clinical and histological features of oral lichen planus from the Department of Cranio-Maxillofacial Surgery at the University Hospital of Münster participated in this prospective study. Clinical parameters of oral lichen planus and the dental restorative materials used were evaluated. Oral health-related quality of life was investigated by using the short form of the German version of the Oral Health Impact Profile (OHIP-14). In addition, physical pain was rated on a visual analogue scale.ResultsThe average OHIP-14 score was 13.54. A high correlation was seen between OHIP and pain. Likewise, higher OHIP-values were seen for male patients, and such as for those patients with non-reticular forms of oral lichen planus (OLP). A local form of OLP is more often seen on female patients, such as with the presence of reticular lichen. In regard to the restorations, the presence of composite restorations is correlated with a local lichen, whereas the presence of gold restorations is often seen with a generalized lichen. Furthermore, the grading of strength of association between mucosal lesion and amalgam/metal was tested. No significant differences revealed the analysis of the relationship between gender, clinical form of OLP, age, and presentation form between the 4 gradings of Thornhill.ConclusionsThe oral health-related quality of life is significantly limited in patients with oral lichen planus. But these OHIP scores are not influenced by the restorative materials. Here, pain severity is the most important aspect. We found no statistical differences in the clinical parameters between patients with amalgam or metal restoration and patients without these restorations. It is not necessary to replace amalgam fillings that are not in direct contact with mucosal surfaces.

Differences in actin expression between primary and recurrent facial basal cell carcinomas as a prognostic factor of local recurrence

IntroductionDue to a relatively high recurrence rate of facial basal cell carcinoma (BCC), its morbidity is very significant.AimTo analyse the expression of α-SMA, E-cadherin, Ber-Ep4 and MOC-31 as predictors of local recurrence in a group of patients with primary and recurrent BCCs of the face in correlation with histological and clinical data.Material and methodsThe study cohort included 79 patients with facial BCC (52 with primary BCC and 27 with recurrent BCC) who were treated at the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University, Krakow in 1997–2009.ResultsSignificant risk factors for local recurrence included: recurrent tumour (p = 0.001), multifocal BCC (p = 0.01), incomplete tumour excision (p = 0.02) and the aggressive infiltrating histologic subtype of BCC (p = 0.05). In the group of primary BCCs, positive expression of stromal α-SMA (p = 0.03) correlated with a statistically significant higher recurrence rate and so did positive expression of α-SMA in tumour cells of recurrent BCC (p = 0.002). In the group of primary aggressive BCC subtypes, reduced expression of MOC-31 was also associated with a higher rate of relapse (p = 0.02).ConclusionsOur findings provide information about α-SMA and MOC-31 expression in primary and recurrent BCCs. These data may contribute to the formulation of a more targeted treatment plan and follow-up strategy for patients with facial basal cell carcinoma.

Does the Clinical Form of Oral Lichen Planus (OLP) Influence the Oral Health-Related Quality of Life (OHRQoL)?

(1) Background: The aim of the study was to investigate the oral health–related quality of life (OHRQoL) of patients with oral lichen planus (OLP) and to evaluate differences between the various clinical forms of OLP. Specifically, the differences in OHRQoL, physical pain levels and eating restriction were assessed; (2) Methods: One hundred and twelve patients with clinical and histological features of OLP from the Department of Cranio-Maxillofacial Surgery of the Münster University Hospital participated in this prospective study. OHRQoL was analysed by using the German short version of the Oral Health Impact Profile (OHIP-14). Physical pain levels and restriction in eating were rated on visual analogue scales (VAS). The statistical analysis was performed using the Mann–Whitney U-Test and the chi-squared test with a significance level at p = 0.05; (3) Results: Group 1 consisted of patients with reticular OLP (n = 50) and group 2 of patients with atrophic, erosive-ulcerative or bullous OLP (n = 62). The average OHIP-14 score was 13.54 points and differed significantly between the two groups. There were significant differences in the domains “physical pain”, “psychological discomfort”, “physical disability” and “social disability”. The VAS “physical pain” score and “restriction in eating” score varied significantly between the clinical forms. Positive correlations were found between the OHIP-14 total scores and the VAS scores; (4) Conclusion: The OHRQoL is significantly limited in patients with OLP; especially, patients with erosive-ulcerative OLP are affected.

Simvastatin induces adverse effects on proliferation and mineralization of human primary osteoblasts

BackgroundFrequently statins were administered to reduce the LDL-concentration in circulating blood. Especially simvastatin (SV) is an often prescribed statin. Pleiotropic effects of these drugs were reported. Thus, the aim of this study was to evaluate effects of SV on osteoblastic mineralization.MethodsAfter informed consent primary osteoblasts were collected from tissue surplus after treatment of 14 individuals in the Department of Cranio-Maxillofacial Surgery, University Hospital Münster. The cells were passaged according to established protocols. Viability, mineralization capability and osteoblastic marker (alkaline phosphatase) were determined at day 9, 13 and 16 after adding various SV concentrations (0.05 μM, 0.1 μM, 0.5 μM, 1.0 μM). Statistical analysis was performed using the Kruskal-Wallis-test.ResultsThe cell cultures showed a time and dose-dependent significantly decreased viability (p < 0.01) and a significantly increased mineralization (p < 0.01) in a late mineralization stage after adding SV. The typical alteration of the alkaline phosphatase (ALP) levels during osteogenic differentiation was not recognizable.ConclusionsThe pleiotropic effects found for different SV concentrations were possibly originated from other mineralization pathways beside the ALP induced one. Additionally, possible alterations of protein expression levels during mineralization and investigation of possible deviating application of SV in other treatment fields can be considered after gaining a deeper insight in the affected mechanisms.

Computed tomography-assisted morphological assessment of the components of the temporomandibular joint – a pilot study

Introduction. Temporomandibular joint (TMJ) disorders are a common diagnostic problem. No universal radiological parameter of the analysis was introduced. Aim. Comparison of values of selected radiological parameters between asymptomatic patients and those with the TMJ arthropathy. Material and methods. Retrospective analysis of CT scans of patients of the Department of Dental and Maxillofacial Radiology and the Department of Cranio-Maxillofacial Surgery, Oral Surgery and Implantology, Medical University of Warsaw. Patients were divided into two groups: 1. without TMJ disorders, 2. with TMJ dysfunction symptoms. Following parameters of heads of mandible were analyzed bilaterally: shape, anteroposterior and lateromedial dimensions, the distance between lateral points of both heads (HL-HR), distance between a head and the mandibular fossa. The angle between the horizontal axis of the head of mandible and the line drawn by posterior points of heads of mandible was measured. Results. The most common type of the head of mandible in group 1 (40 patients; 13 women, 27 men) was convex (14 patients), in group 2 (16 patients; 14 women, 2 men) – plane (8 patients). Significant differences between groups were obtained for: GL-GP (group 1 – 120.35 mm, group 2 – 115.4 mm), dimensions of heads of mandible: lateromedial – 19.7 mm, 18.14 mm, anteroposterior – 8.03 mm, 7.04 mm for group 1 and 2, respectively. Conclusions. Computed tomography allowed for an accurate analysis of the TMJ components. Measurements of structures discussed in this work should be a part of the diagnosis of patients with TMJ dysfunction.

Radiologic Analysis of Surgically Treated Fractures of the Condylar Process by an Endoscopic-Assisted Transoral Approach

This study analyzed the radiologic outcomes of patients with unilateral mandibular condylar fractures treated with open reduction-internal fixation (ORIF) through a transoral approach. In this retrospective study, the radiologic images of 40 patients who underwent open reduction-internal fixation through a transoral approach were presented to 2 independent examiners. All patients underwent the surgical procedure between January 2015 and December 2016 at the Department of Cranio-Maxillofacial Surgery at UniversitätsSpital Zürich and were included in a previous functional outcome study.The surgical results were analyzed and graded as poor, acceptable, or good. The examiners declared whether they would have made any intraoperative revisions if the radiologic information had been available. Finally, the examiners estimated the required duration of elastic intermaxillary fixation (IMF) from the radiologic images, which was compared with the actual duration. Fracture reduction was classified as good in 33 cases (82.5%), acceptable in 5 cases, and poor in 2 cases by one examiner and as good in 32 cases (80%), acceptable in 6 cases, and poor in 2 cases by the other examiner. The inter-rater reliability was determined to be good (Cohen κ=0.92). Correct osteosynthesis placement was found in 19 cases by one examiner and in 21 cases by the other examiner, with good inter-rater reliability (κ=0.8). Moderate inter-rater reliability (κ=0.4) was found for the required duration of elastic IMF. Furthermore, the estimated elastic IMF duration matched the actual duration in fewer than half of the cases. It is feasible to achieve reliably good radiologic results when operating on condylar process fractures by a transoral approach with endoscopic assistance and angled instruments. Intraoperative 3-dimensional imaging enables instant quality control and prompts surgical revision if needed.

Donor-site Morbidity after Retromolar Bone Harvesting Using a Standardised Press Fit Cylinder Protocol.

Precise fitting and immobilisation of bone transplants at the recipient site is of utmost importance for the healing process. With the help of the standardised Osseo Transfer System, the recipient site is adjusted to the graft, rather than vice versa as it is typically done. The aim of this study was to analyse donor-site morbidity after harvesting cylindrical bone grafts from the retromolar region using the Osseo Transfer System. The patient satisfaction with the surgical procedures was also evaluated. All patients treated with this standardised reconstruction method between 2006 and 2013 at the Department of Cranio-Maxillofacial Surgery, University Hospital Giessen, were included in this study. Complications were recorded and evaluated. Bone graft success and patient satisfaction were documented with a questionnaire, and then confirmed by clinical and radiological follow-up examinations. Fifty-four patients were treated and 64 harvested cylindrical autologous bone grafts were transplanted. In all cases, dental implants could be inserted after bone healing. One patient lost an implant, associated with failure of the bone graft. Six patients who were examined continued to show neurological disorders in locally limited areas. No complete or long-term damage of the inferior alveolar nerve occurred. More than 94% (n = 52) of the patients were ‘very satisfied’ or ‘satisfied’ with the results and would recommend this surgical treatment to other patients. The standardised Osseo Transfer was an effective treatment option for small and mid-sized alveolar ridge augmentations. A low donor-site morbidity rate and a high transplant success rate were verified. The Osseo Transfer System demonstrated to be a reliable surgical technique without major complications. We highly recommend this surgical augmentation procedure as a surgical treatment for local bone defects.

Clinical Notes on Herbert Screw Fixation for Fracture of Anterior Mandible.

This article aims to present the outcomes of treating anterior mandibular fractures using Herbert's screw. A total of 10 patients were treated for fractures of anterior mandible by open reduction and internal fixation using the Herbert screw. The patients were collected starting from June 2016 to November 2017, at the Department of Craniomaxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, and Faculty of Dentistry, Ain Shams University, Cairo, Egypt. The follow-up plan was done to evaluate the postoperative clinical outcomes for malocclusion, neurosensory status, hardware failure, malunion/ nonunion, pain, and edema. There were no intraoperative or postoperative complications, except for one case where the Herbert screw was insufficient and needed additional 2.0-mm miniplate at the superior border. The postoperative orthopantomograms revealed satisfactory reduction and fixation of the fractures of all cases. The Herbert screw fixation of anterior mandibular fracture is a reliable technique but sensitive and surgeon dependent and needs further clinical investigation.

Pleomorphic adenoma - the results of a retrospective analysis of 104 patients treated at the Clinical Department of Cranio-Maxillofacial Surgery, Clinic of Otolaryngology and Laryngologic Oncology of the Military Institute of Medicine.

Pleomorphic adenoma, also known as tumor mixtus, is one of the most common types of benign neoplasm of the salivary gland, which presents as a slow growing, painless tumor. Major salivary glands are the typical localization of this neoplasm. It rarely undergoes malignant transformation, however may recur locally post resection. In this study, we present the results of a retrospective analysis of 104 patients treated at the Clinical Department of Cranio-Maxillofacial Surgery, Clinic of Otolaryngology and Laryngologic Oncology of the Military Institute of Medicine between 2004 and 2015 due to pleomorphic adenoma. The study confirmed the parotid gland as the most common location of tumor mixtus. In some cases, the large size of the tumor and its location were the cause of life-threatening complications.

What Is the Incidence of Implant Malpositioning and Revision Surgery After Orbital Repair?

Postoperative radiographic examinations are the gold standard in maxillofacial surgery, except in orbital reconstruction. Therefore, the purpose of this study was to estimate the frequency of implant malposition and revision operation after orbital repair. This retrospective cohort study was conducted in a level I trauma center at the University Hospital in Bern, Switzerland. To assess the incidence of malpositioning, a qualitative analysis of postoperative computed tomography scans, as well as comparative volumetric measurements of the orbits, was conducted. Furthermore, the incidence of and reason for secondary revision procedures were evaluated. From September 2008 to December 2015, a total of 71 emergency patients (73 implants) were treated at the Department of Cranio-Maxillofacial Surgery with a titanium mesh (48 male patients; mean age, 56years). The implant position was rated as poor in 17 cases (23%) by the qualitative analysis. The volumetric assessment showed no significant results. Revision intervention was needed in 12 patients (17%) because of an unsuccessful treatment outcome causing relevant clinical symptoms. Patients with large orbital defects who require surgical treatment with a titanium mesh are at risk of implant malposition. Because in this study, poor positioning of the implant is the main reason for surgical revision, we postulate that a postoperative radiographic control should be obtained routinely. Only then can long-term sequelae due to inadequate reconstruction be avoided.

Parotid gland tumors. Results of retrospective analysis of 149 patients treated at the Clinical Department of Cranio-Maxillofacial Surgery, Clinic of Otolaryngology and Oncologic Laryngology of Military Institute of Medicine in Warsaw in years 2006-2016.

Wstęp: Nowotwory mające swoją etiologię w gruczołach ślinowych występują rzadko i stanowią ok. 3-10% wszystkich guzów w obrębie głowy i szyi. Materiał i metody: W latach 2006-2016 w Klinicznym Oddziale Chirurgii Czaszkowo-Szczękowo-Twarzowej Wojskowego Instytutu Medycznego w Warszawie z powodu nowotworów ślinianek przyusznych hospitalizowano i leczono 149 pacjentów. Podstawą do analizy były historie chorób pacjentów, wyniki badań histopatologicznych oraz protokoły zabiegów operacyjnych. Wyniki: W 126 przypadkach guzy były łagodne, natomiast w 26 guzy złośliwe. Analizując wyniki można stwierdzić, że nowotwory - zarówno łagodne, jak i złośliwe - częściej występowały u mężczyzn. Średni wiek całej grupy badanych wynosił 58,3 lat, dla zmian złośliwych - 65,5 lat, a dla zmian łagodnych był nieznacznie niższy i wynosił 56,9 lat. Wśród pacjentów objętych analizą szczyt zachorowalności przypadał na przedział wiekowy 60-69 lat. Ponadto zwraca uwagę, iż przedział ten był taki sam dla ogólnej liczby guzów, jak i nowotworów łagodnych, natomiast dla nowotworów złośliwych był nieznacznie wyższy i wynosił 70-79 lat. Z analizy zebranego materiału wynika, że guzy łagodne występowały znamiennie częściej, stanowiąc 84,56% wszystkich guzów. Najczęstszymi rozpoznaniami wśród nowotworów łagodnych były gruczolak wielopostaciowy (adenoma pleomorphicum) oraz gruczolak limfatyczny (adenolymphoma), które stanowiły łącznie 93,66%. Rezultaty badań wskazują, że wśród nowotworów złośliwych dominowały: gruczolakorak polimorficzny o niskiej złośliwości (polymorphous low-grade adenocarcinoma) występujący w 26,07% przypadków, gruczolakorak inaczej nieokreślony (adenocarcinoma NOS) oraz rak zrazikowokomórkowy (acinic cell carcinoma). Każdy z nich stanowił po 13,04% rozpoznań. Jak wynika z przeprowadzonej analizy najczęstszą metodą leczenia było leczenie chirurgiczne jako metoda stosowana samodzielnie. Wnioski: Uzyskane z retrospektywnej analizy dane korelują z piśmiennictwem krajowym i światowym.

Gingival hyperplasia as first sign of recurrence of granulomatosis with polyangiitis (Wegener\u2019s granulomatosis): case report and review of the literature

BackgroundGranulomatosis with polyangiitis (GPA), formerly referred to as Wegener’s granulomatosis, is a rare systemic disease of unknown etiology which can affect all areas of the body, including the oral cavity. The typical oral manifestations occur as nonspecific erosive/ulcerative lesions of the oral cavity or appear with hyperplastic gingivitis, a so called “strawberry gingivitis”.Case presentationWe report here about an extremely rare case with hyperplastic gingivitis as the first sign of recurrence of GPA in the absence of oral manifestations in the primary disease. A 72 year-old female was referred to our Department of Cranio-Maxillofacial Surgery with hyperplastic gingivitis. The patient was diagnosed with GPA already eight years before. We referred the patient to our Clinic of Internal Medicine where she was successfully treated with rituximab. At the follow-up visit, the patient showed complete remission of the hyperplastic gingiva.ConclusionThe often overlooked oral manifestation may be interpreted as the first evidence of resurgent GPA in general and therefore could be pathognostic for the disease. This case affirms the need of health professionals to be acquainted with orofacial manifestations of rare diseases such as GPA. As a consequence, dentists will be able to assist in diagnosing GPA more easily leading to a better prognosis for patients suffering from this disease.

Comparison of magnesium versus polylactide-co-glycolide resorbable plates and screws using a new porcine maxillofacial fracture fixation model, a pilot study

Comparison of magnesium versus polylactide-co-glycolide resorbable plates and screws using a new porcine maxillofacial fracture fixation model, a pilot study

Combination of transconjunctival and lateral canthotomy with modified endaural approaches in midface osteogenic distraction

Director of the Oral and Maxillofacial Surgery Residency Program at Universidad El Bosque, Head of the Oral and Maxillofacial Surgery Department, linica El Bosque, and Head of the Cranio-Maxillofacial Surgery Department, Hospital Simon Bolivar, Bogota, Colombia Chief Resident and Head of the Publications Committee, Oral and Maxillofacial Surgery Residency Program at Universidad El Bosque, ogota, Colombia Senior Resident, Oral and Maxillofacial Surgery Residency Program at Universidad El Bosque, Bogota, Colombia

Surgical Safety Checklist: Practice in Cranio-Maxiollofacial Surgery

Background The World Health Organization introduced the Surgical Safety Checklist (SSC) to improve patients’ security in a surgical treatment [1]. The idea of checklists is established in different areas of safety culture, for example in aviation to improve passengers’ security. The SSC was first introduced in 2007. Meanwhile it is worldwide used in developed as well as in developing countries [2] to reduce the complication rate in the operating room. In the Department of Cranio-Maxillofacial Surgery of the University Hospital Graz it is used since 2011. The wellstructured checklist ensures safety standards for the patient and the personal. After a time of conversion and adaption there can be seen an amendment in daily routine.

Ewing’s sarcoma of the maxillary sinus

Ewing’s sarcoma is typically an aggressive, poorly differentiated tumor affecting children and young adults, it accounts for 4–6% of all primary bone tumors and facial primary localizations occur in only 1–4% of all cases, mostly in the mandible and calvaria. Paranasal sinus involvement is rare. A 22-year-old female was reviewed in Oral & Cranio Maxillofacial Surgery Department. She complained of swelling of the right paranasal area, of one-month duration, progressively increasing in size and associated with pain. The medical history was unremarkable, Contrast Enhanced Computed Tomography scan showed a destructive lesion of the anterior wall of the right maxillary sinus reaching up to the medial wall of the maxillary sinus, other paranasal sinus appearance was normal. Incisional biopsy proved it to be Ewing’s Sarcoma. She was treated by chemotherapy using Vincristine, Adriamycin, and Cyclophosphamide alternating with Etoposide & Ifosfamide and Radiotherapy, and this resulted in complete regression of the tumor. Repeated PET scans every 6months did not suggest any recurrence of the right maxillary sinus tumor. We concluded that treatment by induction chemotherapy followed by radiation therapy leads to a favorable outcome in the above described case, avoiding the morbidity that can result from surgical options.