Extent Of Bone Defect Research Articles

Invasive mucormycosis of nasal cavity, paranasal sinuses, bones of the skull in post COVID-19 patients: prospective study

INTRODUCTION: Since 2020, the number of patients with complications after a new coronavirus infection (COVID-19) has increased, including mycoses. Mucormycosis ranks third in the frequency of detection among invasive mycoses in patients with reduced immunity. Acute and chronic invasive fungal rhinosinusitis is the most severe and dangerous variant of the disease.OBJECTIVE: To analyze the features of the osteodestructive process of invasive mucormycosis, its relationship with blood supply, the dynamics of the process under the influence of treatment.MATERIALS AND METHODS: The study evaluated changes in the bone structures of the skull, soft tissues of the facial region, brain, and thorax in a group of 10 patients (62.3±11.4 y.o.) examined in the clinic of maxillofacial surgery and the clinic otorhinolaryngology in the post- covid period. The results of cone-beam computed tomography (Sirona) of the maxillofacial region, Xray computed tomography Optima 540 CT (General Electric) of the maxillofacial region and thoracic cavity organs, magnetic resonance imaging (GE Signa HDxt) of the brain and maxillofacial region with intravenous administration of a paramagnetic contrast agent were analyzed.RESULTS: In all cases, osteolytic lesions as a classical manifestations of invasive mucormycosis, were revealed in: alveolar processes of the upper jaws and walls of the maxillary sinuses in 100% of cases; palatine processes — 90%; nasal septum, walls of the ethmoid sinuses and walls the orbits — 70%; walls of the sphenoid sinus — 50%; pterygoid processes and zygomatic bone — 40%; the body of the sphenoid bone, nasal bones, frontal bones — 30%; the alveolar part of the mandible and temporal bone — 10%. All patients underwent surgery with resection of the affected bones — 100%, while 7 out of 10 patients received antimycotic therapy. When assessing the revealed changes in dynamics in all patients in the long-term postoperative period, sclerosis of small foci of destruction, a decrease in the extent of bone defects, a decrease in the size of sequesters, hyperostosis of the walls of the paranasal sinuses, cells ethmoid sinuses of the after sequestrectomy were noted. There were no fatal cases among the 10 patients we observed at the time of publication.CONCLUSION: The combination of anatomical features and the state of blood supply contributes to the development of invasive mucormycosis of the bones of the facial skull and the RCT data help with determining treatment tactics, the volume of surgery, and assessing dynamics in the early and long-term postoperative period.

10‐year prospective cohort study of immediate extraction implants placed in 3 clinical situations

Background It is an established practice to place implants in immediate extraction sockets with or without periapical pathology, and though studies present high implant survival rates, it has been observed that human studies are limited to a small number of cases or if the sample size is larger, the study was for a short duration of time. The current study bridges the gap by analyzing large data for immediate extraction implants over a 10-year period in 3 different clinical situations Aim/Hypothesis To classify data based on the reason for extraction and its assessment for overall survival rate over a 10-year period thus establishing norms for case selection, favourable surgical techniques and maintenance protocol for long term implant success in immediate extraction implant cases. Material and Methods Data of Xive implants placed in fresh extraction sockets in a single dental practice with a follow-up of 10 years was obtained. Based on the reason for tooth extraction the data was classified as non-restorable teeth with healthy periodontium (Group A-control), periodontally involved teeth with no periapical infection (Group B- experimental) and teeth with chronic periapical infection non-treatable by endodontic therapy (Group C- experimental). These data were further screened and filtered based on the size of implant placed post-surgery, the use of membrane and extent of bone defect. Marginal bone levels, pocket probing depth and bleeding on probing were measured at 12–15 months, 4.5 to 5 years and 10 to 11 years post-cementation. Patient satisfaction for function was assessed. Results 179 implants were taken up for assessments. 57 implants from group A+ 62 implants from group B+ and 60 implants from group C. Mean bone loss comparisons between group A and Group B was statistically significant (0.5319 mm for 12–15 months, 0.6173 mm for 4.5 to 5 years and 0.6557 mm for 10–11 years), mean bone loss comparisons between group A and Group C was statistically significant (0.4996 mm for 12–15 months, 0.6015 mm for 4.5 to 5 years and 0.6692 mm for 10–11 years), whereas, mean bone loss comparisons between group B and Group C was statistically insignificant (0.0323 mm for 12–15 months, 0.0158 mm for 4.5 to 5 years and 0.0135 mm for 10–11 years). Pocket depth, because of its methodology of measurement gave non-conclusive statistics. Number of cases of mucositis and periimplantitis across all 3 groups and over 10-year observation period was statistically insignificant. Conclusion and Clinical Implications With surgical protocols used in the study, implants placed into fresh extraction sites for replacement of teeth with pre-existing infected lesion or pre-existing periodontal infection show higher bone loss as compared to those without infection, however overall, success rate of all these implants is comparable to one another over a 10-year period.

Masquelet Reconstruction for Posttraumatic Segmental Bone Defects in the Forearm

The Masquelet technique is a procedure increasingly utilized for addressing segmental bone defects. The technique involves staged procedures consisting of bone debridement and temporary spacer placement to induce membrane formation, followed by delayed bone grafting. This report summarizes our center's experience with the Masquelet technique to reconstruct bone loss exclusively in the forearm. We reviewed all cases in which the Masquelet technique was used to reconstruct segmental bone defects in the forearm resulting from acute trauma or nonunion, with or without infection, between 2014 and 2017 at a level-1 trauma center. Injury mechanism, prior surgeries, extent of bone defect, and demographic data were collected. Union was assessed along with treatment-related complications or reoperations. We identified 9 patients with segmental bony defects in the forearm treated with the Masquelet technique. Among this cohort, 5 patients had bone defects associated with acute open fractures and 4 patients presented with nonunion (1 atrophic and 3 infected nonunions). The median bony defect was 4.7 cm (range, 1.7-5.4 cm) at the time of grafting. Second stage grafting was performed with Reamer Irrigator Aspirator autograft from the femur in 8 patients and iliac crest bone cancellous graft in 1 patient. Union was achieved in all 9 patients. Six patients achieved union by 3-month follow-up, 2 patients by 6 months, and 1 patient by 12 months. One patient required a reoperation for plate fracture prior to union treated with revision internal fixation and grafting. The Masquelet technique effectively reconstructed traumatic and posttraumatic segmental defects in the forearm with a low incidence of complication. Therapeutic V.

Late Complication of the Frontobasal Trauma

The injuries of the frontobasal region are always a great challenge to a surgeon, especially the management of bone defects of the frontal region. The authors present a patient with late, 33-year postaccident complication, which had been surgically treated, and whose frontal bone defect had been reconstructed with methyl methacrylate. Clinical examination and computed tomography confirmed signs of previous operation and presence of an infection and alloplastic material. Specific for this case was challenge to manage chronic infection and reestablish integrity of the skull in the frontal region. Out of a variety of autogenous or alloplastic materials, and considering the extent of bone defect and previous episodes of treatment aimed at aesthetic and functional results with good prognosis, we opted for reconstruction of the frontal region defect with combined titanium mesh impregnated with the hydroxyapatite cement.

Borggreve-Van Nes rotationplasty for infected knee arthroplasty – a case report

Borggreve-Van Nes rotationplasty for infected knee arthroplasty – a case report