CranioMaxillofacial Surgery

Simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement: A retrospective clinical study of 23 patients Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Levon Khachatryan, Grigor Khachatryan, Gagik Hakobyan, Anna Khachatryan Abstract Objective The aim of this study was to evaluate the efficacy of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement. Patients and methods The study patients (n = 23) were partially or completely edentulous in the posterior maxilla and required maxillary sinus augmentation. All included patients had a sinus pathology confirmed clinically and radiographically. The technique of simultaneous endoscopic endonasal sinus surgery and sinus augmentation was used in 15 patients, with eight endonasal sinus surgery procedures being performed 2–3 months before sinus augmentation. Where possible, implants were placed during the same surgical procedure (with a ridge bone height of at least 4 mm). Results There were no any major intraoperative complications. Implants placed in the reconstructed areas were shown to integrate normally, and postoperative occlusal function and aesthetics were favorable. Of the 95 implants placed in these 23 patients, two failed to osseointegrate. Conclusion The method of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement leads to a reduction in postoperative complications, significantly shortening the rehabilitation period for patients with maxillary sinus diseases and insufficient bone tissue.

Announcements Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s):

Analysing chin prominence in relation to the lower lip: The lower lip-chin prominence angle Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Farhad B. Naini, Umberto Garagiola, David Wertheim Abstract The purpose of this investigation is to describe a potentially useful analysis in assessing the required extent of sagittal chin augmentation or set-back, by relating chin prominence to lower lip position using the ‘lower lip-chin prominence angle’. The secondary aim was to quantitatively evaluate the influence of this angle on perceived attractiveness and desire for surgery. Having described this angular analysis, a quantitative evaluation was undertaken by incrementally altering the angle on an idealised profile image to create a range of images that were rated on a 7-point Likert scale by a pre-selected group of pre-treatment orthognathic patients, clinicians and laypeople. In treatment planning alterations in chin prominence, an ‘ideal’ sagittal position with soft tissue pogonion on or just behind a true vertical line through the most prominent point of the lower lip may be used. Chin retrusion or prominence up to an angle of 15° retrusion to −5° prominence is deemed acceptable. Surgery is desired from chin prominence of greater than −15° and retrusions greater than 25°. The greater the retrusion or prominence of the chin from an angle of 0°, the less the perceived attractiveness and the greater the desire for surgical correction.

Microdialysis in postoperative monitoring of microvascular free flaps: Experiences with a decision algorithm Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Falk Birkenfeld, Hendrik Naujokat, Ann-Kristin Helmers Nicolai Purcz, Björn Möller, Jörg Wiltfang Abstract Background Reconstruction with free flaps has become a usual practice in maxillofacial surgery. Clinical monitoring is still the standard approach for postoperative follow-up, but can be difficult or impossible with intraorally situated or buried flaps. Microdialysis is a sampling technique that offers the possibility to monitor the metabolism of flaps continuously. It is a reliable method for early diagnosis of ischemia. Materials and methods 48 microvascular free flaps applied following oral cancer resection were monitored with a microdialysis (MD) catheter, placed in the flap. Glucose, lactate, and lactate/pyruvate ratio were monitored using a bedside analyser for 5 days. 48 free flaps served as controls and were assessed (refill, flap temperature, and color) by clinical monitoring (CM). Results 12 flaps monitored by MD showed abnormal metabolism and underwent revision. Eight flaps were saved and four were lost within the first 5 days postoperatively. In addition, two flaps were lost at days 15 and 30 postoperatively, without previous complications. Four flaps assessed by CM developed complications, underwent revision, and were saved. In addition, five flaps were lost between the 8th and 23rd days postoperatively, without revision, due to missing previous clinical signs. Conclusion Postoperative monitoring of free flaps using a microdialysis decision algorithm allows early diagnosis of anastomotic complications. It is a clinically feasible and sensitive monitoring method for microvascular flaps, allowing surgical revision to be undertaken before clinical alteration takes place.

Association between gender, estrogen receptors genes and anxiety levels in patients undergoing orthognathic surgery Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Rafaela Scariot, Camila Oliveira Tomaz, Robson Diego Calixto, Jennifer Tsi Gerber, Maria Fernanda Pivetta Petinati, Rafael Correia Cavalcante, Erika Calvano Küchler, Delson João da Costa Abstract Orthognathic surgery is a procedure that is performed for the correction of dentofacial deformities and can lead to a change in an individual's anxiety levels. Anxiety is a multifactorial condition in which hormones and genes play an important role. This study aimed to evaluate if gender and genetic polymorphisms in estrogen receptor alpha (ESR1) and beta (ESR2) are associated with anxiety levels in patients undergoing orthognathic surgery. In this longitudinal observational study, 44 patients were included. Anxiety level assessments were performed at three time periods: 2 days before the surgical procedure and 1 and 6 months postoperatively, using the State-Trait Anxiety Inventory Scale. Gender, age, and facial profile were also evaluated. Additionally, a saliva sample from each individual was collected for the genotypic evaluation of ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) using real time polymerase chain reaction. Data were analyzed with a significance level of 0.05. There was a decrease in trait-anxiety and state-anxiety when comparing the preoperative measurements with those obtained 1 and 6 months postoperatively (p < 0.05). Females were more anxious than males at each time point during the study (p < 0.05). The genetic polymorphism rs9340799 in ESR1 was associated with state-anxiety during the preoperative period (p = 0.046). In conclusion, an individual's gender and genetic polymorphism in ESR1 are associated with anxiety in orthognathic surgery patients.

Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Konstantinos Katoumas, Dimitrios Anterriotis, Maria Fyrgiola, Violetta Lianou, Dimitrios Triantafylou, Ioannis Dimopoulos Abstract Purpose The aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). Methods A retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. Results During the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. Conclusion The data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.

Impact of orthognathic surgery on quality of life: Predisposing clinical and genetic factors Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Marilisa Gabardo, João Zielak, Gabriela Tórtora, Jennifer Gerber, Michelle Meger, Nelson Rebellato, Erika Küchler, Rafaela Scariot Abstract Introduction Dentofacial deformities have an impact on quality of life (QOL). Many factors can influence this perception, including genetic aspects. ANKK1 and DRD2 genes are associated with dopaminergic system and could modulate behavioral dysfunction. Purpose The impact of orthognathic surgery and associated factors on QOL of adults was evaluated. Material and methods The abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was applied to patients from two surgery services one week before (T0) and six months after surgery (T1). The independent variables were age, sex, race, facial pattern, presence of jaw asymmetry and vertical deformities, and polymorphisms associated with ANKK1 and DRD2 genes. Descriptive and bivariate analyses were performed. Results There was improvement in the perception of QOL from T0 to T1 in the general score, in the physical and psychological domains, and in the quality of life and general health perception (QOLGHP) (p < 0.001). In this interval, individuals aged ≥30 years reported positive impacts on all outcomes (p < 0.05), whereas in women this improvement did not occur only for the physical domain (p = 0.136). There was an association between the polymorphisms associated with the ANKK1 gene (rs1800497) and the perception of QOL in the social relationship's domain (p = 0.021) and QOLGHP (p = 0.042). The other clinical conditions were not associated with outcomes (p > 0.05). Conclusion Perception of QOL of patients improved following orthognathic surgery in physical, psychological, and QOLGHP domains. Aged ≥30 years, being women and polymorphisms associated with the ANKK1 gene were related to positive impacts.

A new method for cranial vault reconstruction: Augmented reality in synostotic plagiocephaly surgery Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Wenqing Han, Xianxian Yang, Shuihua Wu, Shuangshi Fan, Xiaojun Chen, Zin Mar Aung, Tianjia Liu, Yan Zhang, Shuo Gu, Gang Chai Abstract Purpose Augmented reality (AR) is considered to be a valuable tool in craniofacial surgery for preoperative design, intraoperative navigation, and postoperative assessment. Corrective surgery is necessary synostotic plagiocephaly for functional and aesthetic outcomes. Open calvarial reconstruction is a difficult classic surgical procedure with a high accuracy requirement. The purpose of this study was to introduce an AR system application in synostotic plagiocephaly surgery. Materials and methods Seven plagiocephaly patients (ages 6 months–24 months, average 16.7 months) were enrolled. Preoperative design was accomplished based on three-dimensional computed tomography (CT) data for patients with synostotic plagiocephaly. We completed the registration with the predefined markers through an image registration process preoperatively. Then, we overlaid the registration results into the surgical field to assist surgeons intraoperatively. CT scans were performed postoperatively. Intracranial volume was measured to judge the surgical outcomes. We performed a quantitative craniometric analysis between the planning of the reconstruction and post-operative results, and the main evaluation indicator was the intracranial volume asymmetry. Results We successfully applied the AR system in patients undergoing synostotic plagiocephaly, providing real-time navigational images of position and orientation information during open calvarial reconstruction surgery in 7 plagiocephaly patients within a span of 5 years. Good appearances were observed after the surgery. Cranial volume asymmetry was decreased from 27.87% to 16.57%, achieving precise intra-operative goals. No significant differences were found between planning and post-operative results. Conclusions The AR system can be applied to plagiocephaly procedures guiding to obtain reliable and accurate results via a precise osteotomy.

Scaffold implantation in the omentum majus of rabbits for new bone formation Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Falk Birkenfeld, Andre Sengebusch, Chiara Völschow, Björn Möller, Hendrik Naujokat, Jörg Wiltfang Abstract Restoration of the mandible after defects caused by ablative surgery remains challenging. Microvascular free flaps from the scapula, fibula or iliac crest remain the ‘gold standard’. A drawback of these methods is donor-side morbidity, availability and the shape of the bone. Former cases have shown that prefabrication of a customized bone flap in the latissimus dorsi muscle may be successful; however, this method is still associated with high donor-side morbidity. Osteogenesis in the omentum majus of rabbits by wrapping the periosteum into it was confirmed recently and is particularly interesting for bone endocultivation. Twelve adult male New Zealand white rabbits were used. In each, two hydroxyapatite blocks were implanted in the greater omentum with autologous bone or autologous bone + rhBMP-2. Bone density measurements were performed by CT scans. Fluorochrome labelling was used for new bone formation detection. The animals were sacrificed at week 10, and the specimens were harvested for histological and histomorphometric analysis. In histological and fluorescence microscopic analysis, new bone formation could be found, as well as new blood vessels and connective tissue. No significant differences were found regarding the histological analysis and bone density measurements between the groups. It could be demonstrated that the omentum majus is a practical way to use one's own body as a bioreactor for prefabrication of tissue-engineered bony constructs. Regarding the influence and exact dose of rhBMP-2, further research is necessary. To establish and improve this method, further large-animal experimental studies are also necessary.

Improved bone regeneration through amniotic membrane loaded with buccal fat pad-derived MSCs as an adjuvant in maxillomandibular reconstruction Publication date: August 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8 Author(s): Fahimeh Akhlaghi, Nima Hesami, Maryam Rezai Rad, Pantea Nazeman, Farahnaz Fahimipour, Arash Khojasteh Abstract Background Human amniotic membranes (HAMs), as a biological membrane with healing, osteogenic, and cell therapy potential, has been in the spotlight to enhance the outcomes of treating bone defects. Present study aims to clinically assess the potential of HAM loaded with buccal fat pad-derived stem cells (BFSCs) as an osteogenic coverage for onlay bone grafts to maxillomandibular bone defects. Materials and methods Nine patients with jaw bone defects were enrolled in the present study. The patients were allocated to two study groups: Iliac crest bone graft with HAM coverage (n = 5), and Iliac bone grafts covered with HAM loaded with BFSCs (n = 4). Five months following the grafting and prior to implant placement, cone beam computed tomography was performed for radiomorphometric analysis. Results The mean increase in bone width was found to be significantly greater in the HAM + BFSCs group (4.42 ± 1.03 mm versus 3.07 ± 0.73 mm, p < 0.05). Further, the changes in vertical dimension were greater in the HAM + BFSCs group (4.66 ± 1.06 mm versus 4.14 ± 1.03 mm, p > 0.05). Conclusion Combined use of HAM with mesenchymal stem cells may enhance bone regeneration specifically in the horizontal dimension. Moreover, this methodology reduces the amount of harvested autogenous bone and diminish secondary bone resorption.