Digital Workflow for Computer-guided Implant Surgery in Edentulous Patients: A Case Report

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ji-Hyeon Oh, Xueyin An, Seung-Mi Jeong, Byung-Ho Choi
The purpose of this article was to describe a fully digital workflow used to perform computer-guided flapless implant placement in an edentulous patient without the use of conventional impressions, models or a radiographic guide. Digital data for the workflow were acquired using an intraoral scanner and cone-beam computed tomography (CBCT). The image fusion of the intraoral scan data and the CBCT data was performed by matching resin markers placed in the patient's mouth. The definitive digital data were then used to design a prosthetically-driven implant position, surgical template, and computer-aided design/computer-aided manufacturing (CAD/CAM) fabricated fixed dental prosthesis. We believe this is the first published case describing such a technique in computer-guided flapless implant surgery for edentulous patients.



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Benchmarking: an effective tool to demystify the academic career

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gino Inverso, John R. Zuniga, Neeraj H. Panchal




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Does dexamethasone facilitate neurosensory function regeneration after zygomatic fracture? A randomized and controlled trial

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Aleksi Haapanen, Hanna Thorén, Satu Apajalahti, Anna Liisa Suominen, Johanna Snäll
PurposeThis study sought to clarify the rate of neurosensory disturbance (NSD) after zygomatic complex (ZC) fractures in general, and the effect of perioperatively administered dexamethasone on neurosensory recovery.MethodsThis was a single-blinded randomized study aiming to clarify the benefits of perioperative dexamethasone after surgery. The patients were randomly assigned to receive either dexamethasone (up to a total dose of 10 mg or 30 mg) or to act as a control (no glucocorticoid treatment). The outcome variable was NSD, the presence of which was established when patients experienced any sensory disturbance of the infraorbital nerve. Other predictor variables included in the analysis were age, gender, timespan from accident to surgery, surgical approach to the fracture line, and the relation of the fracture to the infraorbital foramen. The statistical significance of associations was evaluated with chi-squared tests.Results64 patients were included in the analyses. Of the patients in the dexamethasone group (either 10 mg or 30 mg), 58.3% had NSD six months post-operatively, whereas in the control group 66.7% of the patients suffered from NSD. This finding was not statistically significant (p=0.565). At the one-month interval, the patients without a fracture through the infraorbital foramen (IOF) had less NSD (p=0.009); this finding was not significant at three and six months postoperatively. Age, gender, injury mechanism, surgical approach, or timespan from accident to surgery were not significant predictors for NSD. In total, 64.4% of the patients still suffered from NSD at six months post operatively.ConclusionThis study showed no benefits of short-term high-dose dexamethasone administration in the neurosensory recovery of patients with ZC fractures. The type of primary trauma is the main cause for NSD, but the precise predictors remain unknown.



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Surgical staples:-A superior alternative to sutures for skin closure after neck dissection:-A single-blindprospective randomized clinical study

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shrenik Oswal, Rajiv Borle, Nitin Bhola, Anendd Jadhav, Sanidhya Surana, Rajesh Oswal
PurposeTo evaluate the efficacy of staples in skin closure following neck dissection in patients with oral squamous cell carcinoma. We hypothesize that use of staples results in better wound closure, when compared with non-absorbable monofilament sutures.MethodsA prospective single blind, randomized clinical trial was performed to compare various parameters including time taken, inflammatory changes, pain, cost efficacy, complications and esthetic outcome of skin closure with surgical staples and non-absorbable monofilament sutures and to determine its statistical significance using chi- square and Mann Whitney U tests.ResultIn a study of 124 patients the mean skin closure time was 29.2+4 mins with sutures (n=61) and 5.3 + 1.29 mins with staples (n=63), which was significant (p=.01).The mean pain scores during removal using visual analogue scale (VAS) were 5.08+1.29 and 3.15+ 0.89 with sutures and staples, respectively. Post-operative complications, like gaping and stitch abscess with purulent discharge, were noted.ConclusionStaples provided better esthetics with fewer complications, faster closure, minimal pain on removal and faster healing when compared to sutures. The slowest closure time in staples group was four times faster than the fastest closure time in sutures group. However, staples cost five times more than sutures.



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Initial manifestation of acquired hemophilia A (AHA) after a routine tooth extraction. A case report and literature review

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicholas A. Bennetts, James E. Mergelmeyer, Eric J. Reimer, James C. Melville
Although surgical treatment of patients on anticoagulation regimens is a common practice among oral and maxillofacial surgeons, unexpected and unknown coagulopathies can have devastating and catastrophic consequences for the most routine of procedures. Acquired hemophila A (AHA) is an extremely rare life-threatening bleeding disorder characterized by autoantibodies directed against circulating coagulation factor (F) VIII. The effects of acquired hemophilia A can produce catastrophic bleeding and hematomas. The effect of this uncontrolled hemorrhage post dental-alveolar surgery can mimic severe head and neck infection by causing dysphagia, odynophagia, and acute airway complications. This report describes the case of a 64 year old female who was diagnosed with acquired hemophilia A (AHA) after a routine extraction of tooth #17.



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TheCervicofacialFlapinCheekReconstruction:aGuideforFlapDesign

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): AlHaitham AlShetawi, Anastasiya Quimby, Rui Fernandes
PurposeThecervicofacial(CF)flapisarandompatternflapthatprovidesexcellentmatchforcheekreconstruction.ThedesignoftheCFflapvariesbetweendifferentcheeksubunits.Inthisstudy,wereviewourexperiencewiththisflapandpresentaguideforflapdesignfordifferentcheeksubunits.MaterialsandMethodsPatientswhohadcheekreconstructionwerescreenedusingthedatabaseofthesurgicalproceduresbetween2011-2016.74patientswereidentified.Dataregardingpatientdemographics,diagnosis,defecttypeandoutcomewereretrospectivelyreviewed.Patientswhodidnothavecleardescriptionofthedefectand/orflapdesignwereexcludedfromthestudy.Wedividedthecheekintothreezonesandcreatedaguideforflapdesignforeachzone.Results28patientswithCFflapforcheekreconstructionmettheinclusioncriteria(21males[75%]and7females[25%];meanage57[range8-88years]).57%hadzoneAdefect,18%hadzoneB1defect,14%hadzoneB2defect,and11%hadmultiplezones.Themeanfollow-upwas4.6months(0-17months).93%hadsuccessfuloutcome.Only2patientsexperiencedwoundcomplications.ConclusionTheCFflapisaversatileflapthatprovidesexcellentskincolor,thicknessandtexturematchincheekreconstruction.Planningtheflapdesignisessentialtoachieveagoodoutcome.OuralgorithmprovidesastraightforwardmethodtoreliablydesigntheCFflapforcheekreconstruction.



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A retrospective volume matched analysis of the submental artery island pedicled flap as compared to the forearm free flap: Is it a good alternative choice for the reconstruction of defects of the oral cavity and oropharynx?

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nawaf Aslam-Pervez, Steven J. Caldroney, Amal Isaiah, Joshua E. Lubek
PurposeThe submental artery island pedicled flap (SMIF) is an underutilized alternative for reconstruction of head and neck defects following tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients reconstructed with a SMIF versus those reconstructed using the forearm free flap (FFF).MethodRetrospective cohort study of all patients with oral cavity/oropharyngeal defects reconstructed with a SMIF versus a cohort of FFF patients with similar volume defects were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by ANOVA and Fisher's exact test.ResultsAverage age was 61.8 years (SMIF) vs. 57.9 years (FFF). Most common defect was located in tongue with squamous cell carcinoma the most common pathology identified. Flap volumes were similar 38.79 (SMIF) vs. 39.77 mL (FFF). Significant comparative outcomes identified with SMIF reconstruction vs. FFF included; shorter anesthesia times (815 vs. 1209 min; P < 0.001), operative times (653 vs. 1031 min; P < 0.001) and blood loss (223 vs. 398 mL; P= 0.04). Post-operative ECOG performance score increased greater for FFF than for SMIF (+0.33 vs. +1.25; P=0.0019). Recipient site complication rates were lower for the FFF (0.17/patient vs. 0.42/patient), but were not statistically significant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5 months.ConclusionsThis is the first study to compare the submental artery island flap versus the forearm free flap for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option as compared to the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay and donor site morbidity.



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