Is injury to the inferior alveolar nerve still common during orthognathic surgery? Manual twist technique for sagittal split ramus osteotomy

Publication date: Available online 10 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): B.-K. Choi, W. Lee, L.-J. Lo, E.-J. Yang

Abstract

The osteotomy in a bilateral sagittal split ramus osteotomy (BSSRO) is made in close proximity to the inferior alveolar nerve (IAN), so direct damage to the nerve and irreversible neurosensory deficit may result. The aim of this study was to compare the incidence of injury to the nerve when a conventional osteotomy using an osteotome was made, with that after manual twist splitting. We retrospectively reviewed the casenotes of 769 consecutive patients who had bilateral SSRO either alone or with a simultaneous maxillary procedure by a single surgeon from May 2009 − October 2016. Patients were divided into two groups based on the technique used. Those in the first group had conventional split osteotomy using an osteotome and hammer for splitting (conventional group, 736 sides), and in those in the second group the manual twist technique was used (manual group, 802 sides). Patients who sustained Sunderland fifth degree injuries were identified from an existing record of nerve repairs. Fisher's exact test was used to evaluate the significance of the number of injuries to the nerve in each group. Conventional osteotomy and hammer-assisted SSRO resulted in 8/736 (1.1%) injuries to the IAN, whereas the manual twist splitting technique resulted in 1/802 injuries (0.1%). Our results confirm that the manual twist splitting technique significantly reduces the incidence of injury to the IAN, though the overall incidence was low.

https://ift.tt/2QvQwvv

Prognostic significance of bone morphogenetic protein 6 (BMP6) expression, clinical and pathological factors in clinically node-negative oral squamous cell carcinoma (OSCC)

Publication date: Available online 10 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Petar Suton, Ante Bolanca, Lovorka Grgurevic, Igor Erjavec, Iva Nikles, Danko Muller, Spomenka Manojlovic, Slobodan Vukicevic, Mladen Petrovecki, Stjepan Dokuzovic, Ivica Luksic

Summary

Bone morphogenetic protein 6 (BMP6) has unique properties regarding structure and function in supporting bone formation during development and adult life. Despite its known role in various malignant tumors, the prognostic significance of BMP6 expression in oral squamous cell carcinoma (OSCC) remains unknown. The aim of the study was to investigate immunohistochemical expression of BMP6 in OSCC in correlation with clinical and pathological parameters, disease recurrence and survival. In addition, we investigated other parameters in order to identify prognosticators of neck metastases and final outcome. The study included 120 patients with clinically T1-3N0 OSCC who were primarily surgically treated between 2003 and 2008. There were 99 (82.5%) male and 21 (17.5%) female patients. The five-year disease-specific survival for the whole cohort was 79.7%. Tumors smaller than 2 cm in diameter showed higher incidence of strong BMP6 expression. No statistical correlation was observed between other clinico-pathological factors and BMP6 expression. Expression of BMP6 was not associated with disease recurrence and survival. BMP6 may not serve as prognosticator of final outcome or recurrence in clinically node-negative OSCC subjects. In multivariate analysis predictors of poorer survival were positive surgical margin, moderate tumor cell differentiation and pathological involvement of levels IV and/or V.

https://ift.tt/2T06tvL

The feasibility of rib grafts in long span mandibular defects reconstruction: a long term follow up

Publication date: Available online 10 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Ahmed M.A. Habib, Shady A. Hassan

Abstract

Aims

To evaluate the efficiency of reconstruction of long span mandibular defects using split rib bundle bone graft.

Materials and methods

Six hundred patients with long span mandibular defects (more than 6 cm long), following resection of aggressive mandibular tumours, were reconstructed with split rib bundle bone graft technique. Immediate reconstruction was performed in all patients. A reconstruction plate was used to support the graft. Two ribs were harvested from the right side of the chest, split into four halves and used to restore the continuity of the mandible. The inclusion criterion was post-surgical mandibular bony defects without soft tissue deficiency. Defects with a history of previous or need of future irradiation were excluded.

Results

The appearance of the patients was accepted in 550 patients. Functional reconstruction was done in 320 patients by osseointegrated dental implants (after 15 months), and removable prosthesis in 150 patients. Infection was minor in 31 patients, moderate in 47 patients and severe in 42 patients. Partial loss of graft, up to 25%, due to moderate infection was reported. Total or near total loss of graft due to severe infection was corrected by reoperation six months later.

Conclusions

This technique is simple, safe, and can be effectively used to reconstruct long-span mandibular defects with minimal complications in selected patients.

https://ift.tt/2zMCyxZ

Recovery Pattern following Bimaxillary Orthognathic Surgery: Differences between Sexes

Publication date: Available online 10 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): In-Seok Song, Jimi Choi, Un-Bong Baik, Jae-Jun Ryu, Jong-Woo Lim, Young-Jun Choi, Ui-Lyong Lee

Abstract

The investigators hypothesized there would be differences between the sexes in recovery pattern following bimaxillary orthognathic surgery as measured by patient responses at 5 weeks postprocedure. A total of 378 participants underwent bimaxillary orthognathic surgery with or without adjunctive procedures. Participants received questionnaires 5 weeks postsurgery when they visited the outpatient clinic. The questionnaires include variances in surgical factors by sex, and postoperative symptoms which were most difficult to tolerate experiences by sex, respectively. Females were more likely to undergo malarplasty (zygoma reduction) than were male participants (P = <.001), and they required larger maxillary setback than did male participants (P = .003). Malarplasty was significantly correlated with ear fullness in total and female participants (p-value .018, .016, respectively). Snoring is significantly associated with malarplasty and segment osteotomy procedure without gender predominance (p-value= .026, .028, respectively). Over half of participants complained of nasal congestion (55.6%), followed by swelling (29.3%), pain (15.4%), breathing difficulty (10.6%). In conclusion, males and females showed different patterns of postoperative recovery following bimaxillary orthognathic surgery.

https://ift.tt/2T4JMXa

A simple method to estimate the linear length of the orbital floor in complex orbital surgery

Publication date: Available online 9 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Konstantinos Natsis, Maria Piagkou, Ioannis Chryssanthou, Georgios P. Skandalakis, Georgios Tsakotos, Giannoulis Piagkos, Constantinus Politis

Abstract

Background

The orbital floor (OrF) and infraorbital rim (IOR) repair in cases of complete destruction is challenging mainly due to the fact that the defect length cannot be measured. The aim of the current study is to develop a method of calculating the Orf length by using the gender and the lengths of the medial, superior and lateral orbital walls (OrW) of the same orbit.

Material and methods

Ninety-seven (59 male and 38 female) European adult dry skulls were classified according to age: 20-39, 40-59 and 60 years and above. The length of each OrW was measured by using the direct distance between the optic foramen and a landmark in each orbital rim.

Results

A side asymmetry was detected for the lengths of the inferior, superior and medial OrW. Although a gender dimorphism was detected, no correlation with the age was found. Using the Stepwise multiple regression analysis two formulas were developed, one for the right and one for the left OrF with coefficient of determination R² 0.43 and 0.57, respectively.

Conclusions

The proposed formulas represent a simple, applicable and individualized method to calculate the OrF linear length in cases of complete destruction of the IOR and OrF, with accuracy and without the use of expertise material. Such data may improve the surgery planning of orbital floor fractures and complex orbital reconstructions.

https://ift.tt/2zIOdho

A comparison of the 7th and 8th editions of the AJCC staging system in terms of predicting recurrence and survival in patients with papillary thyroid carcinoma

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Sung Hoon Nam, Mi Rye Bae, Jong-Lyel Roh, Gyungyup Gong, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim

Abstract

Objectives

The recently published 8th edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system was significantly updated following the thyroid cancer-related guidelines to provide better predictability of survival but not focus on recurrence. Therefore, we compared the predictive values of the 7th and 8th editions of the AJCC staging systems for recurrence-free survival (RFS) and overall survival (OS) after thyroidectomy for papillary thyroid carcinoma (PTC).

Methods

This retrospective study included 2930 patients who underwent thyroidectomy and neck dissection for previously untreated PTC between 2006 and 2014. TNM stage was defined according to 7th and 8th editions. Univariate and multivariate Cox proportional hazard regression analyses were used to identify associations between variables and RFS or OS. Multivariate models for the AJCC TNM stages were adjusted for clinical and pathological variables.

Results

A significant number of patients classified as T3 with overall TNM stages II–IV in the AJCC 7th edition were down-staged in the 8th edition. Unadjusted T classification and overall TNM staging in both the 7th and 8th editions were significantly associated with RFS and OS rates (P < 0.001). After adjustment for clinicopathological factors, the overall TNM stage according to the AJCC 8th edition, but not the 7th edition, remained significantly associated with RFS and OS (P < 0.05), with better predictability of recurrence and survival, in patients with PTC.

Conclusions

The 8th edition AJCC staging system down-staged a large proportion of PTC patients, resulting in better predictability of recurrence and survival compared to the previous staging system.

Condensed abstract

This study compared the abilities of the 7th and 8th edition AJCC staging systems to predict recurrence and overall survival in 2930 patients with papillary thyroid carcinoma. The updated guidelines down-staged a large proportion of patients, resulting in better prediction of recurrence and survival than the previous staging system.

https://ift.tt/2Fh1iog

Potential application of tumor suppressor microRNAs for targeted therapy in head and neck cancer: A mini-review

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Isaac Olatunji

Abstract

Head and neck cancer remains a leading cause of death worldwide. Most common available treatment methods which include surgery, radiotherapy, and chemotherapy are associated with numerous side effects. MicroRNA therapeutics is an emerging form of gene therapy with potential for use in treatment of head and neck cancer. MicroRNAs are short nucleotide RNAs that target mRNAs (messenger RNA) to regulate gene expression at the post-transcription level. They may act as either tumor suppressor or oncogene in cancer. In the past, their potential use in cancer management (diagnosis, treatment, prognosis prediction), based on their deregulation have been demonstrated and written about but summaries on their application for targeted therapy are limited. This article aims at discussing the potential of some known tumor suppressor microRNAs for treatment of head and neck cancer, either alone or in combination with other treatment forms. It also aims at highlighting some obstacles against their use. The search for literature was done on PubMed using the search term: "MicroRNA based head and neck cancer treatment". Only free full text original articles on specific microRNAs and their tumor suppressive abilities in head and neck cancer, written in English language were used. Most of the studies demonstrated the ability of microRNAs to inhibit tumor growth by targeting specific oncogenes in cancer cells. Tumor suppressor microRNAs show promise for the treatment of head and neck cancer but more researches are needed to further clear areas of concern.

https://ift.tt/2qBp58i