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Cationic liposomes have been investigated as non-viral vectors for gene delivery for more than a decade to overcome challenges associated with viral gene delivery. However, due to instability of liposomes, siRNA delivery is still a serious problem. In this study, we developed stealth PEGylated liposome formulations and focused on the effects of PEGylated liposomes on parameters related to size, zeta potential, polydispersity index, siRNA-loading efficiency and long-term stability of the siRNA-liposome complex. We were able to generate siRNA lipoplexes that could be very efficiently loaded, did not aggregate, could be stored at 4 °C for at least 6 months with only marginal release (1–5%) of siRNA and enhanced intracellular delivery of siRNA. Moreover, we could demonstrate that PEGylation positively contributed to all these parameters compared to liposomes, which were not PEGylated. The prepared lipoplex was successfully silenced J1P1 expression in MG-63 osteosarcoma cell line. In conclusion, our novel PEGylated liposomes have high potential for systemic delivery of siRNA and can improve in vivo stability of free siRNA and also siRNA lipoplexes.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres.The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture.The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents.The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.

ObjectiveArch bars as treatment for a fractured mandibular condyle are inconvenient to patients and lead to lowered quality of life (QOL). To overcome these inconveniences, IMF-screws (IMFS) to facilitate intermaxillary fixation during surgery have been developed. The purpose of the present study is to investigate and compare QOL for patients treated for a fractured mandibular condyle with either IMFS or arch bars.Material and methodsThis research trial was conducted from 2010 to 2014 as part of an earlier prospective, multicenter, randomized clinical trial in which the use of IMFS was compared to the use of arch bars in the treatment of mandibular condylar fractures.ResultsIn total, 50 patients were included: 30 (60%) male patients and 20 (40%) female patients (mean age: 31.8 years, standard deviation [SD] = 13.9 years, range = 18-64years). A total of 24 (48%) patients were allocated in the IMFS group, and 26 (52%) patients were assigned to the arch-bars control group. Significant results were observed in the subscales social isolation, possibility to eat and vary diet, influence on sleep, and satisfaction with the given treatment, all in favour of IMFS.ConclusionIn conclusion, using IMFS as a method for conservative treatment of condylar fractures led to a higher QOL during the 6-week period of fracture healing. In comparison to arch bars, patients treated with IMFS experienced less social isolation, had fewer problems with eating, and express the feeling they are able to continue their normal diet. Furthermore it seems that the use of IMFS has a lower negative impact on social and financial aspects of the patient.

The aim of the present study was to assess the indications, results and complications of patients treated with porous polyethylene (Medpor®) implants in the Department of Oral and Maxillofacial Surgery of VU Medical Centre, Amsterdam over 17 years. A total of 69 high-density porous polyethylene implants (Medpor® Biomaterial; Porex Surgical, Newman, GA) were used in forty patients (22 males, 18 females). All patients were analysed for gender, age, diagnosis, indications for surgery, follow-up period and postoperative complications. A mean age of 34.1 years was observed. The main reason for implant surgery was post-traumatic functional impairment (27.5%). Most implants were placed at the mandibular angel and the orbital floor. Unsatisfactory appearance scored the highest in postoperative complications (10.1%) followed by infection rate (7.2%). Comparing the number of implants placed over the years and the incidence of complications, makes the overall complications rate of porous polyethylene very low. A consensus about antibiotic prophylaxis is needed. The objective measurements in patient satisfaction and proper implant design would be of great use.

Objectives: The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two centers in Turin, Italy and in Amsterdam, the Netherlands for ten years. Only patients who were admitted for mandibular fractures were considered for this study. Results: Between 2001 and 2010, a total of 752 patients were admitted at Turin hospital with a total of 1167 mandibular fractures not associated with further maxillofacial fractures, whereas 245 patients were admitted at Amsterdam hospital with a total of 434 mandibular fractures. At Amsterdam center, a total of 457 plates (1.5 - 2.7 mm) were used for the 434 mandibular fracture lines, whereas at Turin center 1232 plates (1.5 – 2.5 mm) were used for the management of the 1167 mandibular fracture lines. At Turin center, 190 patients were treated primarily with IMF, whereas 35 patients were treated with such treatment option at Amsterdam center. Conclusions: Current protocols for the management of mandibular fractures are quite efficient. It is difficult to obtain a uniform protocol, because of the difference of course of each occurring fracture and because of surgeons’ experiences and preferences. Several techniques can still be used for each peculiar fracture of the mandible.

We retrospectively analysed the incidence of symptomatic venous thromboembolism (VTE) and associated risk factors in operations under general anaesthesia for cancer of the oral cavity. To identify symptoms related to deep venous thrombosis (DVT) and pulmonary embolism (PE), together with associated risk factors, we reviewed medical records of patients operated on in the department of oral and maxillofacial surgery at the Queen Elizabeth Hospital, Birmingham, United Kingdom, between June 2007 and October 2012. All patients were categorised according to their level of risk of VTE. The incidence of VTE was calculated with univariate associations and odds ratios with related 95% confidence intervals, where possible. In total, 233 patients were included, comprising 244 operations (mean (SD) age at operation 60.9 (13) years). Almost all patients (97%) were classified as having the highest risk of VTE. Swelling of an extremity, expectoration of blood, and tightness of the chest were the most common symptoms for suspected cases. An incidence of 0.41% was found for symptomatic VTE; one man developed a PE 2 days after operation. Associations between the analysed factors and symptomatic VTE were not significant. The development of the complication in oncological oral and maxillofacial operations seems to be rare, even in patients with a high risk. We cannot recommend the use of routine thromboprophylaxis, but it could be advocated in patients with obvious serious risk factors.

AimThe aim of this study was to retrospectively investigate the incidence and associated factors of dental trauma in patients with maxillofacial fractures at the VU Medical Center in Amsterdam.Material and methodsData from 707 patients who were treated surgically for maxillofacial fractures were evaluated. The data were collected retrospectively from patient files and other available databases. The data collected included date of fracture, age, gender, type of fracture, and injured teeth.ResultOf the total 707 patients, 164 patients (23.2%) presented dental injuries associated with facial fractures. Mandibular condylar fractures, mandibular parasymphyseal fractures, Le Fort fractures, and mandibular body fractures were found to be significantly more associated with dental injury. Zygomatic arch or zygomatic complex fractures were significantly less associated with dental injury. Women had a significant higher risk of facial fractures with dental injuries than men. The maxilla demonstrated the highest incidence of injured teeth. The most affected teeth were the maxillary incisors (33.1%), followed by mandible incisors (13.6%), mandible molars (12.8%), and maxillary premolars (12.6%).ConclusionOur findings show a higher risk of dental injury among patients with a mandibular condylar fracture and mandibular parasymphyseal fracture but a lower risk of dental injury among patients with a zygomatic arch or zygomatic complex fracture. On average, patients had more than three injured teeth, with most of the injured teeth being in the upper jaw. The maxillary incisors, followed by the mandible incisors, were the most injured teeth.

Purpose: To employ Doxorubicin-loaded liposomes, modified with YSA-peptide to target EphA2, to reduce adverse effects against primary bone cells and maximize toxicity against Saos-2 osteosarcoma cells. Methods: PEGylated liposomes were prepared by thin film method using Dipalmitoylphosphatidylcholine (DPPC), cholesterol and distearylphosphatidylethanolamine-polyethyleneglycol conjugate (DSPE-mPEG) in 67.9:29.1:3 M ratios, and loaded with DOX (L-DOX) by pH-gradient method. Targeted liposomes (YSA-L-DOX), were prepared by conjugating YSA-peptide to DSPE-mPEG. Liposomes were physicochemically characterized and tested in cellular toxicity assays. Results: YSA conjugation efficiency was >98%. Size and polydispersity index of both L-DOX and YSA-L-DOX were around 88 nm and 0.188, respectively. Both had similar zeta potential, and 85% DOX loading efficiencies. DOX release kinetics followed the Korsmeyer-Peppa model, and showed comparable release for both formulations from 1–8 h, and a plateau of 29% after 48 h. Both formulations could be stably stored for ≥6 months at 4°C in the dark. Toxicity assays showed a significant 1.91-fold higher cytotoxicity compared to free DOX in the Saos-2 cells, and 2-fold lesser toxicity in primary bone cells compared to the Saos-2 cells. Cellular uptake studies showed higher and more nuclear uptake in YSA-L-DOX compared to L-DOX treated cells. Conclusions: YSA-L-DOX vesicles might be effective for targeted treatment of osteosarcoma.

A novel approach was developed for the preparation of stealth controlled-release liposomal doxorubicin. Various liposomal formulations were prepared by employing both thin film and pH gradient hydration techniques. The optimum formulation contained phospholipid and cholesterol in 1:0.43 molar ratios in the presence of 3% DSPE-mPEG (2000). The liposomal formulation was evaluated by determining mean size of vesicle, encapsulation efficiency, polydispersity index, zeta potentials, carrier's functionalization, and surface morphology. The vesicle size, encapsulation efficiency, polydispersity index, and zeta potentials of purposed formula were 93.61 nm, 82.8%, 0.14, and −23, respectively. Vesicles were round-shaped and smooth-surfaced entities with sharp boundaries. In addition, two colorimetric methods for cytotoxicity assay were compared and the IC50 (the half maximal inhibitory concentration) of both methods for encapsulated doxorubicin was determined to be 0.1 μg/ml. The results of kinetic drug release were investigated at several different temperatures and pH levels, which showed that purposed formulation was thermo and pH sensitive.

Head and neck squamous cell carcinoma (HNSCC) is typically regarded as a disease of elderly people. However, increasing numbers of patients worldwide with HNSCC at younger age (defined as

Objectives: In the Netherlands, cyclists continue to outnumber other road users in injuries and deaths. The wearing of bicycle helmets is not mandatory in the Netherlands even though research has shown that wearing bicycle helmets can injuries and helmet protection. Methods: Three patients who had been involved in a bicycle accident while wearing a helmet were subjected to multi-detector row computed tomography (MDCT) imaging after trauma. The helmets were separately scanned using the reduce head and brain injuries by up to 88%. Therefore, the aim of this study was to assess the feasibility of using 3D technology to evaluate bicycle-related head same MDCT scanner with tube voltages ranging from 80. kVp to 140. kVp and tube currents ranging from 10. mAs to 300. mAs in order to determine the best image acquisition parameters for helmets. The acquired helmet images were converted into virtual 3D surface hence Standard Tessellation Language (STL) models and merged with MDCT-derived STL models of the patients' skulls. Finally, all skull fractures and corresponding helmet damage were visualized and related. Results: Imaging bicycle helmets on an MDCT scanner proved to be feasible using a tube voltage of 120. kVp and a tube current of 120. mAs. Merging the resulting STL models of the patients' skull and helmet allowed the overall damage sustained by both skull and helmet to be related.Conclusion: Our proposed 3D method of assessing bicycle helmet damage and corresponding head injuries could offer valuable information for the development and design of safer bicycle helmets.

In this study 6 pre-operative designs for PMMA based reconstructions of cranial defects were evaluated for their mechanical robustness using finite element modeling. Clinical experience and engineering principles were employed to create multiple plan options, which were subsequently computationally analyzed for mechanically relevant parameters under 50N loads: stress, strain and deformation in various components of the assembly. The factors assessed were: defect size, location and shape. The major variable in the cranioplasty assembly design was the arrangement of the fixation plates. An additional study variable introduced was the location of the 50N load within the implant area. It was found that in smaller defects, it was simpler to design a symmetric distribution of plates and under limited variability in load location it was possible to design an optimal for expected loads. However, for very large defects with complex shapes, the variability in the load locations introduces complications to the intuitive design of the optimal assembly. The study shows that it can be beneficial to incorporate multi design computational analyses to decide upon the most optimal plan for a clinical case. V této studii bylo provedeno 6 předoperačních návrhů pro rekonstrukci kraniálních defektů pomocí PMMA implantátů, které byly hodnoceny z mechanického hlediska pomocí výpočtového modelování metodou konečných prvků. Pomocí inženýrského přístupu a klinických zkušeností byly vytvořeny různé varianty výpočtových modelů. Veličinami, které byly následně výpočetně analyzovány při zatížení 50N jsou napětí, deformace a deformace. Hodnotící faktory byly: velikost defektu, umístění a tvar. Posouzení sestavy s kranioplastikou bylo provedeno pro různé uspořádání fixačních desek. Dále byla analyzována poloha zatížení 50N v oblasti implantátu.

Purpose Additive manufactured (AM) skull models are increasingly used to plan complex surgical cases and design custom implants. The accuracy of such constructs depends on the standard tessellation language (STL) model, which is commonly obtained from computed tomography (CT) data. The aims of this study were to assess the image quality and the accuracy of STL models acquired using different CT scanners and acquisition parameters. Design/methodology/approach Images of three dry human skulls were acquired using two multi-detector row computed tomography (MDCT) scanners, a dual energy computed tomography (DECT) scanner and one cone beam computed tomography (CBCT) scanner. Different scanning protocols were used on each scanner. All images were ranked according to their image quality and converted into STL models. The STL models were compared to gold standard models. Findings Image quality differed between the MDCT, DECT and CBCT scanners. Images acquired using low-dose MDCT protocols were preferred over images acquired using routine protocols. All CT-based STL models demonstrated non-uniform geometrical deviations of up to +0.9 mm. The largest deviations were observed in CBCT-derived STL models. Practical implications While patient-specific AM constructs can be fabricated with great accuracy using AM technologies, their design is more challenging because it is dictated by the correctness of the STL model. Inaccurate STL models can lead to ill-fitting implants that can cause complications after surgery. Originality/value This paper suggests that CT imaging technologies and their acquisition parameters affect the accuracy of medical AM constructs.

Background To investigate retrospectively the orthognathic surgery (OGS) patients experience in weight loss and the influence of gender, age, duration of the surgical procedure, length of hospital stay, location of surgery and use of intermaxillary fixation (IMF) or without IMF on postoperative weight loss. Material and Methods A total of 4487 patients treated by OGS where all patients visited the outpatient clinic one, three and six weeks after the surgical procedure. After six weeks, patients filled out a questionnaire in which weight loss was addressed. The patients were asked to give an estimate of their experiences weight loss. The population was first divided in two groups weight loss and no weight loss. Results In the weight loss group there is no significant difference in weight loss between patients with IMF and patients without IMF. In the weight loss group there were significantly more females then males. Further, in the subgroup IMF the operation time was significantly longer compared with the subgroup without IMF. The other parameters including age and hospital stay were not different in the groups. Conclusions IMF in orthognathic treatment does not result in a difference self-reported loss of body weight compared to patients without IMF. Treatment protocols should include pre- and post-operative dietician consultations and possible indications for medical nutrition and vitamins. Key words:Assessing, protocol, weight loss, experiences, orthognathic surgery.

Speekselstenen zijn gecalcificeerde structuren die met name voorkomen in de submandibulaire speekselklieren en de afvoergangen daarvan. De afmetingen en het gewicht van speekselstenen variëren sterk. De etiologie is onbekend. Gesuggereerd wordt dat het ontstaan van speekselstenen is gerelateerd aan een gewijzigde samenstelling van speeksel, de anatomie van de afvoergang van de speekselklier en/of het fuseren van microscopisch kleine speekselsteentjes. Speekselstenen bestaan met name uit anorganische bestanddelen zoals hydroxyapatiet, whitlockiet en calciumfosfaat, maar bevatten ook organische componenten zoals eiwitten en lipiden. De behandeling kan bestaan uit masseren van de speekselklier in combinatie met een zuur dieet, ultrasone vergruizing, en chirurgische of sialoendoscopische verwijdering.

Venous thromboembolism is a common postoperative complication, and orthopaedic procedures are particularly at risk. We designed a retrospective, single centre, observational, cohort study of 4127 patients (mean (SD) age 27 (11) years) who had elective orthognathic operations or distraction osteogenesis between January 1970 and February 2012 at the VU University Medical Centre, Amsterdam, to investigate the incidence in this group over the 42-year period, 2 patients developed symptomatic venous thromboembolism (1 woman had a deep vein thrombosis (DVT) and 1 man had a DVT and pulmonary embolus) postoperatively. In relatively young patients with low to moderate risk factors and short hospital stay this type of operation is associated with a particularly low risk of developing thrombosis. It could be advisable to limit the use of thromboprophylaxis to patients at high risk or according to hospital guidelines.

Several studies have published measurements of the height of the ramus on orthopantomographic (OPT) images of patients with unilateral fractures of the mandibular condyle as a possible quantitative measure for making decisions about treatment. However, we know of no studies that have described the accuracy and validity of such measurements. The aim of the present study was to assess the shortening of the ramus in patients with such fractures, and compare them with differences found in a control group. Seventy-four patients and 74 controls were studied. The height of the ramus on the fractured was less than that on the uninjured side, although this was not statistically significant (p = 0.25). In the control group, 50 subjects (68%) had a difference in the ramal height of more than 2 mm. Of 74 patients, 25 (34%) had a shorter, uninjured ramus on the opposite side. A Bland and Altman scatterplot showed 23 outliers (31%) among the patients, which exceeded the mean (SD 1.96) of the control group. The interobserver and intraobserver reliability both showed excellent agreement for all measurements made. Shortening of the ramus can be measured on OPT images. However, in a control group there was a large mean difference in height. Among the patients, 25/74 (34%) also had an uninjured ramus on the opposite side that was shorter than that on the fractured side. Measurement of the difference in height on an OPT image cannot be relied on as an absolute indication for intervention.

The aim of this study was to assess the characteristics of patients with coronoid fractures treated in two European centres over 10 years and to briefly review the literature.This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures and surgically treated in two European centres between 2001 and 2010.During the 10 years, 1818 patients and 523 patients with maxillofacial fractures were admitted to the two centres respectively: 21 patients (16 males, 5 females) were admitted with 21 coronoid fractures and 28 associated maxillofacial fractures.A mean age of 42.1 years was observed. The fractures were mainly the result of motor vehicle accidents, followed by assaults and falls. The most frequently observed associated maxillofacial fracture was a zygomatic fracture (13 fractures). In both centres, mandibular coronoid fractures are treated unless a severe dislocation of the fractured coronoid is observed or a functional mandibular impairment is encountered.Conservative treatment can be used, together with the open reduction and internal fixation of associated fractures. The crucial point is to prevent ankylosis, which may be prevented by correct and early postoperative physiotherapy and mandibular function.

Maxillofacial trauma is often associated with injuries to the cranium, especially in high-energy trauma. The management of such cases can be challenging and requires close cooperation between oral and maxillofacial surgery and neurosurgical teams. There are few reports in the current literature describing the complications that develop in patients with maxillofacial trauma and traumatic brain injury (TBI). Complications can be categorized as early or late and/or minor and major. The exact definition of complications and their categorization remains a matter of current debate. We present a 10 year retrospective study of complications and their subsequent management in patients receiving maxillofacial and neurosurgical treatment for maxillofacial trauma associated with TBI. The study population consisted of 47 people, excluded from a maxillofacial trauma population of 579 patients. The severity of the trauma was scored as mild, moderate or severe, using the Glasgow Coma Scale at presentation of the Emergency Department. In total 36 patients (76.6%) developed complications. Patients involved in road traffic collision were most likely to develop complications (92.3%). This was followed by falls (66.7%) as mechanism of the injury. Patients aged 60-69 years experienced the highest complication rate (5), followed by patients aged 20-29 years (4.1) and 30-39 years (3.5). The majority of complications were infection and inflammation (36.4%), followed by neurological deficit (24.0%), physiological dysregulation (11.6%) and facial bone deformity (8.3%). Patients who developed no complications, most often presented with mild TBI (72.7%).The most common treatment modality employed to manage complications was pharmacological, followed by antibiotic treatment, conservative treatment and decompression therapy. The mean hospital stay after the trauma for the patients with complications was 28 days. Thirteen patients (36.1%) were transferred to a rehabilitation centre, a nursing home, or a home for the elderly. Nine patients (25%) completely recovered from their complications and 4 patients (11.1%) died after the trauma. This report provides useful data concerning the rate and type of complications that occur, and the multidisciplinary treatment that is required in traumatic maxillofacial and brain injury patients.

BackgroundThe aim of this study was to evaluate the surgical management of posttraumatic dysocclusion in the Department of Oral and Maxillofacial Surgery in the VU Medical Centre in Amsterdam.Patients and methodsAll patients who underwent surgical correction of a posttraumatic dysocclusion between 1970 and 2012 were reviewed. Patient charts were reviewed retrospectively.ResultsA total of 42 patients were included. Twenty-seven patients had a mandibular condyle fracture (64.3%). The initial fracture-treatment was either conservative, consisting only of intermaxillary fixation (IMF), or open reduction and internal fixation (ORIF). Though different orthognathic treatment options were used to regain normal occlusion, the most frequently used surgical techniques were a uni- or bilateral sagittal split osteotomy of the mandible in 21 patients (50.0%), followed by a Le Fort I osteotomy of the maxilla in 17 patients (40.5%).ConclusionsMost dysocclusions occur after mandibular condyle fractures, however fractures of other maxillofacial structures also account for a considerable number of cases. Good results are achieved with orthognathic surgery for posttraumatic dysocclusion.

The aim of the study was to investigate the incidence of the inferior alveolar nerve (IAN) injury in mandibular fractures. This study is based on two databases that have continuously recorded patients hospitalized with maxillofacial fractures in two departments—Department of Maxillofacial Surgery, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands, and Division of Maxillofacial Surgery, San Giovanni Battista Hospital, Turin, Italy. Demographic, anatomic, and etiology variables were considered for each patient and statistically assessed in relation to the neurosensory IAN impairment. Statistically significant associations were found between IAN injury and fracture displacement ( p = 0.03), isolated mandibular fractures ( p = 0.01), and angle fractures ( p = 0.004). A statistically significant association was also found between IAN injury and assaults ( p = 0.03). Displaced isolated mandibular angle fractures could be considered at risk for increased incidence of IAN injury. Assaults seem to be the most important etiological factor that is responsible for IAN lesions.

Background In head and neck cancer, surgical resection using primarily visual and tactile feedback is considered the gold standard for solid tumors. Due to high numbers of tumor-involved surgical margins, which are directly correlated to poor clinical outcomes, intraoperative optical imaging trials have rapidly proliferated over the past 5 years. However, few studies report on intraoperative in situ imaging data that could support surgical resection. To demonstrate the clinical application of in situ surgical imaging, we report on the imaging data that are directly (ie in real-time) available to the surgeon. Study Design Fluorescence intensities and tumor-to-background ratios (TBRs) were determined from the intraoperative imaging data–the view as seen by the surgeon during tumor resection–of 20 patients, and correlated to patient and tumor characteristics including age, sex, tumor site, tumor size, histologic differentiation, and epidermal growth factor receptor (EGFR) expression. Furthermore, different lighting conditions in regard to surgical workflow were evaluated. Results Under these circumstances, intraoperative TBRs of the primary tumors averaged 2.2 ± 0.4 (range 1.5 to 2.9). Age, sex, tumor site, and tumor size did not have a significant effect on open-field intraoperative molecular imaging of the primary tumors (p > 0.05). In addition, variation in EGFR expression levels or the presence of ambient light did not seem to alter TBRs. Conclusions We present the results of successful in situ intraoperative imaging of primary tumors alongside the optimal conditions with respect to both molecular image acquisition and surgical workflow. This study illuminates the potentials of open-field molecular imaging to assist the surgeon in achieving successful cancer removal.

The risk of bias is important in the interpretation of the results of research. The aim of this review was to evaluate the risk of bias in randomised controlled trials (RCTs) in oral and maxillofacial surgery (OMFS) over a 10-year period. We searched databases of publications for RCTs published between January 2000 and January 2010. Papers were assessed with 2 up-to-date logical quality lists, the Delphi list and the Jadad scale. Those papers with a low risk of bias were given a Jadad score >= 4 (range 0-5) and a Delphi score >= 6 (range 0-9). A total of 230 papers met the inclusion criteria, and only 41(18%) were assessed as being at low risk. Most of those included did not correctly describe such important items for risk of bias as method of randomisation (n = 124, 54%), concealment of allocation (n = 143, 62%), blinding (n = 175, 76%), and intention-to-treat analyses (n = 182, 79%). In the fields of implantology, traumatology, obstructive sleep apnoea syndrome, and extractions, no paper had a low risk of bias. This systematic review has shown a shortage of research in OMFS with a low risk of bias published over a 10-year period. Further research should concentrate on better describing items at important risk of bias. (C) 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved

Objectives: Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis. Study design: A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature. Results: The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 – 4 weeks, being shorter than the 3 – 52 weeks reported in the literature. Conclusion: When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 – 4 weeks is generally efficient. Key words:Actinomycosis, actinomyces, actinomycosis treatment, cervicofacial infection, actinomycosis diagnosis, head and neck infection.

Rikkert Ossendorp,1 Tymour Forouzanfar,2 Claire E Ashton-James,2,3 Frank Bloemers11Department of Surgery, VU University Medical Center, 2Department of Oral and Maxillofacial Surgery, VU University Medical Center, 3Department of Social and Organizational Psychology, VU University, Amsterdam, The NetherlandsIntroduction: Every year, over 260,000 patients in the Netherlands are diagnosed with a traumatic fracture. Many patients are treated surgically and need postoperative treatment of pain. Research suggests postoperative pain is often under-treated, leaving a significant proportion of patients in moderate to severe postoperative pain. Specialized, evidence-based pain-management protocols offer patients the best possible pain management, and significantly reduce the risk of pain-related health complications.Objective: Our objective was to review the range of postoperative pain protocols that are currently being used to treat postoperative fracture pain within the Netherlands, and investigate whether a specialized, evidence-based protocol for treating postoperative fracture pain exists within this sample.Methods: A written request for the protocol currently being used for the treatment of postoperative pain following the surgical treatment of a fracture was sent to 101 Dutch hospital departments. The administration and dosage of pain medications used during postoperative pain management were then identified and summarized.Results: Of the contacted hospitals, 57% sent in protocols; 45% of these were eligible for analysis. All of the departments sent a general or acute pain protocol rather than a specialized protocol for the treatment of postoperative pain associated with the surgical treatment of fractures. A total of 22 different analgesics were used for pain management in 135 different administration schemes. Paracetamol, diclofenac, and morphine were used in the majority of protocols. Medication was given via oral, rectal, intravenous, subcutaneous, intramuscular, and epidural routes, amongst others.Conclusion: No specialized, evidence-based protocols for the treatment of postoperative fracture pain were found in this Dutch sample. A wide variety of medications, dosages, and administration schemes were used to manage postoperative pain following the surgical treatment of a fracture. The importance of developing a clear, specialized, evidence-based protocol for the treatment of postoperative pain following fracture surgery is discussed.Keywords: pain management, postoperative pain, fracture, protocol

Delays in treatment may complicate the treatment of mandibular trauma, leading to a bone healing in an abnormal position and to a posttraumatic mandibular deformity such as malunion, malocclusion, and asymmetry. All these features may make delayed treatment a challenging issue. Therefore, early reduction and fixation of displaced mandibular fractures is mandatory to allow precocious healing and return to the normal function. In this article, we describe a patient treated in our unit for a diagnosed posttraumatic malocclusion after lack of primary trauma treatment.

Purpose: The aims of this study were to assess the clinical outcomes of patients with anterior bifocal mandibular fractures and to discuss the management of this peculiar type of trauma. Methods: From the systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients admitted with anterior bifocal bilateral mandibular fractures between 2001 and 2011 were considered. Patients were contacted, and they were invited to volunteer for a clinical follow-up examination. Statistical analysis was performed using the Fisher exact test, and P < 0.05 was considered statistically significant. Results: Forty dentate patients with anterior bifocal bilateral mandibular fractures (without the presence of further mandibular fractures) were included in the study. Nineteen patients with dislocated anterior segment underwent surgical intervention within 12 hours from hospital admission in the emergency department, whereas 21 patients with nondisplaced mandibular fractures were surgically treated in the elective operating room within 72 hours. Only 3 patients underwent tracheostomy. All patients underwent open reduction and internal fixation with 2.0- and 2.4-mm plates via intraoral approach, except for patients with submental or submandibular facial lacerations. Conclusions: Anterior bifocal bilateral mandibular fractures may involve a challenging management because they can compromise the upper airway. Accurate reduction and internal fixation of these fractures have been critical to restoring form and function of the mandible. The upper airway management and securing always take first, but a prompt surgical intervention of dislocated fractures avoids upper airways impairment.

Coeliac disease is a chronic autoimmune-mediated enteropathy, caused by exposure to dietary gluten in genetically predisposed individuals that affects approximately 0.5-1% of the western population. Despite increased awareness of the disease, the majority of patients still remain undiagnosed. Disease frequently manifests in early childhood, but a significant proportion of patients are nowadays diagnosed above the age of 50. Timely diagnosis is important in order to start a gluten-free diet and prevent complications. Symptoms of coeliac disease vary widely and are certainly not restricted to the intestine. They may include, among others, dental and oral manifestations. Most of them are nonspecific but symmetric enamel defects are very specific to coeliac disease. It is important to recognise this relationship since it may help to identify unrecognised patients.

Previous research has demonstrated the efficacy of using local compression to reduce postoperative pain after third molar surgery. It has been theorized that compression reduces pain intensity through vasoconstriction. The current research tests the veracity of this vasoconstriction hypothesis by testing the impact of local epinephrine (a local vasoconstrictor) versus a control on patients' pain ratings over 7 days following surgery.Fifty patients scheduled for mandibular third molar surgery were randomly assigned to receive one cartridge of Ultracaine DS Forte (the treatment group) or one cartridge of Ultracaine DS (the control group) after surgical removal of the third molar. Participants used the visual analog scale (VAS) to provide daily ratings of pain intensity for 7 days following surgery. In addition, on day 7, the perceived effectiveness of the pain treatment was measured with the global perceived effect (GPE) scale. A quality- of-life questionnaire was also completed.A repeated-measures ANOVA indicated that the treatment group perceived significantly less pain than the control group on days 2 to 7 following surgery. In addition, 77.8% of the treatment group perceived their pain treatment to be successful, while only 69.6% of the control group reported that their pain was reduced successfully by day 7.The results of this study provide an initial proof of concept that epinephrine may have an analgesic effect on the period following third molar surgery. Further research with larger sample sizes is needed to strengthen evidence for the clinical utility of offering localized epinephrine to patients following third molar surgery.

In patients with a cleft, the lip as well as the palate can be involved. According to Rocher et al(2010) it presents the majority of congenital malformations in the craniofacial aria. It’s prevalence and appearance depends on the ethnicity, socio-economic state and the geographic location. In the Western world the prevalence is estimated on 1 in 650, and in Asia 1 in 440. As facial disfiguration can influence enormously the quality of life it is of utmost interest to investigate the influence of surgical treatment on quality of life in patient with a cleft lip and palate. The aim of this study is to do compare the quality of life before and after surgery of cleft lip and palate in East Indonesia.The patients are collected by local dentists, which mostly will be found in rural areas of the Island of Celebes and East-Borneo. Patients are asked to fill questionnaires themselves and by their parents. The questionnaires of patients from 11 years and less will be filled in by their parents. The questionnaire used is the COHIP: Child Oral Health Impact Profile.The questionnaires will be collected and converted by SPSS 20.0 for data processing. The data will all be taken on a nominal level, so the Mann Whitney U test will be used to compare the groups on 1 variable. The discrepancy between the scores pre- and post-surgery will be compared with a Wilcoxon signed rank test.

For smaller bone grafts combining bone substitutes with blood derived growth factors such as PRP and PRF leads to good results.However for the treatment of the extremely resorbed edentulous maxilla prior to implant placement, autogenous bone remains the gold standard. Due to the challenging grafts in often older medically compromised patients the use of bone substitutes alone is not as predictable as autogenous bone.Although autogenous bone is the gold standard the use of block grafts from the iliac crest is associated with significant donorsite morbidity.The use of stem cells and growth factors combined with bone substitute is a promising development which might ultimately replace the need for autogenous bone.Our clinic has done a lot of research in using adipose tissue stem cells in sinus lift procedures, the results will be presented here.We will also present our clinical results of using a combination of bone substitutes with bone marrow stem cells and blood derived growth factors in treating the extremely resorbed edentulous maxilla. Focusing on the difference between adipose tissue stem cells bone marrow and the rationale, surgical considerations and the rationale for combining bone marrow stem cells with blood derived growth factors.

Six baby’s with cleft are born in Indonesia every hour. There is no standardized treatment of cleft in East Indonesia. Closure is an important aspect during cleft lip and palate surgery. Various techniques have been advocated to gain tissue for closure of cleft area. Mostly these techniques may only provide a small amount of additional length. For lager defects they may be use the local flaps or the buccal fat pad flap. The aim of this study is gain more information about intraoperative and early postoperative complications using the buccal fat pat during cleft palate surgery in East Indonesia. The mouth can be divided in six parts therefor the LAHSAL index will be used. This LAHSAL system is a diagrammatic classification of cleft lip and palate. The LAHSAL system is being used for this study as this system classifies the cleft primarily on location and also on the cleft being complete or incomplete, which can be significant for the research. After diagnosis and classification, the following patient data was obtained: patient age, weight, gender, type of surgery (primary or following, i.e. when the surgery is a correction of a previous treatment), if a bone graft is needed for closure, history of maxillofacial surgery or orthodontics, operation technique, operation duration, type of an aesthesia (local or general), radiographical records and light photos. These data were collected during the pre-operative consultation, about 24 hours before surgery. It was the policy of the team to admit and see all patients one day prior to surgery for counselling, postoperative instructions and evaluating the patient's facial defect.

Dental implants have been in routine clinical use for over three decades and are a predictable treatment modality. However, as with all other aspects of dentistry, complications occur. A 50-year-old female patient with complaints of a long ongoing unpleasant altered nasal airflow presented herself at the VU University Medical Center Amsterdam. Visual inspection of the right nasal cavity revealed that the apical part of a dental implant placed in the upper right first incisor region had perforated the nasal floor and was partially protruding into the nasal cavity. Subsequent treatment consisted of a transnasal resection of the apical part of the dental implant to the level of the nasal floor. After a 12-month follow-up period, the patient reported having no altered nasal airflow. In conclusion, dental implants protruding into the nasal cavity can cause an alteration to the airflow. Furthermore, a partial removal of the apical part of the dental implant is a viable method of treating dental implants that extend into the nasal cavity.

Sports and exercise are important causes of maxillofacial injuries. Different types of sports might differ in frequency and type of fractures. The aim of the present study was to explore the possible relation between the types of sport practiced and the frequency and nature of the facial bone fractures of patients presenting in an oral and maxillofacial surgery department of a Dutch university center. This study is based on an analysis of patient records containing maxillofacial fractures sustained between January 1, 2000 and April 1, 2014 at the Vrije Universiteit University Medical Center (VUmc) in Amsterdam, The Netherlands. The present study comprised data from 108 patients with 128 maxillofacial fractures. Seventy-nine percent of the patients were male and 21% were female. The patients ranged in age from 10 to 64 years old with a mean age of 30.6 _12.0. The highest incidence of sport-related maxillofacial fractures occurred in individuals between the ages of 20 and 29. The most common sport-related fractures were zygoma complex fractures, followed by mandible fractures. Soccer and hockey were the most prominent causes of sport-related maxillofacial trauma in the present study. Coronoid process fractures were only observed in soccer players and not in other sports groups. Mandible angle fractures were relatively more frequent in rugby than in other sports. The results of this study suggest a relation between type of sport and the nature and frequency of the fractures it causes.

The influence of funding on the main outcome of a random control trial (RCT) is important, as it could potentially lead to bias towards industry, and results that are too optimistic. We investigated the association between funding, the published outcome, and the risk of bias in trials in oral and maxillofacial surgery (OMFS) published from January 2000 to May 2013 listed in PubMed. The methods used were scored using the risk of bias items given in a Delphi List. Sources of funding were recorded and categorised five ways: not funded, funded by industry, not funded by industry, supported by industry, and source of funds not clear. A total of 390 RCT met the inclusion criteria, and there was a correlation between funding and favourable main outcomes, although this was not significant. There was no correlation between the risk of bias and favourable results of the main outcome of a trial, or between the risk of bias and the reported source of funding in post-hoc analysis. We were unable to show a significant correlation between funding and a higher likelihood of a favourable result for the primary outcome in RCT in OMFS. We also failed to show a significant correlation between the risk of bias of a trial and its main outcome. In contrast, the source of funding proved to affect the risk of bias of a trial significantly, although not in post-hoc analysis. Funded trials were better organised, and so had a lower risk of bias. (C) 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved

Recent developments in craniofacial reconstruction have shown important advances in both the materials and methods used. While autogenous tissue is still considered to be the gold standard for these reconstructions, the harvesting procedure remains tedious and in many cases causes significant donor site morbidity. These limitations have subsequently led to the development of less invasive techniques such as 3D bioprinting that could offer possibilities to manufacture patient-tailored bioactive tissue constructs for craniofacial reconstruction. Here, we discuss the current technological and (pre)clinical advances of 3D bioprinting for use in craniofacial reconstruction and highlight the challenges that need to be addressed in the coming years.

Introduction: The incidence of maxillofacial fractures varies widely between different countries. The large variability in reported incidence and aetiology is due to a variety of contributing factors, including environmental, cultural and socioeconomic factors. This retrospective report presents a study investigating the aetiology and incidence of patients with maxillofacial fractures in Amsterdam over a period of 10 years. Results: The study population consisted of 408 males and 171 females with a mean age of 35.9 (SD: ±16.3) years. The age group 20-29 years accounted for the largest subgroup in both sexes. The most common cause of the fractures was traffic related, followed by violence. There were mainly mandibular and zygomatic bone fractures in both males and females, accounting for approximately 80% of all fractures. The main fracture site of the mandible was the combination of mandibular body with mandibular condyle (66 patients; 26.8%), followed by the combination of bilateral condylar fracture and fracture of the symphysis (43 patients; 17.5%). In fractures of the upper 2/3 of the face, zygomatic bone fractures were most common. In patients with alcohol consumption the injury was mostly the result of violence. In conclusion, this report provides important data for the design of plans for injury prevention, as compared with previous studies. Violence related injuries are increasing whereas fractures caused by traffic accidents are decreasing. © 2011 European Association for Cranio-Maxillo-Facial Surgery.

This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial trauma between January 2000 and January 2009 in the Department of Oral and Maxillofacial Surgery of the VU University Medical Center, Amsterdam. Patients' records were reviewed for complaints and information related to deep venous thrombosis (DVT) and pulmonary embolism (PE). The patients were classified according to a risk classification, and the incidence of reported DVT and PE was calculated. None of the patients received any form of thromboembolism prophylaxis. Of the 479 patients included in this study, one presented with VTE (0.2%). This male patient was treated for a panfacial trauma and was classified as high risk. From all analysed parameters only surgery time classification proved to have a significant relationship with VTE. © 2012 International Association of Oral and Maxillofacial Surgeons.

The surgical treatment and complications of patients with mandibular fractures in Amsterdam over a period of 10 years are analysed. Between January 2000 and January 2009 225 patients were surgically treated for a mandibular fracture (mean age of 32.6 (SD ± 14.6) years). A total of 426 fracture lines were identified. Of 213 dentate patients 29 patients were treated primarily with intermaxillary fixation (IMF). IMF combined with osteosynthesis was performed on 99 patients. Seventy-nine patients received IMF only per-operatively to make open reduction and internal fixation (ORIF) possible. Of 12 edentulous patients three patients were treated with Gunning splints. Nine patients were treated by manual reduction and internal fixation. A total of 1965 screws and 442 plates were used. Sixty (26.7%) patients presented with complications, including (transient) hyposensibility of the lip and chin (34 patients), dysocclusion (15 patients), infected osteosynthesis material (six patients) and temporomandibular dysfunction (five patients). Four patients needed surgical retreatment for correction of a dysocclusion. The results of this report are partly in line with other studies and provide important data for improving the treatment of the fractured mandible. © 2011 European Association for Cranio-Maxillo-Facial Surgery.

Objective. Controversy exists about the effectiveness of anticonvulsants for the management of orofacial pain disorders. To ascertain appropriate therapies, a systematic review was conducted of existing randomized controlled trials.Study design. Trials were identified from PubMed, Cochrane, and Ovid Medline databases from 1962 through March 2010, from references in retrieved reports, and from references in review articles. Eight useful trials were identified for this review. Six studies were randomized placebo-controlled trials and 2 studies were randomized active-controlled. Two independent investigators reviewed these articles by using a 15-item checklist.Results. Four studies were classified as "high quality." However, heterogeneity of the trials and the small sample sizes precluded the drawing of firm conclusions about the efficacy of the interventions studied on orofacial pain patients. Conclusions. There is limited to moderate evidence supporting the efficacy of commonly used anticonvulsants for treatment of patients with orofacial pain disorders. More randomized controlled trials are needed on the efficacy of anticonvulsants.

We investigated the etiology, incidence, and complications of patients with mandibular fracture in Amsterdam for a period of 10 years. Between January 2000 and January 2009, 213 patients with surgically treated mandibular fracture were identified. Two hundred thirteen patients were included with a mean age of 32.5 (SD, 15.2) years. Male-female ratio was 2.2:1. A total of 410 fracture lines were identified. In violence-related injuries, angle fractures were proved to be the main fracture site. For male patients, violence (33.6%) was the main cause of injury. The most common cause for female patients was traffic related. In 169 patients, open reduction with internal fixation was performed in 17 patients without intermaxillary fixation. Twenty-seven patients were treated only with intermaxillary fixation. A total of 1738 screws and 393 plates were used. Sixty patients presented with complications. The results of this report are partly in line with other studies and provides important data for the design of plans for injury prevention.

This study retrospectively investigates the incidence and risk factors for venous thromboembolism (VTE) in patients undergoing maxillofacial surgery. Data were obtained from patients treated between January 2005 and June 2006. Patients' records were reviewed for complaints and information relating to deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients completed a questionnaire on complaints relating to DVT and PE. The patients were classified according to risk and the incidence of reported DVT and PE was calculated. The study population comprised 411 patients with a mean age of 32 (± 17) years. The median postoperative follow-up period was 53 (23-639) days. None of the patients received thromboembolism prophylaxis. The incidence of VTE in the study group was 0.5%. Logistic regression analysis demonstrated a relationship between body mass index and hospital stay with thromboembolism (p < 0.05). Patients undergoing pre-implant surgery with bone graft proved to be at risk (p = 0.07). The incidence of VTE in oral and maxillofacial surgery seems to be low, but thromboembolism prophylaxis may be justified in patients with clear potential risk factors. © 2009 International Association of Oral and Maxillofacial Surgeons.

This study was designed to investigate the effect of compression with ice and compression alone on pain and quality of life after surgical removal of mandibular third molars. A prospective, single-blind, randomized controlled study design was chosen. Participants in group A applied 45 min of repeated compression with ice; those in group B applied 45 min of repeated compression without ice (control); and those in group C did not apply any compression. Pain intensity was measured on a visual analogue scale (VAS) three times a day for seven days. At day seven, overall pain reduction was scored on a global perceived effect (GPE) scale and a quality-of-life questionnaire was completed. Ninety-five patients completed the trial.The VAS scores demonstrated a significant pain decrease in groups A and B three days postoperatively. No significant differences were observed between groups A and B. Based on the GPE ratings, in groups A and B more patients indicated that pain was reduced successfully, but this was not statistically significant. Quality of life was significantly better for patients in groups A and B. These results demonstrate that compression after surgical removal of mandibular third molars is a valuable method for preventing pain.

9cells per L and a C-reactive protein concentration of 2629 nmol/L. MRI showed several facial, intraorbital, and intracranial abscesses with bilateral cavernous sinus thrombosis. The patient was given intravenous antibiotics and underwent surgical drainage of the abscesses. Bacterial cultures were positive for Streptococcus anginosus. The patient’s condition improved after 3 weeks and he completely recovered.