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A novel technique to reduce donor site morbidity after radial forearm free flap (RFFF) harvest, using a local full-thickness skin graft (FTSG), is described. Thirty consecutive patients undergoing RFFF for head and neck reconstruction were enrolled in a prospective study. Donor site defect closure was performed with spindle-shaped FTSGs excised from the wavelike skin incision made for the vascular pedicle. Both the removal site of the FTSG on the volar forearm and the covered RFFF donor site healed uneventfully in 29 cases, with no impairment of function related to the skin graft. No skin graft failure and no exposure, tenting, or adherence of the flexor tendons occurred. All patients expressed satisfaction with postoperative pain, the functional outcome, and cosmetic appearance. Primary donor site defect closure could be achieved in all cases with the use of a local FTSG. This graft can be gained at the access incision for the vascular pedicle, avoids expansion of the incision for a local flap technique, and does not prolong wound healing, and thus reduces both donor site and graft site morbidity of the RFFF. This technique leads to an inconspicuous aesthetic result with no apparent relevant functional deficits and avoids the need for a second donor site. [ABSTRACT FROM AUTHOR]

The aim of the present study was to compare subjective experiences using bur, ultrasonic, and sonic osteotomy systems. Ten novice (N) and 10 expert (E) practitioners performed osteotomies on bovine ribs with each system. They scored ease of handling and sense of accuracy on visual analogue scales. The duration of the osteotomy procedure and the amount of noise were recorded objectively. Learning experience was evaluated in a second run. The Mann–Whitney U -test, Wilcoxon signed rank tests, and Spearman's rank correlation coefficient were used for the statistical analyses. The sonic system was significantly slower, with the worst noise impact (92.9 dB; standard deviation (SD) 7.1). However, both user groups improved significantly in the second run (N 7.9, E 7.6). There were no significant differences in handling. The sense of accuracy was evaluated to be significantly best for the sonic system (N 8.4, E 8.4), compared to the ultrasonic system (N 7.1, E 7.1; both P = 0.043) and bur system (N 5.5, P = 0.002; E 6.0, P = 0.006). The practitioners had a promising experience with the application of the ultrasonic system and particularly with the sonic system. [ABSTRACT FROM AUTHOR]

Patients' perspective is increasingly re-cognised as an important outcome measure in oral surgery. However, how patients perceive the surgical treatment cannot be assessed currently. This would be an important indicator for process-related quality of care. It was the aim to develop and to validate an instrument for the assessment of patient-based measures of process-related quality of care in oral surgery. The new Burdens in Oral Surgery Questionnaire (Bi OS-Q) was developed in two steps in patients undergoing oral surgery. First, an item pool was created using semi-structured interviews in 90 patients. Second, a preliminary version was applied in 297 consecutively recruited patients to assess redundancy, completion rates, face validity, difficulty and distribution. Psychometric properties of the final version of the questionnaire were evaluated. The Bi OS-Q consists of 16 items and showed satisfactory internal consistency (Cronbach's alpha = 0·84) and excellent test-retest reliability ( ICC = 0·90). The questionnaire's mean score was significantly correlated with dentists' burdens ( r = 0·44) and patients' overall satisfaction ( r = 0·39) indicating sufficient validity. The Bi OS-Q is a reliable and valid instrument for the assessment of patient-based process-related quality of care in oral surgery. [ABSTRACT FROM AUTHOR]

PURPOSE: Corrective plastic surgery is indicated after accidents, burns, cancer surgery, or postoperative wound healing disorders with large tissue defects. The range of reconstructive techniques includes local skin flaps, pedicle grafts, and microvascular anastomosed flaps in the case of large defects. Main complications such as arterial and venous insufficiency caused by a vessel collapse or a vascular spasm are reported regularly in the area of anastomosed vessels and are the concern of any surgeon. Today, leeches are used if wound healing is at risk because of hemodynamic imbalance or a venous insufficiency. PATIENTS AND METHODS: A retrospective evaluation of 148 patients who underwent medical leech therapy in the case of local or pedicaled flaps and some patients who had undergone reconstruction with microvascular flaps from 2005 and 2010 was conducted. Our sample had the typical symptoms of venous congestions of their flaps, despite suture removal, relief of pressure on the flap, and the elimination of a hematoma beyond the flap after surgery. Medical leech therapy was used in these cases. RESULTS: Our series has confirmed the excellent and predictable healing after medical leech therapy for local and microsurgical anastomosed flaps in the case of venous congestion. CONCLUSION: Leech therapy should be considered as a reliable additional procedure and an advantage in maxillofacial and plastic reconstructive surgery to remedy complications resulting from a hemodynamic imbalance or venous insufficiency in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Purpose: Resorbable alloplastic materials are used in many surgical applications. This retrospective study evaluated the clinical outcome after reconstruction of traumatic orbital floor defects using a polyglactin 910/PDS implant (Ethisorb™). Patients and methods: Seventy patients with isolated blowout fractures of the orbital floor resulting in defect sizes of up to 2.5 cm were included in this study. All patients were clinically examined 5 days after surgery at the time of suture removal (T1) and 18 months postoperatively (T2). Diplopia was graded as significant diplopia or diplopia in extreme gaze. Results: At T1, diplopia was observed in 9% of the patients, swelling of the periorbital region in 6%, and enophthalmus in none of the patients. No persistent complications were observed at T2. Conclusion: Reconstructive surgery of the orbit is one of the most demanding challenges in maxillofacial surgery. For traumatic defects of the orbital floor, reconstruction using a polyglactin 910/PDS implant (Ethisorb) seems to be a reliable method for the repair of small-to-moderate defects. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This study aimed to evaluate the use of intraoperative cone-beam computed tomography (CBCT) in monitoring the results of repositioning and osteosynthesis of condylar process and head (capitulum) fractures of the mandible to see if CBCT is beneficial for these patients. Patients and methods: Sixty patients (22 females and 38 males, age range 16–17 years, average 36.5 years) with condylar process and head fractures according to the classification of Spiessl and Schroll were treated during the study period. Thirty-four of the 60 patients received a CBCT scan immediately after surgical treatment under aseptic conditions. Results: In all 34 cases, intraoperative CBCT provided high-quality imaging of the condylar process in all three planes. In four patients (11.8%), unsatisfactory reposition or unexpected complications were detected which could immediately be corrected with a surgical revision. Conclusion: Intraoperative use of CBCT enables optimization of the surgical outcome for fractures of the condylar process and head of the mandible, reduces postoperative complications, and spares patients from repeated intervention. In addition, intraoperative CBCT enables safer treatment with minimally invasive approaches. [Copyright &y& Elsevier]

Gunshot wounds of the viscerocranium are a rare occurrence during times of peace in Europe. The removal of projectiles is recommended; in some cases, however, this is controversial. The material properties of projectiles and destruction of anatomical landmarks make it difficult to determine their precise location. Therefore, navigation systems and cone-beam computed tomography (CT) provide the surgeon with continuous intraoperative orientation in real-time. The aim of this study was to report our experiences for image-guided removal of projectiles, the use of cone-beam computed tomography and the resulting intra- and postoperative complications. We investigated 50 patients with gunshot wounds of the facial skeleton retrospectively, 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region, 18 had surgical removal of projectiles without navigation assistance and in 28 cases we used cone-beam CT in the case of dislocated projectiles and fractured bones. There was a significant correlation ( p = 0.0136) between the navigated versus not navigated surgery and complication rate (8 vs. 32%, p = 0.0132) including major bleeding, soft tissue infections and nerve damage. Furthermore, we could reduce operating time while using a navigation system and cone-beam CT ( p = 0.038). A high tendency between operating time and navigated surgery ( p = 0.1103) was found. In conclusion, there is a significant correlation between reduced intra- and postoperative complications including wound infections, nerve damage and major bleeding and the appropriate use of a navigation system. In all these cases we were able to present reduced operating time. Cone-beam CT plays a key role as a useful diagnostic tool in detecting projectiles or metallic foreign bodies intraoperatively. [ABSTRACT FROM AUTHOR]

Abstract: Esophageal cancer related gene 1 (ECRG1) is a novel candidate tumor suppressor gene in human esophageal squamous cells. Overexpression of ECRG1 protein inhibits tumor cell proliferation. Genetic polymorphisms in coding sequences of the gene may cause functional alterations of the gene product and be associated with higher cancer risk and disease phenotypes. A single nucleotide polymorphism (SNP) (Arg290Gln) found in the coding region of ECRG1 might play a role in susceptibility to esophageal squamous cell carcinoma. This study examined SNPs in ECRG1 in a similar tumor type (oral squamous cell carcinoma; OSCC) and investigated the relationship between SNPs in ECRG1 and the clinical outcome of patients with OSCC. DNA samples of 137 OSCC patients were analyzed for SNP genotypes Arg/Arg, Arg/Gln and Gln/Gln in the coding region (exon 8) of ECRG1. SNP genotypes Arg/Arg were found in 70 (51%), Arg/Gln in 60 (43%) and Gln/Gln in 7 (5%) patients. There was no significant association between genotypes and survival (p =0.77) or relapse free survival (p =0.32). The Gln/Gln genotype had the best survival (not significant) probably due to rare cases of SNP Gln/Gln genotype. Genotype Arg/Arg might be a potential negative prognostic marker in OSCC, but more studies with higher patient numbers are required. [Copyright &y& Elsevier]

PURPOSE: This retrospective study was performed to compare the bone resorption rates of revascularized free fibular flaps with those of avascular fibular bone grafts. Special attention was drawn to horizontal bone resorption. PATIENTS AND METHODS: One hundred twelve patients who had received fibular grafts for reconstruction of the mandible were included in this study. Surgery was performed between 1991 and 2004, leading to a follow-up of 12 to 140 months. In 7 cases, microvascular onlay grafts (group A), and in 61 cases, microvascular reconstruction of segmental defects (group B) were performed. Avascular onlay grafts were applied (group C) in 41 patients and avascular reconstruction of segmental defects (group D) was performed in 7 patients. Bone heights were measured on panoramic views at 1, 3, and 7 years postoperatively. RESULTS: Most of the resorption in group B occurred during the first postoperative year, at an average rate of 16% (range, 3% to 30%). After the first year, transplants became almost stable, and an average of 80% of bone height was maintained after 7 years. Conversely, bone resorption continued regularly in group C, and up to an average of 51% (range, 5% to 80%) of bone height was lost after 7 years postoperatively. CONCLUSION: After mandibular reconstruction with fibular transplants, resorption occurs among both microsurgical and free grafts; however, the bone resorption rate was higher among avascular grafts. In group A and B patients, fibular grafts became stable after 1 year, but bone resorption continued at a regular rate in groups C and D.Copyright © 2007 by the American Association of Oral and Maxillofacial Surgeons [ABSTRACT FROM AUTHOR]

Copyright of Oral & Maxillofacial Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Oral & Maxillofacial Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Oral & Maxillofacial Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Oral & Maxillofacial Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Oral & Maxillofacial Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Oral & Maxillofacial Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: With respect to high-contrast structures, cone beam computed tomography (CBCT) offers an alternative imaging modality to computed tomography (CT), requiring less radiation exposure. The C-arm system SIREMOBIL Iso-C3D for three-dimensional (3D) reconstruction has made this modality available for intraoperative use. This paper presents the first intraoperative images of the facial skeleton using the SIREMOBIL Iso-C3D. Methods: Cases of a zygomaticomaxillary complex fracture, a mandibular angle fracture and a bimaxillary repositioning osteotomy are described to demonstrate the application possibilities of this system in maxillofacial surgery. Results: In addition to the uncomplicated handling of the SIREMOBIL Iso-C3D, generally important was the low level of metal artefacts in its primary and secondary reconstructions, even in close proximity to the material. However, it has to be kept in mind that while soft tissues are visualized using CBCT, information about soft tissue quality cannot be obtained. Conclusion: The SIREMOBIL Iso-C3D generates intraoperative data sets suitable for the visualization of the facial bones after open reduction of fractures. [ABSTRACT FROM AUTHOR]