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Background: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods: Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. Results: The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. Conclusions: A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations.

Purpose: Intermaxillary fixation (IMF) is traditionally achieved with arch bars; however, this method has several well-known disadvantages and other techniques, such as bone screws, are available. This study evaluated current evidence regarding these IMF screws (IMFSs) for mandibular trauma and to assess whether this allows a change of treatment protocol for IMF. Materials and Methods: A systematic electronic literature search was conducted in the PubMed, Embase, and Cochrane databases. Titles and abstracts retrieved from the search were screened and evaluated for inclusion and exclusion criteria. The full text of all relevant articles was read and citation lists were checked for any missing references. All randomized controlled trials (RCTs) were subjected to a quality assessment. Included articles were checked for outcome measurements concerning occlusion, operative time, oral hygiene, root trauma, wire-stick injuries, and mucosa overgrowth. Results: Twenty-two articles (17 case series, 4 RCTs, and 1 cohort study) were included. None of the RCTs scored high methodologic results in the quality assessment. The results suggest IMFSs have similar malocclusion rates as arch bars, fewer wire-stick injuries, improved oral hygiene, and shorter operative time. Root damage is less likely to occur with self-drilling screws and seldom requires treatment. Conclusions: Although the methodologic quality of the included studies is poor, self-drilling IMFSs are recommended for temporary per-operative IMF of noncomminuted mandibular fractures. More high-quality studies are required to allow an evidence-based change of protocol. (C) 2015 American Association of Oral and Maxillofacial Surgeons

IntroductionA mandibular condyle fracture can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation (ORIF). Many IMF-modalities can be chosen, including IMF-screws (IMFS). This prospective multi-centre randomised clinical trial compared the use of IMFS with the use of arch bars in the treatment of mandibular condyle fractures.ResultsThe study population consisted of 50 patients (mean age: 31.8 years). Twenty-four (48%) patients were allocated in the IMFS group. Twenty-six (52%) patients were assigned to the arch bars group. In total 188 IMF-screws were used (5-12 screws per patient, mean 7.83 screws per patient). All pain scores were lower in the IMFS group. Three patients developed a malocclusion (IFMS-group: one patient, arch bars-group: two patients). Mean surgical time was significantly shorter in the IMFS group (59 vs. 126 min; p < 0.001). There were no needlestick injuries (0%) in the IMFS group and eight (30.7%) in the arch bars group (p = 0.003). One IMF-screw fractured on insertion (0.53%), one (0.53%) screw was inserted into a root. Six (3.2%) screws loosened spontaneously in four patients. Mucosal disturbances were seen in 22 patients, equally divided over both groups.ConclusionConsidering the advantages and the disadvantages of IMFS, and observing the results of this study, the authors conclude that IMFS provide a superior method for IMF. IMFS are safer for the patients and surgeons.

Objective The aim of this article was to review and discuss papers that were published during the past 30 years regarding the distribution and characteristics of motor vehicle accidents-related facial injuries throughout the world. Methods We systematically reviewed all papers that were published in English between January 1980 and December 2013 using MEDLINE and the MeSH term “facial fractures” together with the term “motor vehicle”. Results The percentage of motor vehicle accidents as an etiological factor in epidemiological studies about maxillofacial injuries ranged between 11% and 85%. On the whole, a progressively decreasing trend was observed, particularly in North America, Brazil, and Europe. Discussion Motor vehicle accidents are still one of the most important etiological factors for maxillofacial injuries. A great difference in the incidence of this kind of fractures between developed countries and developing countries can be observed.

ObjectiveThe aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.Study DesignThe following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.ResultsThe most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.ConclusionsFalls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

The aims of this study were to assess and compare epidemiological data on mandibular fractures from two European centres and to perform a review of the literature. Between 2001 and 2010, a total of 752 patients with a total of 1167 mandibular fractures were admitted to a hospital in Turin, and 245 patients with a total of 434 mandibular fractures were admitted to a hospital in Amsterdam. The mean age in Turin was 34.8 years and in Amsterdam was 32 years. The age group 20-29 years showed the highest incidence of mandibular fractures in both centres. The fractures were mainly the result of assaults, in agreement with several articles in the recent literature, followed by falls. The continuous long-term and multicentre collection of data on the epidemiology of maxillofacial trauma is important because it provides the information necessary for the development of preventative measures aimed at reducing the incidence of facial injuries.

PurposeMany studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains.Material and methodsIn this study, an attempt was made to quantify the level of agreement between a sample of maxillofacial surgeons worldwide, on the classification and treatment decisions in three different unilateral mandibular condyle fracture cases.ResultsIn total, 491 of 3044 participants responded. In all three mandibular condyle fracture cases, a fairly high level of disagreement was found. Only in the case of a subcondylar fracture, assuming dysocclusion was present, more than 81% of surgeons agreed that the best treatment would be open reduction and internal fixation.ConclusionsBased on the study results, there is considerable variation among surgeons worldwide with regard to treatment of unilateral mandibular condyle fracture. 3D imaging in higher fractures tends to lead to more invasive treatment decisions.

PurposeWhen establishing intermaxillary fixation (IMF) using bone screws, fracture of a screw is a potential complication. This study was conducted to investigate the forces that arise at bone screw insertion and to determine safety margins between torque for manually tightened insertion and torque until breakage for 3 different IMF screw systems, which could ultimately favor the use of 1 IMF screw system based on decreased risk of complications.Materials and MethodsIMF screws were placed into porcine mandibles by 3 oral and maxillofacial surgeons. The porcine mandibles were evaluated for cortical thickness and suitable insertion sites by cone-beam computed tomography. Measurements of torque until failure were performed on predrilled aluminum plates by the primary author. A digital torque screwdriver measured 180 data points per second as continuous data and recorded the measurements.ResultsMeasurements indicated clear differences in torsion forces between manually tightened insertions and torque until breakage for all 3 IMF screw systems. No statistical difference in safety margins was found among the IMF screw systems.ConclusionsBecause no statistical differences in safety margins were found among the IMF screw systems, this study indicates that IMF screw selection should be based on other clinical factors, such as ease of use or economic factors. Future prospective studies are necessary to fully determine evidence-based criteria for IMF screw selection.

ObjectiveThe aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.Study DesignDemographic and injury data were recorded for each patient who was a victim of an assault.ResultsAssaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.ConclusionsOur data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

OBJECTIVE To describe the comparison of multiple and single pain ratings in patients with complex regional pain syndrome type I (CRPS I). DESIGN Correlation, agreement, and reliability analyses were performed between the average pain intensity measured 3 times a day over a course of 4 days and one single pain rating (designated the "recalled average" pain, as assessed by the patient) before treatment and at 1-, 3-, and 6-month periods after treatment. PATIENTS The patient population consisted of 54 patients with CRPS I in a randomized trial. RESULTS The results show that both measurements correlate and have excellent agreement. Furthermore, both ratings measure significant pain reduction after treatment; "recalled average" pain, however, reflects greater change in pain intensity. CONCLUSIONS In patients with CRPS I a single pain rating is an accurate predictor of the average pain measured by a multiple pain-rating test. Moreover, both assessments are accurate enough to determine changes in pain over time with an effective treatment.

After treatment of fractures in the neck of the mandible by means of immobilization of the dentition, often more or less severe manifestations of malocclusion remain. It was hypothesized that this is caused by an altered articulation in the jaw joint on the affected side. Furthermore, it was hypothesized that an anteriorly displaced condyle, as observed frequently as a side effect of the treatment, is caused by pull of the lateral pterygoid muscle, despite maxillomandibular fixation.Intervention experiments were performed in silico to test these hypotheses. With a biomechanical model of the human masticatory system alterations were applied mimicking a fractured mandibular neck and configurations that had been observed after healing.It was predicted that the altered articulation in the jaw joint caused asymmetrical jaw movements despite symmetrical muscle activation. The jaw was predicted to close with an open bite similar to clinical observations. The predicted laterodeviations, however, were not in accordance with clinical observations. Despite maxillo-mandibular fixation the lateral pterygoid muscle was able to pull the mandibular condyle out of its fossa in anterior direction. Consequently, despite some methodological limitations, in general the predictions corroborated the hypotheses.

The sinus augmentation, or sinus lift procedure, is an internal augmentation of the maxillary sinus, which is intended to increase the vertical bony dimension in the lateral maxilla to make the placement of dental implants possible. Complication rate associated with maxillary sinus augmentation procedures in the literature is quite low. Typically, perforation of the Schneiderian membrane, hemorrhage, infection, and rhinosinusitis are more frequently encountered. Therefore, the aim of this article was to briefly review and resume the more common complications associated with sinus augmentation procedures.

A new staging system for osteoradionecrosis of the mandible has been retrospectively applied to a group of 31 patients. In this system clinicoradiographic signs and symptoms are incorporated in a simplified manner. For imaging purposes the use of plain radiographs such as periapical films and panoramic radiographs is recommended, mainly because of their readily availability. The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes. Key words:Osteoradionecrosis, jaw bones, mandible, staging, classification.

The epidemiology of facial trauma may vary widely across countries (and even within the same country), and is dependent on several cultural and socioeconomic factors. We know of few reviews of published reports that have considered the sex distribution and aetiology of maxillofacial trauma throughout the world. The aim of this review was to discuss these aspects as they have been presented in papers published during the last 30 years. We made a systematic review of papers about the epidemiology of maxillofacial trauma that were published between January 1980 and December 2013 and identified 69 studies from Africa (n=9), North America and Brazil (n=6), Asia (n=36), Europe (n=16), and Oceania (n=2). In all the studies men outnumbered women, the ratio usually being more than 2:1. In American, African, and Asian studies road traffic crashes were the predominant cause. In European studies the aetiology varied, with assaults and road traffic crashes being the most important factors. In Oceania assaults were the most important. A comparison of the incidence of maxillofacial trauma of different countries together with a knowledge of different laws (seat belts for drivers, helmets for motocyclists, speed limits, and protection worn during sports and at work) is crucial to allow for improvement in several countries. To our knowledge this paper is the first attempt to study and compare the aetiologies of maxillofacial trauma.

In the literature it is questioned if the presence of maxillofacial trauma is associated with the presence of brain injury. The aim of this study is to present a 10-year retrospective study of the incidence and aetiology of maxillofacial trauma associated with brain injury that required both oral and maxillofacial and neurosurgical intervention during the same hospital stay. Forty-seven patients from a population of 579 trauma patients undergoing maxillofacial surgery were identified. The main cause of injury was road traffic collision, followed by falls. Interpersonal violence correlated less well with traumatic brain injury. Most of the patients were males, aged 20-39 years. Frontal sinus fractures were the most common maxillofacial fractures (21.9%) associated with neurosurgical input, followed by mandibular fractures and zygomatic complex fractures. In the general maxillofacial trauma population, frontal sinus fractures were only found in 2.2% of the cases.At presentation to the Emergency Department the majority of the patients were diagnosed with severe traumatic brain injury and a Marshall CT class 2. Intracranial pressure monitoring was the most common neurosurgical intervention, followed by reconstruction of a bone defect and haematoma evacuation.Although it is a small population, our data suggest that maxillofacial trauma does have an association with traumatic brain injury that requires neurosurgical intervention (8.1%). In comparison with the overall maxillofacial trauma population, our results demonstrate that frontal sinus fractures are more commonly diagnosed in association with brain injury, most likely owing to the location of the impact of the trauma. In these cases the frontal sinus seems not specifically to act as a barrier to protect the brain.This report provides useful data concerning the joint management of oral and maxillofacial surgeons and neurosurgeons for the treatment of cranio-maxillofacial trauma and brain injury patients in Amsterdam.

Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and such fractures. This study is based on 2 databases that have continuously recorded data of patients hospitalized with maxillofacial fractures between 2001 and 2010. On the whole, 447 patients (334 males, 113 females) with pure blow-out orbital wall fractures were included. The most frequently involved orbital site was the floor (359 fractures), followed by medial wall (41 fractures) and lateral wall (5 fractures). At presentation, 227 patients (50.7%) had evidence of diplopia. In particular, in most patients, a diplopia in all directions was referred (78 patients). Statistically significant associations were found between diplopia on eye elevation and orbital floor fractures (P < 0.05) and between horizontal diplopia and medial wall fractures (P < 0.000005). In patients under evaluation for orbital trauma, the observation of diplopia on eye elevation and horizontal diplopia at presentation could be useful clinical indicators orbital floor and medial wall fractures, respectively.

Objectives: To evaluate the value of Multi-Frequency Bioelectrical Impedance Analysis (MFBIA) in patients suffering from Complex Regional Pain Syndrome Type I (CRPS1). We hypothesised that patients with CRPS I have altered tissue properties in the affected limbs compared with the non-affected limbs and with limbs from unaffected individuals (control limbs). Participants: 28 patients suffering from CRPS I and in 18 healthy right-handed. Methods: Receiver operating characteristic (ROC) analyses and areas under the curve (AUC) were performed to analyse the sensitivity and specificity of the MFBIA to detect CRPS I. Results: Our data showed the phase angle (Φ), which is defined as the relation between the resistance (ability of an medium to conduct an alternating electrical current) and the reactance (resistive effect due to capacitance produced by tissue interface and cell membrane) was decreased in the CRPS I limbs compared with both the contralateral side (p = 0.004) and limbs (p = 0.02) from unaff...

To provide an empirical description of the relationship between the spread of head and neck infections, and the causal tooth.The hospital records of 155 patients presenting with odontogenic head and neck infections due to a single identifiable tooth from January 2000 to August 2011 were reviewed. The following data were collected: age, sex, clinical presentation, etiology, location, and spread of infection. The causal tooth and location of infection were subsequently compared to the literature.In the present study population, the causal tooth most frequently (47.1%) consisted of the third mandibular molar. Infection of maxillary teeth most commonly spread to the buccal space, whereas infection originating in the mandible mostly spread to the submandibular, pterygomandibular, and buccal spaces. The literature search provided 18 usable articles. Fourteen studies discriminated between mandibular and maxillary origin of infection, and three articles elaborated on the direct relationship between causal tooth and location of infection. Spaces most frequently affected in the literature are the submandibular, masticator, lateral pharyngeal, buccal, and sublingual spaces. A large amount of discrepancy was found between studies.When describing the location of infection, most studies do not discriminate between maxillary and mandibular origin. Although the literature seems to be unambiguous about the predetermined spread, this article demonstrates that it is more difficult to predict the spread of an infected tooth than previously expected. Large studies with clearly noted causal teeth in relation to location of spread should shed more light on the discrepancies found in this review.

There is no consensus on the use of antibiotic prophylaxis in orthognathic surgery to prevent infections. A systematic review of randomized controlled trials investigating the efficacy of antibiotic prophylaxis was performed to make evidence-based recommendations. A search of Embase, Ovid Medline, and Cochrane databases (1966-November 2012) was conducted and the reference lists of articles identified were checked for relevant studies. Eleven studies were eligible and were reviewed independently by the authors using two validated quality assessment scales. Three studies were identified to have a low risk of bias and eight studies a high risk of bias. Most studies compared preoperative and perioperative antibiotic prophylaxis with or without continuous postoperative administration. Methodological flaws in the included studies were no description of inclusion and exclusion criteria and incorrect handling of dropouts and withdrawals. Studies investigating the efficacy of antibiotic prophylaxis are not placebo-controlled and mainly of poor quality. Based on the available evidence, preoperative antibiotic prophylaxis appears to be effective in reducing the postoperative infection rate in orthognathic surgery. However, there is no evidence for the effectiveness of prescribing additional continuous postoperative antibiotics. More trials with a low risk of bias are needed to produce evidence-based recommendations and establish guidelines.

Periosteal ossification of the vascular pedicle of a fibular free flap after reconstruction of mandibular and maxillary continuity defects has been thought to be rare. The purpose of this study was to evaluate its incidence and contributory factors to its development.

Rapid prototyping is een methode die het mogelijk maakt een driedimensionaal model te vervaardigen op basis van tweedimensionale beeldvorming. Voor modellering bestaan verschillende methoden, zoals stereolithografie, selectief lasersinteren, laser-metaalsinteren, twee-fotonpolymerisatie, gelamineerde objectmodellering, driedimensionaal printen, driedimensionaal plotten, polyjet inkjettechnologie, gefuseerde depositiemodellering, vacuümgieten en frezen. De diverse methoden die in de biomedische sector worden toegepast, verschillen onderling in productieproces, materiaal en eigenschappen van het geproduceerde driedimensionale model. Rapid prototyping wordt vooral gebruikt voor preoperatieve planning, simulatie, educatie en onderzoek naar en ontwikkeling van de biotechnologische mogelijkheden.

IntroductionWith respect to maxillofacial trauma a substantial part consists of midfacial fractures. The distribution of fracture sites seems to be influenced by the cause of the injury, geographic location, local behaviour and socioeconomic trends. This retrospective study presents an investigation of the aetiology and incidence of midfacial fractures in Amsterdam over a period of 10 years.ResultsThe study population consisted of 278 patients, 200 males and 78 females, with a mean age of 39.3 (SD: ±16.0) years and a male-female ratio of 2.6:1. Most fractures were found in the age group of 20-29 years for males and the age group of 50 years and older for females. The most common cause of the fractures was traffic related accidents. The main fracture site was the zygomatic complex, followed by the zygomatic arch and the orbital floor. In patients with alcohol consumption, violence was the main cause of injury. Complications consisted mainly of suboptimal fracture reduction, followed by temporary paraesthesia of the infraorbital nerve and wound infection. Complications were treated by retreatment, removal of the osteosynthesis material and antibiotic therapy.ConclusionThis study presents the aetiology and incidence of midfacial fractures in a Dutch population over a period of 10 years. Furthermore our treatment protocols for these fractures are discussed.

IntroductionMany studies have compared treatment outcomes after open reduction and internal fixation (ORIF) and closed reduction (CR) of mandibular condylar fractures. Despite this the optimal treatment for these fractures remains a controversy. The purpose of this review is to compare the influence of objective and subjective treatment outcomes after open versus closed treatment of mandibular condyle fractures on quality of life, based on the current literature.MethodsA MedLine and Embase search was performed to find relevant titles on treatment outcomes after open versus closed reduction of mandibular condylar fractures.ResultsThirty-six studies were found. Twenty-eight retrospective studies, in addition to eight prospective studies were assessed. Nine treatment outcome variables were evaluated from the studies. Three studies reported on subjective discomfort. Although many studies investigated (objective) measurements (e.g. range of motion, masticatory function), no studies evaluated quality of life outcomes. In conclusion, prospective, patient-centred research is needed, in order to provide a guideline in decision making in the treatment of mandibular condylar fractures, based on subjective patient satisfaction.

Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4-87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures.

ObjectiveBicycle-related injuries account for an important proportion of road injuries all over the world. As only few reports have focused on the characteristics of maxillofacial fractures sustained in bicycle accidents, the purpose of this study was to present and compare epidemiological data about bicycle-related maxillofacial injuries in two European centers between 2001 and 2010.MethodsBicycle-related facial fractures occurred in 105 patients (79 males, 26 females) in Turin, with a percentage of 5.77 among all facial fractures, and in 103 patients (55 males, 50 females) in Amsterdam, with a percentage of 19.69.ResultsThe major risk groups include young people between their first to third decades. The mandible is the most frequently involved facial bone. Among mandibular injuries the most commonly involved site was the condyle.ConclusionsBicycle-related injuries must be considered an important etiological factor in maxillofacial fractures with typical patterns, such as a peculiar seasonal incidence.

Typical associated signs and symptoms of displaced zygomatic fractures include lack of zygoma projection, diplopia, and sensory disturbances of the infraorbital nerve (ION). The aim of this article was to assess eventual associations between ION sensory disturbances and zygomatic fractures patterns. This study is based on 2 databases that have continuously recorded patients hospitalized with maxillofacial fractures in 2 Departments of Maxillofacial Surgery in Amsterdam, The Netherlands, and Turin, Italy between 2001 and 2010. The following data for patients surgically treated for displaced zygomatic fractures were considered: gender, age, site and severity of facial fractures, etiology, and presenting symptoms. Statistically significant associations were found between ION sensory disturbances and assaults (P = 0.007) and sport accidents (P = 0.00003), as well as between ION sensory disturbances and isolated zygomatic fractures (P = 0.000002) and between ION sensory disturbances and diplopia (P = 0.00009).The severity of injury and the absorption of middle-energy and high-energy forces by the zygomatic complex only were associated with ION sensory disturbances. The etiology and severity of the injury as well as the presence of associated symptoms should be thoroughly investigated when a zygomatic fracture is suspected.

BACKGROUND: For patients with surgical third molar removal, it is unknown what constitutes a clinically important change in patients’ visual analogue scale (VAS) reports of pain intensity.OBJECTIVES: To determine what constitutes a clinically important change in pain intensity on a VAS following surgical removal of the third molar.METHODS: The study population consisted of patients participating in three randomized trials. Patients were asked to rate their pain three times per day over a period of seven days on a 100 mm VAS after surgical removal of the third molar. Global Perceived Effect was measured on day 1 and day 7 and was used as the external criterion for assessing clinically important pain reduction. Global Perceived Effect scores of 6 (‘much improved’) or higher were classified as clinically ‘successful’, and scores of 5 (‘slightly improved’) or below were classified as clinically ‘unsuccessful’. For each trial, the mean absolute and relative changes in VAS scores were calculated for both ‘successful’ and ‘unsuccessful’ treatments. Sensitivity and specificity analyses were performed.RESULTS: The patients who reported ‘successful’ pain reduction showed a relative pain reduction of ≥69% and an absolute pain reduction >2.5 cm on the VAS, whereas patients who classified their pain reduction as ‘unsuccessful’ had a relative pain reduction of ≥18.5% and an absolute pain reduction CONCLUSION: Relative pain reduction of ≥50% and an absolute pain reduction of ≥2.5 cm on the VAS were most accurate in predicting a successful pain reduction after a given treatment.

The high occurrence of orofacial cleft, particularly in South-East Asia, and the psychological and social-economic influence of the condition both advocate to rise attention for patient reported health outcomes in treatment evaluation.This especially applies for surgical procedures since these are invasive, rather drastic for patient and family, go along with several risks and are irrevocable, not to mention the financial implications.Several studies have yet been performed in order to generate a proper tool for evaluation of QoLin patients affect with CLP. However, studies are often of limited value and mainly performed among specific populations from developed countries. Moreover, what the effect is of interventions on the QoL measured, remains unanswered.The authors therefore conclude that additional research is ought to be done. The aim of this study is validate a tool for comparing QoL reported by CLP patients who underwent different (surgical) treatment procedures in Indonesia. The twenty-six item WHOQOL-BREF will be used as it is expected to be suitable for this purpose.The study will contribute to improvement of cleft treatment procedures and academic knowledge on quality of life measurement, both in Indonesia and the rest of the world.This will be performed in a cross-sectional study. The WHOQOL consists of four domains covering different facets of QoL. Adjacently, an individual’s perception of their QoL and their health, identification of the relation between QoL and oral health and biographic parameters will be registered separately. The WHOQOL-BREF will be administered to patients affected with the clinical diagnoses of non-syndromicorofacial cleft in all forms and a matching control group on epidemiological fields. Allindividuals should becapable of independently responding the questionnaire.The administration will be done following the WHOQOL-BREF manual. Statistical analyses will be performed using statistical analysis software SPSS and will be done according academic psychometric protocols.

An advanced technology with implants based has now been developed in recent years.Implant with the bridge superstructure method is employed after variety of considerations where it is expected to meet its function, aesthetics, and comfortability.The alveolar bone existed is one reason for the process of adding bone (bonegraft).This case report proposes to determine the successful insertion of a superstructure anterior implant bridge post autograft.Two female patients were asked to use dental implant anterior with bridge system.The first case, the autograft application is made for a 20-year-old woman with edentulous teeth 11, 21, 22. One year later it was then inserted in the area of dental implant fixture 11 and 22. After 9 months, the healing abutments and the superstructure were inserted too.2 weeks after, the abutments of bridge and crowns of teeth 11, 21 and 22 with a pontic in the teeth 21 had been inserted. The second case, a 46-year-old woman with edentulous 11,12,21,22.They want to change the denture because they did not feel comfortable with the removable denture acrylic.Fixture placement was done a year after autograft.Insertion of healing abutments and the superstructure printing can be done after 6 months.A month later implant abutments and crowns could be inserted.Labial fullness is corrected; an implant-retained in the region of 12 and 21, 12, and 22 used the pontic.Prosthodontic rehabilitation with a fixed denture using the implant bridge after autograft anterior maxilla is an alternative fixed denture placement with satisfactory results, aesthetic correction and comfortably.

Ameloblastoma are benign, odontogenic tumors. Depending on the type of ameloblastoma, treatment often consists of curettage, enucleation or resection. Depending on the size of the resection, reconstruction might be indicated. Radiation or chemotherapy is not considered an effective treatment. Recurrence rates differ for each type of ameloblastoma and each treatment. The purpose of this study is to retrospectively map out different treatment methods used in Makassar, Jakarta and Yogyakarta over the past 20 years (1996 – 2016). Data will be provided by dental hospitals of the following universities:Hasannuddin university in Makassar, University of Indonesia in Jakarta and Gadjah Mada university in Yogyakarta. All patients treated during the indicated timeframe will be included. A data collection questionnaire will be designed to collect the necessary information and will be completed for each treated patient. All treatment methods and any peroperative or postoperative complications (up to two weeks), will be collected. An SPSS 23.0 database will be designed for data analysis, statistical calculations depend on the amount of data available.

Objectives: Additively manufactured bone models, implants and drill guides are becoming increasingly popular amongst maxillofacial surgeons and dentists. To date, such constructs are commonly manufactured using CT technology that induces ionizing radiation. Recently, ultrashort echo time (UTE) MRI sequences have been developed that allow radiation-free imaging of facial bones. The aim of the present study was to assess the feasibility of UTE MRI sequences for medical additive manufacturing (AM). Methods: Three morphologically different dry human mandibles were scanned using a CT and MRI scanner. Additionally, optical scans of all three mandibles were made to acquire a “gold standard”. All CT and MRI scans were converted into Standard Tessellation Language (STL) models and geometrically compared with the gold standard. To quantify the accuracy of the AM process, the CT, MRI and gold-standard STL models of one of the mandibles were additively manufactured, optically scanned and compared with the original gold-standard STL model. Results: Geometric differences between all three CT-derived STL models and the gold standard were

Background In this retrospective study we evaluated the epidemiological data and the clinical and radiographical differences between surgically and non-surgically treated patients with zygomatic complex fractures at their initial assessment in our clinic over a period of 5 years. More knowledge of the clinical similarities and/or differences between the non-surgical and the surgical group will provide us a more complete view and may help physicians to develop any future methods in clinical decision making or even methods in distinguishing patients benefiting from a surgical treatment. Methods Surgically and non-surgically treated patients were included in the study, if clinical and radiographical confirmation of zygomatic complex fractures were present at initial assessment. The patient groups were divided into surgically treated zygomatic complex fractures, and non-surgically treated fractures, with and without displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results In total 283 patients were diagnosed with zygomatic complex fractures, with a mean age of 43 years (±20 years) and a domination of male patients. The mean age was higher in the non-surgically treated group and contained more female patients. Overall type C fractures and the majority of the type B fractures were treated surgically. Only 2.1% of the type A fractures were treated surgically. Overall facial swelling and paraesthesia of the infraorbital nerve were found as most common clinical findings. Additionally, malar depression and extraoral steps were frequently found in the surgically treated group, as in the non-surgically treated group only facial swelling was found frequently, whether there was fracture displacement or not. The clinical characteristics 'extraoral steps', 'intraoral steps', and 'malar depression' were found to be significantly related to surgical treatment. Conclusion Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. The group of non-surgically treated zygomatic complex fractures is a valuable group to investigate as this group also consists of patients with displaced fractures (i.e. surgical indication) and thus, could provide us more insight in future clinical decision methods. Therefore, we highly recommend more research of the non-surgically treated group. © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n = 42, 59%) and falls (n = 20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3-193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p = 0.02). Increasing age was significantly related to reduction in the intensity of pain (p = 0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures.

This study describes the comparison of multiple and single pain ratings in patients after surgical removal of the third molar. Correlation and agreement analysis were performed between the average pain intensity measured three times a day over a period of 7 days and one single pain rating (designated the 'recalled average' pain, as assessed by the patient) after surgical removal of the lower third molar. The study population consisted of patients participating in three randomized trials. The results show that both measurement correlated good to excellent, but there was a large variation in agreement between the ratings. In conclusion, in patients with surgical third molar removal a single pain rating is not an accurate predictor of the average pain measured by a multiple pain-rating test. A single pain rating cannot replace a multiple pain assessment. © 2012 International Association of Oral and Maxillofacial Surgeons.

Orofacial pain is a common complaint with multiple diagnoses. There is controversy about the effectiveness of antidepressants for the management of orofacial pain disorders. In order to be able to make a best evidence choice between available antidepressants for the treatment of orofacial pain, a systematic review was conducted of existing randomized controlled trials of antidepressants. Trials were identified from the Pubmed database up to March 2012, from references in retrieved reports and from references in review articles. Six articles were found and included in this review. Four studies were randomized placebo-controlled trials and two studies were randomized active-controlled trials. Two independent investigators reviewed these articles using a 15-item checklist. All six trials were of high quality according to the 15-item criteria. Nevertheless there was limited evidence to support the effectiveness of antidepressants in orofacial pain disorders, because of the heterogeneity of treatment modalities and the low number of randomized controlled trials per diagnose. More randomized controlled trials are needed to come to a firm conclusion for the use of antidepressants for orofacial pain disorders.

Spinal cord stimulation (SCS) has been used since 1967 for the treatment of patients with chronic pain. However, long-term effects of this treatment have not been reported. The present study investigated the long-term effects of cervical and lumbar SCS in patients with complex regional pain syndrome type I.Thirty-six patients with a definitive implant were included in this study. A pain diary was obtained from all patients before treatment and 6 months and 1 and 2 years after implantation. All patients were asked to complete a seven-point Global Perceived Effect (GPE) scale and the Euroqol-5D (EQ-5D) at each post-implant assessment point.The pain intensity was reduced at 6 months, 1 and 2 years after implantation (P0.05). However, the repeated measures ANOVA showed a statistically significant, linear increase in the visual analogue scale score (P=0.03). According to the GPE, at least 42% of the cervical SCS patients and 47% of the lumbar SCS patients reported at least 'much improvement'. The health status of the patients, as measured on the EQ-5D, was improved after treatment (P0.05). This improvement was noted both from the social and from the patients' perspective. Complications and adverse effects occurred in 64% of the patients and consisted mainly of technical defects. There were no differences between cervical and lumbar groups with regard to outcome measures.SCS reduced the pain intensity and improves health status in the majority of the CRPS I patients in this study. There was no difference in pain relief and complications between cervical and lumbar SCS.

OBJECTIVE To investigate the degree of pain reduction in patients with complex regional pain syndrome type 1 (CRPS 1) that can be defined as "successful." DESIGN All patients rated their pain on a visual analog scale (VAS; 0-10) before treatment and on three occasions after treatment, at 6 months, 1 year, and 2 years. Patients also rated a Global Perceived Effect (GPE) for their pain relief at the same time periods. The GPE items were classified as "successful" or "unsuccessful." The mean absolute and relative pain reduction (using the VAS) was calculated for both "successful" and "unsuccessful" GPE classifications for each time period. Sensitivity and specificity analyses were performed. PATIENTS Sixty-one patients with CRPS 1. RESULTS The patients defined a relative pain reduction of 58% (SD, 23.4) or more as "successful," whereas in "successful" and "unsuccessful" patient groups the pain was reduced significantly on the VAS. Furthermore, sensitivity and specificity analyses showed that a cut-off point of 50% relative pain reduction and a 3-cm absolute pain reduction on the VAS have the highest likelihood that patients will report their treatment "successful" on the GPE. CONCLUSIONS Relative pain reduction of 50% or more and an absolute pain reduction of at least 3 cm on the VAS are accurate in predicting a successful pain reduction after a given treatment.

Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome type I (CRPS I), is a disabling neuropathic pain syndrome. Controversy exists about the effectiveness of therapeutic interventions for the management of RSD/CRPS I. In order to ascertain appropriate therapies we conducted a review of existing randomized controlled trials of therapies for this disabling disease. Eligible trials were identified from the Cochrane, Pubmed, Embase and MEDLINE databases from 1966 through June 2000, from references in retrieved reports and from references in review articles. Twenty-six studies concerning treatment modalities were identified. Eighteen studies were randomized placebo-controlled trials and eight studies were randomized active-controlled trials. Three independent investigators reviewed articles for inclusion criteria using a 15-item checklist. Seventeen of the trials were of high quality according to the 15-item criteria. There was limited evidence for the effectiveness of these interventions because of the heterogeneity of treatment modalities. The search for trials concerning prevention of RSD/CRPS I resulted in two eligible studies. Both were of high quality and dealt with different interventions. There is limited evidence for their preventive effect.

Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Sialoliths are more frequently located in the submandibular gland (84%), than in the parotid gland (13%). The majority of the submandibular stones are located in Wharton's duct (90%), whereas parotid stones are more often located in the gland itself. Salivary stones consist of an amorphous mineralised nucleus, surrounded by concentric laminated layers of organic and inorganic substances. The organic components of salivary stones include collagen, glycoproteins, amino acids and carbohydrates. The major inorganic components are hydroxyapatite, carbonate apatite, whitlockite and brushite. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland.