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The aim of the present study was to analyze the size of the preoperatively calculated defect volume of MRONJ patients (medication-related osteonecrosis of the jaw) and to develop a computer-aided tool based on techniques of AI (artificial intelligence) that facilitates diagnostics of MRONJ. For this purpose, on the basis of 3D (three-dimensional) data sets of 175 MRONJ patients, the outline of the necrosis was marked with the software iPlan 3.0.5 (BrainLAB AG) thus determining the respective volume. The correlation of this volume with other 31 collected parameters was analyzed retrospectively. There was a significant correlation between the defect volume on the one hand, and the MRONJ stage, the number of performed operations, and the therapy invasiveness on the other hand. Furthermore, it could be shown that in one third of the cases no defects could be recognized in the 2D imaging by panoramic radiograph, while in the 3D data sets defects already had been demarcated. On the basis of these data, a computer-aided tool based on the principles of AI was developed and validated, which might allow the automated calculation of the 3D defect extension and classification of the MRONJ cases into a ranking system. In conclusion, preparation of a 3D image can be recommended for reliably making the diagnosis “MRONJ.” Moreover, knowledge of the exact defect volume serves as a decision-making aid with regard to the choice of therapy, ensures intraoperative certitude, and allows an assessment of the prognosis.

ObjectivesThis retrospective study compared two mandibular reconstruction procedures—conventional reconstruction plates (CR) and patient-specific implants (PSI)—and evaluated their accuracy of reconstruction and clinical outcome.MethodsOverall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences.ResultsIn the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 ConclusionFor reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.

Zunehmend werden hochaltrige Patienten auch in Krankenhausern ohne geriatrische Fachabteilung operativ versorgt. Es gilt, moglichst fruh Patienten zu identifizieren, die ein hohes Risikopotenzial fur perioperative Komplikationen mitbringen, und ihre Versorgung anzupassen. Der Einsatz des „Identification of Seniors at Risk“ (ISAR) zur Identifikation von Risikopatienten, die eine spezialisierte perioperative Betreuung erhalten, soll sowohl in der Notaufnahme als auch zwecks Validierungsversuch in der Elektivchirurgie hinterfragt werden. Die vorgestellte Studie hinterfragt den Einsatz des ISAR zum einen, wie langjahrig empfohlen, in der Notaufnahme und zum anderen, als neue Option, zwecks Validierung in der Elektivchirurgie. Retrospektiv wurden Daten von 389 Patienten ausgewertet, die routinemasig im Rahmen der stationaren Aufnahme erfasst worden waren. Bei den Patienten wurden praoperativ der ISAR und ggf. als kognitives Screening der Mini-Mental-Status-Test (MMST) durchgefuhrt, sofern nicht bereits eine vordiagnostizierte Demenz vorlag. Das Delir wurde mithilfe der „Confusion Assessment Method“ (CAM) erfasst. Es dienen 88 Patienten der Unfallchirurgie (Notfall UCH) als Beispiel fur den Einsatz in der Notfallchirurgie und 93 Patienten der Orthopadie fur die Elektivchirurgie (Elektiv ORTHO). Alle Patienten erhielten eine Betreuung durch die Abteilung fur perioperative Altersmedizin. Mit ≥2 Punkten laut ISAR gelten 85,2 % der Behandelten der Gruppe Notfall UCH und 48,4 % der Behandelten der Gruppe Elektiv ORTHO als geriatrische Risikopatienten. Unter den ISAR-negativen Patienten fanden sich besonders in der Gruppe Elektiv ORTHO viele Patienten mit praoperativen kognitiven Auffalligkeiten (positiver MMST-Befund oder vordiagnostizierte Demenz). Die Delirraten betrugen 5,7 % in der Gruppe Notfall UCH und 4,3 % in der Gruppe Elektiv ORTHO. Der ISAR als Screeningtool erwies sich bei einem „Cut-off“-Wert von 2 als nur bedingt geeignet. Insbesondere wurde die erhoffte Filterfunktion in beiden Gruppen nicht erfullt.

Objective In oral squamous cell carcinoma (OSCC), 20% of patients experience local recurrences. In this study, the addition of autofluorescence to a standard incandescent light examination was evaluated to enhance detection rates of recurrences in OSCC. Study Design Patients with OSCC who underwent follow-up examinations were included in this prospective cohort study. All patients (with or without recurrences) were examined clinically and with autofluorescence (using VELscope; Mectron, Cologne, Germany) and biopsy was used to examine suspect lesions for recurrences. Variables likely to influence results were analyzed. An analysis of dependencies, a general log-linear analysis, and a binary regression analysis were performed using SPSS version 26 (SPSS Inc., Chicago, IL). Results The study included 195 patients and in 39 cases a biopsy was performed. Results showed significantly more recurrences with the addition of autofluorescence to the usual clinical examination (P ≥ .5). Sensitivity was 95.2% and specificity was 100%. Conclusions This study showed the advantages of adding autofluorescence to routine clinical assessments in OSCC follow-up examinations. Clinical trial registration: German Clinical Trials Register DRKS-ID: DRKS00004836

As more aged patients are surgically treated in hospitals without specialized geriatric care, patients at risk for perioperative complications must be identified and treatment must be adapted. The aim was the use of the Identification of Seniors at Risk (ISAR) as a screening tool for the identification of high-risk patients, who need specialized perioperative care. The study presented investigated the use of ISAR screening not only as recommended in the emergency room but also in validation tests as a new option in elective surgery.Routine data recorded during inpatient admission of 389 patients were evaluated retrospectively. The ISAR as well as a cognitive screening with the mini mental state examination (MMSE) were conducted in patients as long as a previously diagnosed dementia was not present. Delirium was recorded using the Confusion Assessment Method (CAM). A total of 88 patients from trauma surgery served as an example for emergency surgery and 93 patients from orthopedics for elective surgery. All patients received treatment by the department of Anesthetic and Perioperative Geriatric Care.According to an ISAR score of ≥2 points, 85.2% of traumatology and 48.4% of elective orthopedic patients were considered to be geriatric high-risk patients. Among ISAR negative patients many suffered from preoperative cognitive decline (MMST or diagnosed dementia), especially in the elective orthopedics group. Delirium occurred in 5.7% of trauma surgery patients and in 4.3% of elective orthopedic patients.With 2 as a cut-off, the use of ISAR as a screening tool was only conditionally suitable. In particular, the expected filter function was not fulfilled in both groups.