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The amount of blood loss determined in orthognathic surgery differs greatly among studies. This can be attributed to the inhomogeneity in study cohorts analysed, but may also be a result of the varying methodologies used for blood loss determination. However, this has yet to be explored. Thus, the aim of this study was to investigate the extent to which the formula and time point used to measure blood loss affect the blood loss volume, determined in a homogeneous cohort undergoing bimaxillary surgery. Blood loss was calculated at 24 and 48 hours postoperatively using the haemoglobin balance method and the formula of Hurle et al. The estimated total blood volume was established based on the formulae of Nadler et al. and Choi et al. Differences in blood loss volume with respect to time point and formula were analysed and compared. Fifty-four patients were included in the final analysis. Statistically significant differences in blood loss were observed: a significant increase in the blood loss volume from 24 hours to 48 hours postoperatively was detected. When comparing the formulae used, blood loss differed significantly at 24 hours after surgery; however no such difference resulted at 48 hours postoperatively. These findings imply that the time point of measuring blood loss is highly relevant, whereas the formulae applied seem to have less of an impact on the blood loss volumes calculated.

Mnogostranski tehnicni razvoj je omogocil, da so poglobljene tehnologije - virtualna resnicnost (VR - ang. virtual reality) in obogatena resnicnost (AR - ang. augmented reality) ter njuno zlitje v mesano ali razsirjeno resnicnostjo (MR - ang. mixed reality;XR - ang. extended reality) - nasle svojo pot v razlicna podrocja življenja in dela. Zaradi njihovih skoraj neskoncnih ustvarjalnih možnosti so zelo zanimive tudi za pedagogiko. Kaksne pa so možnosti in kje so omejitve, kje v tem pogledu sploh je Evropa? Da bi nasli odgovore, smo ocenili 25 projektov EU, ki se ukvarjajo z ucenjem na osnovi VR, AR in XR.Alternate abstract:Manifold technical developments have allowed immersive technologies - virtual (VR) and augmented (AR) realities and their fusion to mixed or extended reality (MR/XR) - to find their way into many areas of life and work. Given their almost infinite creative possibilities, they are also of great interest for pedagogy. But what are the possibilities and where are the limits, and where does Europe stand in this respect at all? To find answers, we have evaluated 25 EU projects dealing with VR/AR/XR-based learning.

Introduction: The variety of approaches to the mandibular joint and the multiplicity of different surgical techniques proposed for reducing a chronic recurrent luxation of the temporomandibular joint (TMJ) over the past decades show the complexity of the surgical approach and reveal that an adequate technique is still lacking. Therefore, this paper describes a different surgical approach for a new augmentation technique of the articular eminence by inserting titanium implants into the zygomatic arch root.Materials and Method: Eight cadavers of the Department of Anatomy of the Medical University Graz embalmed with Thiel’s method were chosen due to their hypermobility of the TMJ and were investigated bilaterally. Each cadaver underwent a preoperative computed tomography (CT) for excluding any morphological derangements (tumor masses; fractures) of the TMJ and for determining implant length and implant diameter. The zygomatic arch root was visualized via preauricular access and the planned implants were inserted according to the drilling protocol of Dentsply Sirona. A postoperative Ct-scan was taken to recognize injuries of the mandibular joint. Results: In all cases a significant (pConclusion: The proposed surgical technique shows promising results regarding surgical approach and clinical outcome.

This contribution gives an overview of the use, therapeutic effects and side effects of the antibiotic substance Metronidazole. Metronidazole is effective in the treatment support of paradontitis, microbial-caused halitosis, perioral skin infections and odontogenic hard or soft tissue abscess formations related to anaerobic bacterial infections. Due to its anti- parasitic effect, Metronidazole is also effective in the treatment of protozoa. In adults and children from 12 years on, 200 mg Metronidazole to a maximum of 2000 mg Metronidazole per day can be administered. In children below 12 years of age, an antibiotic dose of Metronidazole between 20 to 30 mg per kilogram body weight is advised.

Different surgical techniques are available to adequately correct the primary cleft lip deformity; however, when compared, none of these techniques have proven superior with regard to achieving optimal aesthetic results. Thus, the aim of this retrospective study was to assess the nasolabial appearance in patients with unilateral cleft lip and palate (UCLP) at age five with reference to two techniques for primary cleft lip repair used in our service: Pfeifer’s wave-line procedure and Randall’s technique. A modified Asher–McDade Aesthetic Index was applied to appraise the nasolabial area by means of 2D photographs of non-syndromic five-year-old patients with a UCLP. In this context, three parameters were assessed: 1. nasal frontal view; 2. shape of the vermilion border and philtrum length; and 3. the nasolabial profile. Five professionals experienced in cleft care were asked to rate the photographs on two occasions. Overall, 53 patients were included in the final analysis, 28 of whom underwent lip repair according to Pfeifer; 25 were treated employing Randall’s technique. Statistically significant differences between the two techniques regarding philtrum length and vermilion border were found (p = 0.046). With reference to the other parameters assessed, no significant differences were determined. The results suggest that Randall’s cleft lip repair may allow for more accurate alignment of the vermilion border and more adequate correction of the cleft lip length discrepancy in comparison to Pfeifer’s wave-line technique.

Background Pierre Robin sequence (Robin sequence) is defined as the triad of micrognathia, glossoptosis, and airway obstruction. It is frequently associated with palatal clefting. In recent years, increased interest in speech outcomes of cleft patients diagnosed with Robin sequence has been shown. Methods Speech outcomes of cleft patients with Robin sequence were assessed at age 5 in comparison with a cleft palate-only cohort. Speech parameters were evaluated according to the Cleft Audit Protocol for Speech-Augmented and analyzed using the National Audit Standards for Speech (United Kingdom). All patients were treated in the same institution during the same period (2005 to 2012). Subjects who needed nasopharyngeal airway support and those whose airway was managed by positioning only were eligible. Results Fifty-one cleft patients diagnosed with Robin sequence were included in this study. Outcomes were compared to those of 128 nonsyndromic cleft palate-only patients.Patients with Robin sequence were shown to present with a significantly higher rate of cleft speech characteristics in comparison to the reference cohort (p = 0.001). Furthermore, it was shown that Robin sequence is associated with a significantly higher rate of secondary speech surgery for velopharyngeal dysfunction before the age of 5 (p = 0.016). Robin sequence patients with a nasopharyngeal airway presented with a higher rate of cleft speech characteristics compared to Robin sequence patients managed with positioning only. Conclusion Cleft patients with Robin sequence are more likely to need further surgery to correct velopharyngeal dysfunction before the age of 5 and are more prone to present with cleft speech characteristics at the age of 5. Clinical question/level of evidence Risk, II.

The use of local anesthetics is known to be safe and efficient in surgical and dental treatments. Local anesthetics are essential in dentistry for appropriate pain control as they inhibit nociception generated during surgical and dental procedures. However, among other precautions, attention has to be paid to the individual maximum dose of the local anesthetics that is administered. This is especially important for children who are, due to their low body weight, more prone to adverse events following substance overdose. Therefore, this contribution gives advice for general dentists on the accurate use and maximum dose of local anesthetics in children.

The antifibrinolytic agent tranexamic acid (TXA) is well known for its capacity to effectively reduce intraoperative blood loss. The effect mechanism of TXA is based on the indirect inhibition of fibrin degradation, whereby existing blood clots within the surgical area are stabilized. Consecutively, the amount of blood loss can be reduced. Due to its great efficacy to minimize blood loss and its low rate of unintended side effects, TXA is regularly used in different surgical fields. Within the field of dentistry TXA is not applied on a regular basis, however, it presents a highly effective and convenient treatment option to reduce bleeding complications.

Objective The objectives of this prospective cohort study were to establish gender-related differences in blood loss and haemostatic profiles associated with bimaxillary surgery. In addition, we aimed to identify if any gender differences could be established which might help predict blood loss volume. Materials and methods Fifty-four patients (22 males; 32 females) undergoing bimaxillary surgery for skeletal dentofacial deformities were eligible for inclusion. Blood samples were taken 1 day preoperatively and 48 h postoperatively for detailed gender-specific coagulation analysis incorporating global coagulation assays (endogenous thrombin potential) and specific coagulation parameters. Blood loss was measured at two different time points: (1) the end of surgery, visible intraoperative blood loss (IOB) using ‘subtraction method’; and (2) 48 h postoperatively perioperative bleeding volume (CBL-48 h) using ‘haemoglobin-balance method’ and Nadler’s formula. Correlation and regression analyses were performed to identify relevant parameters affecting the amount of blood loss. Results Significant differences in IOB and CBL-48 h were observed (p p = 0.056). In contrast, men had significantly higher CLB-48 h (p = 0.019). Reduced CBL-48 h was shown to be most closely associated with the level of Antithrombin-III being decreased in females. Conclusions Male gender is associated with higher IOB and CBL-48 compared with females. Gender does not affect IOB regarding haemostatic profile but does correlate strongly with procedure length. Conversely, CBL-48 is closely associated with gender-specific imbalances in the anticoagulant system. Clinical relevance Knowledge of gender-related differences will help clinicians establish predictive factors regarding excessive blood loss in orthognathic surgery and identify at-risk patients.

The digital transformation, with its ongoing trend towards electronic business, confronts companies with increasingly growing amounts of data which have to be processed, stored and analyzed. Instant access to the “right” information at the time it is needed is crucial and thus, the use of techniques for the handling of big amounts of unstructured data, in particular, becomes a competitive advantage. In this context, one important field of application is digital marketing, because sophisticated data analysis allows companies to gain deeper insights into customer needs and behavior based on their reviews, complaints as well as posts in online forums or social networks. However, existing tools for the automated analysis of social content often focus on one general approach by either prioritizing the analysis of the posts’ semantics or the analysis of pure numbers (e.g., sum of likes or shares). Hence, this design science research project develops the software tool UR:SMART, which supports the analysis of social media data by combining different kinds of analysis methods. This allows deep insights into users’ needs and opinions and therefore prepares the ground for the further interpretation of the voice. The applicability of UR:SMART is demonstrated at a German financial institution. Furthermore, the usability is evaluated with the help of a SUMI (Software Usability Measurement Inventory) study, which shows the tool’s usefulness to support social media analyses from the users’ perspective.

Objective: This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. Material and Methods: Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18–90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. Results: This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. Conclusions: At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.

Extensive defects in the head and neck area often require the use of advanced free flap reconstruction techniques. In this study, the thoracodorsal perforator-scapular free flap technique based on the angular artery (TDAP-Scap-aa flap) was postoperatively evaluated regarding the quality of life and the donor site morbidity using the standardized SF-36 and DASH questionnaires (short form health 36 and disabilities of the arm, shoulder and hand scores). Over a five-year period (2016–2020), 20 selected cases (n = 20) requiring both soft and hard tissue reconstruction were assessed. On average, the harvested microvascular free flaps consisted of 7.8 ± 2.1 cm hard tissue and 86 ± 49.8 cm2 soft tissue components. At the donor site (subscapular region), only a mild morbidity was observed (DASH score: 21.74 ± 7.3 points). When comparing the patients’ postoperative quality of life to the established values of the healthy German norm population, the observed SF-36 values were within the upper third (>66%) of these established norm values in almost all quality-of-life subcategories. The mild donor site morbidity and the observed quality of life indicate only a small postoperative impairment when using the TDAP-Scap-aa free flap for the reconstruction of extensive maxillofacial defects.

Introduction The anatomical position of the inferior alveolar artery (IAA) within the mandibular canal and in relation to the substructures of the neurovascular mandibular bundle has been sparsely described to date. More detailed information on the exact IAA position would be beneficial for both dental and maxillofacial surgical procedures to minimize complications such as bleeding, nerve compression hematoma, and sensory deficiency. Material and methods In 31 Thiel-preserved and fresh-frozen cadaver hemimandibles the position of the IAA in relation to the structures of the inferior alveolar neurovascular bundle and the mandible borders was analyzed anatomically and histologically. Results In 77.4% of the cases, rotation of the IAA around the mental nerve was apparent, resulting in a typical site-dependent IAA position. While the IAA was situated buccally within the pterygomandibular space, buccal-inferior in the mandibular foramen, superior in the molar region, and lingually in the premolar region. In 12.9% of the cases, a persistent lingual position of the IAA was observed for the entire mandibular canal. In one case, an additional mandibular canal and an accessory IAA were identified. Discussion This study provides new and encompassing information on the complete course and position of the IAA. This course is of practical use for oral implantology and various surgical procedures in dental- and maxillofacial surgery. Variations in the typical IAA course and site-dependent positional changes may be referred to as mandible growth and functional adaption to occlusion anomalies. This report helps enhance the morphological and functional understanding of IAA relationship during mandible development.

Im oberbayerischen Unterhaching wurde ein Bürogebäude an Erdwärme angeschlossen. Der Aufwand hat sich für die Klimabilanz des Gebäudes gelohnt. Diese erneuerbare Fernwärme aus der Tiefe kann in Unterhaching sogar drei Viertel des Wärmebedarfs decken.

Das EU Einreise-/Ausreisesystem (EES) ist ein durch das Europaische Parlament geplante System zur Uberwachung von Grenzubertritten in und aus dem Schengen-Raum. Von Burgern aus Drittstaaten, die in den Schengen-Raum einreisen, werden sowohl Gesichtsbilder als auch Fingerabdrucke in einem zentralen System gespeichert. Auf diese Weise konnen Grenzubertritte in und aus dem Schengen-Raum durch biometrische Prufungen starker kontrolliert werden. Eine wesentliche Voraussetzung fur eine zuverlassige biometrische Identifikation und Verifikation im Einreise-/Ausreisesystem EES ist die Verwendung von Gesichtsbildern und Fingerabdrucken, die von hoher Qualitat sind. Dieser Artikel sensibilisiert fur das Thema durch eine Diskussion der moglichen Auswirkung verschiedener Varianten zur Erfassung von Gesichtsbildern an den Grenzkontrollstationen.

This part of the book focuses on computer-aided maxillofacial surgery in the clinical practice and is written by the contributing authors of this chapter Juergen Wallner (j.wallner@medunigraz.at), Michael Schwaiger, Wolfgang Zemann (Graz, Austria), and Philipp Streckbein (Giesen, Germany). The content of the chapter is based on the clinical experience of the authors and on the present literature. Today, computer-aided procedures and technologies in oral and maxillofacial surgery are mainly used for a patient-specific approach, which means that these technologies are used to try to create a personal medical surgical treatment individually for each patient. In that context, the main computer-aided patient-specific approaches are (1) image-based virtual 3D surgical planning and 3D visualization (based on digital image scan files and algorithmic segmentation), (2) 3D printed models (polymer made based on digital image scan files by the support of 3D printers in-house or by the industry partner), (3) virtual planning and manufacturing of surgical cutting guides and splints (image scan based titanium or polymer made), and (4) virtual planning and manufacturing of patient-specific implants (titanium made). This chapter gives an outline of some currently common and routinely used computer-aided procedures and technologies in clinical oral and maxillofacial surgery and includes the connected basic and surrounding information, limitations, involved research topics, and future perspectives. The following subchapters are mainly referred to procedures that are common and relevant in Austria and Germany. Differences to other European countries may exist out of organization and/or financial reasons.

The aim of this prospective observational study was to investigate the parameter 'hidden blood loss' (HBL) in the context of orthognathic surgery, incorporating undetected bleeding volumes occurring intra- and postoperatively. Orthognathic bleeding volumes were recorded at three different time points. At the end of the operation the visible intraoperative blood loss (VBL) was measured. Additionally, the perioperative blood loss was calculated 24 h and 48 h postoperatively using the 'haemoglobin balance method'. Analysis of the HBL was based on the difference between the visible intraoperative blood loss (VBL) and calculated blood loss (CBL), determined 48 h after surgery. 82 patients (male 33, female 49) were included in this study, of whom 41 underwent bimaxillary surgery and of whom 41 underwent Bilateral Sagittal Split Osteotomy (BSSO). Statistically significant differences with reference to the absolute bleeding volumes were found when comparing the two treatment modalities. In terms of HBL, a bleeding volume of 287.2 ml (+/- 265.9) in the bimaxillary group and 346.9 ml (+/- 271.3) in the BSSO cohort was recorded. This accounted for 32.2% (bimaxillary surgery) and 62.6% (BSSO) of the CBL after 48 h (BIMAX vs. BSSO, p < 0. 001). HBL is a valuable adjunct to record within the perioperative management of orthognathic surgery to further improve patient safety and postoperative outcomes. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of European Association for Cranio Maxillo-Facial Surgery.

Purpose The reconstruction of oromandibular defects can be challenging, particularly when considerable amounts of bone and soft tissues are lost. In such cases, the use of a single flap may be unsatisfactory and a concomitant free flap is needed. Here we present a chimeric, thoracodorsal perforator-scapular free flap based on the angular artery of the subscapular system (TDAP-Scap-aa) as an alternative technique for single flap reconstruction of extensive oromandibular defects. Materials and methods The authors studied patients who underwent reconstructions of extensive oromandibular defects with a TDAP-Scap-aa free flap. The operative technique and the clinical experiences are described. Postoperatively, surgical complications were classified with the Clavien-Dindo Classification. Results Five male patients (59.4 ± 8.8 years) were treated with the TDAP-Scap-aa. Average sizes for harvested hard and soft tissue components, which are both included in the flap and completely independently from each other, were 10.4 ± 1.5 cm of bone length, 2.6 ± 0.3 cm of bone height, 11.6 ± 4.8 cm of skin paddle length and 8.4 ± 1.7 cm of skin paddle width. The overall mean operation time (cut-suture) was 14.6 ± 0.9 h. The postoperative follow-up was 6 months. No complications requiring surgical treatment as well as donor site nerve damages were observed. Conclusions In comparison to other double free flaps, the TDAP-Scap-aa offers several advantages such as higher amounts of hard and soft tissues without prolonged operation times, and provides satisfying aesthetic outcomes and little donor site morbidity due to the preservation of muscle and nerve structures. Therefore, the TDAP-Scap-aa constitutes a clinically reliable alternative in extensive oromandibular defect reconstruction.

With the rise of social platforms such as Facebook, Twitter, Instagram etc., recently, a lot of excitement and optimism around the potential of corporate social media usage have emerged. Social media activities allow companies to reach an attractive mass audience segment, but just as for any other marketing medium, measurement is a critical component of success. Hence, many critical success factors (CSFs) necessary for successful B2C social media efforts have been compiled in literature over the last years. Although these CSFs are numerous, a classification for a purposeful application as well as corresponding key performance indicators (KPIs) for the concrete measurement of CSFs are missing. Therefore, first (1), this research aims at the identification of existing CSFs for social media in enterprises in literature and classifying them by their specific application. Second (2), to allow the definite measurement of CSFs, corresponding KPIs are identified and matched towards them.

The innovative TriLock Bridging Plate System (Medartis AG, Switzerland) was developed to reduce common complications related to conventional mandibular reconstruction plates. The novelties regarding the plating system concern the cross-strut structure in the centerpiece, the bendable side elements and the reduction of the plate's thickness to 2.0 mm 4 different models are available, which cover lateral and central segmental mandibular defects. The plating system has only been introduced at selected maxillofacial units so far and clinical assessment is still lacking. Thus, the aim of the study was to analyze the novel Bridging Plate system in terms of its clinical applicability, rate of trimming and postoperative outcomes in a first investigation over 6 months. The study includes 25 patients with segmental mandibular resection, who underwent reconstruction with TriLock Bridging Plates. According to the assessment parameters, excellent clinical applicability was stated in 48%. The overall trimming rate was found to be 88%. Mostly adaptions to the distal bendable elements of lateral plates were performed. The occurrence of postoperative complications was 16%. Plate fracture occurred in 4%. With reference to the results, the novel plating system represents a viable method for segmental mandibular reconstruction, however, further evaluation is needed, for a more detailed analyzation.

OBJECTIVES: Third molars often require surgical removal. Since three-dimensional radiological assessment is often indicated in difficult cases to avoid surgical complications, the radiation burden has to be considered. Here, MRI may offer a dose-free alternative to conventional X-ray techniques. The aim of this retrospective analysis was to evaluate the assessment quality of MRI compared to panoramic radiography in impacted and partially impacted lower third molars. METHODS: Panoramic radiographs and MRI scans of 28 Caucasian patients were assessed twice by four investigators. Wisdom teeth were classified according to Juodzbalys and Daugela 2013. RESULTS: When radiological lower third molar assessments with panoramic radiography and MRI were compared, staging concurred in 73% in the first round of assessments and 77% in the second. CONCLUSIONS: The presented study demonstrates that MRI not only provides much the same information that panoramic radiography usually does, but also has the advantages of a dose-free three-dimensional view. This may facilitate and shorten third molar surgery. Image interpretation, however, can differ depending on training and experience.

Orbital tumours, located in the medial extraconal and intraconal compartment of the orbit, represent a challenge, with regard to surgical exposure. In the present paper removal of a cavernous haemangioma, located in the medial intraconal compartment was accomplished by combining lateral orbitotomy, midfacial degloving and LeFort-I osteotomy. Resection of the tumour could be performed under direct vision. Surgical exposure and removal of the lesion were obtained, without causing damage to surrounding tissues. Aesthetical results and postoperative eye function proved to be highly satisfactorily. With regard to limitations, concerning the combination of these methods, extended surgery duration and invasiveness have to be named. According to the technical feasibility and postoperative results, this new surgical approach represents a reliable and fully viable alternative method for the removal of medial orbital tumours.

We investigate the security of privacy enhancing techniques for biometric applications. The fuzzy vault of Jules and Sudan is a technique that allows error tolerant authentication, while preserving the privacy of the reference data. Several publications have proposed its application to fingerprints in order to implement privacy-enhanced biometric authentication. While the heuristic security estimates given are promising, no rigid security analysis has been presented so far. We explore if and under what circumstances a provably secure fuzzy fingerprint vault can be implemented. Based on bounds on the loss of entropy for the general fuzzy vault and realistic models for minutiae distributions, we deduce lower bounds for attacks that attempt to recover the template. Furthermore, we show how to select optimal parameters and evaluate both, minimum minutiae match rates and minimum number of minutiae needed to obtain an appropriate security level. Our results indicate that a provable secure scheme is hard to achieve with current fingerprint technology.