Diseases having an influence on inhibition of angiogenesis as risk factors of osteonecrosis of the jaw

OBJECTIVES: The objective of this study was to retrospectively investigate the association of diseases having an influence on inhibition of angiogenesis such as hypertension, diabetes mellitus type II, hypercholesterolemia, and rheumatoid arthritis (RA) with the development of osteonecrosis of the jaws. MATERIALS AND METHODS: The 135 patients were allocated into 4 groups of bisphosphonate-related osteonecrosis of the jaw (BRONJ) group (1A); non-BRONJ group (1B); osteonecrosis of the jaw (ONJ) group (2A); and control group (2B), according to histologic results and use of bisphosphonate. This retrospective study was conducted with patients who were treated in one institute from 2012 to 2013. Fisher's exact test and logistic regression analysis were used to analyze the odds ratios of diseases having an influence on inhibition of angiogenesis for development of ONJ. RESULTS: The effects of diabetes and hypertension were not statistically significant on development of ONJ. When not considering bisphosphonate use, RA exhibited a high odds ratio of 3.23 (P=0.094), while hyperlipidemia showed an odds ratio of 2.10 (P=0.144) for development of ONJ. More than one disease that had an influence on inhibition of angiogenesis showed a statistically significant odds ratio of 2.54 (P=0.012) for development of ONJ. CONCLUSION: Patients without diseases having an influence on inhibition of angiogenesis were at less risk for developing ONJ.

Dental implant bottom-up cost analysis / 대한치과보철학회지

PURPOSE: The purpose of this study was to estimate the cost of dental implant using the bottom-up approach with the current data from dental clinics. MATERIALS AND METHODS: In this study, direct and indirect costs required for each treatment were calculated using the bottom-up approach. In the bottom-up costing, the average monthly total cost of dental clinic includes labor and material costs, administrative expenses, medical malpractice costs, and opportunity costs of invested capital. For the dental implant cost components, those include direct costs (labor costs, laboratory costs, material costs, depreciation or other operating costs), indirect costs (administrative costs), and the opportunity costs of investment for dental clinic. RESULTS: Dental implant costs of metal crown, porcelain crown and over-denture were 1,449,000 won, 1,583,000 won, and 2,471,000 won respectively. The proportion of cost components was as follows. The labor cost were 50%, and material, administrative and other cost were 33%, 15% and 2%, respectively. For direct, indirect and investment cost, the ratio were 83%, 15% and 2%, respectively. CONCLUSION: The labor costs were evaluated to comprise largest proportion (about 50%, 730,000 won). Dental implant cost using Bottom-up costing was 1,450,000 won for metal crown and 1,580,000 won for porcelain crown.

Dental implant cost estimation using the Activity-Based Costing approach / 대한치과보철학회지

PURPOSE: There is a growing concern for the cost management of medical institutions. The purpose of this study was to estimate Activity-Based Costing (ABC) for dental implant cost. ABC refers to allocating resources or cost based on the activities of services. MATERIALS AND METHODS: A dental institution located in the metropolitan area was selected in this study. The tax accounting data of the institution were utilized to confirm total cost, and the institution was asked to make out clinical activities to figure out what activities were carried out. The direct cost and indirect cost for dental implant were separately estimated, and cost driver was analyzed to estimate the indirect cost accurately. RESULTS: The rates of the direct and indirect cost respectively stood at 35.8 and 49.5 percent. The cost for a dental implant was found to be approximately 1,579 won, and the cost of prosthetic surgery and treatment that included implant surgery accounted for the largest portion of the cost, which was 470 thousand won (30%). And the weight of training and education on dentistry was relatively higher than that of the other kinds of treatment. CONCLUSION: In order to ensure accurate and scientific costing for dental implant, not only direct medical procedure but every pre- and post-procedure activity should fully be taken into account. Pre-activities, post-activities, education and training are included in the indirect cost, but all these activities are mandatory and associated with the quality of treatment and the satisfaction level of patients.

Application of the hospital survey on patient safety culture (HSOPSC) to dentistry / 대한구강보건학회지

OBJECTIVES: The topic of patient safety has recently gained attention across healthcare institutes. Building a broad awareness of patient safety issues among dental care personnel, thus establishing a sound patient safety culture, has beneficial prophylactic effects on the quality assurance of dental care services. This study examines the adequacy and validity of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire developed by the Agency for Healthcare Research and Quality (AHRQ) for application to Korean dental care institutes. METHODS: The HSOPSC, which is a self-administered questionnaire survey, was administered to dental care workers who participated in the 2011 Dental Care Quality Assurance Symposium. The reliability and construct validity of the questionnaire were tested using STATA 11.0; factor, reliability, and correlation analyses were performed. RESULTS: Awareness of patient safety was dealt with in 10 subareas comprising 38 items. The 10 subareas were included patient safety policy at the institute level, open communication, patient safety-related expectations and behaviors of managers, frequency of reporting on patient safety-related incidents, and teamwork within the department. Both the construct validity and internal consistency of each factor were confirmed to be adequate. CONCLUSIONS: The results of the adequacy test for the application of this questionnaire to dental care institutes revealed that most items had a certain level of validity and reliability. However, it is necessary to reflect upon the specificity of dental care services to assess patient safety culture within dental care institutes more accurately.

Measuring the efficiency of dental hospitals with measurement of the service quality / 대한구강보건학회지

OBJECTIVES: Traditional nonparametric efficiency analysis was based on the relationship between the quantitative input and output measures. This study performed nonparametric efficiency analysis, which uses the results of dental hospital accreditation with quantitative output measures. METHODS: Data came from 35 hospitals between 2008 and 2010 that participated in the demonstration projects of dental hospital accreditation. The study employed two-stage double bootstrapping (TSDB) method to overcome the shortcomings and biased results of the traditional Data Envelope Analysis (DEA). Input measures included staffs, dental hygienists, other chair-side assistants, and administrative personnel, as well as dental equipment (dental chairs). Production measures were total revenues and the number of patients that visited the participating hospitals. We considered the environmental variables, which would affect the efficiency score of dental hospitals, dental hospital types, accreditation scores, and patients' satisfaction scores. RESULTS: There was a large split between the traditional DEA scores and TSDB scores. A total of 22 out of 35 hospitals had perfect efficiency in the traditional method, but none of those showed 100% efficiency in the TSDB. Overall efficiency score was the highest in the dental facility of general hospitals (71% mean efficiency), and dental teaching hospitals were the lowest (55% mean efficiency score). The factors that affected the efficiency of dental hospitals were the types of the dental hospital and the accreditation score. CONCLUSIONS: Traditional DEA scores had biased estimates and tended to be higher. The study found that organizational efforts for improving service qualities and patient safety would affect the efficiency, as well as the accreditation results.

Two Cases of Lipofibromatous Hamartoma

PURPOSE: Lipofibromatous hamartoma (LFH) of nerve is a tumor-like lipomatous process principally involving the young persons. This is a rare disease characterized by a soft slowly growing mass surrounding and infiltrating major nerves and their branches of the palm and digits. LFH of nerve usually affects the median nerve, with the most common sites of presentation being the distal forearm and hand in the wrist or palm. It may cause symptoms of compression neuropathy and is associated with macrodactyly. Recently, MRI plays a major role in confirming the diagnosis of LFH. Therefore, we present two cases of LFH in the hand with MRI features and surgical management. METHODS: One is a 6-year-old girl with macrodactyly involving both soft tissue and bony parts of the second, third and forth digits of her right hand. The other is a 16-year-old boy involving the soft tissue of the second and third digits of his right hand, with pain and numbness, along with motor and sensory deficits in the median nerve distribution. To evaluate LFH, we enforced preoperative MRI and physical examination. After confirming the diagnosis of LFH, we proposed decompression of all compromised peripheral nerve to help alleviate pain and paresthesia to reduce the likelihood of permanent motor and sensory sequelae. RESULTS: A characteristic feature on MRI is the appearance of serpentiform nerve fascicle surrounded by fibro-fatty tissue within the expended nerve sheet. Distribution of fat between fascicles is asymmetric. Two cases were treated by limited debulking of the redundant tumor tissue and excision of epineurial fatty tissue. These cases were performed with relief of symptom. CONCLUSION: MRI confirms the diagnosis, and it also provides a detailed assessment of nerve involvement before the operation. Especially, on coronal images, the nerve has a spagetti-like appearance that is pathognomonic of LFH. Recommendations for early treatment include decompression of the carpal tunnel, debulking of the fibro-fatty sheath, microsurgical dissection of the neural elements and excision of the involved nerve with or without grafting.

A Case Report of Operative Treatment for Pneumosinus Dilatans of Maxillary Sinus

PURPOSE: Pnumosinus dilatans is a rare disease that one or more of the paranasal sinuses are dilatated without functional alteration. The most frequently involved sites are frontal and sphenoid sinus. Facial asymmetric contour is the most common signs and nasal obstruction and pain may be combined. The purpose of reconstruction of pneumosinus dilatans is two-fold, to re-establish a permanent pressure equilibrium of sinus and to correct the possible facial deformities. METHODS: We present a case of a 24-year-old female with a 7-year history of protrusion of right malar region. Plane radiography and computed tomography detailed an abnormal expansion of the right maxillary sinus without thinning of bony wall, leading to diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment with miniplate. RESULTS: Post operative course was uneventful without complication and malar height became symmetric by physical and radiologic examination. CONCLUSION: We corrected successfully pneumosinus dilatans of maxillary sinus by surgical decompression and maxilloplasty. For this case, we reviewed literature related to this topic.

A Case Report of Operative Treatment for Pneumosinus Dilatans of Maxillary Sinus

PURPOSE: Pnumosinus dilatans is a rare disease that one or more of the paranasal sinuses are dilatated without functional alteration. The most frequently involved sites are frontal and sphenoid sinus. Facial asymmetric contour is the most common signs and nasal obstruction and pain may be combined. The purpose of reconstruction of pneumosinus dilatans is two-fold, to re-establish a permanent pressure equilibrium of sinus and to correct the possible facial deformities. METHODS: We present a case of a 24-year-old female with a 7-year history of protrusion of right malar region. Plane radiography and computed tomography detailed an abnormal expansion of the right maxillary sinus without thinning of bony wall, leading to diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment with miniplate. RESULTS: Post operative course was uneventful without complication and malar height became symmetric by physical and radiologic examination. CONCLUSION: We corrected successfully pneumosinus dilatans of maxillary sinus by surgical decompression and maxilloplasty. For this case, we reviewed literature related to this topic.

Versatility of Adipofascial Flap for the Reconstruction of Soft Tissue Defect on Hand or Foot

PURPOSE: Various types of flaps, with their own advantages and disadvantages, have been described for reconstruction of soft tissue defect with exposure of tendons, bones, or joints in the hand or foot. Local flaps with random vascularity have a limitation by their length. Free flaps are time-consuming procedure that may require the sacrifice of some major vessels. The ideal flap for covering soft tissue defects of the hand or foot must provide subcutaneous tissue that tendons can glide through which, supply enough subcutaneous tissue for cover of vital neural, bony, vascular and joint structures, and it has to be aesthetically pleasing. The adipofascial flap fulfills these criteria. It allows immediate or early closure of difficult wound of hand and foot in an easy way, and is especially indicated for small to medium-sized defects. METHODS: From October 2005 to December 2006, seven cases underwent this procedure to reconstruct soft tissue defect on hand or foot. RESULTS: All flaps survived completely, and no complications were observed. CONCLUSION: The adipofascial flap is a convenient flap for coverage of soft tissue with exposure of vital structure in the hand or foot, and provide several advantages, as following; easy and safe, short operating time, one stage procedure, thinness and good pliability of the flap, preservation of the major vascular pedicles, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar.

Dual Preconditioning Effect of Dexamethasone and Epinephrine on TRAM flap Survival in Rats

PURPOSE: The flap delay is a widely used technique to increase the flap survival. Dexamethasone is a well-known drug to have a positive impact on the flap survival. The objective of this study is to investigate the dual synergic effect of epinephrine as a chemical delay agent plus dexamethasone on the TRAM flap survival in rat model. METHODS: Forty Sparague-Dawley rats were divided into 4 groups evenly and a right inferior epigastic vessel pedicled TRAM flap, sized 5.0x3.0cm, was elevated on each upper abdomen. In the control group(N=10), 2 ml saline was injected on transverse abdominis muscle for a week before the flap elevation. In surgical delay group(N=10) all superior pedicles and left inferior pedicle were ligated a week before the flap elevation. In epinephrine group (N=10), 1 : 50000 epinephrine mixed saline was injected to transverse abdominis muscle every day for a week before flap elevation. In epinephrine plus dexamethasone group (N=10), the same procedure as that of epinephrine group was conducted for a week and 2.5 ml/kg dexamethasone was injected transverse abdominis muscle 2 hours before the flap elevation. On the seventh day after flap elevation, the survival area of flaps were measured and the vessel numbers in upper dermis of flap were counted through histologic slides. RESULTS: The results were as follows: the mean percentage of the flap survival area of surgical delay group (60.5+/-2.44%), epinephrine group (75+/-4.43%), and epinephrine plus dexamethasone group (87+/-1.94%) were higher than that of the control group (35+/-6.06%) significantly(p0.05) compared to that of the control group. CONCLUSION: The results indicated that epinephrine plus dexamethasone injection before the flap elevation could be used to increase the TRAM flap survival area in rat model.

Reconstruction of Velopharyngeal Function after Resection of Lateral and Superior Oropharyngeal Cancer

PURPOSE: The reconstruction of oropharyngeal defect after cancer surgery is very difficult because of their complicated structure and the functional importance to prevent velopharyngeal incompetence. In this article we investigated affecting factors of velopharyngeal function after reconstruction and a fundamental rule of reconstruction for saving their functions such as swallowing, speeching and breathing. METHODS: We classified 18 patients into three group under Kimata's grouping. Type I defect(6 patients) was healed by primary closure or secondary intention. In Type II or III defect, two operation methods were used - the folded flap(8 patients) and modified Gehanno method(4 patients), which include a lateral-posterior pharyngeal rotation-advancement flap. We evaluated wound dehiscence between the flap and the soft palate, speech intelligibility using Hirose's method, regurgitation during oral feeding, and hypernasality. RESULTS: Most of type I or II defects patients recovered satisfactory velopharyngeal function. But, in patients with type III defects we found wound dehiscence, worse speech function, and common velopharyngeal incompetence. CONCLUSION: The large defect size and presence of wound dehiscence are major factors of postoperative velopharyngeal function. We conclude that folded flap or modified Gehanno method is a good reconstructive operation method for broad contact between the flap and defect site, preventing wound problem.

Simple Molding Method for Post-distant Flap Stated Finger by Using Surgical Rubber Gloves

In both cosmetic and functional aspects, loss of digital pulp is a common problem. Compound or composite defects of the hand and fingers with exposed denuded tendon, bone, joint, or neurovascular structures may require flap coverage. Most often these lesions can be repaired by using simple local flap, neurovascular flap, thenar flap, and cross-finger flap. But microvascular reconstruction is sometimes needed for large defects. But Authors do not recommend these procedures in case of severe crushing injuries involving multiple finger pulp losses because they have possibility of damage of the vascular network and infection. So we applied distant flaps such as chest flaps, groin flaps, abdominal flaps and etc. And then we applied surgical rubber gloves for remodeling the flap after cutaneous healing. We have acquired satisfactory results, after the simple molding method for distant flap finger by using surgical rubber gloves treatment.

Balanced Tucking of the Levator Muscle and Muller's Muscle in Blepharoptosis

The levator and Muller's muscle balanced tucking was performed to correction myogenic or aponeurotic blepharoptosis. Through the blepharoplasty incision, the upper half of tarsal plate was exposed and the orbital was opened to show the levator aponeurosis. the Muller's muscle dissected from the upper border of the tarsal plate and from the posteriorly located conjunctiva with sharp scissors. Muller's muscle was advanced about 3 mm to 8 mm on anterior surface of the tarsal plate and fixed approximately upper one third of the tarsal plate with three horizontal 6-0 Nylon mattress sutures. The amount of tucking of Muller's muscle was controlled by the location of the upper eyelid margin 2 mm below the upper limbus in primary gaze after first temporary fixations suture in the maximum superior point of the limbus. The amount of advancement of levator aponeurosis was controlled by the location of the upper eyelid margin 1 mm below the upper limbus in primary gaze after first temporary fixations suture in the maximum superior point of the limbus. And then levator aponeurosis was fixed with three horizontal 6-0 Nylon mattress on beside the point that was tucked Muller's muscle. We have been thirty cases with levator and Muller's muscle balanced tucking from January 2004 to Jun 2005. 3 cases were traumatic blepharoptosis with 3-5 mm ptosis and poor levator function. 27 cases were myogenic or aponeurotic blepharoptosis with 2-5 mm ptosis with and more than 4 mm of levator function. the age of the patients ranged from 6 to 78 years. The levator aponeurosis and Muller's muscle tucking procedure can reduce the amount of the levator and Muller's muscle resection, and improve discomfort when the patients open eyes.

An Experimental Study of Bone Distraction in Rabbit Skull

The epiopathogenesis of craniosynostosis remains obscure. According to the studies involved, the conditions observed at birth are very different. In case that a deformity is obvious or the risk of brain compression is possible, strip craniectomy, frontal bone advancement and cranial vault remodeling methods are used. These direct reshaping or remodeling methods are time consuming and require greater use of physical resources and still are not uniformly successful in making skull shape to normal. Distraction of the cranial bone has been studied to solve this problem. This study subsequently included 30 white rabbits aged about 25 weeks. The rabbits were divided in three groups. In group I, a 0.25mm distraction was done every other day after 3 day latency period. In group II, there was a 7 day latency period with the same rate of distraction as in group I. There was a 3 day latency period with a 0.5mm distraction every other day in group III. The contralateral side underwent a sham operation as a control group. During distraction and after consolidation periods, histologic and ultrastructural studies were carried out. And a serial radiologic study was done. As a result, group I and group II showed successful distraction osteogenesis, and we demonstrated the biological and mechanical factor associated with distraction osteogenesis. In group I, despite the short latency period, there was successful bone regeneration. Group III, it also showed successful ossification. During the distraction period, there was a remarkable increase of TGF-beta1 in both groups, especially in periosteum osteoid and newly developed connective tissue. In conclusion, we have demonstrated a useful model of distraction osteogenesis in rabbit skulls, and attempted to evaluate associated biological and mechanical factors.