[Perioral treatment options in cosmetic facial surgery]. / Periorale behandelingsmogelijkheden in de cosmetische aangezichtschirurgie.

The perioral region is unique and important in the face, both from a functional and an aesthetic point of view. There is a strong relationship between the perioral soft tissues, such as the lips and the corners of the mouth, and the underlying dentition and the jaws. Perioral ageing phenomena, such as depressed corners of the mouth, volume loss and wrinkles, can be improved, however, to a limited extent with intraoral treatment. These ageing phenomena can usually be treated more effectively with several extraoral treatment modalities that also enhance perioral aesthetics. The perioral cosmetic treatment options can be divided into various lifting procedures and volumising techniques. Considering that the dentist has to deal regularly with patients with perioral aesthetic wishes and also functional problems, it is important that one has knowledge of the different perioral treatment options, for both cosmetic and functional options.

[Reconstructieve facial surgery in facial defects after the surgical removal of malignant skin tumours]. / Reconstructieve aangezichtschirurgie bij aangezichtsdefecten na chirurgische verwijdering van kwaadaardige huidtumoren.

Because of the enormous and continuing increase in cases of skin cancer in the Netherlands, dentists will increasingly see patients with skin cancer. The most common malignant skin cancers are basal cell carcinoma, squamous cell carcinoma and malignant melanoma. With resection of a skin tumour, the oncological principles should be applied. For the closure of the resulting defect, a choice for the individual patient is made out of numerous techniques. Facial reconstructive surgery aims to restore the face in form and function and to maintain the patient's quality of life. By early recognition of skin tumours of the face, damage to the tissue can be limited. Dentists, who see their patients periodically, can play an important role here.

[Interdisciplinary orthodontic surgical treatment of children with cleft lip and palate from 9 to 20 years of age]. / Interdisciplinaire orthodontisch-chirurgische behandeling van schisis van 9 tot 20 jaar.

Cleft lip and palate is a common congenital malformation with a prevalence of 1:600 newborns. Children with orofacial clefts are treated by an interdisciplinary team of specialists while parents and child play a key role in their own care process. The orthodontic and facial orthopedic treatment of a child with a cleft takes many years. Children often get bored of the long treatment and this can cause problems with compliance and oral hygiene. Therefore it is advisable to distinguish 5 well-defined stages in the orthodontic treatment and to attempt to have some 'orthodontics free' time in between. The 3 orthodontic treatment phases between the age of 9 and 20 years consist of orthodontic treatment concerning the closing of the cleft with a bone transplant, the treatment of the permanent dentition and, finally, a possible combined orthodontic surgical treatment at the end of the period of growth. Good interdisciplinary collaboration among the different dental disciplines is essential in this regard.

Patient discomfort and other side effects after bilateral sagittal split osteotomy or distraction osteogenesis of the mandible: a randomized clinical trial.

A randomized clinical trial was conducted to compare bilateral sagittal split osteotomy (BSSO) with distraction osteogenesis (DO) for the advancement of the mandible, with a focus on patient discomfort, postoperative pain, the need for analgesics, and occurrence of infection. All patients were non-syndromal, had a class II hypoplastic mandible, and had not undergone previous mandibular surgery. A total of 66 patients were allocated randomly to the BSSO group (32 patients) or the DO group (34 patients). Sixty-three patients were eligible for evaluation, 29 in the BSSO group and 34 in the DO group. Patients in the DO group experienced more pain after 6 days postoperative, and were administered more analgesics after 5 days postoperative than patients in the BSSO group (P=0.030 and P=0.045, respectively). The operating time was significantly shorter for the BSSO group than for the DO group (78 min vs. 100 min, P=0.024). All postoperative infections (12 in total) emerged in the DO group (P=0.005). All patients in the DO group had a second surgery in day care to remove the distractor, while two patients in the BSSO group needed plate removal. It is concluded that patients experienced more pain after DO, needed more analgesics postoperatively, and had more infections in comparison to the BSSO group.

Skeletal stability after bilateral sagittal split osteotomy or distraction osteogenesis of the mandible: a randomized clinical trial.

A randomized clinical trial was carried out to evaluate postoperative stability after mandibular advancements in non-syndromal class II patients with a bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DO). In total 32 patients could be included in the BSSO group and 34 patients in the DO group. The BSSO was converted to a unilateral procedure for one patient, and two patients in the BSSO group were lost during follow-up. A total 63 patients could be evaluated, 29 in the BSSO group and 34 in the DO group. Advancement was comparable in the two groups (mean 7.2mm). The mean follow-up period was 23.8 months (range 11-50 months). Lateral cephalograms were hand-traced. Horizontal relapse was measured in Y-B (mm) and SNB (°). For DO this was -0.324 mm and -0.250°, and for BSSO this was -0.448 mm and -0.259°, respectively (both not significant; NS). Vertical relapse measured in X-B was -0.074 mm for DO and -0.034 mm for BSSO (NS). The magnitude of advancement, a high mandibular plane angle, age and gender were not identified as independent risk factors for relapse. In conclusion, a BSSO and DO gave both similar stable results in advancements of the mandible up to 10mm.

Bilateral sagittal split osteotomy versus distraction osteogenesis of the mandible: a randomized clinical trial.

A randomized clinical trial was performed to evaluate differences in postoperative neurosensory disturbance (NSD) between two methods of mandibular advancement surgery. A total of 66 non-syndromal class II patients with mandibular hypoplasia were randomized for either distraction osteogenesis (DO) or bilateral sagittal split osteotomy (BSSO). Twenty-nine patients in the BSSO group and 34 patients in the DO group were available for evaluation. Objective assessment was performed by Semmes-Weinstein (SW) monofilament testing preoperatively and at least 1 year after surgery. Six of the 34 patients (17.6%) in the DO group experienced objective NSD, compared to 5/29 patients (17.2%) in the BSSO group. In the evaluation of nerve function by individual nerves, 8/68 nerves (11.8%) revealed objective NSD in the DO group, compared to 7/58 nerves (12.1%) in the BSSO group. A subjective NSD was reported in 11/34 patients (32.4%) in the DO group, compared to 9/29 patients (31.0%) in the BSSO group. In the evaluation of nerve function by individual nerves, a subjective NSD was reported for 13/68 nerves (19.1%) in the DO group, compared to 13/58 nerves (22.4%) in the BSSO group. None of the differences was significant. No differences in neurosensory disturbance could be found between the two study groups. Objective WS monofilament testing appeared to underestimate NSD compared to subjective patient report.

Three-dimensional changes in nose and upper lip volume after orthognathic surgery.

Orthognathic surgery aims to improve both the function and facial appearance of the patient. Translation of the maxillomandibular complex for correction of malocclusion is always followed by changes to the covering soft tissues, especially the nose and lips. The purpose of this study was to evaluate the changes in the nasal region and upper lip due to orthognathic surgery using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Patients who underwent a Le Fort I osteotomy, with or without a bilateral sagittal split osteotomy, were included in this study. Pre- and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets and analyzed. Anterior translation and clockwise pitching of the maxilla led to a significant volume increase in the lip. Cranial translation of the maxilla led to an increase in the alar width. The combination of CBCT DICOM data and 3D stereophotogrammetry proved to be useful in the 3D analysis of the maxillary hard tissue changes, as well as changes in the soft tissues. Measurements could be acquired and compared to investigate the influence of maxillary movement on the soft tissues of the nose and the upper lip.

[Painful submandibular swelling appears to be a rare odontogenic tumour]. / Pijnlijke submandibulaire zwelling blijkt zeldzame odontogene tumor.

A 15-year-old girl was referred to an oral and maxillofacial surgeon due to a painful submandibular swelling that had been present for 4 to 5 months. After surgical excision and histopathological examination it appeared to be a relatively rare adenomatoid odontogenic tumour. Approximately 4.6% of all odontogenic tumours are adenomatoid odontogenic tumours. This type of tumour is mainly diagnosed between the ages of 10 and 30. Surgical excision is an effective treatment and the adenomatoid odontogenic tumour has a favourable prognosis. The most recent article in Dutch literature on the adenomatoid odontogenic tumour dates back to 1975.

Stability of mandibular advancement procedures: bilateral sagittal split osteotomy versus distraction osteogenesis.

The aim of this study was to compare the postoperative stability of the mandible after a bilateral lengthening procedure, either by bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DOG). All patients who underwent mandibular advancement surgery between March 2001 and June 2004 were evaluated; 26 patients in the BSSO group and 27 patients in the DOG group were included. The decision to use the intraoral distraction or BSSO for mandibular advancement primarily depended on the patient's choice. In both groups, standardized cephalometric radiographs were taken preoperatively, postoperatively (BSSO group) or directly post-distraction (DOG group) and during the last study measurement in May 2005. The cephalometric analysis was performed using the following measurements: Sella/Nasion-Mandibular point B and Sella/Nasion-Mandibular Plane. Point B was used to estimate relapse. This study showed no significant difference in relapse between the BSSO and the DOG group measured 10-49 months after advancement of the mandible (p>0.05). There is no postoperative difference in the stability between BSSO and DOG after mandibular advancement after 1 year.

[Treatment of snoring by a Herbst-activator. Satisfaction of patient and bedfellow]. / Behandeling van snurken met een Herbst-activator. Tevredenheid van patiënten en partners.

Snoring is primarily a social problem which for instance brings considerable pressure on someone's conjugal relationship. Often treatment is demanded by the bedfellow. Patient as well as bedfellow needs to be involved in the treatment of the problem. In this study, twenty-three habitual snorers and their bedfellows completed a questionnaire concerning the effect of the treatment of snoring by a Herbst-activator before treatment and 3 and 6 months after treatment. Two-thirds of the patients and bedfellows were satisfied with the therapy results. The bedfellows exhibited an even more positive therapy effect than the patients.

A case of imported paracoccidioidomycosis: an awkward infection in The Netherlands.

Paracoccidioidomycosis is an important endemic mycosis in South America. In Europe the disease is very rare and only found as infections in travelers to Latin America. We report here the first case encountered in the Netherlands for which the appropriate diagnosis was not attained for several months. A Dutch 60-year-old man presented with a painful ulceration in the buccal mandibular vestibular mucosa of three months duration. While his medical history was uneventful, he had worked, until 8 years prior to his presentation, as a carpenter for 25 years in the jungles of Peru and Ecuador. An aberrant chest radiograph, CT-scan of the lungs and increased erythrocyte sedimentation rate were suggestive of sarcoidosis or a bronchiolitis obliterans organizing pneumonia. There was no improvement in the patient's symptoms despite the use of budesonide and prednisone medication, as well as tuberculosis prophylaxis with isoniazide and rifampicin, and local use of miconazole. Quite to the contrary, as an irritated, irregular hyperemic mucosa and gingiva with ulceration were noticed during this period of time. These precipitated an incisional biopsy through which a mixed inflammatory cellular infiltrate and large yeast cells were found on histopathologic examination. Based on the patient's travel history and the multiple budding yeastlike cells revealed in the biopsy tissue, the diagnosis of paracoccidioidomycosis was finally made. This was supported by the isolation of Paracoccidioides brasiliensis in culture. Antimycotic oral therapy with itraconazole was started and continued for 15 months. At two and five year follow-ups, the patient was asymptomatic. In Europe, it may be expected that diseases that are endemic in other areas will be seen more frequently in countries where the diseases are not routinely encountered. It is most likely that the use of corticosteroid medication, with its inherent immunosuppressive effect, resulted in the reactivation of an infection acquired many years before in Latin America. The etiologic agent then disseminated from the initial focal point to cause the ensuing oral mucous membrane lesions. The importance of the patient's prolonged residence in Latin America was overlooked. The very long latency of endemic mycoses emphasizes the need for a meticulous history which should include not only recent trips, but also past residence in foreign countries.

A noisy zygoma fracture--complication of carotid-cavernous sinus fistula: total recovery of monocular blindness and frozen-eye after endoarterial coil embolization.

A case of a patient with a zygoma fracture in combination with a carotid-cavernous sinus fistula--an arterio-venous fistula between the internal carotid artery and the cavernous sinus--is presented. The most frequent cause is trauma, but the carotid-cavernous sinus fistula itself may have been the cause of trauma. The patient showed complete loss of ocular motility and total monocular blindness. Treatment of the fistula with endoarterial coil embolization was followed by improvement of vision and ocular motility, until finally complete recovery of ocular functions, which is exceptional. In this case, careful analysis of the MRA's showed that the CCSF most likely developed in the posttraumatic phase.

[Surgically assisted rapid maxillary expansion: a retrospective study]. / Chirurgisch ondersteunde bovenkaakexpansie: een retrospectief onderzoek.

Transverse maxillary hypoplasia, in adolescents and adults, may be corrected by means of a 'surgically assisted rapid maxillary expansion' (SARME). The results of 7 patients who were treated by means of a SARME, are presented. Attention is paid to the technique, the type of expansion, and the stability of the expansion of the maxilla 1-1.5 years after SARME. The mean expansion between the cuspids was 4.7 mm (sd 1.7) and between the first molars 5.6 mm (sd 3.2). The SARME technique appeared to give rise to a predictable result and a sufficient amount of expansion, although the sample is small and the follow-up period relatively short. All patients had a satisfactory result without complications.