Morbidity and mortality associated with tracheotomy procedure in a university medical centre.

This prospective study assessed the morbidity and mortality associated with 192 consecutive tracheotomies. Complications were assessed including intraoperative and/or postoperative bleeding, infection, tracheoinnominate fistulae, tracheoesophageal fistulae, dislodgement of the tracheotomy tube, pneumothorax, wound infection and obstruction of the airway. 16% of the tracheotomy procedures resulted in complications. 22 tracheotomy procedures (11%) resulted in postoperative bleeding, 6 procedures (3%) had intraoperative bleeding which exceeded an estimated blood loss of 5 cc and 2 procedures (1%) developed a tracheoesophageal fistula. One patient (0.5%) experienced airway distress related to obstruction of the airway proximal to the tracheotomy tube. No patients required a return to the operating room to manage their complication, no patients developed a tracheoinnominate fistula and none of the tracheotomy sites became infected. The post tracheotomy ventilator wean to trach-collar supplemental oxygen protocol was accomplished with a mean of 6 days in 119 patients for whom data was available. Results demonstrate that the open tracheotomy procedure is a safe and frequently life saving manoeuvre in situations with an unsecured airway, and it provides better outcomes in patients requiring long term ventilatory support. Mortality rates are low and its potential morbidity is exceeded by its benefits.

Complications after two transphyseal bridging techniques for treatment of angular limb deformities of the distal radius in 568 Thoroughbred yearlings.

REASONS FOR PERFORMING STUDY: Surgical correction of carpal angular limb deformities by growth retardation is commonly undertaken with a screws and tension band wire loop technique (S&W) or a single transphyseal screw (STS). This study compares complications after S&W and STS bridging in the distal radius of Thoroughbred yearlings. OBJECTIVE: To compare the prevalence of complications serious enough to require follow-up radiographs following either S&W or STS surgery for growth manipulation in the distal radius of Thoroughbred yearlings. METHODS: Medical records and radiographs from Thoroughbred yearlings (age range 261-457 days) treated for carpal angular limb deformities at a single hospital over 2 years were reviewed. Each of the techniques was used exclusively during a single year. The complication threshold criterion for inclusion was the need for nonroutine radiographs of the operated site anytime after implant insertion or removal. RESULTS: Of 568 horses, 253 received S&W and 315 received STS. Horses were of similar age at the time of surgery for STS and S&W. Single transphyseal screws were left in place for a significantly shorter amount of time (16 days). Sex, the limb(s) treated and medial vs. lateral placement were not significantly different between techniques. Complications included physitis post implant removal, metaphyseal collapse post implant removal, infection, overcorrection and seroma formation severe enough to require radiography. Physitis and metaphyseal collapse occurred significantly more frequently with STS compared with S&W. Infection, overcorrection and seromas were not significantly different between techniques. CONCLUSION: The STS and S&W techniques are both viable treatment options for correction of carpal angular limb deformities. However, horses treated with the STS technique have a significantly increased risk of developing physitis or metaphyseal collapse. POTENTIAL RELEVANCE: Horses treated with STS bridging have a significantly increased risk of developing the post correction complications of moderate to severe physitis and metaphyseal collapse compared with horses treated with S&W bridging.

[New condylar head system for temporary condylar reconstruction in ablative tumour surgery]. / Neu entwickeltes Kiefergelenkkopfimplantat zur temporären Kondylus-Rekonstruktion in der ablativen Tumorchirurgie.

BACKGROUND: Based on own retrospective studies a condylar head add-on system for immediate, temporary reconstruction in patients undergoing ablative surgery requiring the removal of the manibular condyle has been developed in cooperation with the Department of Oral and Maxillofacial Surgery of the University of Tennessee, USA, and the Association for the Study of Internal Fixation (AO/ASIF). PURPOSE: The design of the new condylar head add-on system and its use in an anatomical dissection study on a human cadaver are introduced and discussed. DESIGN AND FIRST EXPERIENCES: The condylar replacement is made of commercial pure titanium and is conceived as an add-on system. It consists of a reconstruction plate (2.4 Uni-LOCK-System) und an adaptable condylar head that can be fitted on either side. The offset of the condylar head in a medial direction allows anatomically correct positioning of the implant. The slanted oval head shall provide a large contact area while maintaining function of the mandibular joint. The height-adjustable positioning of the condylar head add-on with four different fixations plates facilitates an intraoperative vertical correction of the condylar head without necessary bending of a new reconstruction plate. A condylar head add-on used on both sides and combined with the frequently used 2.4 Uni-LOCK-plate benefits from reduced storekeeping and turns out to be advantageous from an economic point of view. PERSPECTIVE: An international, prospective multi-center study evaluating the intraoperative applicability of the new condylar head add-on system and its functional as well as aesthetic results during the first two postoperative years has started in September 2006.

Bone grafting the jaws in the 21st century: the use of platelet-rich plasma and bone morphogenetic protein.

The use of PRP and rhBMP-2 in facial skeletal reconstruction is supported by theoretical and practical human and animal data that represent exciting prospects for the 21st century. Although the use of PRP in conjunction with autogenous grafting of the maxillofacial complex increases the already impressive predictability of this technique, it is possible that improvement of the clinical use of rhBMP-2 may one day obviate the need for a donor site harvest of bone.

Platelet-rich plasma: Growth factor enhancement for bone grafts.

Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).

Accelerated fractionation radiotherapy and concomitant chemotherapy in patients with stage IV inoperable head and neck cancer.

BACKGROUND: Stage IV inoperable head and neck cancer has a 2-year mortality rate of greater than 70% when treated with conventional radiotherapy. A Phase II study was undertaken to evaluate the effects of concomitant chemotherapy and accelerated, interrupted, twice-a-day radiotherapy on tumor response, locoregional control, survival, and morbidity. METHODS: Thirty-four patients with Stage IV inoperable squamous cell carcinoma of the head and neck and a minimum follow-up of 36 months were evaluated. Concomitant chemoradiotherapy was administered during weeks 1, 3, and 5 (with planned breaks during weeks 2 and 4), consisting of cisplatin 60 mg/m2 on day 1, continuous 5-day infusion of 5-fluorouracil, 750 mg/m2 per day, and radiotherapy, 2 Gy twice a day, more than 6 hours apart, followed by 3 days of radiation therapy alone (final "boost") in week 6, for a total dose of 70 Gy and treatment duration of 5 1/2 weeks (38 days). RESULTS: Twenty-seven patients achieved a clinical complete response (82%). Actuarial locoregional control at 3 years was 73% and the actuarial 3-year survival probability, including all deaths, was 38%. All locoregional recurrences were manifested within 12 months. Of the 20 deaths, 12 were tumor related (locoregional and/or metastatic), 3 were treatment related, and 5 were due to other causes. Acute toxicity consisted of grade 3 mucositis and dysphagia and grade 2-3 leukopenia, not requiring treatment interruption or cessation. CONCLUSION: Concomitant accelerated radiation therapy and chemotherapy is a feasible treatment approach in this prognostically poor patient population, yielding dramatic tumor responses and impressive locoregional control at the cost of somewhat increased acute toxicity. Although serious late complications have not been observed, caution should be exercised in view of the relatively short follow up.

The potential for HIV transmission through allogeneic bone. A review of risks and safety.

Over the past two decades, oral and maxillofacial surgeons have gained a greater appreciation for the biology of allogeneic bone healing, resulting in a dramatic increase in its indications and use. Unfortunately, this time period has also ushered in near epidemic proportions of HIV-infected persons, some of whom might be considered as potential donors of allogeneic bone. As this article will discuss, surgeons and tissue bank teams alike must be aware of the clinical and serologic criteria associated with an acceptable donor. Only in this way can contamination-free specimens be obtained and surgically implanted.

Isolation of Actinomyces species and Eikenella corrodens from patients with chronic diffuse sclerosing osteomyelitis.

Cultures from 26 patients with chronic diffuse sclerosing osteomyelitis of the mandible were studied. In most cases there was a mutualistic infection involving any one of the known human Actinomyces species together with Eikenella corrodens. In a few cases, Arachnia species were substituted for Actinomyces and gram-negative anaerobes for E corrodens. The specific culture protocol used to identify these organisms from clinical specimens is described. Taxonomic and experimental evidence that supports an infectious etiology are presented.

Tissue banking safety: caveats and precautions for the oral and maxillofacial surgeon.

Oral and maxillofacial reconstructive surgeons using allogeneic tissues have expressed justifiable concern over the safety of these tissues as they relate to the transmission of infectious disease. This report reviews cases of infectious disease transmission from inadequately screened donors of allogeneic tissues, as well as those related to improper sterilization and cataloging of these tissues. It is concluded that good judgment and attention to good science on the part of the tissue bank as well as the surgeon can maximize the ability to place contamination-free specimens, thereby avoiding complications similar to those described.