Postoperative long-term results for the comparison of the symmetry of the upper lip during lip closure according to Millard and Pfeifer.

BACKGROUND: Clefts in newborns are associated with severe morphological and functional impairment. Especially the lip is of importance as if the treatment result is unsatisfactory, it can lead to psychological changes in the patient. Different operative procedures have been developed over the last decades. The aim of the presented study was the comparison of the surgical techniques according to Millard and Pfeifer regarding the temporal development of the postoperative symmetry of the lip height and mouth width. METHODS: Digitized photographs of patients from the department of oral and maxillofacial surgery at the University of Göttingen were evaluated from 1979 to 1996. With a video analysis program, the lip height and mouth width were analyzed regarding the symmetry. We demonstrated the symmetry values over a period of 8 years in order to show the influence of growth on postoperative results. RESULTS: The development of the vertical symmetry of the Philtrum and the lip vermillion on the cleft side in comparison to the healthy side behaves differently depending on Pfeifer and Millard. The lip height of the cleft lip was shorter in both techniques than on the healthy side, but Pfeifer's difference was significantly more pronounced. The lip vermillion height on the cleft side was slightly shorter in the Millard group and markedly larger in the Pfeifer group. Both techniques can achieve good symmetry results for the vertical dimension of the lip. According to Pfeifer, the development of the horizontal dimension on the cleft side is bigger within the first 4 years than on the healthy side; according to the Millard technique, the horizontal development is smaller. These differences are greater within the first 6 years and approach between the 6th and 8th year. CONCLUSIONS: The Millard technique demonstrates better results concerning the philtrum and vermillion symmetry during growth within the first 6 years. Over the whole study period, growth corrects the philtrum and vermillion symmetry within the Pfeifer group.

Accuracy of Navigation-Guided Dental Implant Placement with Screw Versus Hand Template Fixation in the Edentulous Mandible.

PURPOSE: Preoperative planning of the implant position as part of a coordinated prosthetic and surgical concept is becoming increasingly important regarding function and esthetics. The aim of this study was to investigate the transmission accuracy of template fixation during surgery in edentulous arches with hand fixation in comparison to intermediary screw fixation. MATERIALS AND METHODS: Preoperatively, 10 implant positions were planned using computed tomography (CT) with the system med3D for implant placement in four mandible models of the Goettingen study model, using a prosthetic diagnostic template. A total of 40 implant insertions were created. For every 20 insertions, the template was temporarily fixed with three screws and compared with the insertion using a hand-fixed template. The precision of the transmission was evaluated with and without screw fixation by re-evaluating the preimplant planning with additional CT scanning of the respective models. RESULTS: Compared with the hand-fixed procedure (HFG) in the model situation, there were no significant differences between the deviations of planned and final implant position in the screw-fixed group (FG). According to the study results, the fixed procedure leads to less depth deviation and lateral error of the implant base in relation to the HFG. Within both groups, there were significant differences between the radial deviation tendencies from the implant base to the implant apex (P = .033 for FG and P = .001 for HFG). CONCLUSION: The use of CT-based implant planning succeeds in fixed and hand-fixed surgical procedures with high precision in the atrophic, edentulous mandible model. According to the results of this study, in cases demanding high depth precision, screw-fixation of the template can be helpful.

The incidence of occult metastasis and the status of elective neck dissection in salivary adenoid cystic carcinoma: a single center study.

OBJECTIVE: Adenoid cystic carcinoma (ACC) is characterized by a high rate of local recurrence and late distant metastasis. The status of an elective neck dissection (END) is controversial in the literature. STUDY DESIGN: In this study we retrospectively analyzed the surgical treatment and follow-up examinations of 59 patients with ACCs of a salivary gland treated in a single center between 1980 and 2016. RESULTS: The incidence of occult nodal metastases among all patients who underwent END was 20.6%. The overall survival and the disease-free survival of patients who underwent END versus patients without END had no significant differences. Even in the case of positive lymph nodes metastasis there was no significant benefit in survival or local recurrence control. CONCLUSION: The incidence of occult neck metastases in patients with ACC was 20.6%. There was no significant enhanced survival in the group of patients who underwent an END.

Clinical prognostic factors of salivary adenoid cystic carcinoma: A single-center analysis of 61 patients.

PURPOSE: Adenoid cystic carcinomas are rare malignant tumors of the salivary glands. They are characterized by a high rate of local recurrence, late distant metastasis and a poor disease-free survival. In this study, we analyzed a series of 61 patients who were all treated at the University of Göttingen over a period of 21.0 years. MATERIALS AND METHODS: In all 61 patients with salivary adenoid cystic carcinoma, clinical data, demographic data, risk factors, tumor location, tumor stage, status of surgical margin, surgical treatment, postoperative radiotherapy and follow-up interval were assessed. RESULTS: The overall survival (OS) and the disease-free survival (DFS) of patients who underwent surgery and those who underwent combined surgery with radiotherapy showed no significant differences. Neither did the T-stage (T1/T2 vs. T3/T4) show significant differences in OS and DFS. Only the status of the surgical margin was significantly associated with a longer OS and a longer DFS. CONCLUSION: The present results confirm that the radical surgical resection with clear tumor-free margins is the most important predictor for a longer survival. Adjuvant radiotherapy should be discussed from case to case, but should not be seen as an absolute prognostic factor for OS.

Deep neck infections: A single-center analysis of 63 cases

Background and Purpose: With the use of antibiotic therapy, the incidence of deep neck infections has decreased in recent decades. The aim of this investigation was to review the clinical course and the management of deep neck infections in our department, compare them to the experiences of the common literature and identify predisposing factors for lethal complications. Material and Methods: In this single-center analysis, 63 patients with deep neck infections were treated surgically. The following clinical data were analyzed and compared: age, gender, laboratory data, spatial manifestation, therapeutic modalities, comorbidities, length of hospitalization and complications. Results: There was a predominance of male patients (58.7%) and a mean age of 57.9 years. The most common symptoms at diagnosis were sore throat (96.8%) and neck swelling (92.0%). Cardio/pulmonary diseases and diabetes mellitus were the most common comorbidities. There was a significantly longer hospital stay for patients with diabetes mellitus. The most common manifestation was a parapharyngeal abscess in 24 patients (38.1%), followed by peri-/retrotonsillar infections in 19 patients (30.2%). In 29 patients, a multiple space infection was observed, with a significantly longer duration of hospitalization and a higher rate of complications. The main lifethreatening complication was the development of airway obstruction in 20 patients (31.7%), who all received a tracheostomy. The duration of hospitalization for patients with complications was significantly longer. Conclusions: Close attention must be paid to the management of patients with deep neck infections, especially patients with diabetes mellitus and cardio/pulmonary diseases or patients with multiple space infections (AU)

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Bacterial and histopathological findings in deep head and neck infections: a retrospective analysis.

OBJECTIVES: Deep neck infections are among the most dangerous acute diseases in the head and neck region. This analysis gives an overview of the bacterial and histopathologic findings of deep neck infections. STUDY DESIGN: From January 2002 to December 2012, 63 patients were diagnosed with and treated for deep neck infections at the University Medical Center Göttingen. Bacterial and histopathologic examinations were made, and the occurrence of bacterial pathogens and histopathologic findings were analyzed. RESULTS: The most commonly isolated aerobic gram-positive pathogen was Streptococcus viridans (26.7%); Staphylococcus epidermidis and Staphylococcus aureus were each found in 16.7% of infections. The most commonly isolated aerobic gram-negative pathogens were Escherichia coli, Klebsiella oxytoca, and Haemophilus influenzae. In 1.6% of patients, a malignant cancer was detected. CONCLUSION: For clear diagnosis and effective therapy, a bacteriologic investigation of deep neck infections is essential because of the heterogeneous spectrum of the detected bacteria. In contrast to Asia, where Klebsiella pneumoniae is the most common pathogen, in South Lower Saxony, Germany, we discovered a dominating spectrum of aerobic gram-positive cocci. Biopsy obtained from an abscess cavity for histologic examination should always be part of the diagnostic process in order to exclude a malignant process.

Osteoblast-like cells with different embryologic origins behave differently in increasing zoledronic acid concentrations: a pilot study in pigs.

OBJECTIVE: We compared the intraindividual effects of increasing zoledronic acid (ZA) concentrations on osteoblast-like cells with different embryologic origins. STUDY DESIGN: Cultured osteoblast-like cells from mandible and iliac crest bone samples of domestic pigs were exposed to increasing concentrations of ZA (0, 10-8, 10-6, and 10-4 M). Proliferation was assessed by cell counting. Receptor activator of nuclear factor kB ligand and osteoprotegerin (OPG) messenger RNA expression were assessed at 0, 1, 4, 7, and 10 days. RESULTS: The OPG expression level was higher in the iliac crest than in the mandible. Neither ZA concentration nor the cells' origin affected the expression of receptor activator of nuclear factor kB ligand. At 10-6 M, OPG expression from both locations reached the same level after 7 days of cultivation, as OPG expression increased to a greater extent in the mandible in comparison to the iliac crest. CONCLUSION: Cultured mandibular osteoblast-like cells reacted more sensitively to high ZA concentrations than did osteoblast-like cells from the iliac crest.

Can tongue shadow in panoramic radiographs be avoided by using the tongue repositioning maneuver?

OBJECTIVE: The purpose of this study was to evaluate the use of the tongue repositioning maneuver (TRM) during panoramic radiography so as to avoid the error of tongue shadow. STUDY DESIGN: A total of 300 panoramic radiographs were evaluated. One hundred and fifty orthopantomograms with conventional positioning technique were used as a control group, while other 150 were taken with the patient performing the TRM. The tongue shadow was measured in each radiograph in the first molar regions bilaterally and in the midsagittal plane. Wilcoxon Mann-Whitney U-Test was used to test the significance difference between the groups. RESULTS: The tongue-palate distance in the study group was reduced from a mean value of 6.4 mm to 1 mm in the right first molar, 8.0 mm to 2.2 mm in the midsagittal region, and 6.6 mm to 1.2 mm in the left first molar position. Statistical evaluation exhibited significant differences of tongue shadow at all measuring sites between study and control group (P < .0001). CONCLUSIONS: The present study demonstrates that the TRM leads to a substantial reduction of the tongue position error in panoramic radiography.

Sialoendoscopy as a diagnostic and therapeutic option for obstructive diseases of the large salivary glands-a retrospective analysis.

OBJECTIVES: The diagnosis and therapy of obstructive inflammatory disorders of the salivary glands have changed in the past decades following the introduction of sialoendoscopy. The aims of the present study were to analyze the relevance of sialoendoscopy using our own data and to compare the results to those of other studies. PATIENTS AND METHODS: A retrospective analysis of 70 patients was performed, who were treated for obstructive disorders of the parotid and/or submandibular gland in whom sialoendoscopy was indicated. Two categories of interventions were considered: diagnostic interventional sialoendoscopy and endoscope-assisted interventions. Interventional sialoendoscopy procedures requiring extirpation of the gland were included in the analysis, as were abnormal intraductal processes that were detected during endoscopy. RESULTS: Treatment was successful in 58 of 67 (86.6 %) procedures (sialoendoscopy without surgical intervention n = 59; endoscope-assisted surgical intervention n = 8). Based on the underlying disease, the success rate was 88.6 % (n = 39) in patients with obstructive sialadenitis without sialolithiasis and 86.6 % (n = 19) in patients with sialolithiasis. It was not possible to draw definitive conclusions on the underlying disease from the observed pathological intraductal changes. CONCLUSIONS: Sialoendoscopy is an effective and safe diagnostic and therapeutic option with low complication rate. However, limiting factors such as the size or the position of potentially removable obstacles must be taken into consideration. CLINICAL RELEVANCE: The rate of gland extirpations can be reduced using sialoendoscopy.

A review of pathogenesis, diagnosis, treatment options, and differential diagnosis of odontogenic infections: a rather mundane pathology?

Odontogenic infections are common in the dental practice and their treatment should be a standard procedure for every dentist. For optimal management of septic intraoral problems, the practitioner must understand the underlying causes and etiologies of odontogenic infections. Therefore, the purpose of this article is to outline basic inflammatory processes involved in the development of odontogenic and intraoral infections including relevant pathogens, biochemical processes mediated by pro-inflammatory molecules, the basics of abscess formation, the host response, and the clinical appearance of intraoral septic processes. Furthermore, treatment modalities of odontogenic infections and associated lesions are discussed and a brief explanation of possible complications and their management is provided.

Early disruption of the blood-brain barrier after thrombolytic therapy predicts hemorrhage in patients with acute stroke.

BACKGROUND AND PURPOSE: Leaks of the blood-brain barrier can be detected on postcontrast-enhanced T1-weighted MRIs. Although early disruptions of the blood-brain barrier appear to be an important risk factor for tissue plasminogen activator-related hemorrhages in rodents, little is known about their incidence and consequences in human stroke. METHODS: This is a retrospective analysis of a prospectively collected stroke database over the past 6 years. In 52 patients, multimodal MRI (including diffusion-weighted, perfusion-weighted, and postcontrast-enhanced T1-weighted MRI to detect blood-brain barrier changes) had been performed immediately before systemic thrombolysis and in 48 patients within a median of 30 minutes (interquartile range: 30 to 60 minutes) after recombinant tissue plasminogen activator treatment. The incidence of symptomatic hemorrhage (SICH), defined as any parenchymal hemorrhage leading to deterioration in the patient's clinical condition, was related to several clinical and imaging variables, including early blood-brain barrier changes. RESULTS: Overall, SICH was detected in 9 (9%) patients and among these, 2 died. Although no blood-brain barrier changes were detectable before thrombolysis, 3 of 48 patients (6.25%) had a parenchymal gadolinium enhancement in the areas of initial infarction after tissue plasminogen activator treatment. All 3 patients developed SICHs at sites corresponding to the areas of enhancement. The presence of a parenchymal enhancement was significantly associated with SICH (P<0.01), whereas other clinical and imaging variables did not predict SICH in this series. CONCLUSIONS: Early parenchymal enhancement after intravenous tissue plasminogen activator is significantly associated with subsequent SICH and could therefore become a useful imaging sign for the rapid initiation of preventive strategies in the future.