Characteristics of pulpal blood flow levels associated with non-segmented and segmented Le Fort I osteotomy.

OBJECTIVES: Laser Doppler flowmetry (LDF) is a noninvasive method to assess pulpal blood-flow (PBF). The purpose of this study was (1) to test whether Le Fort I (LF-I) osteotomy may show tooth type-related effects on LDF measurements, and (2) to investigate whether LF-I and tooth type may predict adverse PBF outcomes. MATERIAL AND METHODS: PBF was recorded bilaterally in maxillary incisors, canines, and first premolars in a surgical group of patients who underwent a segmented (n = 14) or nonsegmented LF-I osteotomy (n = 12), and in a nonsurgical group of control subjects (n = 12) who did not undergo orthodontic treatment. PBF measurements were made before surgery (session I), and at intervals between 3 and 5 days (session II), and 55 and 59 days after surgery (session III). The nonsurgical control subjects were tested at similar intervals. An adverse outcome was defined as the presence of "PBF reduction of > 40%." Statistical analysis consisted of univariate analysis of variance for repeated measurements. A multiple logistic regression analysis was used to compute the odds ratio for LF-I and tooth type for adverse outcome versus nonadverse outcome. RESULTS: For the LF-I osteotomy study group there was a significant change in PBF values (P = .000). Analysis of session-related measurements revealed a significant difference between session I- and II-related measurements for the canine (P = .004) of the segmented LF-I osteotomy. Significant increase in risk of a session II-related adverse outcome occurred with a nonsegmented (16.6 odds ratio) (P = .009) and segmented LF-I osteotomy (59.2 odds ratio) (P = .000). The odds ratio that a patient with a segmented LF-I osteotomy might belong to the session III-related adverse outcome group was strong (20.6) and significant (P = .007). CONCLUSIONS: LF-I osteotomy type proved to be linked to changes in tooth type-related LDF measurements; it was an important prognostic determinant of adverse PBF outcomes.

EpCAM expression in squamous cell carcinoma of the oral cavity: frequency and relationship to clinicopathologic features.

This retrospective study was designed to investigate the prognostic significance of EpCAM expression in human oral squamous cell carcinoma on a long-term follow-up. EpCAM expression was examined immunohistochemically on a tissue microarray (TMA) of paraffin embedded tissue specimens from 77 consecutive patients who underwent surgical treatment for squamous cell carcinoma of the oral cavity in the period between 1980 and 1997 at the Department of Craniomaxillofacial and Oral Surgery, Innsbruck Medical University. High EpCAM expression was found in 17 (22.1%) of the tumor samples. Using Kaplan-Meier analysis no correlation of EpCAM overexpression was observed with conventional clinicopathologic features in this patient cohort. Taken together, these data suggest that EpCAM might become an attractive treatment target in a subgroup of patients with OSCC.

STAT1 activation in squamous cell cancer of the oral cavity: a potential predictive marker of response to adjuvant chemotherapy.

BACKGROUND: For patients with squamous cell carcinoma of the oral cavity, both locoregional and distant recurrences are common, and an appropriate adjuvant treatment modality has yet to be defined. Thus, there is an urgent need to identify novel molecular markers with potential prognostic and/or predictive value to improve treatment outcome in these patients. This retrospective study was designed to investigate the predictive and/or prognostic value of STAT1 activation in squamous cell carcinoma of the oral cavity. METHODS: STAT1 expression and subcellular localization was examined immunohistochemically on a tissue microarray of paraffin-embedded tumor specimens from 89 patients who underwent surgical treatment in the period between 1980 and 1997. A nuclear staining score of greater than 35% was defined as high STAT1 activation. RESULTS: According to study criteria, 18% of analyzed tumor samples exhibited high STAT1 activation. High STAT1 activation was associated with negative lymph node status. Moreover, in the subgroup of patients who received chemotherapy, high nuclear STAT1 staining in the tumor was associated with good prognosis. CONCLUSIONS: This is the first report demonstrating the potential predictive value of STAT1 activation status in patients with squamous cell cancer of the oral cavity. If confirmed in large prospective trials, this molecular marker could help in guiding therapeutic decisions in these patients.

High EGFR expression predicts poor prognosis in patients with squamous cell carcinoma of the oral cavity and oropharynx: a TMA-based immunohistochemical analysis.

This retrospective study was designed to investigate the prognostic significance of EGFR overexpression in human oral squamous cell carcinoma on a long-term follow-up. EGFR expression was examined immunohistochemically on a tissue microarray (TMA) of paraffin embedded tissue specimens from 109 patients who underwent surgical treatment for squamous cell carcinoma of the oral cavity and oropharynx in the period between 1980 and 1997. High EGFR expression was found in 80 (73.42%) of the tumour samples. Kaplan-Meier curves showed that EGFR overexpression was significantly related to decreased overall survival (p=0.05). Multivariate analysis showed that EGFR overexpression is an independent prognostic marker in these patients (p=0.02, RR 3.6). These results confirm that EGFR overexpression is an independent prognostic marker in patients with squamous cell carcinoma of the oral cavity and oropharynx. The EGFR antigen represents an attractive target for targeted therapies with monoclonal antibodies or specific tyrosine-kinase inhibitors in these patients.

Effectiveness of ultrasonography in determining medial and lateral orbital wall fractures with a curved-array scanner.

PURPOSE: The purpose of the study was to evaluate the diagnostic value of ultrasonography to determine medial and lateral orbital wall fractures. MATERIALS AND METHODS: Sixty-two patients with the clinical diagnosis of an orbital trauma underwent coronal computed tomography (CCT) and ultrasonographic investigation (US). Inclusion criteria were clinically suspected orbital injuries defined by reduced bulbus motility, diplopia, or additional traumatic injuries of the orbit or the globe. US and CCT were used as imaging diagnostic methods. RESULTS: Ultrasonography showed a sensitivity of 56%, a specificity of 95%, and an accuracy of 88% at the medial orbital rim. Regarding the lateral orbital rim, ultrasonography showed a sensitivity of 92%, a specificity of 88%, and an accuracy of 90% using CCT as a reference method. CONCLUSION: Ultrasonography with a curved-array scanner seems to be a valuable method in the detection of lateral orbital wall fractures. Further studies have to be done to improve sensitivity in the interpretation of medial orbital wall fractures.

Evaluation of pulpal blood flow after tooth splinting of luxated permanent maxillary incisors.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood flow (PBF). Dental injury has been associated with losses of pulpal sensibility. The purpose of this study was to assess whether LDF could be used to detect short- and long-term changes of PBF values of luxated permanent maxillary central incisors after repositioning and splinting. In 18 trauma patients, a single maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units (PU) were taken in four sessions: on the day of splint removal, and 12, 24, and 36 weeks after splint removal. Analysis of the luxation type-related PBF measurements revealed intrusion type-related PBF values to be associated with a significant decrease in PBF values (P < 0.05), while lateral luxation and extrusion type-related PBF values showed no significant difference between the session-related values (P > 0.05). PBF measurements did not change over time for the contralateral incisors (P > 0.05). Teeth affected by an intrusion-type luxation injury remained unresponsive to sensitivity testing at follow up, while 3 (60%) developed grey discoloration of the crown. LDF may become useful in the detection of ischemic episodes of luxated maxillary central incisors after repositioning and splinting. Further studies are warranted to assess the validity of post-traumatic 'ischemic episodes' by comparing it to histological tooth pulp changes.

Ultrasound versus computed tomography in the imaging of orbital floor fractures.

PURPOSE: The aim of the study was to investigate whether orbital ultrasonography (US) with a curved-array transducer could be an alternative imaging method to computed tomography (CT) to detect orbital wall fractures and fractures of the infraorbital rim. MATERIALS AND METHODS: Fifty-eight patients with the clinical ophthalmologic or radiologic diagnosis of an orbital trauma were investigated prospectively by US and CT. The reference method was the intraoperative findings. RESULTS: CT evaluation of the infraorbital rim yielded a sensitivity of 79%, a specificity of 90%, and an accuracy of 94%. The positive predictive value (PPV) and the negative predictive value (NPV) of the infraorbital rim reached 69% and 83%, respectively. CT evaluation of the orbital floor showed a sensitivity of 96%, a specificity of 71%, and an accuracy of 96%. PPV and NPV resulted in 71% and 93%, respectively. US investigation of the infraorbital rim yielded a sensitivity of 77%, a specificity of 89%, and an accuracy of 97%, whereas PPV and NPV reached 65% and 83%, respectively. US investigation of the orbital floor reached a sensitivity of 94%, a specificity of 57%, and an accuracy of 96%, whereas PPV and NPV yielded 57% and 91%, respectively. No significant difference was found between US and CT in the investigation of the infraorbital rim (P =.809) and the orbital floor (P =.729). CONCLUSIONS: US with a curved-array transducer appears to be a useful alternative method in the investigation of orbital floor fractures. Further studies have to be conducted to reduce the presence of false-negative results.

Clinical signs of orbital wall fractures as a function of anatomic location.

OBJECTIVE: The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor. STUDY DESIGN: The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component. RESULTS: Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence (P =.001) of diplopia and exophthalmos (P =.039) than fractures without involvement of the medial wall. CONCLUSION: Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.

Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study.

OBJECTIVE: The purpose of the study was to investigate whether a flexible, biodegradable material (Ethisorb) shows better long-term results with regard to diplopia, bulbus motility, and exophthalmos/enophthalmos compared to the use of lyophilized dura-patches and polydioxanone (PDS) foils. METHODS: During a period of 6 years 435 patients with an orbital fracture were investigated retrospectively. Inclusion criteria were patients with fractures of the orbital floor with a maximum size of 2 x 2 cm. Bulbus motility, exophthalmos, enophthalmos, and diplopia were investigated during a period of 2 years. RESULTS: One hundred twenty orbital floors were reconstructed by lyophilized dura-patches, 81 by PDS, and 136 by Ethisorb. An exploration without an implantation was performed in 91 patients. The long-term investigation 12 to 15 months after surgery showed an exophthalmos and enophthalmos incidence of 1%, whereas a reduced bulbus motility and diplopia were found in 5% and 4%, respectively. Fifteen to 24 months after surgery 2% of the patients had an exophthalmos and 1% had an enophthalmos. A reduction of bulbus motility was found in 4% of the patients, and diplopia was found in 3%. The use of Ethisorb resulted in a significantly lower incidence of exophthalmos 3 months after surgery compared to PDS. CONCLUSION: The low rate of acquired bulbus motility demonstrates acceptable results in using Ethisorb in the floor of the orbit.

Assessing revascularization of avulsed permanent maxillary incisors by laser Doppler flowmetry.

BACKGROUND: Laser Doppler flowmetry, or LDF, is a noninvasive method used to assess pulpal blood flow, or PBF. Dental avulsion is associated with loss of pulpal sensitivity. The authors conducted this study to assess whether LDF could be used to detect revascularization of replanted teeth. METHODS: The authors used LDF to assess the PBF values of avulsed permanent maxillary incisors treated using replantation and splinting in 17 subjects. They took measurements at four sessions: on the day of splint removal and at 12 weeks, 24 weeks and 36 weeks after splint removal. Five vital control teeth and five nonvital control teeth were used to assess the background signal. At 36 weeks, the authors determined clinically and radiographically whether revascularization had occurred. RESULTS: LDF readings correctly predicted the pulp status in 88.2 percent of the readings. Of the readings for vital teeth, 100 percent were correct, and of the readings for nonvital teeth, 80 percent were correct. Univariate analysis of variance demonstrated that in revascularized teeth, the PBF value increased significantly from splint removal to week 12 after splint removal and from week 24 to week 36 after splint removal. In the teeth that failed to revascularize, the PBF value dropped significantly from week 24 to week 36 after splint removal. CONCLUSIONS: The results of this study suggest that LDF accurately diagnoses revascularization of avulsed maxillary incisors after replantation and splinting. CLINICAL IMPLICATIONS: LDF may become useful in detecting revascularization much earlier than standard sensitivity tests.