"Religious Belief": An Undervalued Ethical Inclusion Criterion for Clinical Trials on Bone Grafting Procedures.

The aim of the present review was to assess randomized controlled trials (RCTs) on bone grafting procedures that included religious belief as an eligibility criterion. Indexed databases were searched up to and including February 2019 using different search strategies. In strategy 1, the following terms were used: (a) belief; (b) bone graft; (c) faith; (d) inclusion; (e) exclusion; (f) eligibility; (g) criteria; (h) randomized clinical trial; (i) religion; and (j) xenograft. In strategy 2, the following terms were used in addition to those used in strategy 1: Xenografts AND oral surgery OR xenografts AND maxillofacial OR xenografts AND dental implants. These searches were filtered using the terms "Randomized clinical trial" and "human studies". The initial search yielded 3932 studies. Filtration of results using the terms "Randomized clinical trial" and "human studies" showed 0 studies. Evaluation of patients' religious beliefs seems to be undervalued in RCTs related to the placement of xenografts. This is an essential and ethical criterion that should be taken into consideration prior to inclusion of participants and signing the informed consent form for RCTs related to the placement of bone grafts.

Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction.

OBJECTIVES: Segmental resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. METHODS: Using the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after segmental resection of the lateral mandible. RESULTS: Thirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after segmental resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. CONCLUSIONS: Reconstruction of segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of segmental defects of the lateral mandible.

Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey.

PURPOSE: To assess up-to-date expectations and preferences of patients seeking dental implants. MATERIAL AND METHODS: One hundred and fifty consecutive patients (66 male and 84 female interviewees) were asked to rank their concerns regarding implant therapy and answer a questionnaire on implant and bone graft surgery, cost and time considerations and second-opinion behaviour. RESULTS: Treatment predictability and avoidance of removable dentures were ranked high priority (compared with time and cost efficiency or avoidance of bone grafts). Patients' estimation of the 10-year implant success rate was 84%, and 59% of patients expected implants to last for a lifetime. Total treatment time was estimated to be 4 months on average, and only 12% would tolerate increased risk of implant failure for the sake of shortening treatment duration. 61% of interviewees accepted autologous bone grafts (the majority favouring the retromolar area), while only 23% were willing to undergo bone harvesting from the hip. 43% opted for bone substitute material to avoid donor site morbidity. 67% would accept the additional costs associated with computed tomography, software-based treatment planning and guided implant placement to avoid bone graft surgery. Motivation for second-opinion seeking was high (46-62%), especially in young and male patients. CONCLUSION: Patient expectations on implant success and predictability are high compared with their reluctance towards treatment costs and duration. Acceptance of treatment morbidity is high among patients reporting low denture satisfaction; however, minimally invasive treatment alternatives are generally preferred.

Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap.

Our aim was to evaluate the quality of life (QoL) in patients with ameloblastoma who had been treated by immediate mandibular reconstruction with a fibular free flap, and to analyse the association between QoL and their sociocultural and medical characteristics. We assessed the QoL outcomes of 33/45 patients using the University of Washington quality of life (UW-QoL) questionnaire and the 14-item Oral Health Impact Profile (OHIP-14). Thirty-three of the 45 questionnaires were returned (73%). In the UW-QoL the best-scoring domain was "shoulder", whereas the lowest scores were for "chewing" and "activity". In the OHIP-14 the lowest-scoring domain was "handicap", followed by "social disability" and "psychological discomfort". Mandibular reconstruction with a fibular free flap significantly influenced the patients' QoL and oral function. Their sociocultural data showed that most patients had a fairly low level of education.

Clinical application of the FACES score for face transplantation.

OBJECTIVE: This study aimed to systematically evaluate all reported outcomes of facial allotransplantation (FT) using the previously described FACES scoring instrument. METHODS: This was a retrospective study of all consecutive face transplants to date (January 2012). Candidates were identified using medical and general internet database searches. Medical literature and media reports were reviewed for details regarding demographic, operative, anatomic, and psychosocial data, which were then used to formulate FACES scores. Pre-transplant and post-transplant scores for "functional status", "aesthetic deformity", "co-morbidities", "exposed tissue", and "surgical history" were calculated. Scores were statistically compared using paired-samples analyses. RESULTS: Twenty consecutive patients were identified, with 18 surviving recipients. The sample was composed of 3 females and 17 males, with a mean age of 35.0 ± 11.0 years (range: 19-57 years). Overall, data reporting for functional parameters was poor. Six subjects had complete pre-transplant and post-transplant data available for all 5 FACES domains. The mean pre-transplant FACES score was 33.5 ± 8.8 (range: 23-44); the mean post-transplant score was 21.5 ± 5.9 (range: 14-32) and was statistically significantly lower than the pre-transplant score (P = 0.02). Among the individual domains, FT conferred a statistically significant improvement in aesthetic defect scores and exposed tissue scores (P ≤ 0.01) while, at the same time, it displayed no significant increases in co-morbidity (P = 0.17). CONCLUSION: There is a significant deficiency in functional outcome reports thus far. Moreover, FT resulted in improved overall FACES score, with the most dramatic improvements noted in aesthetic defect and exposed tissue scores.

[Informed consent to postmortem tissue donation: a catamnestic survey within a year of the donor's death]. / Die muskuloskelettale Gewebespende: Rückblickende Bewertung durch die Angehörigen des Spenders im Jahresabstand nach dem Tod.

UNLABELLED: The authors present data from 36 musculoskeletal donors. Talking to the next of kin plays a key role in the consenting process for tissue donation. We give an overview of our fundamental thoughts and the guidelines developed for the contact with the family and present the results of a catamnestic review. METHODS: One year after procurement, we contacted the consenting persons by telephone for an interview using a semi-standardized questionnaire to evaluate the information given on tissue donation and the emotional processing of the death. RESULTS: 8-18 months after the donation, 26 (72.2 %) consenting persons could be reached and gave a positive feedback with regard to the information and support provided and the consent given by them at that time. DISCUSSION: The telephone contact of physicians from an Institute of Legal Medicine with the family of a deceased is perceived as being helpful in an acute stress situation caused by a sudden death and as an accepted way to ascertain the deceased's last will with regard to a potential musculoskeletal donation. According to the German Transplantation Act asking for musculoskeletal donations is the duty of every physician. Our data show that this does not constitute an additional burden for the relatives, if the question is asked in an appropriate way.

The posterior bone block procedure in posterior shoulder instability: a long-term follow-up study.

We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years' follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations.

Patient self-evaluation of intra-oral bone grafting treatment to the maxillary frontal region.

Bone grafting to the anterior region of the maxilla is a treatment method often used for reconstruction after dental trauma when teeth have been lost. The purpose of this study was to interview patients who underwent bone grafting from the chin or lateral mandible to assess the patients' experiences, especially regarding morbidity of the donor site and their overall assessment of treatment and care. Twenty-six patients who had undergone bone grafting from the chin and lateral mandible regions before implant treatment were interviewed about their experiences of treatment and present status 3-5 years after surgery. The patients rated the quality of presurgical information, quality of care, postoperative discomfort, postoperative pain, present discomfort and satisfaction with the final results. The patients, in general, were positive to the presurgical information and the quality of care. Postoperative pain during the first week was rated higher when grafts were taken from the chin than from the lateral mandible. Patient satisfaction with the outcome was high 3-5 years after surgery. However, patients that underwent bone grafting from the lateral mandible rated discomfort significantly lower and satisfaction significantly higher than patients who underwent chin grafting. More discomfort was reported in patients where wide bone grafts had been taken from the chin. A high degree of patient satisfaction with treatment and outcome can be expected after intra-oral bone grafting. However, surgeons should be cognizant of and patients informed about the risks of morbidity, especially when harvesting wide bone grafts from the chin. If possible, a first-hand choice for the surgeon should be grafting from the lateral mandible before considering chin graft.

Use of free vascularized fibular graft for congenital ulnar pseudarthrosis: surgical decision making in the growing child.

Congenital pseudarthrosis of the ulna may cause growth disturbance and progressive forearm deformity, leading to functional compromise of the upper extremity. Treatment is challenging, and surgical decision making must take into account three goals of treatment: bony healing, distal radioulnar joint (DRUJ) stability, and continued skeletal growth. Four cases of congenital ulnar pseudarthrosis treated with free vascularized fibular graft are presented here. In two cases, the vascularized fibular graft included the proximal fibular epiphysis to reconstruct the DRUJ and ulnocarpal joints. Average age of the four patients at time of vascularized fibular grafting was 10 years (range 3-16 years). Patients had undergone up to three previous failed operations. A step-cut osteotomy technique with rigid internal fixation was used in all patients. Donor-site distal tibiofibular arthrodesis was performed in skeletally immature patients when appropriate. At average follow-up of 60 months (range 33-83 months), all patients achieved bony union with full wrist range of motion compared with the contralateral extremity. The DRUJ was stable in all patients. Two skeletally immature patients with concomitant epiphyseal transfer showed continued skeletal growth. Two patients nearing skeletal maturity achieved revascularization of the distal ulna. Free vascularized fibular grafting is a successful option in the treatment of congenital ulnar pseudarthrosis. Reconstruction of the distal radioulnar and ulnocarpal joints using concomitant proximal fibular epiphyseal transfer should be considered in the skeletally immature patient with distal ulnar involvement.

Health-related quality of life after maxillectomy: a comparison between prosthetic obturation and free flap.

PURPOSE: The purpose of this cross sectional study was to evaluate the health-related quality of life of patients following maxillectomy and to compare obturation and free flap reconstruction. PATIENTS AND METHODS: At the Regional Maxillofacial Unit in Liverpool, United Kingdom, between 1992 to 1996, 39 patients underwent maxillectomy for malignant pathology. Of these patients, 28 (10 underwent obturation and 18 underwent free tissue reconstruction) completed a postoperative semi-structured interview. Eight questionnaires were used to test aspects of health-related quality of life and function. RESULTS: The main findings were the associations between the size of maxillectomy defect and the University of Washington activity (-0.53; P =.005) and recreation (-0.70; P <.001) domains, and with the physical functioning (-0.58; P =.001) and quality of life (-0.51; P =.007) domains of the European Organization for Research and Treatment of Cancer questionnaire. No statistically significant differences were seen between the obturator and free flap groups. Borderline trends were for obturator patients to be more concerned about their appearance, to have more pain and soreness in their mouths, to be more aware of their upper teeth, more self-conscious and less satisfied with their upper dentures, and less satisfied with function. CONCLUSION: Similar subjective outcomes were found for both groups, and a larger longitudinal study is needed to test these relationships more rigorously.

Dental implants in reconstructed jaws: patients' evaluation of functional and quality-of-life outcomes.

PURPOSE: To evaluate the quality-of-life aspect of treatment outcome following functional jaw reconstruction and dental implants in the maxilla or mandible. MATERIALS AND METHODS: This cross-sectional study used a questionnaire interview of 28 rehabilitated patients who received autogenous bone grafts from the ilium and endosseous implants (14 maxillary and 14 mandibular cases; 134 implants) for functional jaw reconstruction between 1988 and 1999. A questionnaire was developed to assess the quality-of-life outcome for those patients who had finished their rehabilitation at least 6 months prior to the interview. Responses to the questions were recorded by means of visual analog scales. RESULTS: In general, patients gave positive comments on the restoration of their orofacial appearance and function (mastication and speech). The majority (85.7%) found no problem in various daily social activities, including dining in public. DISCUSSION: The overall level of satisfaction with the treatment outcome and the degree of recommendation of the treatment to others were both favorable (mean scores 8.6 and 8.7 out of 10, respectively). CONCLUSION: Oral rehabilitation using functional jaw reconstruction can reach a satisfactory level of esthetics, function, and psychosocial well being of patients, thus improving their quality of life.

Complications of posterior iliac crest bone grafting in spine surgery in children.

STUDY DESIGN: The perioperative and postoperative complications associated with harvesting posterior iliac crest bone graft in children were reviewed. A retrospective study was performed and a questionnaire interview conducted. OBJECTIVES: To determine the morbidity associated with posterior iliac crest bone graft in children. SUMMARY OF BACKGROUND DATA: Iliac crest bone is commonly used as a source of bone graft in spine surgery. Although there are multiple reports of complications in adults, there are no reports in children. METHODS: A retrospective chart review was performed of 214 consecutive children who underwent spinal fusion with posterior iliac crest bone graft from 1990 through 1996. An interview was conducted of 87 patients with normal mental status, predominantly those with idiopathic scoliosis with a minimum of 2 years' follow-up (mean, 55 months). RESULTS: The review showed one (0.5%) instance of arterial injury in the sciatic notch. Two (1%) patients had infections, both of which resolved with a single irrigation and débridement. There was one documented instance of sacroiliac penetration that did not cause clinical problems. The chart review showed three (1.4%) instances of continued pain and one (0.5%) of numbness. By contrast to the few reports of pain in the chart review, responses to an interview of 87 patients showed 21 (24%) children reporting pain at the iliac crest site, with 13 (15%) reporting problems with daily activities. The self-reported pain, on a scale of 1 to 10, ranged from 1 to 10 with a mean of 4. Nonsteroidal anti-inflammatory drugs (NSAIDS) were taken by eight (9%) children for pain at the bone graft site. Five (6%) reported skin irritation, and 18 (20%) mentioned numbness surrounding the scar. CONCLUSION: The perioperative rate of complications in iliac crest bone grafting in children is low (2%). The complication of pain (24%) and pain that is severe enough to interfere with daily activity (15%) is significant at a mean follow-up of more than 4 years. The true extent of pain and numbness after posterior iliac crest bone grafting in children was severely underreported in the medical records and may be underrecognized.

Prefabrication of combined scapula flaps for microsurgical reconstruction in oro-maxillofacial defects: a new method.

Nowadays, in congenital or acquired large oro-maxillofacial defects, microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps. The aims of reconstruction include not only restoration of stability and aesthetic contour, but also the restoration of a functioning 'chewing organ'. In addition to bulkiness of the flaps, the stepwise surgical procedure (microvascular reconstruction, osseointegration of implants, secondary correction of flaps including preprosthetic surgery, etc.) prevents physiological oral function for a long time, and has some implications for creating an alternative method of microsurgical reconstruction with newly designed flaps. For reconstruction in maxillary and midface defects we prefer the use of the scapula flap. Since modern diagnostic methods allow comprehensive planning and defining of all relevant anatomical and functional factors in advance, the 'simultaneous' microvascular reconstruction by prefabricated scapula flaps has become possible and offers some advantages. The tissue prefabrication results in osseointegrated implants and thin mucosal linings with stable peri-implant soft tissue conditions at the time of microsurgical reconstruction. Postoperatively, after immediate dental restoration full oral function is attained. The 'simultaneous' reconstruction improves the psychosocial situation of the patient considerably.

Pseudarthrosis of the scaphoid treated by the Matti-Russe operation. A long-term review of 77 cases.

We report the long-term results of the Matti-Russe operation for pseudarthrosis of the scaphoid in 100 cases, reported previously by Mulder in 1968. Clinical results for 77 patients and radiographic data for 74 were reviewed at 22 to 34.8 years after surgery. In general, there was satisfactory relief of pain and stiffness but some patients had limitation of motion and reduced grip-strength, with usually slight osteoarthritic changes. There was poor correlation between subjective, objective, and radiographic results but 88% of the patients were satisfied with their results.