[Mandibular advancement: bilateral sagittal split versus -distraction osteogenesis]. / Verlenging van de onderkaak: bilaterale sagittale splijtingsosteotomie versus distractieosteogenese.

In the 1990s intra-oral distraction osteogenesis (DO) became available as an alternative for bilateral sagittal splitosteotomy (BSSO) for advancement of the mandible. It was thought that DO would lead to more stability in the results and fewer neurosensory disturbances of the inferior alveolar nerve. However, there was no scientific evidence for this assumption. This article describes a number of recently published, prospective studies that demonstrate that BSSO is not inferior to DO with respect to stability and neurosensory disturbances of the inferior alveolar nerve. They also demonstrate that BSSO leads to less pain in patients and to lower total costs. It can be concluded that BSSO should be considered the standard therapy for mandibular advancement up to 10 mm in non-syndromal patients.

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.

[Throat ache ans swelling of the neck: first symptoms of Lemierre's syndrome]. / Keelpijn en zwelling van de hals: eerste symptomen van het syndroom van Lemierre.

Lemierre's syndrome, a thrombophlebitis of the internal jugular vein, is a rare disorder, usually caused by the microorganism Fusobacterium necrophorum. Throat ache and swelling of the neck are often the first symptoms. Without adequate treatment, Lemierre's syndrome may result in thrombosis of the internal jugular vein and metastatic lung abscesses, with a mortality rate of 18%. On the basis of 2 cases, Lemierre's syndrome is described here. In cases where Lemierre's syndrome is suspected, hospitalization often follows, with the administration of intravenous antibiotics and drainage of the abscesses. One should be on the alert for Lemierre's syndrome when a patient is presented with swelling in the neck following an oropharyngeal infection.

Maxillary sinus recovery and nasal ventilation after Le Fort I osteotomy: a prospective clinical, endoscopic, functional and radiographic evaluation.

The condition of the maxillary sinus is not routinely assessed before a Le Fort I osteotomy. Performing this procedure in an infected sinus might account for a considerable proportion of the complications, such as excessive bleeding and sinusitis. The aim of this study was to evaluate the maxillary sinus and nasal ventilation after Le Fort I osteotomy. Twenty patients were evaluated before and 2 months after surgery using validated questionnaires for sinonasal complaints (RSOM-31 and VAS score), nasal endoscopy, peak nasal inspiratory flow (PNIF), and a computed tomography (CT) scan. There were no differences in complaints before and 2 months after surgery (P>0.24). Also, the PNIF did not change significantly (P=0.10). On CT evaluation before surgery, a previously unnoted sinusitis was diagnosed in two patients. Postoperatively, a thickened sinus mucosa was present in all patients near the osteotomy line, the osteosyntheses, and around sequesters. This report describes maxillary sinus evaluation after Le Fort I osteotomy in a more comprehensive way by using CT. The Le Fort I procedure did not influence already existing physical or mental complaints, and nasal ventilation was not negatively affected. However, evaluation of sinonasal pathology should be emphasized in the preoperative work-up.

[Peri-implantitis in the general oral and maxillofacial surgery practice. A pilot study]. / Peri-implantitis in de algemene kaakchirurgische praktijk. Een pilotonderzoek.

A peri-implant infection is a disorder with an annually increasing prevalence and incidence as a result of the increasing number of oral implants utilized. Based on existing literature, a patient-control study was carried out, as a pilot study, among patients who had been treated with oral implants at a department of oral and maxillofacial surgery in a general hospital. Significant relations were found between on the one hand the prevalence of peri-implantitis and on the other hand bone augmentation, a suprastructure of a fixed partial denture or a complete removable overdenture on a ball attachment mesostructure when compared to a crown, poor oral hygiene, poor periodontal condition, and the absence of keratinized mucosa surrounding the implant.

Long term 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 (DO). All patients who underwent mandibular advancement surgery between March 2001 and June 2004 were evaluated. There were 17 patients in the BSSO group and 18 patients in the DO group. The decision to use intra-oral distraction or BSSO for mandibular advancement primarily depended on the choice of the patient and their parents. In both groups, standardized cephalometric radiographs were taken preoperatively, postoperatively (BSSO group) or directly post-distraction (DO group) and during the last study measurement in May 2008. 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 DO groups measured 46-95 months after advancement of the mandible (P>.05). It can be concluded from this study that there is no postoperative difference in the stability between BSSO and DO after mandibular advancement after 4 years.

[The closed eruption technique in cases of impaction of permanent maxillary canines]. / Gesloteneruptietechniek bij impactie van maxillaire cuspidaten.

The impaction of permanent maxillary canines occurs frequently. In recent decades, research has led to 2 methods of treatment: the modified window technique and the closed eruption technique. Although these methods have been described in detail, it is still not clear which method is most effective. In a study involving 73 orthodontic patients with an impacted, palatally displaced permanent maxillary canine, this cuspid was exposed by means of a gingival flap and an orthodontic bracket was immediately fixed on the exposed canine, after which the gingival flap was repositioned using sutures. The patients were clinically and radiographically examined 3 months after the orthodontic treatment. In a control group consisting of 93 orthodontic patients, there were no cases of impacted permanent maxillary cuspids. The overall success rate for the treatment in the study group was 63%. Problems in adjacent teeth were correlated significantly with older age among the patients. There was a significant difference in the number of pockets around the teeth adjacent to the canines in the study group and in the control group.

[A woman with ankylosis of the temporomandibular joint]. / Een vrouw met ankylose van het temporomandibulaire gewricht.

A 56-year-old woman was referred to an oral and maxillofacial surgeon because of facial stiffness and restricted mouth opening, 13 years after receiving multiple mandible fractures in a car accident. After clinical investigation and computer tomography, ankylosis of the right temporomandibular joint was diagnosed. The patient was treated by means of gap-arthroplasty, in which a myofascial flap of the temporalis muscle was used as an interposition transplant. After a period of physiotherapy, an acceptable recovery of the mouth opening was achieved. Traumatic injury is by far the most prevalent etiology of temporomandibular joint ankylosis, followed by an infection of the temporomandibular joint. Treatment consists basically of a gap-arthroplasty, with or without interposing a transplant between the ramus mandibulae and the joint socket or resection of the ankylotic tissues followed by reconstruction of the mandibular caput with an autologue transplant or an alloplastic material.

Evaluation of alveolar nerve function after surgical lengthening of the mandible by a bilateral sagittal split osteotomy or distraction osteogenesis.

This study compares the effects of bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) for lengthening the mandible regarding loss of function of the inferior alveolar nerve (IAN). In a retrospective cohort study design, the function of the IAN was tested with a Weinstein monofilament 3.22, 1 year after the surgical procedure in 65 patients (35 BSSO; 30 DO). This was defined as the upper limit for normal function. Of 130 IAN studied (70 BSSO, 54%; 60 DO, 46%), nerve function was disturbed in 23 (18%). In this group, 14 cases (61%) had undergone BSSO and 9 (39%) DO. One-hundred and seven nerves had no neurosensory IAN changes; of these BSSO had been performed in 56 cases (52%) and DO in 51 cases (48%). After eliminating confounding factors, there was no significant difference in the occurrence of neurosensory changes between the treatment options (DO versus BSSO, odds ratio: 1.254 with 95% CI: 0.366-4.300). In conclusion, there was no difference in IAN function between patients treated with BSSO or DO for lengthening the mandible.

[An endodontic ultrasonic system for apical endodontic surgery]. / Ultrasone wortelpuntpreparatie bij een chirurgische apicale endodontische behandeling.

Apical endodontic surgery is applied frequently following a failed conventional endodontic treatment. The apical preparation can be carried out conventionally using a round bur or using an endodontic ultrasonic system. The purpose of this study was to compare the outcome of the 2 treatment options by a randomized prospective clinical study. Patients (n=399) were at random allocated to treatment using a conventional round bur or using an ultrasonic system (P-max Newtron) according to a for the rest similar treatment protocol. One year post treatment, the treatment outcomes were determined by 2 oral and maxillofacial surgeons, blinded for the treatment option. Adequate follow-up data were obtained from 290 patients. The overall success rate was 71% in the patients treated conventionally and 81% in the patients treated using the ultrasonic system. In molar teeth, the difference in success rate was statistically significant.

[Implant treatment of the edentulous maxilla. A new method]. / Behandeling van de edentate bovenkaak met implantaten. Een nieuwe methode.

A 49-year-old woman was referred to an oral and maxillofacial surgeon by her family dentist because of severe periodontal disease in the maxilla. Their request was to estimate the feasibility of reconstruction using implants, after the removal of all maxillary teeth. A new method of treatment which makes use of computer tomography, virtual implant planning and a customized surgical template was applied. With the benefit of this method, 4 implants were inserted without bone augmentation, on which a previously constructed superstructure was placed during the same treatment session. This treatment concept makes optimal use of the bone volume available. Additional advantages are the possibility of flapless transmucosal immediate implant insertion and the possibility of immediately placing the superstructure. However, inaccuracies during implant planning and surgical treatment can easily lead to a poor fitting superstructure. Moreover, determining primary implant stability during treatment is difficult.

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.

The effect of nasal application of cocaine/adrenaline on blood loss in Le Fort I osteotomies.

Cocaine is a very potent vasoconstrictor that is used by ENT specialists to reduce blood loss and enhance visibility during nasal surgery. In orthognathic surgery, especially Le Fort I procedures, excessive blood loss is a relatively frequent complication. In this study, a prospective randomized clinical trial on the effect on blood loss of cocaine/adrenaline application to the nasal floor is presented. Thirty patients who underwent a Le Fort I procedure were randomized for cocaine/adrenaline application. Blood loss and duration of surgery were registered for both groups. The results showed a significant reduction of blood loss in the group with cocaine/adrenaline application (P<0.001), but no significant difference in operating time. No side effects were observed. From this study, it can be concluded that the application of cocaine/adrenaline to the nasal floor is a safe procedure to reduce blood loss during a Le Fort I procedure.

[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.