Quality of Postoperative Pain Management After Maxillofacial Fracture Repair.

BACKGROUND: Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail. MATERIALS AND METHODS: In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients' characteristics and pain-related parameters. RESULTS: Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021). CONCLUSIONS: Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.

Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management.

OBJECTIVES: Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters. RESULTS: Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min. CONCLUSIONS: Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand. CLINICAL RELEVANCE: Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.

Cross-Sectional Study of four Serological Bone Turnover Markers for the Risk Assessment of Medication-Related Osteonecrosis of the Jaw.

BACKGROUND: Despite the benefits related to the use of bisphosphonates and denosumab, medication-related osteonecrosis of the jaw (MRONJ) is a serious complication. The purpose of this study was to investigate the utility of 4 biochemical markers including serum c-terminal telopeptide cross-link of type I collagen (s-CTX), serum osteocalcin (s-OC), serum parathormon (s-PTH), and serum bone-specific alkaline phosphatase (s-BAP) as useful clinical tools to help assess the risk for MRONJ prior to invasive oral surgery. MATERIALS AND METHODS: Twenty patients diagnosed with MRONJ and 20 controls who have been on antiresorptive therapies with no occurrence of MRONJ were included in this 2-arm cross-sectional study. The s-CTX, s-OC, s-PTH, and s-BAP values were measured. Mann-Whitney U test compared the s-CTX, s-OC, s-PTH, and s-BAP values of the MRONJ group and the controls (P < 0.05). RESULTS: Lower values were observed in the MRONJ group compared with the control group for s-CTX (130.00 pg/mL versus 230.0 pg/mL; P = 0.12) and for s-OC (10.6 ng/mL versus 14.80 ng/mL; P = 0.051) both without significance and for s-BAP (0.23 µkat/L versus 0.31 µkat/L; P = 0.002) with significance. By contrast, the median s-PTH value of the MRONJ group was higher (30.65 ng/L versus 25.50 ng/L; P = 0.89), but without significance. CONCLUSIONS: The evaluation of the 4 biochemical markers showed that only the value of s-BAP was significantly decreased in the MRONJ patients compared with the controls. Presently, because of the lack of evidence, a routine check prior to oral surgery for the risk assessment of MRONJ cannot be recommended.

Salivary MMP-9 in the detection of oral squamous cell carcinoma

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most common malignant tumour of the oral cavity. Detection of OSCC is currently based on clinical oral examination combined with histopathological evaluation of a biopsy sample. Direct contact between saliva and the oral cancer makes measurement of salivary metalloproteinase- 9 (MMP-9) an attractive alternative. MATERIAL AND METHODS: In total, 30 OSCC patients and 30 healthy controls were included in this prospective study. Saliva samples from both groups were collected, centrifuged and supernatant fluid was subjected to ELISA for assessment of MMP-9. The median salivary MMP-9 values with interquartile range (IQR) of OSCC patients and the control group were statistically analysed using the Mann-Whitney U-test. The receiver operating characteristic (ROC) curve was constructed and the area under curve (AUC) was computed. RESULTS: The median absorbance MMP-9 value of the OSCC group was 0.186 (IQR = 0.158) and that of control group was 0.156 (IQR = 0.102). MMP-9 was significantly increased in the OSCC patients than in the controls by +19.2% (p = 0.008). Median values in patients with recurrence and in patients with primary event were 0.233 (IQR = 0.299) and 0.186 (IQR = 0.134) respectively. MMP-9 was significantly increased in patients with primary event (p = 0.017) compared to controls by +19.2%. No significant increase of MMP-9 level was detected when comparing patients with recurrence and healthy controls (+49.4%; p = 0.074). The sensitivity value of MMP-9 was 100% whereas the specificity value was 26.7% with AUC of 0.698. CONCLUSIONS: The present data indicates that the elevation of salivary levels of MMP-9 may be a useful adjunctive diagnostic tool for detection of OSCC. However, further studies are necessary to provide scientific and clinical validation

Cranio-maxillofacial reconstruction with microvascular radialis flaps-parameters and correlations of postoperative pain management.

OBJECTIVES: Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients' characteristics, pain parameters, outcome and pain therapy process parameters. RESULTS: Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence. CONCLUSIONS: QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction. CLINICAL RELEVANCE: Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.

Oral health and dental anxiety in a German practice-based sample.

OBJECTIVE: Does dental anxiety have an effect on dental and periodontal health? METHODS: Survey data was collected from n = 200 adults (53 % females, average age 49 years) in a cross-sectional study. Dental anxiety was measured with the modified dental anxiety scale (MDAS, score 1-5, the greater the score, the greater the anxiety). Clinical parameters including probing depth (PD), clinical attachment level (CAL), plaque index (SLI), and bleeding on probing (BoP) as well as the DMFT index were recorded and statistically analyzed. RESULTS: Rating of dental anxiety was higher in women than in men (65 vs 35 %). Subjects with higher MDAS values visited the dentist less frequently (p = 0.001) and had more decay (DT 6.7 ± 4.2 vs 1.7 ± 2.4; p < 0.001) but fewer filled teeth than subjects with lower ratings of dental anxiety (FT 7.1 ± 4.5 vs 9.8 ± 5.7; p = 0.042). There were no differences in PD or CAL between subjects with or without dental anxiety, while patients with higher MDAS value showed significantly more BoP (50 ± 19 vs 34 ± 20 %; p = 0.002) than patients with low MDAS scores (no or low dental anxiety). CONCLUSIONS: Patients with higher ratings of dental anxiety had significantly more caries experience and gingivitis. Therefore, dental anxiety is associated with negative effect on dental and periodontal health. CLINICAL RELEVANCE: Identifying patients with high dental anxiety and helping to manage this anxiety has important implications to improve oral health in adults. The MDAS appears to be an easy and efficient tool that can be used to identify patients with dental anxiety in dental practices.

Wearing complete dental prostheses - Effects on perioral morphology

BACKGROUND: To adequately perform rehabilitation of edentulous patients by a complete removable dental prosthesis (CRDP) is from basic interest to dentists to understand the morphologic changes caused by re-establishment of a physiologic jaw relationship. Anthropometric analyses of standardized frontal view and profile photographs may help elucidate such changes. MATERIAL AND METHODS: Photographs of 31 edentulous patients were compared in relaxed lip closure and after insertion of a CRDP in stable occlusion. 2232 anthropometric distances were raised. Eighteen anthropometric indices reflecting the perioral morphology and its integration in the vertical facial harmony were investigated. RESULTS: The intercanthal - mouth width index (p < 001), medial - lateral cutaneous upper lip height index (p = .007), lower vermilion contour index (p = .022), vermilion - total upper lip height index (p = .018), cutaneous - total upper lip height index (p=.023), upper lip - nose height index (p = .001), nose - upper face height index (p = .002), chin - mandible height index (p = .013), upper lip - mandible height index (p = .045), nose - lower face height index (p = .018), and nose - face height index (p = .029) showed significant pre- to post-treatment changes. CONCLUSIONS: The investigated anthropometric indices presented reproducible results related to an increase in occlusal vertical dimension. Their application may be helpful in assessment, planning, and explanation of morphologic effects of CRDPs on the perioral and overall facial morphology, which may helps to improve the aesthetic outcome

Presence of Biofilms on Polyurethane-Coated Breast Implants: Preliminary Results.

Polyurethane-coated breast implants seem to be associated with lower medium- and long-term capsular contracture rates in comparison to textured or smooth implant surfaces. Although the etiology of capsular contracture is uncertain, bacterial biofilms have been suggested to trigger chronic peri-implant inflammation, eventually leading to capsular contracture. It is unknown whether polyurethane-coated implants are less prone to biofilm colonization than other implant surfaces. We extracted data from patient records included in a prospective cohort between 2008 and 2011. All patients who underwent removal of polyurethane-coated implants were included in this current study and screened for presence of biofilms by sonication. In addition, implant- and patient-related data were analyzed. Of the ten included polyurethane-coated breast implants, six had been inserted for reconstructive purposes and four for aesthetic reasons. The median implant indwelling time was 28.3 mo. Overall, sonication cultures were positive in 50% of implants. Propionibacterium acnes and coagulase-negative staphylococci were the predominant pathogens isolated from biofilm cultures. Like other implant surfaces, polyurethane-coated implants are prone to biofilm colonization. Further investigations are needed to determine why capsular contracture rates seem to be lower in polyurethane implants than in other implant surfaces. Notably, in this study, 40% of the implants were explanted from breasts with severe capsular contracture.

Morphologic outcome of bimaxillary surgery-An anthropometric appraisal

OBJECTIVES: To adequately perform orthognathic surgery procedures, it is from basic interest to understand the morphologic changes caused by orthognathic surgery. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate and understand such changes. Study DESIGN: We present a pre- to postoperative evaluation of orthognathic surgery results based on anthropometric indices described by Farkas and cephalometric measurements. 30 Class III patients undergoing maxillary advancement by Le Fort I Osteotomy and mandibular setback by bilateral sagittal split osteotomy were evaluated. Preoperative as well as three and nine months postoperative lateral cephalograms as well as standardized frontalview and profile photographs were taken. On the photographs 21 anthropometric indices given by Farkas were evaluated. In cephalograms SNA and SNB angle as well as Wits appraisal were investigated. RESULTS: The investigated anthropometric indices showed a significant increase of the vertical height of the upperlip without changing the relation of the upper vermilion to the cutaneous upper lip. The lower vermilion height increased relatively to the cutaneous lower lip without vertical changes in the lower lip. Due to maxillary advancement the upper face height increased meanwhile the lower face height decreased due to mandibular setback. SNA and SNB angle and Wits appraisal showed typical changes related to surgery

Quality of postoperative pain management after midfacial fracture repair--an outcome-oriented study.

OBJECTIVES: There is a lack of literature regarding the procedure-specific quality of acute postoperative pain management after midfacial fracture repair. The purpose of the presented prospective clinical study was to evaluate postoperative pain management after surgical repair of midfacial fractures. MATERIALS AND METHODS: Eighty-five adults were evaluated on the first postoperative day following midfacial repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. The main outcome measures were patients' characteristics and clinical- and patient-reported outcome parameters. RESULTS: Overall, pain on the first postoperative day was moderate. A significant correlation between process and outcome parameters could be shown. Duration of surgery above the calculated median was significantly associated with higher maximum pain intensity (p = 0.017). Patients requiring opioids in the recovery room presented significantly higher pain on activity (p = 0.029) and maximum pain (p = 0.035). Sleeping impairment (p = 0.001) and mood disturbance (p = 0.008) were significantly more prevalent in patients undergoing repair of a centrolateral midfacial fracture. CONCLUSIONS: QUIPS is a simple and qualified tool to evaluate the procedure specific quality of acute postoperative pain management. Pain on the first postoperative day following midfacial fracture repair seems overall to be moderate. Nearly a third of the patients showed inadequate postoperative pain management. To prevent inadequate postoperative pain management, it is necessary to establish a continued procedure-specific outcome measurement.

Morphologic outcome of bimaxillary surgery--an anthropometric appraisal.

OBJECTIVES: To adequately perform orthognathic surgery procedures, it is from basic interest to understand the morphologic changes caused by orthognathic surgery. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate and understand such changes. STUDY DESIGN: We present a pre- to postoperative evaluation of orthognathic surgery results based on anthropometric indices described by Farkas and cephalometric measurements. 30 Class III patients undergoing maxillary advancement by Le Fort I Osteotomy and mandibular setback by bilateral sagittal split osteotomy were evaluated. Preoperative as well as three and nine months postoperative lateral cephalograms as well as standardized frontal view and profile photographs were taken. On the photographs 21 anthropometric indices given by Farkas were evaluated. In cephalograms SNA and SNB angle as well as Wits appraisal were investigated. RESULTS: The investigated anthropometric indices showed a significant increase of the vertical height of the upper lip without changing the relation of the upper vermilion to the cutaneous upper lip. The lower vermilion height increased relatively to the cutaneous lower lip without vertical changes in the lower lip. Due to maxillary advancement the upper face height increased meanwhile the lower face height decreased due to mandibular setback. SNA and SNB angle and Wits appraisal showed typical changes related to surgery. CONCLUSIONS: The investigated photo-assisted anthropometric measurements presented reproducible results related to bimaxillary surgery.

Role of bacterial biofilms in patients after reconstructive and aesthetic breast implant surgery.

INTRODUCTION: Capsular contracture is a feared complication following both reconstructive and aesthetic breast surgery. The etiology is uncertain, but bacterial biofilms have been suggested as trigger for chronic peri-implant inflammation, eventually leading to capsular contracture. METHODS: Data were extracted from patient records included in a prospective cohort between 2008 and 2010. We compared patients who underwent submuscular breast reconstruction using expander implants and those needing implant removal for capsular contracture after aesthetic submuscular breast augmentation. RESULTS: Of 36 included breast implants from 27 patients, 18 implants were inserted for reconstructive reasons and 18 for aesthetic reasons. The median indwelling time was 3 years for aesthetic implants and 3 months for reconstructive expanders. Overall, sonication cultures were positive in 13 implants (36%). In aesthetic implants, sonication cultures were positive in 28% and sonication cultures were positive in expander implants in 44%. Propionibacterium acnes and coagulasenegative staphylococci were predominant. CONCLUSION: Sonication cultures were positive in approximately 33% of removed breast implants and were comparable for reconstructive expander and aesthetic implants. These findings support the hypothesis that bacterial biofilms play a role in the pathogenesis of capsular contracture, especially after expander reconstruction, as these implants are at the highest risk of contamination during repeated implant-filling procedures.

Perioral aging--an anthropometric appraisal.

To adequately perform perioral rejuvenation procedures, it is necessary to understand the morphologic changes caused by facial aging. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate such changes. Photographs of 346 male individuals were evaluated using 12 anthropometric indices. Data from two groups of health subjects, the first exhibiting a mean age of nearly 20 and the second of nearly 60 years, were compared. To evaluate the influence of combined nicotine and alcohol abuse, the data of the second group were compared to a third group exhibiting a similar mean age who were known alcohol and nicotine abusers. Comparison of the first to the second group showed significant decrease of the vertical height of upper and lower vermilion and relative enlargement of the cutaneous part of upper and lower lips. This effect was stronger in the upper vermilion and medial upper lips. The sagging of the upper lips led to the appearance of an increased mouth width. In the third group the effect of sagging of the upper lips, and especially its medial portion was significantly higher compared to the second group. The photo-assisted anthropometric measurements investigated gave reproducible results related to perioral aging.

Cheek rotation flap reconstruction--an anthropometric appraisal of surgical outcomes.

OBJECTIVES: Cheek rotation flaps are an established surgical procedure for coverage of facial skin defects especially of the cheek and infraorbital region. A comparison of pre- and postoperative anthropometric measurements may help to objectify intraoperative estimations with regards to postoperative appearance. MATERIALS AND METHODS: We present an evaluation of 31 patients undergoing periorbital reconstruction by a cheek rotation flap on standardized photographs based on reference anthropometric data. Analysis included intercanthal, binocular and eye fissure width, eye fissure, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, scleral show, ectropion, and canthal tilt. Furthermore, it was clearly differentiated whether the defect to cover included eyelid skin or not. RESULTS: Ectropion showed a significant association to surgery (p = 0.03) and time (p = 0.03). If the defect to cover included lower eyelid skin, lower iris coverage values decreased significantly (p = 0.02), meanwhile the rate of scleral show increased significantly (p < 0.01), indicating pre- to postoperative lower eyelid retraction. CONCLUSIONS: In all patients analyzed, indices were reproducible and reliable. An association between surgery and ectropion was detectable. Whenever lower eyelid skin is involved in the defect to be covered, the significantly decreased lower iris coverage and increased rate of scleral show indicate an increased risk of lower lid retraction. CLINICAL RELEVANCE: Whenever eyelid skin is involved in a defect to be covered by a cheek rotation flap, there is an increased risk of postoperative lower lid distortion. Special care has to be taken to perform techniques preventing lower lid retraction.

Soft tissue outcome after mandibular advancement--an anthropometric evaluation of 171 consecutive patients.

OBJECTIVES: There is an ongoing discussion in the literature about preoperative planning and postoperative evaluation of orthognathic surgery and its impact on facial appearance and aesthetics. MATERIALS AND METHODS: We present an anthropometric and cephalometric evaluation of orthognathic surgery results based on reference anthropometric data. In 171 Class II patients, mandibular advancement by bilateral sagittal split osteotomy was performed. Preoperative as well as 3 and 9 months postoperative standardized frontal view and profile photographs and lateral cephalograms were evaluated in a standardized manner by use of 21 anthropometric indices. In cephalograms, SNA and SNB angle as well as Wits appraisal were investigated. Results of anthropometric and cephalometric measurements were correlated. RESULTS: Lower vermilion contour, vermilion and cutaneous total lower lip height, nose-lower face height, nose-face height, upper face-face height, upper lip- and chin-mandible height index showed significant pre- to postoperative changes as well as SNB angle and Wits appraisal. Furthermore, medial-lateral cutaneous upper lip height, vermilion and cutaneous total lower lip height and philtrum-mouth width index presented significant correlations to cephalometric measurements. CONCLUSIONS: The investigated anthropometric indices and cephalometric measurements presented reproducible results related to surgery. The correlation of cephalometric to anthropometric measurements has been proven useful for preoperative planning and postoperative evaluation of orthognathic surgery patients. CLINICAL RELEVANCE: The presented anthropometric measurements and their observed correlation to cephalometric measurements could lead to a better prediction and optimized planning of the soft tissue result in orthognathic surgery patients and thereby improve the aesthetic outcome.

Transconjunctival versus subciliary approach for orbital fracture repair--an anthropometric evaluation of 221 cases.

OBJECTIVES: In the literature, there is an ongoing discussion about the influence of orbital fractures and the surgical approach on the rate of eyelid deformities of the lower eyelid. MATERIALS AND METHODS: We present an evaluation of a series of 221 patients 9 months after zygomaticomaxillary complex fracture repair that underwent implant removal. Reference anthropometric data were measured on standardized pre- and postoperative photographs. Analysis included eye fissure width and height, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion, and entropion. Both operated and contralateral eyelids were evaluated as well as whether a transconjunctival or a subciliary approach was performed. RESULTS: Time, surgery, and surgical approach presented significant effects on eye fissure index and lower iris coverage. Scleral show was significantly influenced by the surgical procedure itself as well as by the type of incision. The rate of ectropion increased significantly pre- to postoperative. CONCLUSIONS: The subciliary approach included the highest risk of lower lid retraction. The low pre- to postoperative increase of scleral show and ectropion compared to recent studies gives us an idea about the influence of the underlying trauma on the rate of lower lid retraction. The standardized measurements described are accurately and objective to evaluate postoperative results. CLINICAL RELEVANCE: The transconjunctival approach is preferable in orbital fracture repair.

Objective anthropometric analysis of eyelid reconstruction procedures.

Before undergoing facial tumour resection and reconstruction, especially of the eyelids, patients are worried about their postoperative appearance. "Eye-balling" of postoperative results may not be sufficient to adequately judge surgical results. Reference anthropometric measurements for the eyelids are available. We present an evaluation of a series of tumour resection and reconstructive procedures of the eyelids on standardized photographs based on reference anthropometric data. 51 patients underwent eyelid reconstruction with different established techniques after resection of local eyelid tumours. Analysis included intercanthal width, biocular width, eye fissure width, eye fissure height, lid sulcus height, upper lid height, upper iris coverage, lower iris coverage, position of cornea to palpebra inferior, scleral show, ectropion, and canthal tilt. We clearly differentiated between resections including eyelid margin or not. Time (p = 0.04) and surgery (p = 0.03) showed a significant association with decreased values of lower eyelid coverage. Resection of the eyelid margin showed no significant influence on the values investigated. In all the patients analysed the indices were reproducible and reliable. Not surprisingly an association between surgery and lower eyelid retraction was found. Resection of the eyelid margin does not seem to cause a greater risk of eyelid deformity. The standard measurements described are accurate and objective to evaluate postoperative results.

The zygomaticomaxillary complex fracture - an anthropometric appraisal of surgical outcomes.

Before undergoing repair of zygomaticomaxillary complex fractures, most patients are worried about their postoperative appearance. Furthermore, there is an ongoing discussion about the selection of the surgical approach to the inferior orbita and resulting eyelid deformities. We present a photo-assisted postoperative evaluation of zygomaticomaxillary complex fracture repair based on reference anthropometric data. Two hundred and twenty-one patients underwent zygomaticomaxillary complex fracture repair. An analysis of standardized postoperative photographs included measurements of eye fissure width and height, lid sulcus height, upper lid height, upper and lower coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, and whether a transconjunctival or a subciliary approach was performed. Surgery per se significantly influenced eyelid deformities as measured by its impact on eye fissure index, lower iris coverage and rate of scleral show and ectropion. The surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating distortion of the lower eyelid. Investigations regarding orbital fractures should clearly differentiate the type of fracture. The subciliary approach included the highest risk of postoperative lower eyelid deformity in zygomaticomaxillary complex fracture repair. The standardized measurements described here are accurate and objective to evaluate postoperative results.

Deep and superficial fat ratio in dietary and surgically induced weight loss patients.

BACKGROUND: Architecture of abdominal fat above and below Scarpa's fascia is morphologically different. Little information is available about the relative distribution patterns of deep and superficial fat layers in massive weight loss (MWL) patients. This study aimed to evaluate the relative distribution patterns of deep and superficial abdominal fat layers in two groups of MWL patients presenting for abdominoplasty: (1) MWL via nutritional management and (2) MWL via bariatric surgery. METHODS: All MWL patients with stable body weight for a minimum of 24 months presenting for abdominal body contouring at Lausanne University Hospital, Department of Plastic Surgery between July 2008 and June 2009 were included. Patients with preexisting metabolic diseases were excluded. Patients with nutritional deficiencies were deferred until corrected. RESULTS: Nineteen consecutive patients were included in the study, 7 post-bariatric patients and 12 patients after dietary-induced weight loss (5 were males and 14 were females; average age 45.5 years, range 36-64 years), with an average weight loss of 48 kg (57 kg post-bariatric, 28 kg dietary induced) and a mean body mass index of 29.2 kg/m(2) (range 24.0-40.7) at the time of abdominoplasty. Morphologic evaluation yielded a relative distribution of deep to superficial fat layers of 42 to 58 % in the post-bariatric group versus 31 to 69 % (p < 0.05) in the nutritionally induced group. CONCLUSIONS: These data show that the morphologic distribution patterns of deep and superficial abdominal fat layers differ with regards to mode of weight loss.

Standardized anthropometric evaluation of ectropion repair results.

BACKGROUND: Before undergoing ectropion repair, most patients are concerned not only about the functional result, but also about their postoperative aesthetic appearance. Furthermore, there is an ongoing discussion in the literature about the influence of various surgical techniques on eyelid function and morphology. We present a photograph-assisted evaluation for preoperative planning, intraoperative estimation, and postoperative evaluation of ectropion surgery based on anthropometric measurements and clinical data. PATIENTS AND METHODS: From January 2008 to December 2010, 36 ectropion patients underwent a lateral tarsorrhaphy or fascial sling repair. An analysis of standardized preoperative and postoperative photographs included measurements of intercanthal width, biocular width, eye fissure width, eye fissure height, lid sulcus height, upper lid height, upper iris coverage, lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, and ectropion. RESULTS: Eye fissure index (P < 0.01) and lower iris coverage (P < 0.01) were statistically significantly influenced by surgery and time. The rates of scleral show (P < 0.01) and ectropion (P < 0.01) were significantly influenced, too. The 2 applied surgical techniques, lateral tarsorrhaphy and fascial sling repair, presented no significantly different effect in the preoperative to postoperative measurements. CONCLUSIONS: In all analyzed patients, the performed measurements were reproducible and reliable. The methods described may help to estimate the necessary extent of correction in ectropion repair surgery. Furthermore, intraoperatively performed measurements could be compared with the postoperative results.