Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer.

Background/Objectives: Dental rehabilitation after extended tumour resection and jaw reconstruction is challenging. The present study aimed to report the prosthetic outcome and quality of life (QoL) in patients with head and neck cancer (HNC) after microvascular alveolar ridge reconstruction. Methods: The prosthetic outcomes of all consecutive patients with HNC who underwent microvascular alveolar ridge reconstruction at the University Hospital Salzburg between 2011 and 2018 were investigated. Oral health-related QoL (OHrQoL) and overall QoL were assessed using the validated Oral Health Impact Profile-49 (OHIP-49) and Short Form-36 questionnaires. Results: During the study period, 115 consecutive patients with head and neck cancer underwent microvascular jaw reconstruction. Among them, 23.3% and 27.4% received conventional tissue-borne prostheses and implant-supported prostheses, respectively, while 48.7% did not undergo dental rehabilitation. The prosthetic outcome was not associated with tumour stage (p = 0.32). Oral health-related quality of life (OHrQoL) was best in patients with implant-supported dental rehabilitation (OHIP-49 median score = 7) and worst in those with conventional removable dentures (OHIP-49 median score = 54). The corresponding OHIP-49 median score for patients who could not undergo dental rehabilitation was 30.5. All Short Form-36 subscale scores were equal to or higher than the malignancy norm scores. Conclusions: After microvascular jaw reconstruction, approximately one-third of the HNC patients received adequate implant-supported dental rehabilitation. However, the risk of dental rehabilitation failure was 50%. The different prosthetic outcomes affected OHrQoL, but not overall QoL.

The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction-A Case Series.

Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery.

Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making.

This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.

Nasolabial Appearance in 5-Year-Old Patients with Repaired Complete Unilateral Cleft Lip and Palate: A Comparison of Two Different Techniques of Lip Repair.

Different surgical techniques are available to adequately correct the primary cleft lip deformity; however, when compared, none of these techniques have proven superior with regard to achieving optimal aesthetic results. Thus, the aim of this retrospective study was to assess the nasolabial appearance in patients with unilateral cleft lip and palate (UCLP) at age five with reference to two techniques for primary cleft lip repair used in our service: Pfeifer's wave-line procedure and Randall's technique. A modified Asher-McDade Aesthetic Index was applied to appraise the nasolabial area by means of 2D photographs of non-syndromic five-year-old patients with a UCLP. In this context, three parameters were assessed: 1. nasal frontal view; 2. shape of the vermilion border and philtrum length; and 3. the nasolabial profile. Five professionals experienced in cleft care were asked to rate the photographs on two occasions. Overall, 53 patients were included in the final analysis, 28 of whom underwent lip repair according to Pfeifer; 25 were treated employing Randall's technique. Statistically significant differences between the two techniques regarding philtrum length and vermilion border were found (p = 0.046). With reference to the other parameters assessed, no significant differences were determined. The results suggest that Randall's cleft lip repair may allow for more accurate alignment of the vermilion border and more adequate correction of the cleft lip length discrepancy in comparison to Pfeifer's wave-line technique.

The fasciocutaneous iliotibial band perforator flap in soft tissue and tendon reconstruction of the foot: A case report.

In cases of large defects of the limbs, post-traumatic deformity and disability can have devastating effects on patients' quality of life. The purpose of this report is to describe the technique for raising a fasciocutaneous iliotibial perforator flap and present its application in the reconstruction of a complex soft tissue defect of the foot. The patient was a 13-year-old male who had suffered a crush injury to the foot in a motor vehicle accident 5 years earlier. Due to retraction of the skin, together with the extensor tendons of the digits, the patient could not flex the digits II, III, IV, and V. To reconstruct the defect, the authors harvested a fasciocutaneous flap based on a perforator branch of the superior lateral genicular artery and accompanying veins. The immediate postoperative course was uneventful, with progressive and complete recovery of power and range of motion in the foot and knee within 6 weeks. Despite the tendency to form hypertrophic scars again, the functionality of the operated foot was excellent 29 months after the reconstruction. According to the American Orthopedic Foot and Ankle Society scale, the patient scored 100 points on the midfoot section and 93 points on the section forefoot rays two to five. The iliotibial perforator flap could be a new tool for a state-of-the-art functional reconstruction of soft tissues defects of the limbs and head and neck.

Microvascular reconstruction and dental rehabilitation of benign severely atrophic jaws and defects of the alveolar ridge: our philosophy in 2019.

We deal regularly with patients who present with severe atrophy of the jaws, compromised soft tissue, or penetrating defects of the alveolar ridge that are not the result of malignant disease. For these patients we use microvascular bony flaps together with dental implants and implant-supported prostheses. The purpose of this retrospective study was to present our current management and the lessons we have learned over a 16-year period while treating 86 patients for these indications with 87 microvascular bone flaps. We used a transoral approach for the anastomosis in 60 flaps, thereby avoiding visible scars, and inserted 281 dental implants to support fixed or removable dental prostheses. Two femoral flaps developed partial necrosis, and seven implants were lost. Eighty-five of the 86 patients were satisfied with the improvement in their orofacial function and aesthetics. Poor oral hygiene, active osteomyelitis, and severe bruxism are absolute contraindications.

Author Correction: Effects of biochar, waste water irrigation and fertilization on soil properties in West African urban agriculture.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Agronomic benefits of biochar as a soil amendment after its use as waste water filtration medium.

In many water-scarce countries, waste water is used for irrigation which poses a health risk to farmers and consumers. At the same time, it delivers nutrients to the farming systems. In this study, we tested the hypotheses that biochar can be used as a filter medium for waste water treatment to reduce pathogen loads. At the same time, the biochar is becoming enriched with nutrients and therefore can act as a fertilizer for soil amendment. We used biochar as a filter medium for the filtration of raw waste water and compared the agronomic effects of this "filterchar" (FC) and the untreated biochar (BC) in a greenhouse pot trial on spring wheat biomass production on an acidic sandy soil from Niger. The biochar filter showed the same removal of pathogens as a common sand filter (1.4 log units on average). We did not observe a nutrient accumulation in FC compared to untreated BC. Instead, P, Mg and K were reduced during filtration while N content remained unchanged. Nevertheless, higher biomass (Triticum L. Spp.) production in BC (+72%) and FC (+37%) treatments (20 t ha-1), compared with the unamended control, were found. There were no significant differences in aboveground biomass production between BC and FC. Soil available P content was increased by BC (+106%) and FC (+52%) application. Besides, mineral nitrogen content was reduced in BC treated soil and to a lesser extent when FC was used. This may be explained by reduced sorption affinity for mineral nitrogen compounds on FC surfaces. Although the nutrients provided by FC decreased, due to leaching in the filter, it still yielded higher biomass than the unamended control.

Effects of biochar, waste water irrigation and fertilization on soil properties in West African urban agriculture.

In large areas of sub-Saharan Africa crop production must cope with low soil fertility. To increase soil fertility, the application of biochar (charred biomass) has been suggested. In urban areas, untreated waste water is widely used for irrigation because it is a nutrient-rich year-round water source. Uncertainty exists regarding the interactions between soil properties, biochar, waste water and fertilization over time. The aims of this study were to determine these interactions in two typical sandy, soil organic carbon (SOC) and nutrient depleted soils under urban vegetable production in Tamale (Ghana) and Ouagadougou (Burkina Faso) over two years. The addition of biochar at 2 kg m-2 made from rice husks and corn cobs initially doubled SOC stocks but SOC losses of 35% occurred thereafter. Both biochar types had no effect on soil pH, phosphorous availability and effective cation exchange capacity (CEC) but rice husk biochar retained nitrogen (N). Irrigation with domestic waste water increased soil pH and exchangeable sodium over time. Inorganic fertilization alone acidified soils, increased available phosphorous and decreased base saturation. Organic fertilization increased SOC, N and CEC. The results from both locations demonstrate that the effects of biochar and waste water were less pronounced than reported elsewhere.

The effects of woodchip- and straw-derived biochars on the persistence of the herbicide 4-chloro-2-methylphenoxyacetic acid (MCPA) in soils.

Sorption and degradation are the primary processes controlling the efficacy and runoff contamination risk of agrochemicals. This study assessed the influence of two biochars, made from woodchips and straw at a pyrolysis temperature of 725°C and applied to a loamy sand and a sandy soil in the concentration of 5.3 g 100 g(-1) sandy soil and 4.1 g 100 g(-1) loamy sand soil, or 53 t ha(-1) for both soil types, on degradation of the herbicide 4-chloro-2-methylphenoxyacetic acid (MCPA). Soils were spiked with 50 mg MCPA kg(-1) soil. In the sandy soil, significantly more MCPA remained after 100 days if amended with straw-derived biochar in comparison to wood-derived biochar. Both biochars types significantly increased urease activity (p<0.05) after 37 days in the loamy sand soil, but these differences disappeared after 100 days. A root and shoot elongation test demonstrated that the soils containing straw-derived biochar and spiked with MCPA, showed the highest phytotoxicity. Both biochars were found to retard MCPA degradation in loamy sand and sandy soils. This effect could not be explained only by sorption processes due to comparatively low developed micro/mesoporous structure of both biochars shown by BET surface analysis. However, an enhanced MCPA persistence and soil toxicity in sandy soil amended with straw biochar was observed and further studies are needed to reveal the responsible mechanisms.

Reducing nitrogen loss during poultry litter composting using biochar.

Poultry litter (PL) is a potentially underused fertilizer because it contains appreciable amounts of N, P, K, and micronutrients. However, treatments like composting to reduce potential pathogens, weed seeds, and odor often result in high losses of N through NH3 volatilization. Biochar (BC) has been shown to act as an absorber of NH3 and water-soluble NH4+ and might therefore reduce losses of N during composting of manure. We produced three PL compost mixtures that consisted of PL without added BC (BCO), PL + 5% BC (BC5), and PL + 20% BC (BC20). The BC was produced from pine chips and used without further modifications. Three replicates of each treatment were placed in nine bioreactors to undergo composting for 42 d. The entire composting experiment was repeated three times in a complete-block design. Moisture content, temperature, pH, mass loss, gas (NH3, CO2, H2S) emissions, C, and nutrient contents were measured periodically throughout the experiments. Results showed no difference in PL mass loss with BC addition. Moisture content decreased, pH increased significantly, and peak CO2 and temperatures were significantly higher with BC20 compared with BC0. These results indicate a faster decomposition of PL if amended with BC. Ammonia concentrations in the emissions were lower by up to 64% if PL was mixed with BC (BC20), and total N losses were reduced by up to 52%. Biochar might be an ideal bulking agent for composting N-rich materials.

Does early administration of selenium improve neurological outcome after cardiac arrest?

OBJECTIVE: Existing data indicate that selenium supplementation may be beneficial in critically ill patients and in those with ischemic stroke. The purpose of this retrospective study was to explore the influence of early administration of selenium on neurological outcome after cardiopulmonary resuscitation (CPR). METHODS: We examined 227 consecutive unconscious patients after CPR and excluded 1 individual. The decision to administer selenium was left to the discretion of the attending physician, resulting in 124 patients (55%) who received intravenous selenium (200-1000 microg/d) for a median of 5 days after CPR. Patients were classified according to the best Glasgow-Pittsburgh cerebral performance categories (CPCs 1-5) achieved within 6 months of follow-up. RESULTS: The rate of regaining consciousness (CPC 1-3) after CPR was 58%. Multivariable logistic regression analysis confirmed a shockable first monitored rhythm (adjusted odds ratio, 3.73; 95% confidence interval, 1.85-7.52; P < .001), time to return of spontaneous circulation (adjusted odds ratio, 0.94; 95% confidence interval, 0.91-0.96; P < .001), administration of selenium (adjusted odds ratio, 2.38; 95% confidence interval, 1.19-4.76; P = .014), and the Simplified Acute Physiology Score II (adjusted odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .034) as independent predictors of regaining consciousness after CPR. Survival at 6 months of follow-up was not improved significantly by selenium. CONCLUSION: This retrospective analysis leads to the hypothesis that early administration of selenium may improve neurological outcome after cardiac arrest.

Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase.

AIMS: Data on the diagnostic accuracy of neuron-specific enolase (NSE) as marker of hypoxic brain damage are conflicting. The purpose of this prospective observational cohort study was to explore the prognostic value of serum NSE after cardiopulmonary resuscitation (CPR) and to define the most sensitive cutoff value with a specificity of 100% for the prediction of persistent coma. METHODS AND RESULTS: Serum NSE concentrations were serially determined in 227 consecutive unconscious patients after CPR who were classified according to the best Glasgow-Pittsburgh cerebral performance categories (CPC, 1-4) achieved within 6 months follow-up. Sixteen patients were excluded due to incomplete NSE data and 34 due to death under analgesia sedation. The prevalence of poor neurological outcome (persistent coma, CPC 4) in our 177 analysed patients was 33%. At a specificity of 100%, a peak NSE concentration above 80 ng/mL predicted persistent coma with a sensitivity of 63%, a positive predictive value of 100%, a negative predictive value of 84%, and a predictive accuracy of 88%. CONCLUSION: A peak serum NSE concentration exceeding 80 ng/mL is a highly specific but only moderately sensitive marker for a poor neurological outcome after CPR.