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In Vitro Enhanced Osteogenic Potential of Human Mesenchymal Stem Cells Seeded in a Poly (Lactic-co-Glycolic) Acid Scaffold: A Systematic Review. 体外增强人间质干细胞在聚(乳酸-共-羟基乙酸)支架中的成骨潜能:系统综述。
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-02-13 DOI: 10.1177/19433875231157454
Karla C Maita, Francisco R Avila, Ricardo A Torres-Guzman, Rachel Sarabia-Estrada, Abba C Zubair, Alfredo Quinones-Hinojosa, Antonio J Forte

Study design: Human bone marrow stem cells (hBMSCs) and human adipose-derived stem cells (hADSCs) have demonstrated the capability to regenerate bone once they have differentiated into osteoblasts.

Objective: This systematic review aimed to evaluate the in vitro osteogenic differentiation potential of these cells when seeded in a poly (lactic-co-glycolic) acid (PLGA) scaffold.

Methods: A literature search of 4 databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in January 2021 for studies evaluating the osteogenic differentiation potential of hBMSCs and hADSCs seeded in a PLGA scaffold. Only in vitro models were included. Studies in languages other than English were excluded.

Results: A total of 257 studies were identified after the removal of duplicates. Seven articles fulfilled our inclusion and exclusion criteria. Four of these reviews used hADSCs and three used hBMSCs in the scaffold. Upregulation in osteogenic gene expression was seen in all the cells seeded in a 3-dimensional scaffold compared with 2-dimensional films. High angiogenic gene expression was found in hADSCs. Addition of inorganic material to the scaffold material affected cell performance.

Conclusions: Viability, proliferation, and differentiation of cells strongly depend on the environment where they grow. There are several factors that can enhance the differentiation capacity of stem cells. A PLGA scaffold proved to be a biocompatible material capable of boosting the osteogenic differentiation potential and mineralization capacity in hBMSCs and hADSCs.

研究设计:人类骨髓干细胞(hBMSCs)和人类脂肪来源干细胞(hADSCs)已被证明在分化成成骨细胞后具有再生骨骼的能力:本系统综述旨在评估这些细胞在聚乳酸-共聚乙醇酸(PLGA)支架中播种后的体外成骨分化潜力:方法:2021 年 1 月,我们按照《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南对 4 个数据库进行了文献检索,以评估播种在 PLGA 支架中的 hBMSCs 和 hADSCs 的成骨分化潜力。仅纳入体外模型。结果:结果:去除重复研究后,共发现 257 篇研究。有 7 篇文章符合我们的纳入和排除标准。这些综述中有四篇使用了 hADSCs,三篇在支架中使用了 hBMSCs。与二维薄膜相比,所有在三维支架中播种的细胞的成骨基因表达都出现了上调。hADSCs 中的血管生成基因表达较高。在支架材料中添加无机材料会影响细胞的表现:细胞的活力、增殖和分化在很大程度上取决于其生长环境。有几种因素可以提高干细胞的分化能力。事实证明,PLGA支架是一种生物相容性材料,能够提高hBMSCs和hADSCs的成骨分化潜能和矿化能力。
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引用次数: 0
Open vs Closed Management of Condylar Fracture Our Experience of 100 Cases in a Suburban Tertiary Care Hospital. 髁状突骨折的开放式治疗与闭合式治疗 我们在一家郊区三级医院 100 例病例中的经验。
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2022-12-13 DOI: 10.1177/19433875221143852
Manoj Kumar, Sathyanarayanan Ramanujam, Raghu Kumaravelu, Raja Sethupathy Cheeman, Raymond Joseph Periera, Sarah Titus

Study design: Retrospective Observational Study.

Objective: Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction.

Methods: The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18 years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6 months.

Results: It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2 years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6 months follow-up when compared to that of the 2 month follow up.

Conclusions: From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5 years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.

研究设计回顾性观察研究:下颌骨髁状突骨折在颌面部损伤中具有独特性,因为它会破坏下颌骨功能,而其他外伤则不会。髁状突骨折可采用保守治疗(闭合复位和固定)或手术治疗(切开复位和内固定)。这两种治疗方式各有利弊,也有适应症和禁忌症。本研究的目的是总结和比较我们在通过切开复位和闭合复位治疗髁突骨折方面的经验:本次回顾性分析共纳入 100 例髁突骨折患者,患者年龄均大于 18 岁,根据 Edward Ellies 标准随机分为非手术组和手术组。在本研究中,髁状突骨折保守治疗与手术治疗的结果将从 7 个参数进行讨论,包括最大龈间张口、下颌骨的前伸和侧方偏移运动、咬合状态、张口时下颌骨的偏移、颞下颌紊乱和面神经麻痹,并在术前和术后的不同时间间隔进行测量和评估。随访期为 6 个月:结果表明,髁突骨折的主要原因是外伤,男性居多,平均年龄(32.6 ± 1.2)岁。髁突下骨折是最常见的髁突骨折类型。33.3%的患者张口受限,57%的患者咬合失调。37%的患者接受了手术治疗,其中48.6%的骨折采用了近角入路。与 2 个月的随访相比,更多患者在 6 个月的随访中张口度增加,咬合稳定:从上述研究中我们可以得出结论,治疗方案应针对患者的具体情况,并遵循特定类型骨折的算法。根据我们过去 5 年治疗髁状突骨折的经验,我们赞同这一观点。决策的艺术完全取决于外科医生在处理髁突骨折方面的专业知识。
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引用次数: 0
Sliding Spine Relocation Surgery with Anterior Septal Reconstruction. 前隔膜重建滑动脊柱移位手术
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-01-25 DOI: 10.1177/19433875231152947
Thomaz Fleury Curado, Ahmed El Abany, Sam P Most

Study Design: Technical note. Objective: The lower nasal architecture is dependent on caudal septal integrity. Deviations of the caudal septum can compromise nasal airflow. The presence of anterior nasal spine deviations contributes to septal and medial crural shifting with ipsilateral encroachment. It is essential to identify nasal spine deviation during surgery in order to reconstruct the septum in a midline position at its base. This allows an appropriate management plan that creates a better functional and aesthetically pleasing outcome. A stable midline anterior nasal spine is warranted to support the newly reconstructed straight caudal strut, which can be effectively corrected by anterior septal reconstruction. Methods: The proposed method intends to combine anterior nasal spine centralization with correcting caudal septal deviation and nasal obstruction through a modified extracorporeal septoplasty technique. We describe a novel technique to centralize the deviated anterior nasal spine using the piezoelectric device by performing a contralateral adjacent ostectomy and en-bloc relocation and fixation of the anterior nasal spine with microplates and screws. Results: This surgical approach creates a stable caudal septum and a centrally positioned anterior nasal spine, which improves nasal airflow and ensures a stable repair. Conclusion: Sliding spine relocation surgery with anterior septal reconstruction repositions a deviated anterior nasal spine and corrects caudal septum deviation, that can impair the nasal airway.

研究设计:技术说明。研究目的下鼻腔结构取决于鼻中隔的完整性。鼻中隔尾部偏曲会影响鼻腔气流。鼻前部脊柱偏曲会导致鼻中隔和内侧嵴移位,造成同侧鼻腔受侵。必须在手术中识别鼻椎偏曲,以便在鼻中隔基部的中线位置重建鼻中隔。这样才能制定出适当的治疗方案,获得更好的功能和美观效果。稳定的中线前鼻骨脊柱可支撑新重建的直尾支柱,通过鼻中隔前部重建可有效矫正鼻中隔。方法:所提出的方法旨在通过改良的体外鼻中隔成形术,将前鼻椎集中化与矫正鼻中隔尾端偏曲和鼻阻塞结合起来。我们描述了一种使用压电装置集中偏曲前鼻骨脊柱的新技术,方法是进行对侧邻近鼻骨切除术,并用微型板和螺钉对前鼻骨脊柱进行整体搬迁和固定。结果:这种手术方法可形成稳定的鼻中隔尾部和位于中心位置的前鼻椎,从而改善鼻腔气流并确保修复的稳定性。结论滑动脊柱重新定位手术与前鼻中隔重建术可重新定位偏曲的前鼻中隔脊柱,并纠正可能影响鼻气道的鼻中隔尾部偏曲。
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引用次数: 0
Can the Malnutrition Universal Screening Tool (MUST) Predict Healing Complications Following Microvascular Reconstruction of the Head and Neck? 营养不良通用筛查工具 (MUST) 能否预测头颈部微血管重建术后的愈合并发症?
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-02-24 DOI: 10.1177/19433875231160346
Camilo Mosquera, Marina Morante Silva, Ashleigh M Weyh, Michael A Malik, Rui Fernandes

Study design: Retrospective cohort study.

Objective: Malnutrition has been found to have negative effects on the immune system and inflammatory responses, impairing the wound healing process. Free flap failure is a serious complication in patients undergoing microvascular reconstruction, as it increases patient morbidity, length of stay in the hospital, patient, and hospital costs, as well as causes the need for further surgical interventions1. Malnutrition is estimated to be present in 35-50% of head and neck cancer patients with higher rates in those experiencing hypo-oropharyngeal disease. This is often caused by functional and pain limitations from due to disease burden causing odynophagia and dysphagia. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides three scores for risk classification: high, intermediate, and low2. We argue that the use of MUST as a preoperative assessment tool is useful to predict postoperative surgical site infection and delayed wound healing in patients that will undergo reconstruction with free flaps for head and neck defects.

Methods: A retrospective cohort study was designed to include all subjects who underwent head and neck microvascular free tissue transfer at a single institution between 2013 and 2019. Primary and secondary reconstructions were included, for benign or malignant pathology, osteonecrosis, osteomyelitis, congenital defects, and trauma. The nutritional risk was evaluated using MUST, which analyzes body mass index, weight loss, and acute disease effect, to classify patients as low, intermediate, and high risk. We further divided the subjects into two comparison groups- low-intermediate and high risk. The primary outcome was surgical site complications and delayed wound healing. Data was analyzed as frequencies and means with standard deviations, as well as Fisher's exact test and t-test. P-values <0.05 were considered statistically significant. Analyses were done utilizing IBM SPSS Statistics Version 29.

Results: 131 subjects were included for data analysis, with 54 being considered low MUST risk, 12 intermediate risk (66 low-intermediate), and 65 were high risk. The mean BMI overall was 25.5 ±5.3, and 27.2 in the low-intermediate group, and 23.7 in the high-risk group. Eighty-two subjects experienced <5-pound weight loss in the preceding 6 months to surgery, while 17 lost between 5-10 pounds, and 23 lost 10< pounds. Cancer/osteonecrosis was the etiology for 54 (82%) subjects of the low-intermediate group, and 61 (92%) of the high-risk group (P = .089). The subjects classified in High-risk group according to the MUST score had 11% more surgical site complications (P = .120) and 13.7% more delayed wound healing and dehiscence(P = .09); only 3 subjects in the study presented total flap loss and they were all in the High-risk g

研究设计回顾性队列研究:营养不良会对免疫系统和炎症反应产生负面影响,损害伤口愈合过程。游离皮瓣失败是微血管重建患者的严重并发症,因为它会增加患者的发病率、住院时间、患者和医院的费用,并导致需要进一步的手术干预1。据估计,35%-50% 的头颈部癌症患者会出现营养不良,其中口咽下部疾病患者的营养不良率更高。这通常是由于疾病负担造成的功能和疼痛限制导致的吞咽困难和吞咽困难。营养不良通用筛查工具(MUST)被推荐用于风险筛查,并提供了三个风险分类分数:高、中、低2。我们认为,使用营养不良通用筛查工具作为术前评估工具有助于预测头颈部缺损游离皮瓣重建患者术后手术部位感染和伤口延迟愈合的情况:设计了一项回顾性队列研究,纳入2013年至2019年期间在一家机构接受头颈部微血管游离组织转移的所有受试者。研究对象包括因良性或恶性病变、骨坏死、骨髓炎、先天性缺损和创伤而进行的初次和二次重建。我们使用MUST对营养风险进行了评估,MUST分析了体重指数、体重减轻和急性疾病效应,将患者分为低风险、中风险和高风险。我们进一步将受试者分为两个对比组--中低风险组和高风险组。主要结果是手术部位并发症和伤口延迟愈合。数据分析采用频率、平均值和标准差,以及费雪精确检验和 t 检验。P值结果:131 名受试者被纳入数据分析,其中 54 人被认为是低 MUST 风险,12 人为中度风险(66 人为低中度风险),65 人为高度风险。总体平均体重指数为 25.5 ±5.3,中低风险组为 27.2,高风险组为 23.7。82名受试者经历了P = .089)。根据 MUST 评分被归入高风险组的受试者,其手术部位并发症发生率高出 11% (P = .120),伤口延迟愈合和开裂发生率高出 13.7% (P = .09);研究中只有 3 名受试者出现皮瓣完全脱落的情况,他们都属于高风险组。手术部位并发症、伤口延迟愈合率、部分或全部皮瓣缺失率并没有因为任何特定的合并症或病史(如放疗或化疗)而增加:总之,MUST评分高的受试者并发症和伤口愈合不良的几率更高,而急性疾病影响导致无期超过5天的受试者皮瓣全部脱落和手术部位并发症的风险更高。
{"title":"Can the Malnutrition Universal Screening Tool (MUST) Predict Healing Complications Following Microvascular Reconstruction of the Head and Neck?","authors":"Camilo Mosquera, Marina Morante Silva, Ashleigh M Weyh, Michael A Malik, Rui Fernandes","doi":"10.1177/19433875231160346","DOIUrl":"10.1177/19433875231160346","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Malnutrition has been found to have negative effects on the immune system and inflammatory responses, impairing the wound healing process. Free flap failure is a serious complication in patients undergoing microvascular reconstruction, as it increases patient morbidity, length of stay in the hospital, patient, and hospital costs, as well as causes the need for further surgical interventions<sup>1</sup>. Malnutrition is estimated to be present in 35-50% of head and neck cancer patients with higher rates in those experiencing hypo-oropharyngeal disease. This is often caused by functional and pain limitations from due to disease burden causing odynophagia and dysphagia. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides three scores for risk classification: high, intermediate, and low<sup>2</sup>. We argue that the use of MUST as a preoperative assessment tool is useful to predict postoperative surgical site infection and delayed wound healing in patients that will undergo reconstruction with free flaps for head and neck defects.</p><p><strong>Methods: </strong>A retrospective cohort study was designed to include all subjects who underwent head and neck microvascular free tissue transfer at a single institution between 2013 and 2019. Primary and secondary reconstructions were included, for benign or malignant pathology, osteonecrosis, osteomyelitis, congenital defects, and trauma. The nutritional risk was evaluated using MUST, which analyzes body mass index, weight loss, and acute disease effect, to classify patients as low, intermediate, and high risk. We further divided the subjects into two comparison groups- low-intermediate and high risk. The primary outcome was surgical site complications and delayed wound healing. Data was analyzed as frequencies and means with standard deviations, as well as Fisher's exact test and t-test. P-values <0.05 were considered statistically significant. Analyses were done utilizing IBM SPSS Statistics Version 29.</p><p><strong>Results: </strong>131 subjects were included for data analysis, with 54 being considered low MUST risk, 12 intermediate risk (66 low-intermediate), and 65 were high risk. The mean BMI overall was 25.5 ±5.3, and 27.2 in the low-intermediate group, and 23.7 in the high-risk group. Eighty-two subjects experienced <5-pound weight loss in the preceding 6 months to surgery, while 17 lost between 5-10 pounds, and 23 lost 10< pounds. Cancer/osteonecrosis was the etiology for 54 (82%) subjects of the low-intermediate group, and 61 (92%) of the high-risk group (<i>P</i> = .089). The subjects classified in High-risk group according to the MUST score had 11% more surgical site complications (<i>P</i> = .120) and 13.7% more delayed wound healing and dehiscence(<i>P</i> = .09); only 3 subjects in the study presented total flap loss and they were all in the High-risk g","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82711543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Wire Osteosynthesis in the Treatment of Mandible Fractures in Low Resource Settings: A Force Study. 钢丝骨合成术在资源匮乏地区下颌骨骨折治疗中的应用:力量研究。
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2022-12-20 DOI: 10.1177/19433875221143605
Shekhar K Gadkaree, Adeeb Derakhshan, Victor Nyabenda, Isaie Ncogoza, Gratien Tuyishimire, David A Shaye

Study design: Cadaveric investigation.

Objective: Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF.

Methods: Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site.

Results: For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (P < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (P < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (P = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (P = .29).

Conclusions: Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.

研究设计尸体调查:在中低收入国家,由于资源有限,使用钢板和螺钉进行刚性内固定(RIF)往往不可行。通常使用骨间布线来实现半刚性固定,但缺乏生物力学力数据。在此,我们旨在定量比较骨间接线和 RIF:方法:尸体下颌骨骨骺旁和骨骺角骨折。采用单线环形和八字形骨间布线固定,以及钢板和螺钉固定(每个骨折部位每种固定方式的人数均为 5 人)。使用测力计测量固定部位达到舒张和完全破坏所需的牛顿(N)数:对于角状骨折,单线、八字形接线和钢板固定的初始舒张力平均值分别为 4.1、5.9 和 10.9 牛顿(P < .001)。三种方法的完全失败力分别为 152.9、168.9 和 237.6 牛顿(P < .001)。对于骺旁骨折,单线、八字形布线和钢板接合的完全失败力分别为 197.7、263.0 和 262.8 牛顿(P = .002)。三种固定方法在实现骺旁骨折初始舒张力方面的差异无统计学意义(P = .29):结论:与金标准的钢板固定相比,八字形骨间接线对下颌骨骨折的抗力相当。在资源有限、无法使用钢板和螺钉的情况下,可以考虑使用这种技术实现下颌骨骨折的半刚性固定。
{"title":"Wire Osteosynthesis in the Treatment of Mandible Fractures in Low Resource Settings: A Force Study.","authors":"Shekhar K Gadkaree, Adeeb Derakhshan, Victor Nyabenda, Isaie Ncogoza, Gratien Tuyishimire, David A Shaye","doi":"10.1177/19433875221143605","DOIUrl":"10.1177/19433875221143605","url":null,"abstract":"<p><strong>Study design: </strong>Cadaveric investigation.</p><p><strong>Objective: </strong>Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF.</p><p><strong>Methods: </strong>Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site.</p><p><strong>Results: </strong>For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (<i>P</i> < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (<i>P</i> < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (<i>P</i> = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (<i>P</i> = .29).</p><p><strong>Conclusions: </strong>Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72740793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The K9-Teen Pandemic: When Good Boy Goes Bad. The Epidemiology, Management and Public Health Ramifications of Facial Dog Bite Injuries: Newcastle, Australia, Experience. K9-Teen 流行病:好孩子变坏的时候面部被狗咬伤的流行病学、管理和公共卫生影响:澳大利亚纽卡斯尔的经验
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-03-07 DOI: 10.1177/19433875231161941
Sophie K M Kelly, Gary R Hoffman

The purpose of this study was to investigate the epidemiology, pattern of injury and management of facial dog bite injuries. Methods: The authors conducted a retrospective cohort study over a 5-year period of patients who sustained a facial dog bite injury. The study setting was an Oral and Maxillofacial Surgery Department at a level 1 trauma centre, servicing an estimated catchment population in excess of 950,000 people. Results: In total, 171 patients were managed in the designated period from January 2017 to January 2022. The median age was 9 years (range 11 months to 77 years), with the highest incidence of a single age 4 years. The frequency was slightly greater amongst males (n = 93) than females (n = 78). The most common responsible breed were Pitbull types (n = 26). Overall, bites most often resulted from the family dog (n = 87), in the victim's own home (n = 84) and whilst playing with the dog (n = 64). The primary sites involved were the lips (n = 70), cheek (n = 53) and nose, representing the so called 'target area'. In 53 cases, the injuries were classified as severe. 138 patients required hospital admission, and of these, 130 required surgical management under general anaesthesia. Conclusions: Facial dog bite injuries present a significant burden on the healthcare system and result in physical, functional and/or emotional distress for the patient. As the rates of dog ownership continue to rise, a consequential increase in these injuries is also likely. Further, public health intervention is essential, particularly as the most susceptible demographic remains young male children.

本研究旨在调查面部被狗咬伤的流行病学、伤害模式和处理方法。研究方法作者对面部被狗咬伤的患者进行了为期 5 年的回顾性队列研究。研究地点是一级创伤中心的口腔颌面外科,估计服务人口超过 95 万。研究结果在 2017 年 1 月至 2022 年 1 月的指定时间段内,共有 171 名患者接受了治疗。中位年龄为 9 岁(范围为 11 个月至 77 岁),发病率最高的年龄为 4 岁。男性发病率(n = 93)略高于女性(n = 78)。最常见的肇事犬种是比特犬(n = 26)。总的来说,咬伤最常见的原因是被家犬咬伤(87 人)、在受害者自己家中咬伤(84 人)和与狗玩耍时咬伤(64 人)。咬伤的主要部位是嘴唇(70 例)、脸颊(53 例)和鼻子,即所谓的 "目标区域"。其中 53 例伤势严重。138 名患者需要入院治疗,其中 130 人需要在全身麻醉的情况下进行手术治疗。结论面部被狗咬伤给医疗系统带来了巨大的负担,并给患者的身体、功能和/或情绪造成了困扰。随着养狗率的不断上升,这类伤害也可能随之增加。此外,公共卫生干预也是必不可少的,尤其是最容易受到伤害的人群仍然是年轻男性儿童。
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引用次数: 0
Is Using the Harmonic Scalpel Better than Conventional Hemostasis in Neck Dissection? A Meta-Analysis. 在颈部切除术中使用谐波手术刀比传统止血方法更好吗?一项 Meta 分析。
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-04-15 DOI: 10.1177/19433875231170924
Ishaque Hameed, Mohammad Omer Khan, Syed Abdus Samad, Samar Mahmood, Omer Mustafa Siddiqui, Indallah Hameed, Muhammad Nashit, Ayman Iqbal, Shayan Marsia, Al Haitham Al Shetawi

Study design: Systematic review and meta-analysis.

Objective: The clinical decision to pursue harmonic scalpel (HS) method vs conventional hemostasis to treat head and neck cancers has been arguably predicated on the clinical outcomes observed. This study aims to evaluate the surgical outcomes of neck dissection between both techniques and perform an updated meta-analysis using the available literature.

Methods: We searched PubMed, Scopus, and Cochrane Library through 31st December 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcome metrics included operative time and intraoperative blood loss. Secondary outcomes consisted of length of hospital stay, length of drain stay, total drain output, and postoperative complications. A meta-analysis was conducted using Review Manager Version 5.3 (RevMan) software employing the Random Effects Model.

Results: We identified 114 articles, out of which 10 randomized control trials (RCTs) analyzing a combined total of 558 patients met the inclusion criteria after title and full-text screening. Meta-analysis shows the group treated with HS had a significantly shorter operative time. [MD = -23.21, 95% CI (-34.30, -12.12) P value <.0001 I2 = 92%] but an insignificant lesser intraoperative blood loss [MD = -61.53, 95% CI (-88.61, -34.45) P < .00001 I2 = 79%].

Conclusions: This study confirms that that HS use in neck dissection yields a reduced operative time and intra operative blood loss relative to conventional hemostasis. Furthermore, our paper shows no superiority of HS method over conventional hemostasis where length of hospital stays, length of drain stays, and postoperative complications are concerned. Future RCTs with high-level evidence may further elucidate the relative effectiveness of HS method over conventional hemostasis in treating head and neck cancers.

研究设计系统综述和荟萃分析:在治疗头颈部癌症时,临床决定采用谐波手术刀(HS)法还是传统止血法,主要取决于观察到的临床结果。本研究旨在评估两种技术的颈部解剖手术效果,并利用现有文献进行最新的荟萃分析:根据系统综述和荟萃分析首选报告项目(PRISMA)指南,我们检索了截至 2021 年 12 月 31 日的 PubMed、Scopus 和 Cochrane 图书馆的文献。结果指标包括手术时间和术中失血量。次要结果包括住院时间、引流管留置时间、引流管总输出量和术后并发症。我们使用Review Manager Version 5.3(RevMan)软件,采用随机效应模型进行了荟萃分析:经过标题和全文筛选,我们确定了 114 篇文章,其中有 10 项随机对照试验(RCT)符合纳入标准,共分析了 558 名患者。Meta 分析显示,接受 HS 治疗的一组患者的手术时间明显更短。[MD = -23.21,95% CI (-34.30, -12.12) P 值 2 = 92%],但术中失血量明显减少[MD = -61.53,95% CI (-88.61, -34.45) P < .00001 I2 = 79%]:本研究证实,与传统止血方法相比,在颈部解剖中使用 HS 可减少手术时间和术中失血量。此外,我们的论文显示,在住院时间、引流管停留时间和术后并发症方面,HS方法没有优于传统止血方法。未来具有高水平证据的研究性临床试验可能会进一步阐明HS止血法在治疗头颈部癌症方面相对于传统止血法的有效性。
{"title":"Is Using the Harmonic Scalpel Better than Conventional Hemostasis in Neck Dissection? A Meta-Analysis.","authors":"Ishaque Hameed, Mohammad Omer Khan, Syed Abdus Samad, Samar Mahmood, Omer Mustafa Siddiqui, Indallah Hameed, Muhammad Nashit, Ayman Iqbal, Shayan Marsia, Al Haitham Al Shetawi","doi":"10.1177/19433875231170924","DOIUrl":"10.1177/19433875231170924","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>The clinical decision to pursue harmonic scalpel (HS) method vs conventional hemostasis to treat head and neck cancers has been arguably predicated on the clinical outcomes observed. This study aims to evaluate the surgical outcomes of neck dissection between both techniques and perform an updated meta-analysis using the available literature.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, and Cochrane Library through 31st December 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcome metrics included operative time and intraoperative blood loss. Secondary outcomes consisted of length of hospital stay, length of drain stay, total drain output, and postoperative complications. A meta-analysis was conducted using Review Manager Version 5.3 (RevMan) software employing the Random Effects Model.</p><p><strong>Results: </strong>We identified 114 articles, out of which 10 randomized control trials (RCTs) analyzing a combined total of 558 patients met the inclusion criteria after title and full-text screening. Meta-analysis shows the group treated with HS had a significantly shorter operative time. [MD = -23.21, 95% CI (-34.30, -12.12) <i>P</i> value <.0001 I<sup>2</sup> = 92%] but an insignificant lesser intraoperative blood loss [MD = -61.53, 95% CI (-88.61, -34.45) <i>P</i> < .00001 I<sup>2</sup> = 79%].</p><p><strong>Conclusions: </strong>This study confirms that that HS use in neck dissection yields a reduced operative time and intra operative blood loss relative to conventional hemostasis. Furthermore, our paper shows no superiority of HS method over conventional hemostasis where length of hospital stays, length of drain stays, and postoperative complications are concerned. Future RCTs with high-level evidence may further elucidate the relative effectiveness of HS method over conventional hemostasis in treating head and neck cancers.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82771308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mandible Fractures Undergoing Transfer Rarely Require Acute Intervention. 转移过程中的下颌骨骨折很少需要急性干预。
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-03-01 DOI: 10.1177/19433875231161907
Damon R T McIntire, Carole S L Spake, Charles C Jehle, Marten N Basta, Joseph W Crozier, Albert S Woo

Study design: A retrospective review was conducted of all patients with mandibular fractures who were evaluated by plastic surgery at a Level I trauma center between January 1, 2017 and May 1, 2020. Data including demographic characteristics, mechanism of injury, type of presentation (e.g., primary or transfer), treatment plan, and time to intervention were recorded.

Objective: Mandibular fractures are common traumatic injuries. Because these injuries are managed by surgical specialists, these patients are often emergently transferred to tertiary care hospitals. This study aims to assess the benefits of emergent transfer in this patient group.

Methods: Variables were summarized using descriptive statistics. The relationship with initial disposition was assessed via tests of association, including Student's t-test, Fisher's exact test, or chi-square tests. Significance was set to p values less than 0.05. Multivariate regression analysis was conducted to determine predictors of presentation to outside hospital followed by transfer to our institution.

Results: Records from 406 patients with isolated mandibular fractures were evaluated. 145 (36%) were transferred from an outside hospital specifically for specialty evaluation. One patient required intervention in the Emergency Department (ED). Of the 145 patients that were transferred to our facility, eight (5.5%) were admitted for operative management. Patients with open injuries and pediatric patients showed benefit from transfer.

Conclusions: Patients are frequently transferred to tertiary care facilities for specialty service evaluation and treatment. However, when isolated mandible fractures were evaluated, only one patient required intervention in the ED. Patients with grossly open fractures and pediatric patients were more frequently admitted specifically for operative management. This practice of acute interfacility transfer represents an unnecessary cost to our health system as isolated mandible fractures can be managed on an outpatient basis. We suggest that pediatric patients and patients with open fractures be transferred for urgent evaluation and management, whereas most patients would be appropriate for outpatient evaluation.

研究设计:对2017年1月1日至2020年5月1日期间在一级创伤中心接受整形外科评估的所有下颌骨骨折患者进行回顾性研究。记录的数据包括人口统计学特征、受伤机制、发病类型(如初诊或转院)、治疗方案和干预时间:下颌骨骨折是常见的外伤。目的:下颌骨骨折是一种常见的外伤,由于这些损伤需要外科专家进行处理,因此这些患者通常会被紧急转送到三级医院。本研究旨在评估紧急转院对这类患者的益处:方法:使用描述性统计对变量进行总结。通过学生 t 检验、费雪精确检验或卡方检验等关联检验来评估与初始处置的关系。显著性设定为 p 值小于 0.05。进行了多变量回归分析,以确定转院到外院的预测因素:对 406 名孤立性下颌骨骨折患者的记录进行了评估。145例(36%)患者是从外院转入本院进行专科评估的。一名患者需要在急诊科(ED)接受治疗。在转入本院的145名患者中,有8名(5.5%)患者入院接受了手术治疗。开放性损伤患者和儿童患者从转院中获益匪浅:结论:患者经常被转送到三级医疗机构接受专科评估和治疗。然而,在对孤立的下颌骨骨折进行评估时,只有一名患者需要在急诊室进行干预。严重开放性骨折患者和儿科患者则更多需要入院接受手术治疗。由于孤立性下颌骨骨折可以在门诊进行治疗,因此这种急性医院间转院的做法给我们的医疗系统带来了不必要的成本。我们建议将小儿患者和开放性骨折患者转院进行紧急评估和治疗,而大多数患者适合在门诊进行评估。
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引用次数: 0
Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature. 一级创伤中心额窦骨折的处理:回顾性研究和文献综述。
IF 0.9 Pub Date : 2024-03-01 Epub Date: 2023-02-09 DOI: 10.1177/19433875231155727
Kimberly Oslin, Meryam Shikara, Joshua Yoon, Pharibe Pope, Kelly Bridgham, Suneet Waghmarae, Andrea Hebert, Fan Liang, Kalpesh Vakharia, Natalie Justicz

Study design: Case series.

Objective: This retrospective review of frontal sinus fractures aims to describe our current experience managing these fractures at an urban level I trauma center.

Methods: An institutional database of 2081 patients who presented with maxillofacial fractures on computed tomography face/sinus in 2019 was queried for all patients with traumatic frontal sinus fractures. Demographics, trauma-related history, management approach, and follow-up data were collected and analyzed.

Results: Sixty-three (7.3%) patients had at least one fracture involving the frontal sinus. The most common etiologies were assaults, falls, and motor vehicle accidents. Surgical repair was performed in 26.8% of patients with frontal sinus fractures, and the other 73.2% were observed. Fractures that were displaced, comminuted, obstructive of the frontal sinus outflow tract, or associated with a dural tear or cerebrospinal fluid leak were more likely to be operative.

Conclusions: The majority of frontal sinus fractures in this study were treated with observation. Despite advances in transnasal endoscopic approaches, many surgeons still rely on open approaches to repair frontal sinus fractures.

研究设计病例系列:这篇额窦骨折的回顾性综述旨在描述我们目前在城市一级创伤中心处理这些骨折的经验:方法:在机构数据库中查询了2019年在计算机断层扫描脸部/窦颌面骨折的2081名患者,以了解所有创伤性额窦骨折患者的情况。结果:63名(7.3%)患者至少有一处涉及额窦的骨折。最常见的病因是袭击、跌倒和机动车事故。26.8%的额窦骨折患者接受了手术修复,73.2%的患者接受了观察。骨折移位、粉碎、阻塞额窦流出道或伴有硬脑膜撕裂或脑脊液漏者更有可能进行手术:结论:本研究中的大多数额窦骨折患者都接受了观察治疗。尽管经鼻内窥镜方法取得了进步,但许多外科医生仍依赖开放式方法修复额窦骨折。
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引用次数: 0
Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series. LeFort III型牵张截骨术对综合征性颅缝闭闭患者阻塞性睡眠呼吸暂停的围手术期处理:一个病例系列。
IF 0.9 Pub Date : 2023-12-01 Epub Date: 2022-11-28 DOI: 10.1177/19433875221142676
Kathryn W Brown, Shelley R Edwards, Ian C Hoppe

Study design: Retrospective observational study.

Objective: The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement.

Methods: After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care.

Results: Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation.

Conclusions: The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.

研究设计:回顾性观察性研究。目的:本出版物的目的是解决缺乏文献详细说明在LeFort III推进放置牵引硬体但在充分的中面部推进之前,术后立即间隔期间综合征性颅缝闭闭和阻塞性睡眠呼吸暂停患者的呼吸管理的问题。方法:经IRB批准后,研究者回顾性地选择纳入该病例系列的候选人。样本由四名年龄在10至19岁之间的患者组成,他们在一个三级保健中心接受了为期一年的LeFort III中脸进展。所有手术均由一名外科医生完成。经多导睡眠描记术确定,其中3例患者有明显的阻塞性睡眠呼吸暂停,需要进行手术。1例患者术后出现持续性呼吸暂停,需要长期ICU护理。结果:4例患者中有3例经多导睡眠图诊断为重度OSA, AHI中位数为28.3。3例术前OSA患者中有2例在术后未发生不良呼吸损害;一个需要夜间氧气帐篷,另一个不需要补充氧气。患者1术后出现明显的呼吸窘迫,伴有夜间呼吸暂停发作和低饱和度,需要补充氧气和频繁刺激。结论:本研究提示早期介入睡眠医学和管理患者期望是至关重要的。在ICU进行非常密切的术后监护是必要的。在开始和完成中脸推进前接受LeFort III型截骨术的患者,阻塞性睡眠呼吸暂停的围手术期管理需要进一步的研究。
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引用次数: 0
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Craniomaxillofacial Trauma & Reconstruction
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