Oral and Maxillofacial Surgery-Heidelberg最新文献

Background: Immunoglobulin G4 related disease (IgG4-RD) is an immune-mediated, multifocal, fibroinflammatory disease with varied clinical manifestations. The involvement of head and neck region is infrequent. The objective was to report a case of localized IgG4-RD of mandible that clinically mimicked a lytic lesion.

Case presentation: A 22 year old female presented with restricted mouth opening and swelling over right ramus and angle region of mandible. Radiographic imaging showed an ill-defined radiolucent lytic lesion infiltrating adjacent muscles. An incisional biopsy was performed and histopathological picture was suggestive of benign spindle cell neoplasm. Immunohistochemistry was suggestive of IgG4-RD involving mandible adjoining soft tissues. Elevated serum IgG4 levels were noted. Oral steroid therapy was initiated and tapered without maintenance dose. The patient progressed without any sequelae. Imaging 2 years after completion of treatment showed complete resolution of the radiolucent lesion.

Conclusion: The precise diagnosis of this lesion is challenging and depends on many different factors. A non-specific localized lesion should be investigated as a systemic condition. Early diagnosis and prompt initiation of steroid therapy should be favored. Continued follow up is critical due to the indolent nature of this disease. The future of management of this disease is the development of specific diagnostic criteria and targeted therapy of head & neck lesions.

Purpose: This study aimed to evaluate the dental and skeletal stability one year after Miniscrew-Assisted Rapid Palatal Expansion (MARPE) by using 3D image data.

Methods: Patients with transverse maxillary deficiency from the age of 16 onwards were enrolled consecutively in this prospective longitudinal cohort study. The MARPE appliance was digitally and individually designed and fabricated. Cone-beam computed tomography (CBCT) scans and intra-oral scans (IOS) were acquired before the start of MARPE treatment (T0), immediately after active expansion (T1) and one-year post-expansion (T2). Nasal floor width (NFW), palatal alveolar width at the first molar (M1) and first premolar (P1) (PAW), nasal cavity width (NCW), intermolar width (IMW) and interpremolar width (IPW) were measured to assess the immediate (ΔT0-T1) and net (ΔT0-T2) skeletal and dentoalveolar expansion and relapse (ΔT1-T2). Potential correlations with age, sex and midpalatal suture maturation (MSM) stage were also investigated.

Results: Thirty-one patients (6 men, 25 women, mean age: 26.2 years) were included. The mean follow-up time (T0-T2) was 12.2 months. The initial NFW increase demonstrated a relapse of 0.6 ± 1.2 mm, or 11.6% of the initial expansion (p < 0.01). Expansion at the alveolar level remained stable during the follow-up. IPW also remained stable during the follow-up (4.2 ± 1.3 mm at T1; 4.4 ± 2.6 mm at T2). IMW exhibited a relapse of 3.8 ± 2.1 mm, or 60.2% of the initial expansion (p < 0.001) during T1-T2. There was no statistically significant correlation between stability and age, sex and MSM stage.

Conclusions: MARPE is an effective therapy for the correction of transverse maxillary discrepancy in late adolescents and adults, achieving a clinically stable skeletal outcome one year after expansion.

Purpose: Ameloblastoma is a benign tumor originating from odontogenic epithelium with a global incidence of about 0.5 cases per million persons per year. The overall recurrence rate of ameloblastomas range from 55% -90%. In this retrospective study we have analyzed the factors associated with recurrence and recurrence free survival in ameloblastoma of the jaws.

Methods: Retrospective chart review of 10 years was done from records directory. All demographic data, data on diagnostic modalities, clinical presentations, radiology, management and histology were taken into consideration. Kaplan Meir estimator was used to evaluate recurrence rate and Cox regression analysis (univariate and multivariate) was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence and influence recurrence free survival. ROC curve (Receiver Operating Characteristic) was used to find out the optimal cut off point for size of the lesion in predicting recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval.

Results: A total of 75 patients had recurrence with a median follow up of 65 months. The overall 5 year RFS was 19.5%. Conventional ameloblastomas, cortical/ soft tissue invasion, conservative treatment and tumor size ≥ 4 cm were independent predictors of recurrence.

Conclusion: Aggressive treatment is preferred for conventional ameloblastomas ≥ 4 cm with cortical/ soft tissue invasion.

Background: The pre-extraction overbuilding procedure was designed aiming to mitigate buccal bone resorption following tooth extraction. The objective of this study was to compare the efficacy of pre-extraction and juxta-extraction buccal overbuilding treatments in preserving buccal bone volume following tooth extraction.

Material and methods: At the test sites (pre-extraction sites), an alveolar crest overbuilding was performed on the buccal aspect of the distal root of the fourth premolar using a xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both fourth premolars were extracted and the alveoli were filled with a collagenated xenograft. An overbuilt procedure was performed also at the control sites (juxta-extraction sites). After 3 months, biopsies were collected.

Results: Considering the initial height difference between the lingual and buccal bone plates at the time of extraction, histological evaluation revealed that the resorption of the buccal bone relative to the lingual bone wall was 3.2 mm at the pre-extraction sites and 3.3 mm at the juxta-extraction sites. New bone originated from the residual pre-existing bone crest in an attempt to restore the original dimension.

Conclusion: The buccal overbuilding procedures performed three months before tooth extraction did not contribute to preserve the buccal bone crest, despite necessitating an additional surgical procedure. Evidence of ongoing bone regeneration was observed within the augmented space maintained by the biomaterial, suggesting that a prolonged healing period, potentially exceeding six months as indicated by this study, might be required to achieve optimal outcomes.

Purpose: This report aims to present an interdisciplinary approach to diagnosing and treating a case of Common Variable Immunodeficiency (CVID), an inborn error of immunity, resulting in successive complications following a third molar extraction procedure.

Case presentation: The patient, a 37-year-old Caucasian female, sought a specialist for the extraction of an impacted lower third molar associated with dentigerous cyst. Due to the possibility of mandibular fracture, a bone fixation system was used in the region. However, she experienced recurrent infections following the procedure despite various treatments and hospitalizations, and these infections could not be explained by any factors. The diagnosis of CVID was established through exclusionary factors, low immunoglobulin levels, and comprehensive allergy assessments by an immunologist. Resolution of the patient's condition and discharge were achieved only after removing the fixation system and implementing monthly immunoglobulin infusions.

Conclusion: CVID is often diagnosed late, resulting in significant economic, social, and health burdens, including recurrent hospitalizations, allergies, and increased risk of malignancy. This case underscores the importance of considering CVID in patients presenting with unexplained recurrent infections following oral and maxillofacial surgeries. Additionally, it highlights the necessity of a multidisciplinary approach for effectively managing patients with CVID.

Aim: Insertion of dental implants causes bone deformation and induces residual bone compression stress, which can lead to implant failure if the bone loss threshold is exceeded. The current literature about bone stress is restricted to computer simulations and implant primary stability measurements after installation. This work measures the torque and deformation during implant insertion testing.

Purpose: The aim of this work was to analyze the influence surface treatment, thread profile, body shape and the presence of microthreads in the neck on the primary stability, bone deformation and residual stress during dental implants insertion. The insertion torque and resonance frequency analysis (RFA) are the main technique used to measure the primary stability of dental implants.

Material and methods: Five models of dental implants with different surface treatments (machined and acid etching), thread profiles (triangular and trapezoidal) and body shapes (cylindrical and conical) were inserted in synthetic bone blocks (polyurethane) with a density of 30 PCF (0.48 g/cm³) compatible with the D2 bone. The insertion torque was quantified by a digital torque driver. Strain gauge extensometry technique was used to measure bone deformation during implant insertion.

Results: The bone deformation and torque increase as the number of implants turns insertion increases. Dental implant with trapezoidal thread profile needs higher insertion torque than triangular threads. Implants with a conical shape require higher insertion torque than cylindrical ones. The bone stress induced by machined implant insertion exceeded the bone's mechanical resistance, causing cracks. Conical implants showed better performance than cylindrical ones. The implants with a trapezoidal thread and those with a conical body induce greater insertion torque.

Conclusion: Comparing the mechanical behavior, it was found that the machined implants had the worst performance in terms of stress distribution in the synthetic bone, resulting in cracks in the specimen during insertion. Implants with trapezoidal threads and those with a conical body induce insertion torque and bone compression stresses that do not harm osseointegration.

Clinical relevance: Excessive deformations in the peri-implant bone led to bone necrosis and implant failure. Thus, the surgeons must analyze the influence of surface treatment, thread profile, and body shape on the osseointegration process.

Introduction: This study aimed to explore the predictive and prognostic value of tumor-stromal ratio (TSR) and tumor budding (TB) in the recurrence and outcome of patients with Oral tongue squamous cell carcinoma (OTSCC).

Methods: All patients with OTSCC who underwent glossectomy with or without neck dissection in a tertiary center between 2010 and 2020 were included. The pathology slides of all patients were reviewed by a consulting pathologist. All pathologic features including tumor size, tumor grade, tumor thickness, surgical margin status, lymphovascular- and perineural invasion, T-stage, number of dissected, TB, TSR, and involved, tumor budding and tumor-stromal ratio were defined, we categorized the tumors as stroma-rich (low TSR) and stroma-poor (high TSR); as well as TB as low (0-4 buds) and high (≥ 5 buds). The inter-observer reliability of TB and TSR was assessed using the Kappa statistics analysis.

Results: A total of 109 patients, with a median age of 62 (range 19-88) years, were included. There was a significant correlation between TSR and tumor budding with other adverse pathologic features and prognostic factors. In univariate analysis, both stromal-rich tumors and tumor budding were poor prognostic factors for disease-free survival (DFS) and overall survival (OS). However, on multivariate analysis, N-stage, adjuvant radiotherapy, tumor size, depth of invasion (DOI) and tumor budding emerged as independent prognostic factors for DFS. Likewise, N-stage, and DOI were recognized as independent prognostic factors for OS.

Conclusion: Both TSR and TB are important histopathological parameters strongly linked to other pathologic prognostic indicators. Additionally, they play key roles in predicting tumor behavior, recurrence, and patient survival.

Purpose: To evaluate the efficacy of two third-generation resorbable biomaterials-F18 bioglass and β-tricalcium phosphate (β-TCP)-in promoting new bone formation in post-extraction sockets in rats. β-TCP, a synthetic porous ceramic, is well-established in clinical use, while F18 bioglass, a novel silica based bioglass.

Methods: After extraction of the right upper incisor of 45 rats, the sockets were filled either with F18 or β-TCP, or left to naturally fill with a blood clot in control group. To quantify new bone formation, five animals from each group were euthanized at 7, 14, and 28 days post-extraction. Subsequently, the hemi-maxillae were analyzed using microtomography and histomorphometry.

Results: Two-way ANOVA revealed significant differences in bone neoformation. β-TCP induced notably higher levels of new bone growth compared to the control group, as evidenced by microtomographic parameters such as bone volume (p = 0.033), bone surface (p = 0.039), and trabecular thickness (p = 0.002). F18 bioglass also induced higher new bone growth compared to the control group, evidenced by bone volume (p = 0.039). Although F18 bioglass did not significantly differ from the control group in other microtomographic parameters of new bone formation, its overall performance was comparable to that of β-TCP.

Conclusion: β-TCP has proven to be effective in promoting new bone formation. Although F18 bioglass did not significantly differ from the control group in several microtomographic parameters, its overall capacity to promote new bone growth was comparable to that of β-TCP. This outcome supports the use of F18 bioglass as a promising alternative biomaterial for alveolar ridge preservation.

Objective: Sublingual varicose veins are variations of normality that appear more prominent during aging. The systematic review aim to investigate sublingual varicose veins frequency in patients exposed to systemic and environmental exposed factors linked to cardiovascular diseases.

Methods: This systematic review was based on the PECO strategy, and the PubMed, Web of Science, Scopus, Embase and Grey Literature library were searched for publications examining the association between sublingual varicose veins and systemic and environmental exposed factors linked to cardiovascular diseases, such as hypertension, diabetes, smoking, and leg varices. A meta-analysis was conducted using random-effects models. This review included 11 studies with a total of 2,272 patients with sublingual varicosity and systemic exposed factors linked to cardiovascular diseases. The quality assessment was improved by Newcastle and Ottawa Scales (NOS).

Results: Consistent results were observed across all systemic and environmental exposed factors linked to cardiovascular diseases subgroups. We found association between sublingual varicose veins and hypertension [p = 0.0002; 95%IC2.90 [1.66-5.06]; I² 91%); diabetics (p = 0.009; 95%IC 3.19 [1.34 - 7.62]; I² 84%); tobacco abuse (p = 0.002; 95%IC 1.97 [1.29 - 3.01]; I² 82%) and leg varicosity (p = 0.03; 95%IC 2.63 [1.08 - 6.44]; I² 95%). Seven articles received score 7, indicating good quality and four articles received moderate quality.

Conclusion: Patients exposed to exposed factors that affect blood vessels showed a higher prevalence of sublingual varicose veins. These findings emphasize the importance of recognizing oral signs underlying systemic diseases.

Systematic review registration: PROSPERO CRD42023397166.