Implant born prosthetic rehabilitation of tumour patients can be difficult to perform. Challenges in treating such patients include disrupted anatomy with limited mouth opening due to previous ablative surgery as well as free-flaps or simple bone grafts, adjuvant therapy such as radiotherapy and, in general, poorer general health. Combining classical knowledge of ideal prosthesis placement and current virtual planning possibilities the positioning and in consequence the survival of dental implants can be optimised. Since prosthetic rehabilitation has a positive effect on the patients' quality of life and general health, we propose performing such surgeries as early as possible. All patients at our institution receiving pre-planned guided implant reconstruction and postoperative evaluation with Cone Beam Computed Tomography (CBCT) between 2015 and 2018 were evaluated for inclusion. Eight patients with a total of 30 implants met the inclusion criteria. The planned implant position was compared to the outcome position by fusing the two and deviations in entry-point position, apex-position, angular deviation and depth error were recorded. The mean (SD) discrepancy at entry-point was 2.28 (1.45) mm and 2.89 (1.53) mm at the apex, respectively. Mean (SD) angulation discrepancy was 9.5˚ (4.13˚) and the mean (SD) depth deviation was 1.52 (0.86) mm. Our results demonstrate the feasibility of pre-planned implant placement in challenging clinical situations and that only few concessions have to be made for precision.

Mit einem Anteil von 3 bis 6 % zahlt das odontogene Myxom zu den drei haufigsten odontogenen Tumoren. Es wird aufgrund der klinischen Symptomatik oder als radiologischer Zufallsbefund entdeckt. Die Behandlung besteht in der Regel aus der Resektion des Tumors. Angesichts der hohen Rezidivrate ist post operationem eine jahrliche klinische und radiologische Nachsorge erforderlich. Der Beitrag beschreibt die Befundaufnahme, die Diagnostik und die Therapie bei einer 32-jahrigen Patientin mit einem odontogenen Myxom im Oberkiefer.

• CDC and CCI® facilitate standardization of complication grading. • CDC and CCI® applicability for head & neck microvascular reconstruction established. • Further adaptations of CDC and CCI® have been suggested. • Head & neck risk factors for morbidity and more severe complications identified.

This study was performed to report the outcomes of patients with oral squamous cell carcinoma (OSCC) of the tongue over a 10-year period with the aim of testing the hypothesis that the lymph node ratio (LNR) has a significant influence on loco-regional recurrence. The charts of 227 patients with OSCC of the mobile tongue treated at the University Hospital of Zurich from 2003 to 2012 were screened. Following the application of the exclusion criteria (prior chemotherapy, radiotherapy, or surgery, perioperative death, N3 disease, unresectable disease, synchronous second primary, no signed informed consent, and follow-up <3years), prospective data were collected and a retrospective analysis performed for 88 of these patients who were treated with selective neck dissection. During a mean follow-up period of 78 months (standard deviation 37 months), loco-regional recurrence was diagnosed in 25 patients (28%). The overall and disease-specific survival rates for the study population were 72% and 80%, respectively. Perineural invasion was identified as an independent risk factor for decreased disease-specific survival, whereas LNR was not. LNR did not show an influence on disease recurrence. Thus, its prognostic value in patients with tongue cancer remains uncertain and the decision regarding adjuvant therapy should not be made solely on the basis of LNR.

Purpose: Dental rehabilitation in patients receiving free flap reconstructive surgery on the mandible or maxilla is an important part of bringing patients back to normality in both a physical and psychological way. It is therefore important to be able to do this in the fastest way possible. Virtual preplanned reconstructions of jaws with implants placed simultaneously are a good way to expedite this process and have the advantage of allowing true backward planning to achieve bone placement where it prosthetically needs to be. Thus, the precise transfer of the virtually preplanned implant position to the intraoperative situation is crucial for prosthetic rehabilitation. Patients and Methods: We compared a control group of patients (4 patients with 15 implants) with preplanned fibular reconstructions of the mandible with implants incorporated in the planning and a trial group of patients (4 patients with 13 implants) with an additional intraoperative splint for the verification of the implants' angulation. The preoperative planning and postoperative computed tomography scans were compared. Results: The average positioning error at bone level was 0.9 mm in the trial group and 1.3 mm in the control group. The average angulation error in the buccolingual plane was 2.9 degrees in the trial group and 5.5 degrees in the control group; axially, the difference was 6.3 degrees in the trial group and 4.1 degrees in the control group. Conclusions: The use of digitally backward-planned fibula cutting guides with direct dental implant positioning is feasible, and the precision found is comparable with that of standard splint-guided implant placement in the general population. Although the axial angulation error has more to do with anatomic variance and positioning of the bony cutting guide, the trial population clearly profited from the additional splint in the important buccolingual angulation. Overall, we showed a high level of precision over all implants in both groups. (C) 2018 American Association of Oral and Maxillofacial Surgeons

This study was performed to report the usage of sentinel lymph node biopsy (SLNB) in clinical stage I or II tongue cancer patients with cN0 necks seen over a 14-year period. Data were collected prospectively, and a retrospective analysis was performed of 41 patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Sentinel lymph node (SLN)-positive patients underwent elective neck dissection, whereas SLN-negative patients were kept under careful observation. Seven of the 41 (17%) patients enrolled in the study were found to have occult metastases. The patients were followed up for a mean duration of 92 months (range 60–144 months). The neck recurrence rate for SLN-positive patients was 0% and for SLN-negative patients was 3%. The authors recommend the routine use of SLNB in patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Furthermore, special focus should be placed on isolated tumour cells, as their presence is of high clinical relevance.

Objective. Fractures of the zygoma and orbit are common facial skeleton injuries. Inadequate reduction and internal fixation may result in functional and aesthetic impairment. The aim of this study was to assess the use of intraoperative 3-dimensional (3-D) cone beam computed tomography (CBCT) for determining the intraoperative revision rate and the need for additional reconstruction of the orbit. Study Design. We conducted a retrospective analysis of 48 consecutive patients (15 females, 33 males) suffering from simple or complex zygomatic fractures, seen between June 2015 and October 2016. Intraoperative 3-D CBCT (Xoran Technologies, Ann Arbor, MI) was performed, and the intraoperative image was overlaid on the preoperative image by using iPlan software (Brainlab, Feldkirchen, Germany) for quality control. Categorical variables were cross-tabulated and compared using Fisher's exact test. P values and 95% confidence intervals were assessed. Results. In 6 of 48 patients, intraoperative revision was deemed necessary on the basis of the superimposition on the preoperative images. Five of these 6 patients had comminuted fractures (P = .001). In 7 patients, the indication for orbital reconstruction was revised after intraoperative 3-D CBCT. Conclusions. Intraoperative 3-D CBCT allows for immediate revision and prevents unnecessary orbital reconstruction.

The Surgical reconstruction of defects of the face is challenging. Local and regional flaps have an important part to play, but large defects of bone and soft tissue are a greater problem. Microvascular tissue transfer has become the standard for such patients, and preoperative planning of bony reconstructions is now common. To use these preplanning tools best the implants should be placed in the prosthetically ideal place, and the bone positioned to surround the implants – that is, truly backward planning of the position of the bone. The buccolingual angulation and the actual position of the implants during operation can be difficult to verify. Using commonly available software and 3-dimensional printing solutions, therefore, we have constructed an algorithm to optimise the position of these implants during the operation, and to get their position as close to the planned outcome as possible. This algorithm is adaptable to any implant system and is potentially possible in any implant or preplanning software unit.

The authors have no conflict of interest to declare.

Background: Bone necrosis of the jaw is a serious condition with a broad differential diagnosis of pathologies such as cutaneous histiocytosis, bone metastases or malignant tumours. In addition to the most common cause, medication related osteonecrosis of the jaw (MRONJ), one must consider a number of other causes, such as histiocytosis. Langerhans cell histiocytosis (LCH) is a histiocytic disorder with a large spectrum of clinical manifestations and with possible involvement of a variety of organs. This case shows the importance of an early detection of this rare disease in order to prevent further spreading. Even if an initial diagnosis in the oral cavity is rare, dentists should be aware of this disease. Case presentation: The presented case describes a patient who was referred for evaluation and treatment due to exposed bone and extensive osteolysis in the region of the upper and lower jaw. After biopsy and diagnosis of LCH, the patient was treated with systemic therapy, achieved remission and is disease free after a 2 year of follow up. Conclusions: This case report illustrates that when dealing with unclear osteolytic changes of the jawbone, Langerhans cell histiocytosis must be taken into consideration in the differential diagnosis and biopsy must be performed in case of suspicion.

Riesenzellgranulome stellen die Patienten und den Behandler vor eine grosse Herausforderung. Die frühzeitige Diagnose durch den Zahnarzt und die zeitnahe Therapie sind essentiell.

Introduction. Early surgical management is often advocated for fractures of the tooth-bearing portion of the mandible. A 6-hour delay has been mentioned for the fixation of these fractures. Our aim was to bring this paradigm into question.Methods. All patients referred to our department from September 2012 to May 2014 for fractures of the tooth-bearing portion of the mandible were retrospectively included. For each patient, age, gender, aetiology of the fracture, and characteristics of the fractures were recorded. Tobacco and/or alcohol addictions, diabetes and mandibular dental condition were taken into account. We also noticed the preoperative delay and the occurrence of complications such as: haematoma, infection, wound dehiscence, osteosynthesis failure and pseudarthrosis.Results. Among the 47 patients referred, 36 were treated with a delay of more than 6 hours (76.6%). In 88.8% of the cases, the reason for this delay was unavoidable. The mean delay time from trauma to surgery was 52 hours (range: 7-312). Forty-nine percent of the patients had comorbidities. Complications occurred in 6 patients leading to an overall complication rate of 16.67%. A statistically significant higher complication rate was observed among smokers (P = 0.006). No statistical relationship was found between the delay and the occurrence of complications (P = 0.994). This study suggests that fractures of the tooth-bearing portion of the mandible should no longer be considered as an emergency that must be treated within a 6-hour delay. (C) 2015 Elsevier Masson SAS. All rights reserved.

Objectives: Free fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction. Material and Methods: We retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula) transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU). Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test. Results: Ten patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001). There was a statistical significant increase in bone density in cortical (P < 0.001) and cancellous (P = 0.004) bone. Conclusions: Dental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.

Calcium pyrophosphate dihydrate deposition disease (CPPD) is a metabolic disorder characterized by noninfectious joint inflammation with intra- or periarticular calcification. 1 Atzeni F. Sarzi-Puttini P. Bevilacqua M. Calcium deposition and associated chronic diseases (atherosclerosis, diffuse idiopathic skeletal hyperostosis, and others). Rheum Dis Clin North Am. 2006; 32 (viii): 413 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In 1962, Kohn et al 2 Kohn N.N. Hughes R.E. McCarty D.J.J. et al. The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: The "pseudogout syndrome." III. dentification of crystals. Ann Intern Med. 1962; 56: 738 Crossref PubMed Scopus (177) Google Scholar were the first to describe the association of CPPD crystals in the synovial fluid of the knees of patients with cartilage calcifications visible on standard radiographs, termed "chondrocalcinosis," 3 Richette P. Bardin T. Doherty M. An update on the epidemiology of calcium pyrophosphate dihydrate crystal deposition disease. Rheumatol Oxf Engl. 2009; 48: 711 Crossref PubMed Scopus (141) Google Scholar and acute symptoms commonly associated with gout. Most population-based research uses chondrocalcinosis as the basis for the presence of CPPD, and this is strongly associated with an increase in age. Of the patients older than 60 years, 6% to 15% demonstrate radiologic signs of chondrocalcinosis. For those older than 80 years, the prevalence increases to 30% to 40%. 1 Atzeni F. Sarzi-Puttini P. Bevilacqua M. Calcium deposition and associated chronic diseases (atherosclerosis, diffuse idiopathic skeletal hyperostosis, and others). Rheum Dis Clin North Am. 2006; 32 (viii): 413 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar , 4 Announ N. Guerne P.A. [Calcium pyrophosphate dihydrate crystal induced arthropathy]. Rev Med Suisse. 2007; 3 (744, 746): 740 PubMed Google Scholar Despite the increasing awareness, most manifestations are likely to be underdiagnosed. 5 Iacopino A.M. Wathen W.F. Craniomandibular disorders in the geriatric patient. J Orofac Pain. 1993; 7: 38 PubMed Google Scholar

We thank Dr Krishnan for his contribution. 1 Krishnan B. RE: Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2011; 69: 962 Abstract Full Text Full Text PDF Scopus (3) Google Scholar We agree that local anesthesia can inhibit the occurrence of the trigeminocardiac reflex (TCR) and that it should be a basic part of any maxillofacial procedure, even under general anesthesia. It is perhaps because local anesthesia is such a basic measure that we failed to mention it explicitly. Classification of Potential Risk Factors for Trigeminocardiac Reflex in Craniomaxillofacial SurgeryJournal of Oral and Maxillofacial SurgeryVol. 68Issue 6PreviewTrigeminocardiac reflex (TCR) in craniomaxillofacial surgery can lead to severely life-threatening situations. At least mild forms are probably much more common than the existing surgical literature suggests. Therefore, the aim of this presentation of cases and literature review was to evaluate the predisposing factors leading to a classification of risk factors for potential TCR and to give information concerning preventive measures and management procedures. Full-Text PDF Re: Classification of Potential Risk Factors for Trigeminocardiac Reflex in Craniomaxillofacial SurgeryJournal of Oral and Maxillofacial SurgeryVol. 69Issue 4PreviewTo the Editor:—I recently read the article “Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery”1 published in this journal. I would like to note a small yet pertinent point that seems to have escaped the attention of the authors. The authors classified potential risk factors for trigeminocardiac reflex (TCR) and recommended prophylactic administration of a vagolytic drug (atropine) right before any surgical manipulation known to be risky for TCR. However, a simpler alternative to avoid this rare intraoperative complication would be to ensure that the surgical site is blocked with suitable regional nerve blocks using vasoconstrictors. Full-Text PDF

We read with interest the article by Lübbers et al 1 Lübbers H.T. Zweifel D. Grätz K.W. et al. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2010; 68: 1317 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar entitled “Classification of Potential Risk Factors for Trigeminocardiac Reflex in Craniomaxillofacial Surgery.” Having read the article carefully, we would like to address a new finding about “trigeminocardiac reflex” (TCR) and one more risk factor, which is revealed by our recent work. This may be interesting information to the readers and a novel additional factor for the article. In replyJournal of Oral and Maxillofacial SurgeryVol. 68Issue 11PreviewWe agree with Arakeri that one should be familiar with the different forms of syncope and that trigeminocardiac reflex (TCR) occurring with the patient under local anesthesia might mimic vasovagal syncope.1,2 We also agree that, in principle, extraction of a tooth is a possible trigger for TCR, especially if local anesthesia is not complete. This was not mentioned in our article3 because literature research at that time did not show any results for TCR triggered by exodontia. Full-Text PDF

Purpose: Trigeminocardiac reflex (TCR) in craniomaxillofacial surgery can lead to severely life-threatening situations. At least mild forms are probably much more common than the existing surgical literature suggests. Therefore, the aim of this presentation of cases and literature review was to evaluate the predisposing factors leading to a classification of risk factors for potential TCR and to give information concerning preventive measures and management procedures.Patients and Methods: All surgery reports from the Department of Cranio-Maxillofacial and Oral Surgery in the University Hospital in Zurich between 2003 and 2008 were searched for severe intraoperative cardiovascular complications, and a literature review was performed for publications concerning asystole or bradycardia during maxillofacial surgical procedures.Results: Three incidents were revealed in which severe bradycardia in 2 cases followed by asystoly - had occured. All incidents were successfully managed.Conclusion: All craniomaxillofacial surgeons involved in orbital surgery in general and in the treatment of midface fractures, eyelid surgery, and orthognathic procedures in particular should be aware of the possibility of the TCR and should be familiar with its prevention and therapy. (C) 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:1317-1321, 2010

A noteworthy article published in this journal 1 Lübbers H.T. Zweifel D. Grätz K.W. et al. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2010; 68: 1317 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar aimed to evaluate the predisposing factors leading to a classification of risk factors for potential intraoperative occurrence of the trigeminal cardiac reflex (TCR). Although it is timely to make such an effort, the article has several points that need to be discussed. The authors claim that the oculocardiac reflex, a subgroup of the TCR, which was studied previously, occurred in up to 90% of patients operated for strabismus. 1 Lübbers H.T. Zweifel D. Grätz K.W. et al. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2010; 68: 1317 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Because most of these data were gathered from children's strabismus operations 2 Blanc V.F. Hardy J.F. Milot J. et al. Oculocardiac reflex: A graphic and statistical analysis in infants and children. Can Anaesth Soc J. 1983; 30: 360 Crossref PubMed Scopus (154) Google Scholar and the obscurity of diagnosis of this entity in children, which can be interpreted as commotio cerebri rather than being attributable to TCR, we believe that the incidence may be massively overrated. In addition, we know well that children are more prone to develop the TCR. 3 Schaller B. Cornelius J.F. Prabhakar H. The trigemino-cardiac reflex: An update of the current knowledge. J Neurosurg Anesthesiol. 2009; 21: 187 Crossref PubMed Scopus (159) Google Scholar In replyJournal of Oral and Maxillofacial SurgeryVol. 68Issue 11PreviewWe do thank Bohluli et al for their contribution. For the most part, we can agree; and in our view, their comments raise an important question, along with perspectives for future research, on the topic of trigeminal cardiac reflex (TCR). Full-Text PDF

We describe a patient with panniculitis ossificans traumatica that arose adjacent to the mandible. Panniculitis ossificans traumatica is an unusual form of heterotopic calcification that develops within subcutaneous fat as a result of injury. There have been few reported cases, and we know of none in the maxillofacial region despite the frequency of trauma to this region. As a result few treatment protocols exist. We describe an experience with its diagnosis and management.