A Novel 3D Evaluation of the Correlation Between the Condylar Position and Angle Classification in a Lebanese Population: A Pilot Study

Résumé Introduction : L’articulation temporo-mandibulaire (ATM) est l’une des articulations les plus complexes. Sa morphologie varie selon les individus, et même entre les côtés gauche et droit. Plusieurs études ont démontré une relation significative entre certaines caractéristiques occlusales et la morphologie articulaire. La tomodensitométrie à faisceau conique (CBCT) est actuellement la modalité la plus largement adoptée pour l’examen de l’ATM. Objectif : Cette étude vise à comparer, dans une cohorte Libanaise, l’espace interarticulaire avec les différentes classes d’Angle en utilisant le CBCT. Méthodologie : Une analyse rétrospective a été menée sur des images CBCT réalisées à l’Université Saint Joseph de Beyrouth sur une période de 1 an, entre 2021 et 2022. Quatre valeurs de clairance ont été sélectionnées, représentant la distance minimale entre l’os temporal et le condyle mandibulaire qui définit l’espace interarticulaire : 0,5 mm, 1 mm, 1,5 mm et 2 mm. Pour chaque valeur choisie, nous avons recherché la présence ou non d’une surface visible. Cette surface correspond à la zone du condyle ayant une distance du condyle à l’os temporal inférieure ou égale à la valeur choisie. Résultats : Vingt-neuf patients âgés de 12 à 60 ans ont été inclus ; 12 (41 %) étaient des hommes et 17 (59 %) des femmes. Les 48 images CBCT (23 du côté droit et 25 du côté gauche) ont été réparties en trois groupes selon la classification d’Angle : classe I (n = 14), classe II (n = 29) et classe III (n = 5). Pour une distance de [0 mm ;0,5 mm ;1mm et 1,5mm] correspondent des surfaces de valeurs nulles. Pour un intervalle compris entre [1,5 – 2mm] correspond une surface de 18,8 mm2 pour les sujets de classe I, 16,6 mm2 pour les sujets de classe II, et 30,5 mm2 pour les sujets de classe III. Les résultats n’ont pas montré de corrélation statistiquement significative entre l’espace interarticulaire et les différentes classes d’Angle. Conclusion : L’évaluation tridimensionnelle de la position condylienne par CBCT a montré qu’il n’existe pas de corrélation entre les espaces interarticulaires et les différentes classes d’Angle. Mots clés : position condylienne ; classification d’Angle ; occlusion ; CBCT ; tomodensitométrie. Abstract Introduction: The temporomandibular joint (TMJ) is one of the most complex joints. Its morphology varies between individuals, and even between the left and right sides. Several studies have found a significant relation between certain occlusal features and joint morphology. Cone-beam computed tomography (CBCT) imaging is currently the most widely adopted modality for the examination of the TMJ. Objective: This study aimed to compare the joint space in a Lebanese cohort with different Angle classification using CBCT. Methodology: We retrospectively analyzed CBCT images performed at the Saint Joseph University of Beirut in Lebanon, over a period of 1 year, between 2021 and 2022. Four clearance values were selected, representing the minimum distance between the temporal bone and the mandibular condyle that defines the joint space: 0.5 mm, 1 mm, 1.5 mm, and 2 mm. For each value chosen, we looked for the presence or not of a visible surface. This surface corresponds to the area of the condyle with a distance from the condyle to the temporal bone less than or equal to the chosen value. Results: Twenty-nine patients aged between 12 and 60 years old were included; 12 (41%) were males and 17 (59%) females. We classified 48 CBCT images (23 on the right side and 25 on the left side) into three groups according to Angle’s classification: class I (n=14), class II (n=29), and class III (n=5). For a distance of [0-1.5 mm] corresponded a surface of 0 mm2. For the interval between [1.5-2 mm] corresponded a surface of 18,8 mm2 for class I subjects, 16,6 mm2 for class II, and 30,5 mm2 for class III. The results showed no statistically significant differences between the articular spaces and the different types of occlusion. Conclusion: The three-dimensional evaluation of the condylar position by CBCT showed that there are no significant differences between the joint spaces and the different types of occlusion according to Angle’s classification. Keywords: condylar position; Angle classification; occlusion; CBCT

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Canine et incisive maxillaires : mieux connaître la morphologie pour optimiser la fonction

Étude biométrique de la morphologie coronaire des incisives et canines maxillaires humaines actuelles Le positionnement orthodontique ou la réhabilitation prothétique du secteur antéro-maxillaire se base sur de rares données biométriques disponibles. L’ objectif de cette étude est de mesurer l’angulation de la surface fonctionnelle linguale de la canine et de l’incisive médiale par rapport au plan axio orbitaire. Matériel et méthode Il s’agit d’une étude rétrospective basée sur l’analyse de dossiers pédagogiques de sujets jeunes. Les mesures sont réalisées sur 49 modelages en matériau silicone de dents saines, naturelles, fonctionnelles, en classe I, du groupe antéro-maxillaire. Résultats Ils confirment que l’inclinaison des faces linguales, par rapport au plan axio-orbitaire, diminuent nettement de 10º en allant de l’incisive médiale (57º) à la canine (47º). Si l’on note une nette stabilité de la morphologie vestibulaire, il existe une variabilité de la morphologie linguale, en particulier de la canine. Ces variations d’une zone essentielle sur le plan fonctionnel sont suffisamment importantes pour en tenir compte sur le plan clinique

Upper canines and incisors: how a better knowledge of their morphology can help us to optimise their function

Biometric study of contemporary human maxillary incisors and canine coronal morphology The orthodontic alignment or prosthetic rehabilitation of the upper anterior sector is based on available biometric data. The aim of this study is to measure the angle formed between the functional lingual surface of the canine and central incisor and the axial-orbital plane. Materials and methods This retrospective study is based on an analysis of documents of young dental students. The measurements were made on 49 silicone models of healthy, natural, functional teeth, in class I occlusion for the maxillary anterior group. Results The values of slope angulations of the lingual surfaces relative to the axial-orbital plane clearly decrease by 10° from the central incisor (57°) to the canine (47°). If there is stability in buccal morphology, there is variability in anterior lingual morphology, particularly of the canine. These variations in an essential zone on the functional level are marked enough to warrant being taken into account in clinical practice

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit