Bild- und Darstellungsqualität verschiedener digitaler Volumentomographen im Vergleich zur Computertomographie

Hintergrund: Die digitale Volumentomographie (DVT) stellt mittlerweile für viele Indikationen in der Oral- und Mund-, Kiefer- und Gesichtschirurgie eine essentielle Diagnostik dar. Viele Hersteller werben mit ihren DVT-Geräten als eine Alternative zum Goldstandard Computertomographie (CT). Ziel dieser Studie war es herauszufinden, ob sich Bild- und Darstellungsqualität verschiedener DVT-Geräte unterscheiden und diese mit einem CT zu vergleichen. Methoden: Bilddatenakquise erfolgte an 12 humanen, in Thiel konservierten Schädelpräparaten mit 10 der gängigsten DVT-Geräte in der optimalen Geräteeinstellung. Als Vergleich wurden die selben Präparate mit einem 128-Zeilen-CT analysiert. Bild- sowie Darstellungsqualität verschiedener vorgegebener anatomischer Strukturen wurden durch 6 Mund-, Kiefer- und Gesichtschirurgen bewertet und zwischen den verschiedenen Geräten sowie zum Goldstandard CT verglichen. Ergebnisse und Schlussfolgerung: Insgesamt zeigten alle DVT-Geräte, bis auf drei, eine vergleichbare Darstellungsqualität im Vergleich zum CT. Allerdings wurden die verschiedenen DVT-Geräte hinsichtlich ihrer Bildqualität und Darstellungsgenauigkeit untereinander sehr unterschiedlich bewertet. Eins der DVT-Geräte wurden von den Auswertern deutlich besser beurteilt. Es gibt deutliche Unterschiede in Bildqualität und Darstellungsgenauigkeit bei den verschiedenen angebotenen DVT-Geräten. Auch im Vergleich zum Goldstandard CT zeigten sich Unterschiede in der Leistungsfähigkeit der Geräte. Je nach Einsatzgebiet empfiehlt es sich, dies bei einem Kauf gut abzuwägen

Bild- und Darstellungsqualität verschiedener digitaler Volumentomographen im Vergleich zur Computertomographie

Hintergrund: Die digitale Volumentomographie (DVT) stellt mittlerweile für viele Indikationen in der Oral- und Mund-, Kiefer- und Gesichtschirurgie eine essentielle Diagnostik dar. Viele Hersteller werben mit ihren DVT-Geräten als eine Alternative zum Goldstandard Computertomographie (CT). Ziel dieser Studie war es herauszufinden, ob sich Bild- und Darstellungsqualität verschiedener DVT-Geräte unterscheiden und diese mit einem CT zu vergleichen. Methoden: Bilddatenakquise erfolgte an 12 humanen, in Thiel konservierten Schädelpräparaten mit 10 der gängigsten DVT-Geräte in der optimalen Geräteeinstellung. Als Vergleich wurden die selben Präparate mit einem 128-Zeilen-CT analysiert. Bild- sowie Darstellungsqualität verschiedener vorgegebener anatomischer Strukturen wurden durch 6 Mund-, Kiefer- und Gesichtschirurgen bewertet und zwischen den verschiedenen Geräten sowie zum Goldstandard CT verglichen. Ergebnisse und Schlussfolgerung: Insgesamt zeigten alle DVT-Geräte, bis auf drei, eine vergleichbare Darstellungsqualität im Vergleich zum CT. Allerdings wurden die verschiedenen DVT-Geräte hinsichtlich ihrer Bildqualität und Darstellungsgenauigkeit untereinander sehr unterschiedlich bewertet. Eins der DVT-Geräte wurden von den Auswertern deutlich besser beurteilt. Es gibt deutliche Unterschiede in Bildqualität und Darstellungsgenauigkeit bei den verschiedenen angebotenen DVT-Geräten. Auch im Vergleich zum Goldstandard CT zeigten sich Unterschiede in der Leistungsfähigkeit der Geräte. Je nach Einsatzgebiet empfiehlt es sich, dies bei einem Kauf gut abzuwägen

Recurrent osteomyelitis with proliferative periostitis after segmental resection and reconstruction of the mandible: a case report

A 50-year-old patient presented with a two-year history of chronic osteomyelitis of the left mandibular body. It was treated by wide segmental resection of the left hemimandible and reconstruction with a free vascularized fibular graft. Six months after surgery, the patient returned with pain, swelling, and moth-like lesions in the transplant in combination with appositional bone formation surrounding the ossified fibular bone. Radiographic and histological examination led to the diagnosis of a recurrent osteomyelitis with proliferative periostitis affecting the resected and reconstructed mandible. Application of ibandronate led to a significant symptom decrease

Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases

Background/Aim Mandibular condylar fractures represent 25%–35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. Methods A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal–Wallis test and t-test were carried out for statistical analysis. Results The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). Conclusion Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle

Elective Tracheotomy in Patients Receiving Mandibular Reconstructions: Reduced Postoperative Ventilation Time and Lower Incidence of Hospital-Acquired Pneumonia

Elective tracheotomy (ET) secures the airway and prevents adverse airway-related events as unplanned secondary tracheotomy (UT), prolonged ventilation (PPV) or nosocomial infection. The primary objective of this study was to identify factors predisposing for airway complications after reconstructive lower ja surgery. We reviewed records of patients undergoing mandibulectomy and microvascular bone reconstruction (N = 123). Epidemiological factors, modus of tracheotomy regarding ET and UT, postoperative ventilation time and occurrence of hospital-acquired pneumonia HAP were recorded. Predictors for PPV and HAP, ET and UT were identified. A total of 82 (66.7%) patients underwent tracheotomy of which 12 (14.6%) were performed as UT. A total of 52 (42.3%) patients presented PPV, while 19 (15.4%) developed HAP. Increased operation time (OR 1.004, p = 0.005) and a difficult airway (OR 2.869, p = 0.02) were predictors, while ET reduced incidence of PPV (OR 0.054, p = 0.006). A difficult airway (OR 4.711, p = 0.03) and postoperative delirium (OR 6.761, p = 0.01) increased UT performance. HAP increased with anesthesia induction time (OR 1.268, p = 0.001) and length in ICU (OR 1.039, p = 0.009) while decreasing in ET group (HR 0.32, p = 0.02). OR for ET increased with mounting CCI (OR 1.462, p = 0.002) and preoperative radiotherapy (OR 2.8, p = 0.018). ET should be strongly considered in patients with increased CCI, preoperative radiotherapy and prolonged operation time. ET shortened postoperative ventilation time and reduced HAP

Treatment of late-onset temporomandibular joint prosthesis infection by prosthesis revision: a case report

Late-onset infection of an inserted temporomandibular joint prosthesis is a difficult complication to treat. Most treatment protocols for late prosthetic infections include device replacement. A 40-year-old female patient with an infected and exposed temporomandibular joint prosthesis presented 3 years after implant placement. The patient was treated with prosthesis revision including fistula coverage with a temporalis muscle flap and prolonged antibiotic therapy for 10 weeks. Since completion of treatment, the patient has been infection-free

Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions

In microvascular head and neck reconstruction, various factors such as diabetes, alcohol consumption, and preoperative radiation hold a risk for flap loss. The primary objective of this study was to examine the vessel morphology of both recipient and donor vessels and to identify predictors for changes in the diameters of H.E.-stained specimens associated with flap loss in a prospective setting. Artery and vein samples (N = 191) were collected from patients (N = 100), with sampling from the recipient vessels in the neck area and the donor vessels prior to anastomosis. External vessel diameter transverse (ED), inner vessel diameter transverse (ID), thickness vessel intima (TI), thickness vessel media (TM), thickness vessel wall (TVW), and intima-media ratio (IMR) for the recipient (R) and transplant site (T) in arteries (A) and veins (V) were evaluated using H.E. staining. Flap loss (3%) was associated with increased ARED (p = 0.004) and ARID (p = 0.004). Preoperative radiotherapy led to a significant reduction in the outer diameter of the recipient vein in the neck (p = 0.018). Alcohol consumption (p = 0.05), previous thrombosis (p = 0.007), and diabetes (p = 0.002) were associated with an increase in the total thickness of venous recipient veins in the neck. Diabetes was also found to be associated with dilation of the venous media in the neck vessels (p = 0.007). The presence of cardiovascular disease (CVD) was associated with reduced intimal thickness (p = 0.016) and increased total venous vessel wall thickness (p = 0.017) at the transplant site. Revision surgeries were linked to increased internal and external diameters of the graft artery (p = 0.04 and p = 0.003, respectively), while patients with flap loss showed significantly increased artery diameters (p = 0.004). At the transplant site, alcohol influenced the enlargement of arm artery diameters (p = 0.03) and the intima–media ratio in the radial forearm flap (p = 0.013). In the anterolateral thigh, CVD significantly increased the intimal thickness and the intima–media ratio of the graft artery (p = 0.01 and p = 0.02, respectively). Patients with myocardial infarction displayed increased thickness in the A. thyroidea and artery media (p = 0.003). Facial arteries exhibited larger total vessel diameters in patients with CVD (p = 0.03), while facial arteries in patients with previous thrombosis had larger diameters and thicker media (p = 0.01). The presence of diabetes was associated with a reduced intima–media ratio (p < 0.001). Although the presence of diabetes, irradiation, and cardiovascular disease causes changes in vessel thickness in connecting vessels, these alterations did not adversely affect the overall success of the flap