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

N-terminal-pro-brain natriuretic peptide is decreased in insulin dependent gestational diabetes mellitus: a prospective cohort trial

<p>Abstract</p> <p>Background</p> <p>N-terminal-pro-brain natriuretic peptide (NT-proBNP) is elevated in gestational hypertension and preeclampsia. This trial aimed to generate data for gestational diabetes mellitus patients, who are at risk to develop these complications.</p> <p>Methods</p> <p>We have measured NT-proBNP in 223 otherwise healthy women between gestational week 24 and 32 referred to the outpatient diabetes unit in a cross-sectional study.</p> <p>Results</p> <p>88 control subjects, 45 patients with indication for medical nutrition therapy (MNT) alone and 90 patients who required insulin therapy were included. Groups of women were comparable regarding gestational week. Body mass index before pregnancy and at blood draw was significantly higher in subjects with insulin dependent gestational diabetes mellitus compared to MNT controlled gestational diabetes mellitus. NT-proBNP was significantly lower in patients with insulin dependent gestational diabetes mellitus (35 ± 25 pg/ml) compared to controls (53 ± 43 pg/ml, p = 0.012).</p> <p>Conclusions</p> <p>NT-proBNP is within the reference range of normal subjects in women with gestational diabetes mellitus. Differences in body mass index, changes in glomerular filtration rate and haemodynamics may explain lower NT-proBNP concentrations in insulin dependent gestational diabetes mellitus. A false negative interpretation needs to be considered in these women.</p

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

Bioimpedance cardiography in pregnancy: A longitudinal cohort study on hemodynamic pattern and outcome

Background: Pregnancy associated cardiovascular pathologies have a significant impact on outcome for mother and child. Bioimpedance cardiography may provide additional outcome-relevant information early in pregnancy and may also be used as a predictive instrument for pregnancy-associated diseases. Methods: We performed a prospective longitudinal cohort trial in an outpatient setting and included 242 pregnant women. Cardiac output and concomitant hemodynamic data were recorded from 11th-13th week of gestation every 5th week as well as at two occasions post partum employing bioimpedance cardiography. Results: Cardiac output increased during pregnancy and peaked early in the third trimester. A higher heart rate and a decreased systemic vascular resistance were accountable for the observed changes. Women who had a pregnancy-associated disease during a previous pregnancy or developed hypertension or preeclampsia had a significantly increased cardiac output early in pregnancy. Furthermore, an effect of cardiac output on birthweight was found in healthy pregnancies and could be confirmed with multiple linear regression analysis. Conclusions: Cardiovascular adaptation during pregnancy is characterized by distinct pattern described herein. These may be altered in women at risk for preeclampsia or reduced birthweigth. The assessment of cardiac parameters by bioimpedance cardiography could be performed at low costs without additional risks

Alternatives to free flap surgery for maxillofacial reconstruction: focus on the submental island flap and the pectoralis major myocutaneous flap

Background Microvascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in multimorbid elderly patients and after surgery or radiotherapy, which aggravate microsurgery. This study evaluates indications and outcome of the submental island flap (SMIF) and the pectoralis major myocutaneous flap (PMMF) as alternatives to the free radial forearm flap (RFF). Methods This retrospective study included 134 patients who had undergone resection and reconstruction with SMIF, PMMF, or RFF at our department between 2005 and 2020. The level of comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). Primary outcome variables were flap success, complications, wound dehiscence, surgery duration, as well as time at the ICU and the ward (hospitalization). Chi-square tests, t-tests, and ANOVA were performed for statistics. Results 24 SMIFs, 52 RFFs, and 58 PMMFs were included in this study. The flap types did not significantly differ in terms of flap success, complications, and healing disorders. The SMIF presented a success rate of 95.8% and was significantly more often used in elderly patients (mean age = 70.2 years; p < 0.001) with increased comorbidities than the PMMF (p < 0.01) and RFF (p < 0.001). SMIF reconstruction reduced surgery duration (p < 0.001) and time at the ICU (p = 0.009) and the ward (p < 0.001) more than PMMF and RFF reconstructions. PMMF reconstruction was successful in 91.4% of patients and was more frequently used after head and neck surgery (p < 0.001) and radiotherapy (p < 0.001) than SMIF and RFF reconstructions. Patients undergoing PMMF reconstruction more frequently required segmental jaw resection and had presented with advanced tumor stages (both p < 0.001). Nicotine and alcohol abuse was more frequent in the RFF and PMMF groups (both p < 0.001) than in the SMIF group. Conclusions The pedicled SMIF represents a valuable reconstructive option for elderly patients with increased comorbidity because of the shorter duration of surgery and hospitalization. On the other hand, the PMMF serves as a solid backup solution after head and neck surgery or radiotherapy. The rates of flap success, complications, and healing disorders of both pedicled flaps are comparable to those of free flap reconstruction

Significance of site‐specific radiation dose and technique for success of implant‐based prosthetic rehabilitation in irradiated head and neck cancer patients—A cohort study

Background Radiotherapy aggravates implant‐based prosthetic rehabilitation in patients with head and neck cancer. Purpose To evaluate the impact of radiation dose at implant and parotid gland site for prosthetic rehabilitation. Material and methods The retrospective study includes 121 irradiated head and neck cancer patients with 751 inserted implants. Radiation doses on implant bed and parotid gland site were recorded by 3‐dimensional modulated radiation plans. Implant success was clinically and radiographically evaluated according to modified Albrektsson criteria and compared to treatment‐ and patient‐specific data. Results Implant overall survival after 5 years was 92.4% with an implant success rate of 74.9%. Main reasons for implant failure were marginal bone resorption (20.9%), implant not in situ or unloaded (9.6%) and peri‐implantitis (7.5%). A mean radiation dose of 62.6 Gy was applied with a mean parotid dose of 35 Gy. Modulating radiation techniques went along with lower grades of xerostomia (p 50 Gy (HR 7.9), parotid dose >30 Gy (HR 2.3), bone (HR 14.5) and soft tissue (HR 4.5) transplants, bad oral hygiene (HR 3.8), nonmodulated radiation treatment planning (HR 14.5), and nontelescopic prosthetics (HR 5.2). Conclusion Radiotherapy impedes implant success in a dose‐dependent manner at implant site. Modern radiation techniques effectively reduce xerostomia favoring implant‐based prosthetic rehabilitation. Implantation in bone grafts is more critical and telescopic‐retained overdentures should be preferred

Influence of Radiotherapy on Ossification of Vascularized Osseous Reconstruction of the Jaw: A Radiological Retrospective Cohort Study Based on Panoramic Radiographs

Background: The aim of this study was to evaluate the impact of irradiation and time of irradiation on the ossification of jaws reconstructed with free bone grafts. Methods: In total, 100 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs (immediate postOP, approximately 6, 12 and 24 months follow-up). Three subgroups were divided according to the time of irradiation: preoperative radiation therapy (n = 41), postoperative radiation therapy (n = 26) and patients without any radiation therapy (n = 33) as the control group. Ossification time and influencing factors were documented. Results: The fastest ossification with a median of 304 ± 37 days was observed (p < 0.001) in the nonirradiated control group. No significant difference (p = 0.087) in ossification was found between the pre- (447 ± 136 days) and postoperative (510 ± 112 days) radiation groups. Ossification between two graft segments (336 ± 38 days) showed significantly (p < 0.001) faster ossification than between the original and grafted bone (448 ± 85 days). Moreover, closer initial contact between the segments resulted in faster ossification (p < 0.001). When analyzing cofactors, tobacco consumption was the only negative factor aggravating ossification (p = 0.006). Conclusion: Head and neck radiation corresponded with the impaired and prolonged ossification of jaw reconstructions with free bone grafts. There was no difference in ossification if radiotherapy was performed before or after reconstructive surgery. A close bony contact was particularly important for ossification between the original and grafted bone

Antiresorptive agents enhance ossification of free flap reconstructions of the mandible: a radiological retrospective cohort study

Background: The aim of this study was to investigate the effect of antiresorptive agents on the ossification of reconstructed mandibles by free bone grafts for the first time. Methods: A total of 38 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs. The study group (n = 13) had segmental resection of the mandible and free bone flap reconstruction due to medication-related osteonecrosis of the jaw (MRONJ). The control group (noMRONJ, n = 25) comprised segmental mandibular resections and free bone flap reconstructions due to tumors, chronic osteomyelitis, or trauma without any radiation. Ossification time and influencing factors were evaluated. Results: Both duration of surgery (346 ± 90 min. vs. 498 ± 124 min.; p < 0.001) and hospitalization (8.7 ± 2.8 days vs. 13.4 ± 5.3 days, p = 0.006) were shorter in the MRONJ group compared to the noMRONJ group. Ossification after mandibular reconstruction was significantly faster in the MRONJ study group [224 days, interquartile range (IQR) 175–287] compared to the control group (288 days, IQR 194–445; p < 0.001). Moreover, good initial contact between the segments resulted in faster ossification (p < 0.001) in the MRONJ group. Ossification rate between original and grafted bone or between grafted bone segments only did not differ in both the study and control groups (MRONJ, p = 0.705 vs. control, p = 0.292). The type of antiresorptive agent did not show any significance for ossification. The rate of wound healing disturbances did also not differ between the study and control groups (p = 0.69). Conclusion: Advanced MRONJ (stage 3) can be resected and reconstructed safely with free microvascular bone flaps. Antiresorptive agents enhance the ossification of the bone segments. Optimal initial contact of the bone segments accelerates bone healing. Surgery and hospitalization are markedly shortened in this vulnerable group of MRONJ patients compared to oncologic patients

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