Quality of Life Assessment for Intraoral Reconstruction

Svrha istraživanja bila je usporediti tri najčešće upotrebljavane metode rekonstrukcije usne šupljine na našoj Klinici nakon resekcije intraoralnog karcinoma. Uspoređivani su lokalni režnjevi (jezični i nazolabijalni), regionalni pektoralis major i slobodni podlaktični režanj. Uspoređivane tri skupine bolesnika nisu se razlikovale u stadiju bolesti. Za ocjenu uspješnosti rekonstrukcije kreiran je klinički upitnik od dva dijela. Prvi dio kliničkog upitnika sadrži opće podatke o bolesniku te podatke o tumoru. Drugi dio kliničkog upitnika sastoji se od ciljanih pitanja o postoperativnim funkcijskim i estetskim rezultatima. Osim usporedbe triju metoda rekonstrukcije istražili smo o kojim parametrima općenito ovisi uspjeh rekonstrukcije te utječe li rekonstrukcija na postoperativnu kakvoću života i na koji način. Raščlamba dobivenih podataka pokazala je da ni jedna od triju metoda rekonstrukcije nije superiornija u svim parametrima od preostalih dviju metoda. Slobodni podlaktični režanj nije statistički znatno pokazao očekivane teoretske prednosti pred regionalnim pektoralis major režnjem, iako je u gotovo svim parametrima bolje bodovan. Stadij bolesti i opseg resekcije bitni su parametri za postoperativne rezultate rekonstrukcije neovisno o tipu režnja.The aim of the investigation was to compare the three most commonly used methods of reconstruction of the oral cavity in the University Hospital “Dubrava”, after resection of intraoral carcinoma. In a group of 50 patients, with no statistically significant differences with regard to the stage of disease, local flaps (19 patients), regional pectoralis major flap (11 patients) and free forearm flap (20 patients) were compared. A clinical questionnaire was prepared for evaluation of the success of reconstruction, consisting of two parts. The first part of the questionnaire contained general information on the patient and data on the tumour. The second part of the questionnaire consisted of questions on postoperative functional and aesthetic results. Apart from comparison of the three methods of reconstruction, we also investigated on a sample of 55 patients which parameters were most important for the success of the reconstruction and whether and in what way reconstruction has an effect on postoperative quality of life on a sample of 55 patients. Analysis of the obtained data indicated that none of the three methods of reconstruction were superior in all parameters compared to the other two methods. Free forearm flap did not statistically significantly show the expected theoretic advantage over the regional pectoralis major flap, although it scored higher in almost all parameters. The stage of the disease and extent of resection are the most significant parameters for postoperative result of reconstruction, regardless of the type of flap

Orthodontic Treatment of Dentofacial Deformities

Međučeljusni nesklad stvara velike probleme pacijentima i estetski i funkcionalno. Razlog dolaska pacijenata u Kliniku uglavnom je estetske naravi, jer se radi o mlađim osobama, a funkicionalne su smjetnje u drugome planu. Uzimanje hrane, govor i disanje u takvih su osoba znatno otežani. Prikazat ćemo jedan od slučajeva liječenje kombiniranoga dentofacijalnog deformiteta: PROGNATHISMUS ET LATEROGNATHISMUS MANDIBULARIS. Pacijentica, 34 godine. Iz anamnestičkih podataka nismo saznali da sličnih problema ima u obitelji. Motiv dolaska na Kliniku bio je estetske naravi, premda se je pacijentica žalila na bolove u oba čeljusna zgloba, otežano uzimanje hrane i na nešto teži izgovor pojedinih glasova. Plan liječenja donesen je na osnovi sljedećih potanko provedenih postupaka: • raščlamba lica rađena je na osnovi fotogarafija napravljenih iz profila i en face • raščlamba okluzije učinjena je na studijskim modelima • rentgenkefalometrijska raščlamba profilnog i AP kraniograma učinjena računalom i ručno samo je potvrdila već spomenutu dijagnozu Liječenje je provedeno isključivo intraoralnom i ekstraoralnim ortodontskim napravama te smo smatrali korisnim iznijeti naša iskustva ovakvim načinom liječenja. Izgled pacijentice nakon liječenja vidi se na slikama. Ponovne kefalometrijske raščlambe rađene su nakon završetka liječenja. Svi parametri su u granicama normale, kako se vidi iz tabele s prikazanim vrijednostima prije i poslije liječenja. Raščlambe mekih česti pacijentice također pokazuju znatne promjene, a odnosi nos, gornja usnica, donja usnica i brada veoma su dobri. Dentofacijalni deformiteti danas se vrlo uspješno rješavaju. Dobre studijske raščlambe, na osnovi kojih se određuje plan liječenja, jamstvo su uspješnoga liječenja. Vrlo malo je ostalo tajni u liječenju dentofacijalnih deformiteta, ali ona od terapeuta traži visoku profesionalnost i učinkovitost.Disharmony of the jaws presents a great aesthetic and functional problem for patients. The reason for reporting to a clinic is mainly of an aesthetic nature, since most commonly young people are involved, while functional disturbances remain secondary. Such persons have difficulty eating, speaking and breathing. We will present one case of combined dentofacial deformity: PROGNATHISMUS ET LATEROGNATHISMUS MANDIBULARIS. Female patient, 34 years old. From anamnestic data we did not find out whether there were similar problems in the family. The motive for reporting to the clinic was aesthetics, although the patient complained of pain in both temporomandibular joints, difficulty eating and somewhat more difficult pronunciation of certain vocals. A treatment plan was based on: • Analysis of the face, based on profile and en face photographs. • Analysis of occlusion, based on study models. • Roentgen-cephalometry of the profile and AP craniogram, performed on a computer as well as manually, confirmed the above mentioned diagnosis. The treatment was performed exclusively with intraoral and extraoral orthodontic appliances, and we therefore believe that it would be useful to present our experience with such a treatment method. The appearance of the patient after treatment can be seen on the photographs. Repeated cephalometric analyses were performed after completion of the treatment. All parameters were within normal limits, as can be seen from the table presenting pre- and post treatment values. Analysis of the soft tissues also shows significant changes, and relations between the nose, upper lip, lower lip and chin are very good. Today dentofacial deformities are successfully solved. Good study analyses, which serve as the base for planning treatment, guarantee successful treatment. There are very few secrets in ortognatic treatment, but it still requires high professionalism and effectivness

Ostaoplasty with Autologous Cancellous Hip Bone

Autologni koštani graftovi i danas se smatraju metodom izbora u rekonstrukciji limitiranih defekata donje čeljusti, te rekonstrukciji koštanih “defekata” srednje i gornje trećine lica. Autologna kost je izvrstan osteokonduktivan materijal i iznimno rijetko ga organizam odbacuje. Najčešća donorna regija krista ilijaka. Kao slobodni koštani graft može se primjeniti koetikalna kost spongioza. U radu je prikazana uporaba autologne spongioze kuka kod: • osteoplastike alveolarnoga grebena u djece s rascjepom, • korekcije kontura čela bolesnika nakon maksilektomije, • rekonstrukcije defekta donje čeljusti. Bolesnici su praćeni godinu dana nakon osteoplastike. Uspješnost uporabe koštanih graftova verificirana je kliničkim nalazom, rtg-om, te kod rekonstrukcije donje čeljusti i histološkom verifikacijom nakon odstranjivanja OS materijala. Osim manjeg ožiljka nije bilo drugih oštećenja donorne regije. Osteoplastika autolognom spongiozom kuka predstavlja i danas “zlatni standard” kod ispravno odabranih indikacija.Autologous bone grafts are believed to be the method of choice in the reconstruction of limited mandibular defects and in the reconstruction of the bone defects of the middle and upper part of the face. Autologous bone is an excellent osteoconductive material and is very rarely rejected by the body. The most frequent donor region is crista illiaca. Cortical bone and cancellous bone can be used as a free bone flap. In this study we present the application of autologous cancellous hip bone in the following cases: • Osteoplasty of the alveolar ridge in children with shisis. • Correction of the forehead contour after maxillectomy. • Reconstruction of mandibular defects. The patients were followed during one year after osteoplasty. The success of the implementation of bone grafts was verified with clinical findings, X-rays, in cases of mandibular reconstruction, with pathohistological verification after the removal of the OS material. Apart from a small scar, there was no other damage to the donor region. Osteoplasty with autologous cancellous hip bone graft represents a golden standard in properly chosen indications

Facial Bite Wound

Ugrizne rane jedne su od najčešćih ozljeda u ljudi. Najčešći su ugrizi pasa (više od 80%), mačaka i ljudi. U velikom postotku ugrizne rane locirane su na licu, osobito kod djece. Najčešće bakterije koje se mogu naći u ugriznoj rani su aerobi i anaerobi iz oralne flore napadača i aerobi s kože žrtve. Liječenje ugriznih rana lica je specifično u odnosu prema ostalim dijelovima tijela. Ugrizne rane lica primarno se šivaju, a zbog dobre prokrvljenosti komplikacije su rijetke, no ako se dogode mogu biti opasne za život. U radu je predstavljen slučaj infekcije ugrizne rane na licu uzrokovane konjskim ugrizom i liječenje komplikacija.Bite wounds are one of the most frequent human traumas. Most frequently it is the dog bites (more than 80%), cats, and humans. Great percentage of these traumas is located on the face, especially in children. Most frequently isolated bacteria in the wounds are aerobes and anaerobes from the oral flora of the attacker and aerobes from the victim’s skin. The treatment of facial bite wounds has its characteristics when compared to other body parts, in that they are primarily sutured. Due to the excellent vascularity the complications are rare, but if they occur, they can be life threatening. This article reports an infection of a facial bite wound caused by horse bite and the treatment of subsequent complications

Facial Bite Wound

Ugrizne rane jedne su od najčešćih ozljeda u ljudi. Najčešći su ugrizi pasa (više od 80%), mačaka i ljudi. U velikom postotku ugrizne rane locirane su na licu, osobito kod djece. Najčešće bakterije koje se mogu naći u ugriznoj rani su aerobi i anaerobi iz oralne flore napadača i aerobi s kože žrtve. Liječenje ugriznih rana lica je specifično u odnosu prema ostalim dijelovima tijela. Ugrizne rane lica primarno se šivaju, a zbog dobre prokrvljenosti komplikacije su rijetke, no ako se dogode mogu biti opasne za život. U radu je predstavljen slučaj infekcije ugrizne rane na licu uzrokovane konjskim ugrizom i liječenje komplikacija.Bite wounds are one of the most frequent human traumas. Most frequently it is the dog bites (more than 80%), cats, and humans. Great percentage of these traumas is located on the face, especially in children. Most frequently isolated bacteria in the wounds are aerobes and anaerobes from the oral flora of the attacker and aerobes from the victim’s skin. The treatment of facial bite wounds has its characteristics when compared to other body parts, in that they are primarily sutured. Due to the excellent vascularity the complications are rare, but if they occur, they can be life threatening. This article reports an infection of a facial bite wound caused by horse bite and the treatment of subsequent complications

Orthognathic Surgery - Our Concept

Ortognatska kirurgija spada u skupinu estetsko-funkcionalnih operacija. Većina naših bolesnika dolazi na prvi pregled zahtijevajući promjenu izgleda. Prvi pregled je razgovor s bolesnikom i na njemu se uvijek nazočni ortodont i maksilofacijalni kirurg. Uzimaju se otisci fotografija an face i profila te telerendgen snimke. Na osnovi dobivenih podataka stvara se okvirni plan liječenja. Na drugome pregledu iznosi se plan liječenja i potanko se objašnjavaju postupci ortodontskog i kirurškog liječenja i moguće komplikacije. U razgovoru se rabi baza podataka ortognatskih zahvata i računalna simulacija. Bolesnici donose konačnu odluku te se na trećemu pregledu dogovara liječenje. Aktivno liječenje rijetko počinjemo prije sedamnaeste godine. Ovisno o planu, uključuje se oralni kirurg i počinje se s ortodontskim tretmanom. Kada je priprema za zahvat završena, ponavlja se razgovor s bolesnikom i dogovara se termin primitka. Bolesnik dolazi na bolničko liječenje pripremljen i s obavljenim anesteziološkim pregledom. Operacija je najčešće na dan primitka, a bolesnik u bolnici boravi 3 do 5 dana. Na primjerima vraćanja i izvlačenja donje i gornje čeljusti te bimaksilarnih zahvata prikazati ćemo naš pristup ortognatskoj kirurgiji.Orthognathic surgical treatment is both functional and esthetic. For most of our patients the reason for the first visit is esthetics. The first appointment is made in the combined maxillofacial and orthodontics clinic. During the first appointment we talk to the patient to get a general idea of his/her wishes and medical photographs, jaw models and X-rays are taken. After collecting all data a general plan for the treatment is made. During the second appointment we discuss our treatment plan together with details of both orthodontic and surgical therapy with the patient. In this discussion we use photographs from our data base and computer simulation. After the final patient’s decision is made, we start with the treatment. Depending on the treatment plan, it starts with either oral surgery or orthodontics. For most of the patients we do not start with treatment before seventeen years of age. After presurgical treatment is finished, we again discuss details of the operation with the patient and a hospital appointment is made. The operation is usually performed on the day of admission, and the hospital stay is 3 to 5 days. We discuss our treatment concept based on patients with the different types of skeletal deformities

Ossifying Fibroma of the Orbit

Osificirajući fibrom glave i vrata rijedak je tumor koji najčešće zahvaća gornju i donju čeljust. Javlja se u trećem i četvrtom desetljeću života. Lezija je obično solitarna, dobro ograničena. Postupnim rastom stanjuje okolno zdravo koπtano tkivo. Radiološka slika ovisi o trajanju bolesti. U ranome stadiju prikazuje se kao oštro ograničeno prosvjetljenje s pojedinačnim nakupinama kalcifikata. U daljnjem tijeku, uz oštro ograničenu zonu prosvjetljenja na periferiji, središnje smještene nakupine kalcifikata postaju gušće. Histološku sliku karakterizira fibrozno tkivo isprepleteno koštanim trabekulama lamelarne kosti koje su obrubljene osteoblastima i mjestimice miksomatoznom stromom. Terapija je kirurška i sastoji se u potpunoj resekciji tumora, koja jedino može spriječiti pojavu lokalnoga recidiva. U radu smo prikazali rijedak slučaj osificirajućeg fibroma orbite koji je zahvatio zigomatičnu kost i proširio se preko velikoga krila sfenoida do optičkoga kanala. Specifičnost terapije u naše bolesnice jest u tome što je unatoč doticaja tumora s prednjom lubanjskom bazom nije upotrijebljen neurokirurški pristup.Ossifying fibroma of the head and neck is a rare tumour which most frequently involves the upper and lower jaw. It occurs during the third and fourth decade of life. The lesion is usually solitary and well circumscribed. It grows slowly, thinning the surrounding healthy bone tissue. Radiographic appearance depends on the duration of the disease. In the early stage it presents as a sharply circumscribed zone of translucency with single accumulations of calcification. During the further course, with the sharply circumscribed zone of translucency on the periphery, the centrally located accumulations of calcification become denser. The histological appearance is characterised by fibrous tissue, interwoven with bony trabeculae of lamellar bones, which are bordered with osteoblasts and scattered myxomatous stroma. Therapy is surgical and consists of total resection of the tumour, which is the only way to prevent the occurrence of a local recurrence. In this paper we present a rare case of ossifying fibroma of the orbit which involved the zygomatic bone and spread/extended via the large branch of the sphenoid up to the optic canal. The specificity of the therapy in our female patient was that in spite of contact of the tumour with the frontal base of the skull, a neurosurgical approach was not used

Indication for the Closure of a Facial Defects by Second Intention Healing

Zatvaranje defekata u području glave i vrata sekundarnim cijeljenjem alternativa je primarnoj rekonstrukciji. Za dobar poslijeoperacijski estetski rezultat važno je odabrati veličinu i lokalizaciju kožnoga defekta te podučiti bolesnika o njezi rane i dužini liječenja. U pravilu su konkavni predjeli kože lica najpogodniji za sekundarno cijeljenje. Kod dobro postavljenih indikacija sekundarno je cijeljenje metoda s izvrsnim estetskim poslijeoperacijskim rezultatom. Ako je rezultat estetski neprihvatljiv, i dalje ostaju moguće sve druge kirurške metode rekonstrukcije.Closure of a defect in the head and neck area by second intention is an alternative to primary reconstruction. In order to achieve a satisfactory post-operational, aesthetic result it is important to choose the size and localisation of the dermal defect, and to educate the patient on care of the wound for the duration of treatment. As a rule the concave areas of the facial skin are the most suitable for healing by second intention. In cases of well-established indications healing by second intention is a method with excellent esthetical post-operational result. However, if the result is aesthetically unacceptable, the possibility of performing other surgical methods of reconstruction, remains

MODELIRANJE I IZRADA PELTON TURBINE SA DVA MLAZNIKA ZA POTREBE NOVOFORMIRANE LABORATORIJSKE INSTALACIJE

After surveying the existing teaching and research installations with Pelton turbines worldwide, it was concluded that there are no appropriate laboratory installations with a two-nozzle-Pelton turbine. Therefore, the design, techno-economic analysis and construction of one such laboratory installation have been conducted, where all the necessary energy characteristics of Pelton turbines will be tested. This adaptable installation can be used for various researches in order to determine numerous influential geometrical parameters with the aim of optimizing the construction of such type of hydraulic turbines. In addition to presenting the conceptual solution of the installation, the modeling and production of vital parts of the Pelton turbine, applying modern engineering recommendations and techniques are given in the paper.Nakon sagledavnja postojećih nastavno-istraživačkih instalacija sa Pelton turbinama u svetu, utvrđeno je da ne postoje odgovarajuće laboratorijske instalacije sa dvomlaznom Pelton turbinom. Stoga se pristupilo projektovanju, tehno-ekonomskoj analizi i izradi jedne takve laboratorijske instalacije na kojoj bi se ispitivale sve potrebne energetske karakteristike Pelton turbine. Predviđena instalacija je adaptibilnog tipa na kojoj se mogu raditi raznovrsna istraživanja u cilju određivanja brojnih uticajnih geometrijskih parametara na optimizaciju konstrukcije ovog tipa hidrauličkih turbina. U radu je, pored prikaza idejnog rešenja instalacije, dato modeliranje i izrada vitalnih delova Pelton turbine primenjujući savremene inženjerske preporuke i tehnike

Cross-validation of amorality scale and dark triad scales

U nastojanju da istraže strukturu psihopatije i razviju instrumente koji bi bili upotrebljivi u kliničkom i istraživačkom kontekstu, referentni autori su produkovali značajan broj ček-lista, dijagnostičkih kriterijuma i upitnika. Naše istraživanje je imalo za cilj da unakrsno validira dve savremene operacionalizacije unutrašnjih dispozicija antisocijalnog ponašanja. Paulus i Vilijams (2002) smatraju da se „crna trijada“ ličnosti može opisati putem tri povezana, ali nezavisna konstrukta: makijavelizma (merenog putem MACH-IV skale), psihopatije (SRP) i narcisizma (NPI). Ekstremni skorovi na pomenutim instrumentima, tvrde autori, odlikuju socijalno malevolentnu ličnost. Sa druge strane, skala amoralnosti Kneževića i Radovića (1998) mapira dispozicije koje se nalaze u osnovi amoralnog ponašanja. Konstrukt amorala je strukturalno prikazan putem devet dimenzija, koje se grupišu oko tri faktora drugog reda. Bliskost dve operacionalizacije najpre je proveravana pomoću Pirsonovih koeficijenata linearne korelacije. Nalazi svedoče o povezanosti (1) makijavelizma sa (MACH-IV) sa dimenzijama resentimana (r=.44, p<.01), destruktivnosti (r=.40, p<.01) i sadizma (r=.30, p<.01); (2) narcisizma (NPI) sa resentimanom (r=.47, p<.01) i makijavelizmom (r=.42, p<.01); (3) psihopatije sa resentimanom, niskom kontrolom i destruktivnošću (.39, .38., .35, datim redosledom; p<.01). Rezultati kanoničke korelacione analize sugerišu da „crna trijada“ ne uključuje one apsekte dispozicija za amoralno ponašanje koji se odnose na agresivnost iz brutalnosti, a koji su predstavljeni u modelu amorala. Drugim rečima, čini se da je Kneževićev model komprehenzivniji, odnosno da obuhvata širi raspon ličnosnih dispozicija za devijantna ponašanja.In an effort to explore the structure of psychopathy and to develop instruments which could be applied in both clinical and scientific context, a significant number of check-lists, diagnostic criterias and questionnaires have been developed by relevant authors (Hare, 1985, 1991, 1997, 2003; Edens et al., 2006; Coid & Yang, 2008). The aim of this research was to cross-validate two contemporary operationalizations of internal dispositions of antisocial behavior. Paulhus and Williams (2002) assumed that the „dark triad“ of personality can be described through three combined, but independent constructs: Machiavellianism (measured by MACH-IV scale), Psychopathy (SRP) and Narcissism (NPI). Extreme scores on above mentioned instruments characterize a socially malevolent personality. In addition, a scale of amorality (Knezevic and Radovic, 2003), maps dispositions which are in the core of amoral behavior. The construct of amorality is structurally presented through nine dimensions which are grouped around three second order factors. The overlapping of the two operationalizations is firstly checked by Pearson product-moment correlation coefficients. Results suggest connection of: (1) Machiavellianism (MACH-IV) with dimensions of resentment (r=.44, p<.01), destructiveness (r=.40, p<.01) and sadism (r=.30, p<.01); (2) narcissism (NPI) with resentment (r=.47, p<.01) and machiavellianism (r=.42, p<.01); (3) psychopathy with resentment, low control and destructiveness (.39, .38., .35, respectively; p<.01). Results of canonic correlation and multiple regression analyses suggest that „dark triad“ does not include those aspects of dispositions for amoral behavior which regard aggression driven from brutality and which is proposed in the model of amorality. In the other words, Knezevic’s model is more comprehensive in the matter that it involves a wider range of personality dispositions for deviant behavior