Evaluation des operativen Ergebnisses oberer und unterer Blepharoplastiken mit ästhetischer Indikation anhand klinischer und anthropometrischer Parameter

Blepharoplastiken mit ästhetischer Indikation gehören weltweit zu den am häufigsten durchgeführten ästhetischen Operationen. Bisher war in der Literatur keine adäquate Methode einer nachhaltigen und objektivierbaren Evaluation des operativen Ergebnisses ästhetischer Blepharoplastiken beschrieben worden. Die verwendeten anthropometrischen Parameter basierten auf den Untersuchungen von Leslie G. Farkas und waren Eye Fissure Index, Upper Lid Sulcus Height, Upper Iris Coverage und Canthal tilt. Daneben wurden noch das Zeichen der sichtbaren Sklera sowie die Position des Unterlides zum Unterrand der Cornea erhoben. Desweiteren wurde die Faltenarchitektur der Oberlider des Patientenkollektivs untersucht. EFI und UIC zeigten keine signifikanten Veränderungen. nur geringgradige Veränderungen. ULSH, scleral show, die Position des Unterlides zum Limbus corneae und die intercanthale Neigung zeigten signifikante Veränderungen zu normativen Werten hin. Das neu etablierte System der Bemessung der Reduktion der Lidlaxität der Oberlider in einem Felderraster ergab eine signifikante Reduktion der Lidfalten. In Bezug auf den standardisierten Fragebogen korrelierte das Ausmaß der Zufriedenheit der Patienten mit ihren präoperativen Erwartungen. Die Patientenzufriedenheit an sich scheint in erheblichem Maße von der präoperativen Erwartungshaltung abhängig zu sein. Die Ergebnisse der Studie weisen daraufhin, dass eine nachhaltige und objektivierbare Evaluation des operativen Ergebnisses ästhetischer Blepharoplastiken möglich ist

Management of dental extraction in patients with Haemophilia A and B: a report of 58 extractions

Objectives: Patients with inherited bleeding disorders are at high risk of bleeding following oral surgery and present challenges to the oral surgeons. Aim of this study was to report our experience in dental extraction in patients exhibiting Haemophilia A and B between 2007 and 2012. Patient and Methods: 58 dental extractions in 15 patients during 19 interventions were performed. Replacement therapy with recombinant and plasma-derived factor VIII and IX was applied systematically in combination with antifibrinolytic treatment and local haemostatic measures. The following data were recorded: type of surgery, applied local haemostatic measures, general substitution, systemic antifibrinolytic agents and occurrence of postoperative bleeding complications. Results: Two patients presented postoperative bleeding. One had secondary bleeding requiring additional injection of factor concentrates. The other one presented epistaxis which was managed conservatively with a nasal tamponade. Conclusions: Excellent haemostasis is achievable after dental extractions in patients with Haemophilia A and B by following a protocol using defined pre- and postoperative doses of factor concentrates in combination with haemostatic measures

Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma

Background: Quality of life (QoL) has become increasingly important in cancer treatment. It refers to the patient’s perception of the effects of the disease and therapy, and their impact on daily functioning and general feeling of well being. Material and Methods: In this prospective study, a total of 100 patients treated at our institution, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific EORTC QLQ-H&N35 module. The questionnaires were distributed to the patients between 12 and 60 months postoperatively. Results: Global QoL score was 58.3 and mean score for functioning scale was 76.7. Fatigue (28.7 ± 26.1), followed by financial problems (27.7 ± 33.5), insomnia (26.7 ± 34.5) and pain (26.3 ± 29.9) had highest symptom score on QLQ-C30. Fatigue (r=-0.488), insomnia (r=-0.416) and pain (r =-0.448) showed highest value for significantly negative correlation to global QoL. In the H&N35 module, restriction of mouth opening (43.3 ± 38.6), dry mouth (40.7 ± 36.9), sticky saliva (37.3 ± 37.1) and eating in public (33.8 ± 31.9) were the four worst symptoms. Swallowing problem (r=-0.438), eating in public (r=-0.420) and persistent severe speech (r=-0.398) ranked as the three worst symptoms with highest value for significantly negative correlation to global QoL. Conclusions: Longterm QoL after oncologic surgery and microvascular free flap reconstruction in patients with oral cancer is satisfactory. Measuring QoL should be considered as part of the evaluation of cancer treatment

Salivary MMP-9 in the detection of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most common malignant tumour of the oral cavity. Detection of OSCC is currently based on clinical oral examination combined with histopathological evaluation of a biopsy sample. Direct contact between saliva and the oral cancer makes measurement of salivary metalloproteinase- 9 (MMP-9) an attractive alternative. In total, 30 OSCC patients and 30 healthy controls were included in this prospective study. Saliva samples from both groups were collected, centrifuged and supernatant fluid was subjected to ELISA for assessment of MMP-9. The median salivary MMP-9 values with interquartile range (IQR) of OSCC patients and the control group were statistically analysed using the Mann-Whitney U-test. The receiver operating characteristic (ROC) curve was constructed and the area under curve (AUC) was computed. The median absorbance MMP-9 value of the OSCC group was 0.186 (IQR=0.158) and that of control group was 0.156 (IQR=0.102). MMP-9 was significantly increased in the OSCC patients than in the controls by +19.2% (p=0.008). Median values in patients with recurrence and in patients with primary event were 0.233 (IQR=0.299) and 0.186 (IQR=0.134) respectively. MMP-9 was significantly increased in patients with primary event (p=0.017) compared to controls by +19.2%. No significant increase of MMP-9 level was detected when comparing patients with recurrence and healthy controls (+49.4%; p=0.074). The sensitivity value of MMP-9 was 100% whereas the specificity value was 26.7% with AUC of 0.698. The present data indicates that the elevation of salivary levels of MMP-9 may be a useful adjunctive diagnostic tool for detection of OSCC. However, further studies are necessary to provide scientific and clinical validation

Morphologic outcome of bimaxillary surgery–An anthropometric appraisal

Objectives: To adequately perform orthognathic surgery procedures, it is from basic interest to understand the morphologic changes caused by orthognathic surgery. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate and understand such changes. Study Design: We present a pre- to postoperative evaluation of orthognathic surgery results based on anthropometric indices described by Farkas and cephalometric measurements. 30 Class III patients undergoing maxillary advancement by Le Fort I Osteotomy and mandibular setback by bilateral sagittal split osteotomy were evaluated. Preoperative as well as three and nine months postoperative lateral cephalograms as well as standardized frontal view and profile photographs were taken. On the photographs 21 anthropometric indices given by Farkas were evaluated. In cephalograms SNA and SNB angle as well as Wits appraisal were investigated. Results: The investigated anthropometric indices showed a significant increase of the vertical height of the upper lip without changing the relation of the upper vermilion to the cutaneous upper lip. The lower vermilion height increased relatively to the cutaneous lower lip without vertical changes in the lower lip. Due to maxillary advancement the upper face height increased meanwhile the lower face height decreased due to mandibular setback. SNA and SNB angle and Wits appraisal showed typical changes related to surgery. Conclusions: The investigated photo-assisted anthropometric measurements presented reproducible results related to bimaxillary surgery

Wearing complete dental prostheses - Effects on perioral morphology

Background: To adequately perform rehabilitation of edentulous patients by a complete removable dental prosthesis (CRDP) is from basic interest to dentists to understand the morphologic changes caused by re-establishment of a physiologic jaw relationship. Anthropometric analyses of standardized frontal view and profile photographs may help elucidate such changes. Material and Methods: Photographs of 31 edentulous patients were compared in relaxed lip closure and after insertion of a CRDP in stable occlusion. 2232 anthropometric distances were raised. Eighteen anthropometric indices reflecting the perioral morphology and its integration in the vertical facial harmony were investigated. Results: The intercanthal – mouth width index ( p <.001), medial – lateral cutaneous upper lip height index ( p= .007), lower vermilion contour index ( p= .022), vermilion – total upper lip height index ( p= .018), cutaneous – total up - per lip height index ( p= .023), upper lip – nose height index ( p= .001), nose – upper face height index ( p= .002), chin – mandible height index ( p= .013), upper lip – mandible height index ( p= .045), nose – lower face height index ( p= .018), and nose - face height index ( p= .029) showed significant pre- to post-treatment changes. Conclusions: The investigated anthropometric indices presented reproducible results related to an increase in occlusal vertical dimension. Their application may be helpful in assessment, planning, and explanation of morphologic effects of CRDPs on the perioral and overall facial morphology, which may helps to improve the aesthetic outcome

Management of dental extraction in a female patient with fanconi anemia.

Oral surgery in patients with bleeding disorders is associated with a high risk of bleeding during and after surgery. This article is aimed to present the case of an eight-year-old girl suffering from severe Fanconi anemia with pancytopenia who underwent a dental extraction. The hemostatic effect of local administration of tranexamic acid in combination with a primary suture seems to be extremely helpful in order to reduce the necessity of blood products and the risk of postoperative bleeding