Preventing hypoesthesia after a buccal plate fracture in a sagittal split procedure: A technical note

© 2018 European Association for Cranio-Maxillo-Facial Surgery If during a sagittal split osteotomy a buccal plate fracture occurs, it inevitably results in a time-consuming procedure with, in many cases, hypoesthesia of the mental region as a consequence of manipulation of the inferior alveolar nerve. We would like to present a novel technique to solve a (threatening) buccal plate fracture that is quick and easy to perform, and has thus far not resulted in hypoesthesia

Preventing hypoesthesia after a buccal plate fracture in a sagittal split procedure: A technical note

© 2018 European Association for Cranio-Maxillo-Facial Surgery If during a sagittal split osteotomy a buccal plate fracture occurs, it inevitably results in a time-consuming procedure with, in many cases, hypoesthesia of the mental region as a consequence of manipulation of the inferior alveolar nerve. We would like to present a novel technique to solve a (threatening) buccal plate fracture that is quick and easy to perform, and has thus far not resulted in hypoesthesia

Reproducibility and construct validity of the utrecht mixing ability Test to obtain masticatory performance outcome in patients with condylar mandibular fractures

Objective: This study assessed the test-retest reproducibility of the Utrecht mixing ability test (MAT) and the construct validity of the MAT in relation to the Mandibular Function Impairment Questionnaire (MFIQ) in patients with mandibular condylar fractures. Material and methods: Twenty-six patients treated for a mandibular condylar fracture participated in this clinimetric study; all patients performed the MAT twice. Simultaneously the MFIQ was conducted. Test-retest reliability and construct validity were assessed using the intra-class correlation coefficient (ICC) and Spearman correlation, respectively. Results: The ICC of the MAT was 0.906 (95% CI: 0.801-0.957), which indicates an excellent reliability. A weak correlation of 0.386 (P =.052) between the first MAT and the overall outcome of the MFIQ was found. A significant moderate correlation of 0.401 (P =.042) was found between the retest of the MAT and the overall outcome of the MFIQ. One question on the MFIQ (about yawning) showed a moderate positive correlation of 0.569 (P =.002) and 0.416 (P =.034) for the MAT test and retest, respectively. Conclusion: The MAT is an easy test to use in follow-up of patients. The test-retest reliability of this test is excellent in condylar trauma patients. As the validity of the MAT and the MFIQ could not be confirmed, the MFIQ may be an addition to patient's feedback about the rehabilitation process of their mandibular functioning

Layer-specific cell differentiation in bi-layered vascular grafts under flow perfusion

Bioengineered grafts have the potential to overcome the limitations of autologous and non-resorbable synthetic vessels as vascular substitutes. However, one of the challenges in creating these living grafts is to induce and maintain multiple cell phenotypes with a biomimetic organization. Our biomimetic grafts with heterotypic design hold promises for functional neovessel regeneration by guiding the layered cellular and tissue organization into a native-like structure. In this study, a perfusable two-compartment bioreactor chamber was designed for the further maturation of these vascular grafts, with a compartmentalized exposure of the graft's luminal and outer layer to cell-specific media. We used the system for a co-culture of endothelial colony forming cells and multipotent mesenchymal stromal cells (MSCs) in the vascular grafts, produced by combining electrospinning and melt electrowriting. It was demonstrated that the targeted cell phenotypes (i.e., endothelial cells (ECs) and vascular smooth muscle cells (vSMCs), respectively) could be induced and maintained during flow perfusion. The confluent luminal layer of ECs showed flow responsiveness, as indicated by the upregulation of COX-2, KLF2, and eNOS, as well as through stress fiber remodeling and cell elongation. In the outer layer, the circumferentially oriented, multi-layered structure of MSCs could be successfully differentiated into vSM-like cells using TGFβ, as indicated by the upregulation of αSMA, calponin, collagen IV, and (tropo)elastin, without affecting the endothelial monolayer. The cellular layers inhibited diffusion between the outer and the inner medium reservoirs. This implies tightly sealed cellular layers in the constructs, resulting in truly separated bioreactor compartments, ensuring the exposure of the inner endothelium and the outer smooth muscle-like layer to cell-specific media. In conclusion, using this system, we successfully induced layer-specific cell differentiation with a native-like cell organization. This co-culture system enables the creation of biomimetic neovessels, and as such can be exploited to investigate and improve bioengineered vascular grafts

Value of cone beam computed tomography for detecting bone invasion in squamous cell carcinoma of the maxilla

Objective: To determine the diagnostic value of cone beam computed tomography (CBCT) in detecting bone invasion in maxillary squamous cell carcinoma (MSCC). Study Design: In this retrospective cohort study, preoperative CBCT scans were independently assessed by a single surgeon in imaging assessment 1 (IA 1) and by 1 surgeon with 2 dentists in consensus (IA 2) for the presence of bone invasion in MSCC. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, area under the receiver operating characteristic curve (AUC), and Cohen's κ were calculated. Histopathologic results of resection specimens served as the reference standard. Results: Of 27 patients, 19 (70%) had proven bone invasion. IA 1 yielded 68.4% sensitivity, 75.0% specificity, 86.7% PPV, 50.0% NPV, 70.4% accuracy, and 0.717 AUC. All results of IA 2 were true-positive and true-negative, resulting in 100% sensitivity, specificity, PPV, NPV, accuracy, and AUC. The assessments differed in 6 cases. Interobserver κ was fair (0.38, 95% CI 0.04-0.72, P = .038). There was a significant association between CBCT detection of bone invasion and extent of surgical treatment (P = .006) Conclusions: The diagnostic accuracy of CBCT was high but observer-dependent. CBCT examination may be useful in surgical treatment planning

Intraoral ultrasonography to measure tumor thickness of oral cancer : A systematic review and meta-analysis

Early oral cancer is preferably treated by surgery. Its complete removal is essential for locoregional control and disease-free survival. Inadequate resection margins require adjuvant therapy such as re-resection or (chemo)radiation, that causes extra morbidity and oral discomfort. Intraoral ultrasonography (US) is reported to be of value in determining tumor thickness. Intraoperative visualization of the tumor may facilitate the resection and ensure adequate surgical margins. Furthermore, accurate prediction of tumor thickness could help determine the treatment strategy of the clinically node-negative neck, as thickness and depth of invasion are predictors of cervical metastasis as well as prognosticators of survival. The 8th edition of the American Joint Committee on Cancer staging system for oral squamous cell carcinoma has included depth of invasion as parameter for cT-stage. The aim of this review is to analyze the accuracy of intraoral US in determining tumor thickness in oral cancer. A systematic search was conducted, and the quality of the included papers was assessed using the QUADAS-2 tool for diagnostic accuracy studies. Subsequently, a meta-analysis was performed on the available individual participant data of 240 patients. Most of the twelve included studies focused on T1-2 tongue cancer (n = 129). Meta-analysis showed a high correlation in tumor thickness within this subgroup as measured by intraoral US and histopathology (r = 0.82, p <.001), with minor overestimation of 0.5 mm on US. It is concluded that intraoral US is very accurate in determining tumor thickness in early oral tongue cancer

Value of cone beam computed tomography for detecting bone invasion in squamous cell carcinoma of the maxilla

Objective: To determine the diagnostic value of cone beam computed tomography (CBCT) in detecting bone invasion in maxillary squamous cell carcinoma (MSCC). Study Design: In this retrospective cohort study, preoperative CBCT scans were independently assessed by a single surgeon in imaging assessment 1 (IA 1) and by 1 surgeon with 2 dentists in consensus (IA 2) for the presence of bone invasion in MSCC. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, area under the receiver operating characteristic curve (AUC), and Cohen's κ were calculated. Histopathologic results of resection specimens served as the reference standard. Results: Of 27 patients, 19 (70%) had proven bone invasion. IA 1 yielded 68.4% sensitivity, 75.0% specificity, 86.7% PPV, 50.0% NPV, 70.4% accuracy, and 0.717 AUC. All results of IA 2 were true-positive and true-negative, resulting in 100% sensitivity, specificity, PPV, NPV, accuracy, and AUC. The assessments differed in 6 cases. Interobserver κ was fair (0.38, 95% CI 0.04-0.72, P = .038). There was a significant association between CBCT detection of bone invasion and extent of surgical treatment (P = .006) Conclusions: The diagnostic accuracy of CBCT was high but observer-dependent. CBCT examination may be useful in surgical treatment planning