Maxillofacial Reconstruction Using Polyetheretherketone Patient-Specific Implants by "Mirroring” Computational Planning

In the vast majority of cases, precise symmetric reconstruction of maxillofacial defects remains an unsolved problem for craniofacial surgeons. Computer-designed alloplastic implants have contributed considerably to improvement in the accuracy and reliability of facial rehabilitation, rapidly becoming an irreplaceable part of the surgical armamentarium. In recent years, the subsequently developed new generation of computational technologies has allowed planning to be done by preoperative "mirroring” using the healthy side as a template to fabricate an ideal prosthesis for reestablishment of facial symmetry. Two cases of facial defects are reported, one of the midface and another of the lower face reconstructed using a computer-designed polyetheretherketone (PEEK) patient-specific implant (PSI) technique based on "mirroring” computational planning. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/0026

Upper lip swelling caused by a large dentigerous cyst

Swelling of the upper lip can result from various diseases such as salivary tumors, infectious and inflammatory diseases and cysts. Among the latter, dentigerous cysts, typically involving unerupted teeth, are sometimes associated with supernumerary teeth in the maxillary anterior incisors region called the mesiodens. We report an unusual case of a large dentigerous cyst associated with an impacted mesiodens in a 42-year-old male who presented with a slow-growing swelling in the upper li

Removal of unusual, large high-velocity metallic maxillary sinus foreign bodies by a modified free bone flap technique

Metallic foreign bodies are rarely found in the maxillary sinus, and usually they have a dental origin. Potential complications related to foreign bodies include recurrent sinusitis, rhinolith formation, cutaneous fistula, chemical poisoning, facial neuralgic pain and even malignancies. Two main surgical approaches are currently used for the removal of foreign bodies in the maxillary sinus: the bone flap and the endoscopic sinus techniques. We are reporting two unusual cases of large high-velocity foreign bodies removed by a modified maxillary lateral antrotomy, with free bone flap repositioning and fixation with a titanium miniplat

Severe subcutaneous and deep cervicofacial emphysema of unusual etiology

Subcutaneous and deep cervical emphysema (SCE) in the head and neck are found in a wide spectrum of conditions. Most of them are seen in patients with midfacial trauma or oropharyngeal infections. Subcutaneous and deep cervical emphysema can also be a symptom of life-threatening mediastinitis and/or necrotizing fasciitis, both of which need immediate surgery. Rarely however does SCE occur in isolation as a consequence of elevated intraoral pressure in combination with or without visible lacerations of the oral mucosa. As a consequence, air penetrates the mucosal tears and results in subcutaneous emphysema even extending down to the mediastinum in severe cases. This article describes a series of five cases of isolated SCE. It discusses the diagnosis, the pathomechanism, the differential diagnosis and the treatment. It underlines the importance of anamnesis and careful physical and laboratory examinations in order to differentiate isolated SCE from more severe conditions such as necrotizing fasciitis or mediastinitis, which necessitate immediate surger

Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease

We report a case of an asymptomatic healthy 49-year-old male patient with an incidental finding of enlargement of the right inferior alveolar nerve (IAN) canal (9 vs. 4mm). After 2years, follow-up magnetic resonance imaging (MRI) revealed no change in the findings. In addition, MR-based diffusion tensor imaging with tractography of the right and left mandibular nerves showed that the difference in size between the right and left nerves was caused by an increased number of nerve fibers in the right IAN. During the entire follow-up period of 4years, the patient remained symptom-free. Therefore, we suggest that the enlargement in our patient was a pure anatomic variant. However, a multitude of conditions are known to produce the identical radiological appearance in conventional radiology, including benign and malignant tumors, vascular malformations, and inflammatory disorders. We describe these pathologies in more detail as well as the possibilities for examinations with different MRI sequence

Deep neck space abscesses of dental origin: the impact of Streptococcus group Milleri

In recent years, there has been rising interest in Streptococcus group Milleri (SM) because high mortality rates have been related to it. In case of deep neck infections (DNI), whatever the origin, mortality rates as high as 26% were reported. But there are no data available for DNI with SM of purely dental origin. The aim of our article was to describe and analyse DNI of purely dental origin involving on one hand SM and on the other hand infections without presence of SM. We compared these two groups and statistically investigated if there were differences in clinical presentation (age, mouth opening, length of hospital stay, laboratory parameters) or clinical behaviour (re-operation, re-hospitalisation, secondary osteomyelitis, stay at intensive care, length of antibiotic treatment, presence of resistances against antibiotics, incapacity to work). For this, we retrospectively searched medical records of our institution for all purulent DNI treated from 2004 till 2012. We found 81 patients meeting all inclusion criteria. Thirty-four patients had involvement of SM, 47 did not. The only statistically significant difference between the SM group and the non-SM group was the length of incapacity to work. All other parameters were non-significant. Furthermore, there were no fatalities. In conclusion, the clinical importance of this article is that patients with deep neck abscesses of purely dental origin involving SM do not need more or different care when compared to all other DNI of dental origin

Effects of olive oil calcium soaps and phase of lactation on the fatty acid composition in the milk of Massese ewes

A basic diet of hay and concentrate, the latter supplemented with olive oil calcium soap (7% as fed) was given to 11 Massese ewes (group S) for a 3-month period, while a basic diet without the supplement was given to 11 control Massese ewes (group C) during the same period. Fatty acid composition of milk produced from the 5th to the 16th week post-partum was evaluated monthly. In group S, the fatty acids C6:0, C8:0, C10:0, C12:0, C14:0, C14:1, C18:3n-6 and C20:3n-3 (P<0.01) decreased significantly and C16:0, C18:1, total CLA, C20:0, C20:1, C20:2, C20:5n-3 (EPA), C23:0 (P<0.01) and C18:2 (P<0.05) increased with respect to the control group C. This trend lead to a decrease in short-chain fatty acids (P<0.05), an increase in unsaturated fatty acids (P<0.01), particularly MUFA, and an improved UFA/SFA ratio in group S (P<0.01). The lactation phase also significantly influenced fatty acid composition: the unsaturated/saturated fatty acids ratio was higher at the end of the lactation period. It can be concluded that the addition of protected olive oil fats to the diet of lactating ewes may improve fatty acid milk composition. In addition, the final phase of production positively affects milk quality relative to human health

Accuracy of Computational Soft Tissue Predictions in Orthognathic Surgery From Three-Dimensional Photographs 6 Months After Completion of Surgery: A Preliminary Study of 13 Patients

Background: This study aimed at a preliminary evaluation of the accuracy of computed three-dimensional (3D) predictions in orthognathic surgery by comparing predicted and real postoperative results. Methods: Pre- and postoperative 3D photographs and time-matching computed tomography (CT) and cone-beam CT scans of the face of 13 patients with dentofacial deformities were analyzed. Three-dimensional photographs were fused with preoperative CT data using dedicated software (3dMDvultus, version 2.2.0.8). Postoperative CT data were superposed on the preoperative skull. With an activated rendering function, the osteotomies were simulated in the preoperative CT data and the bony segments moved to their real postoperative position, resulting in a textured soft tissue prediction. This computed skin surface was compared with the real postoperative result by dividing the face into a surgically treated lower half and an untreated upper half. A statistical quantitative analysis of the surfaces was performed. Results: The mean differences between surfaces were +0.27mm for the untreated upper half and -0.64mm for the surgically treated lower half (p<0.001). Averaged distributions of absolute errors showed more discrepancies between predicted and real postoperative results in the lower half of the face. Errors exceeding 3mm were encountered in 4% of the upper halves versus 29.8% of the lower halves (p<0.001). Conclusions: The accuracy of a specific software platform for predicting 3D soft tissue changes after surgery was insufficient. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Accuracy evaluation of CAD/CAM generated splints in orthognathic surgery: a cadaveric study

Introduction To evaluate the accuracy of CAD/CAM generated splints in orthognathic surgery by comparing planned versus actual post-operative 3D images. Methods Specific planning software (SimPlant® OMS Standalone 14.0) was used to perform a 3D virtual Le Fort I osteotomy in 10 fresh human cadaver heads. Stereolithographic splints were then generated and used during the surgical procedure to reposition the maxilla according to the planned position. Pre-operative planned and postoperative 3D CT scan images were fused and imported to dedicated software (MATLAB®) 7.11.) for calculating the translational and rotational (pitch, roll and yaw) differences between the two 3D images. Geometrical accuracy was estimated using the Root Mean Square Deviations (RMSD) and lower and upper limits of accuracy were computed using the Bland & Altman method, with 95 % confidence intervals around the limits. The accuracy cutoff was set at +/− 2 mm for translational and ≤ 4° for rotational measurements. Results Overall accuracy between the two 3D images was within the accuracy cutoff for all values except for the antero-posterior positioning of the maxilla (2.17 mm). The translational and rotational differences due to the splint were all within the accuracy cutoff. However, the width of the limits of agreement (range between lower and upper limits) showed that rotational differences could be particularly large. Conclusion This study demonstrated that maxillary repositioning can be accurately approximated and thus predicted by specific computational planning and CAD/CAM generated splints in orthognathic surgery. Further study should focus on the risk factors for inaccurate prediction

Proteus syndrome revealing itself after the treatment of a bilateral subdural haematoma

Introduction: Hypertrophy of the calvarium has different aetiologies, among them the rare Proteus syndrome. Case report: We report here the case of a young girl initially treated for relapsing right then left large chronic subdural haematoma, who progressively developed craniofacial hypertrophy consistent with the diagnosis of Proteus syndrome. Calvarium hypertrophy was shaved and remodelled combining midface advancement, essentially for cosmetic purposes. During the first calvarium remodelling, important bleeding of the bone required large volume of blood replacement. Haemostasis workup revealed platelets aggregation anomalies. Bleeding issues during subsequent surgeries were controlled with tranexamic acid and desmopressin acetate. Discussion: Other manifestations of Proteus syndrome, such as a right hypertrophy of the face with hypoplasia of its middle third, a pigmented epidermal nevus and asymmetric limbs and scoliosis, appeared progressively over time. Blood and fibroblast phosphatase and tensin homolog mutation was not found. Conclusion: Literature review of operated patients with Proteus syndrome did not reveal an association with platelets anomalies. A complete haemostasis workup following this unexpected haemorrhagic complication is recommended for this rare patholog