Ashkan Rashad

Surgically Assisted Rapid Palatomaxillary Expansion With or Without Pterygomaxillary Disjunction: A Systematic Review and Meta-Analysis.

PURPOSE The purpose of this review was to evaluate the outcome measurements of anterior expansion, posterior expansion, and complications after surgically assisted rapid palatal expansion (SARPE) with or without pterygomaxillary disjunction (PMD). MATERIALS AND METHODS A computerized database search was performed using PubMed, CINAHL, Cochrane, Scopus, and Web of Science. Then, a computerized search was conducted in Google Scholar and ProQuest to overcome publication bias. RESULTS From the original 125 combined results, 3 met the inclusion criteria. The Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project assessed 2 articles as weak and 1 as moderate. The systematic review included a total of 48 patients (11 male and 37 female). For 25 patients, SARPE was performed with PMD and for 23 patients SARPE was performed without PMD. A tooth-borne fixed hyrax-type palatal expansion screw appliance was used for all cases, activated 1 to 2 mm intraoperatively, and, after a latency period of 3 to 7 days, activated 0.5 to 0.6 mm per day for 38 patients and 0.25 mm for the other 10 until adequate expansion. Postexpansion retention was performed using ligature wired hyrax in 18 patients for 4 months. Comparisons were based on cone-beam computed tomographic projections, study models only, or a combination of study models, anteroposterior cephalometric radiographs, and occlusal radiographs. The time to measure the changes ranged from before fixed orthodontic retention to 6 months after the completion of active expansion. A meta-analysis was possible only for anterior (intercanine) and posterior (inter-molar) dental expansions. CONCLUSION The literature is inconclusive regarding the effect of PMD on the outcomes of SARPE. Further controlled trials are needed.

Intraosseous heat generation during sonic, ultrasonic and conventional osteotomy.

OBJECTIVES To assess heat generation in osteotomies during application of sonic and ultrasonic saws compared to conventional bur. METHODS Two glass-fiber isolated nickel-chromium thermocouples, connected to a recording device, were inserted into fresh bovine rib bone blocks and kept in 20 ± 0.5 °C water at determined depths of 1.5 mm (cortical layer) and 7 mm (cancellous layer) and 1.0 mm away from the planned osteotomy site. Handpieces, angulated 24-32°, were mounted in a vertical drill stand, and standardized weights were attached to their tops to exert loads of 5, 8, 15 and 20 N. Irrigation volumes of 20, 50 and 80 ml/min were used for each load. Ten repetitions were conducted using new tips each time for each test condition. The Mann-Whitney-U test was used for statistical analysis (p < 0.05). RESULTS Both ultrasonic and sonic osteotomies were associated with significantly lower heat generation than conventional osteotomy (p < 0.01). Sonic osteotomy showed non-significantly lower heat generation than ultrasonic osteotomy. Generated heat never exceeded the critical limit of 47 °C in any system. Variation of load had no effect on heat generation in both bone layers for all tested systems. An increased irrigation volume resulted in lower temperatures in both cortical and cancellous bone layers during all tested osteotomies. CONCLUSION Although none of the systems under the conditions of the present study resulted in critical heat generation, the application of ultrasonic and sonic osteotomy systems was associated with lower heat generation compared to the conventional saw osteotomy. Copious irrigation seems to play a critical role in preventing heat generation in the osteotomy site.

Management of comminuted but continuous mandible defects after gunshot injuries.

INTRODUCTION Firearm injuries continue as a major public health problem, contributing significant morbidity, mortality, and expense to our society. There are four main steps in the management of patients with gunshot wounds to the face: securing an airway, controlling haemorrhage, identifying other injuries and definitive repair of the traumatic facial deformities. The objective of this study was to determine late outcome of two treatment options by open reduction and internal fixation versus closed reduction and maxillomandibular fixation (MMF) in the treatment of gunshot injuries of the mandible. METHODS Sixty patients of gunshot injury were randomly allocated in two groups. In group A, 30 patients were treated by open reduction and internal fixation and in group B, 30 patients were treated by closed reduction and maxillomandibular fixation. Patients were discharged as the treatment completed and recalled for follow up. Up to 3 months after injury, fortnightly complications like infection, malocclusion, malunion of fractured fragments, facial asymmetry, sequestration of bone and exposed plates were evaluated and the differences between two groups were assessed. The follow-up period ranged from 3 months to 10 months. RESULTS Patients treated by open reduction tended to have less complications as compared to closed reduction. CONCLUSION Based on this study open reduction and internal fixation is the best available method for the treatment of gunshot mandible fractures without continuity defect.

Practitioner experience with sonic osteotomy compared to bur and ultrasonic saw: a pilot in vitro study

The aim of the present study was to compare subjective experiences using bur, ultrasonic, and sonic osteotomy systems. Ten novice (N) and 10 expert (E) practitioners performed osteotomies on bovine ribs with each system. They scored ease of handling and sense of accuracy on visual analogue scales. The duration of the osteotomy procedure and the amount of noise were recorded objectively. Learning experience was evaluated in a second run. The Mann-Whitney U-test, Wilcoxon signed rank tests, and Spearmans rank correlation coefficient were used for the statistical analyses. The sonic system was significantly slower, with the worst noise impact (92.9dB; standard deviation (SD) 7.1). However, both user groups improved significantly in the second run (N 7.9, E 7.6). There were no significant differences in handling. The sense of accuracy was evaluated to be significantly best for the sonic system (N 8.4, E 8.4), compared to the ultrasonic system (N 7.1, E 7.1; both P=0.043) and bur system (N 5.5, P=0.002; E 6.0, P=0.006). The practitioners had a promising experience with the application of the ultrasonic system and particularly with the sonic system.

The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: a randomized double-blind controlled clinical trial.

Pain in the throat after extubation is one of the most common complaints after maxillofacial operations under general anaesthesia. We have evaluated the amount of pain after extubation when we controlled the pressure in the endotracheal cuff during operation by analysing the records of 43 patients who had maxillofacial operations under general anaesthesia. In the study group (n=20) the cuff pressure of the endotracheal tube was adjusted using a pressure gauge at the beginning of intubation and every hour during operation. In the control group (n=23), an experienced anaesthetist adjusted the pressure only at the beginning of the operation by palpating the pilot balloon. Throat pain was evaluated 1, 6, and 24h postoperatively on a visual analogue scale (VAS), and the pain scores in the control and study groups postoperatively was 5.3 (1.1) compared with 3.9 (1.5) (p=0.002); 4.5 (1.3) compared with 3.1 (1.5) (p=0.002); and 1.9 (1.1) compared with 1.6 (1.2) (p=0.4), respectively. The differences between the two groups at 1h and 6h postoperatively were significant, but that at 24h was not. Control of the cuff pressure of the endotracheal tube with a gauge at the beginning of the operation, and adjustment of the pressure during operation, can reduce postoperative complications such as throat pain.

Thromboelastometry: A contribution to perioperative free-flap management

BACKGROUND Microvascular tissue transfer is a fundamental part of reconstructive surgery. Different perioperative anticoagulation regimens exist, influencing hemostatic parameters. Since bleeding and thrombosis are major reasons for revision procedures and flap loss, current practice regarding anticoagulative treatment needs further refinement. Thromboelastometry has been demonstrated as worthwhile in the determination of alterations of the anticoagulation cascade. We evaluated this aspect of thromboelastometry for free flap surgery. METHODS Thirty-five patients undergoing free-flap surgery were enrolled in this study. Blood samples were obtained at three time points: at the beginning of surgery, at time of anastomosis and after 24 h. At each time point, thromboelastometry with special regard to clotting times for the intrinsic and extrinsic paths of coagulation was immediately performed. Global coagulation markers and clinical parameters were collected simultaneously. RESULTS Hemostatic changes were deducible using thromboelastometry perioperatively. Measured parameters differed significantly over time (p < 0.05). Heparin therapy showed a significant effect on the measured slope of INTEM-clotting times (p < 0.001). Altered values of thromboelastometry suggested non-inferiority to standard testing. Neither standard testing nor thromboelastometry were capable of predicting adverse events such as thrombosis, bleeding or flap loss (p > 0.05). CONCLUSIONS Thromboelastometry monitors hemostatic effects almost in real-time and could serve as a supplementary tool in microvascular tissue transfer once its use has been standardized. The utilization of thromboelastometry allows for assessment of the anticoagulation needs of individual patients undergoing free flap surgery, which is frequently accompanied by hemostatic changes in the perioperative setting. Our findings implicate further validation of thromboelastometry in free-flap surgery.

Bisphosphonates and Connexin 43: A Critical Review of Evidence

Abstract Bisphosphonates (BPs) are drugs commonly used in the treatment of various disease arising or affecting bone tissue. There is a standard use in bone neoplasia and metastasis, hormonal and developmental disorders as well as for compensation of adverse effects in several medical therapies. Many in-vivo and in-vitro studies have assessed the efficacy of this drug and its function in cellular scale. In this concern, BPs are described to inhibit the resorptive function of osteoclasts and to prevent apoptosis of osteoblasts and osteocytes. They can preserve the osteocytic network, reduce fracture rate, and increase the bone mineral content, which is therapeutically used. Connexin 43 (Cx43) is a crucial molecule for basal regulation of bone homeostasis, development, and differentiation. It is described for signal transduction in many physiological and pathological stimuli and recently to be involved in BP action.

Extraction bradycardia: a pilot case-crossover study

PurposeSignificant vasovagal reaction is one of the untoward events in the course of simple extractions. The present study then aimed to record the patients’ heart rate during the extraction procedure.Materials and methodsInformed consents were obtained in advance. Patients were placed in the dental chair and their heart rate was measured before /and prior to the anesthetic injection, during, and after dental extraction on a pulse oxymeter device. Data were analyzed using paired t-test.ResultsSixty one patients were included. The mean heart rates of these patients prior, during, and after extraction were 88, 86 and 81, respectively. Two by two comparisons showed a significant decrease in the mean heart rate during extraction compared to the baseline and also after extraction compared to both before and during extraction (p < 0.05 for all three).ConclusionsDespite the presence of sufficient local anesthesia and performing the extraction with the least trauma, a significant decrease in heart rate is evident.

Functional donor site morbidity longer than one year after fibula free flap: A prospective biomechanical analysis

The fibula free flap is the workhorse procedure for osseous reconstruction. The objective of this study was to investigate long‐term functional outcomes of the harvesting site.

RANK-Ligand inhibitor associated osteonecrosis of the jaw

Osteonecrosis of the jaw may be caused by many different triggers. One of them is described to be the drug or medication related osteonecrosis of the jaw. Since many years bisphosphonates induced the dreaded diagnosis. Recently a drug named denosumab is reported to show similar effects on the jaw. In this case report we present a RANK-Ligand inhibitor associated osteonecrosis of the lower jaw and discuss the lights and shadows of this newly introduced drug.