Clemens Klug

TREATMENT RESULTS OF BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAWS

Osteonecrosis of the jaws occurs after the administration of bisphosphonates. An unequivocal treatment strategy is yet to be devised. We assess the treatment of patients with bisphosphonate‐related osteonecrosis of the jaws (BRONJ).

Computer simulation and rapid prototyping for the reconstruction of the mandible.

Augmented-reality environments, that is, computer graphics merged with 3-dimensional representations of anatomic regions generated from imaging modalities (mainly computed tomography [CT] and magnetic resonance imaging), have their background in well-known and well-established conventional image-guided surgery, which we can describe as the “first generation of navigation.” 1-3 Although the surgeon is solely supplied with “information,” this technology significantly expands the range of the intraoperatively available information. Nevertheless, it does not provide any kind of haptic feedback, and the transfer of all the computer information is accomplished manually during the treatment of the patient. Technical progress led to the integration of rapid prototyping techniques (3-dimensional stereolithography) in image-guided surgery workflows and therefore can add “haptic” information to the computerbased visualization. Therefore we can call such approaches the “second generation of navigation.” Simulation and planning of surgical interventions by use of stereolithographic models can contribute to the optimization of treatment and can also enhance quality management in craniomaxillofacial surgery, because the specific anatomic situation of each patient can be comprehensively analyzed preoperatively. Navigation technology enables the precise transfer of the

Maxillomandibular advancement for treatment of obstructive sleep apnea syndrome: a systematic review.

PURPOSE To perform a systematic review of the published data concerning maxillomandibular advancement for the treatment of obstructive sleep apnea syndrome. MATERIALS AND METHODS A systematic literature search was performed in the PubMed database. Original articles in the English language were reviewed to obtain information about patient data, success rates, and outcome measures. RESULTS The systematic literature search yielded 1,113 citations, of which 101 articles met our inclusion criteria. After a review of the full text, 39 studies were included in the analysis. Most articles were classified as evidence level 4, and 5 met the inclusion criteria for level 2b. The only prospective randomized controlled study had been published in January 2010 and was assigned level 1b. CONCLUSIONS A recommendation grade of A to B was achieved with regard to the levels of evidence-based medicine. Our results have shown that maxillomandibular advancement is the most successful surgical therapy, and the postoperative polysomnography results are comparable to those under ventilation therapy.

Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections

OBJECTIVE The purpose of this retrospective study was to identify the major pathogens responsible for deep space head and neck infections and their current resistance to routinely used antibiotics in a university hospital setting. STUDY DESIGN A total of 206 patients suffering from odontogenic deep space infections were treated at our department by means of surgical intervention and intravenous administration of antibiotics. RESULTS The predominant bacteria were viridans group streptococci (VGS), staphylococci, Prevotella, Peptostreptococcus, and Bacteroides. In the aerobic spectrum, resistance against clindamycin was found in 18%, against macrolides in 14%, and against penicillin G in 7%. The anaerobes were resistant to clindamycin in 11%, to metronidazole in 6%, and to penicillin G in 8%. CONCLUSION The high resistance rate for clindamycin and macrolides was especially striking and may necessitate an adaptation of our antibiotic regime in the future.

Preoperative chemoradiotherapy in the management of oral cancer : A review

INTRODUCTION Multi-modality treatment concepts involving preoperative radiotherapy (RT) or chemoradiotherapy (CRT) and subsequent radical resection are used much less frequently than postoperative treatment for oral and oropharyngeal squamous cell carcinomas. In some centres, however, the preoperative approach has been established for several years. MATERIAL The present review is a compilation of the existing evidence on this subject. METHODS In a literature-based meta-analysis, the survival data of 1927 patients from 32 eligible publications were analysed. RESULTS The calculated survival rates of documented patients show remarkably good results with preoperative CRT and radical surgery. However, the findings of this analysis are based on data with a large proportion of studies using consecutive patient series. CONCLUSION Hard evidence providing sufficient data from prospective randomised studies is as yet missing for preoperative CRT. Prospective randomised studies are mandatory in this area.

Factors influencing surgical treatment of bisphosphonate‐related osteonecrosis of the jaws

Bisphosphonates are known to be associated with osteonecrosis of the jaw. We assess factors underlying the success of surgical treatment in patients with bisphosphonate‐related osteonecrosis of the jaw (BRONJ).

Closure of oroantral communications with Bichat's buccal fat pad.

PURPOSE The aim of the present study was to evaluate the use of the pedicled buccal fat pad for the closure of oroantral communications (OACs) and to describe our experience with this surgical procedure. PATIENTS AND METHODS A retrospective review of 161 patients treated at the University Hospital for Cranio-Maxillofacial and Oral Surgery in Vienna, Austria, from 2000 to 2005, with the diagnosis of an OAC was performed. All defects were closed by application of a buccal fat pad. Data were obtained from chart review, a compiled database, and clinical follow-up and included the location of the defect, the cause of the OAC, the modality of anesthesia, intraoperative complications, any complications during the process of wound healing, and any late adverse effects. RESULTS The buccal fat pad for closure of an OAC was successfully used in 161 patients at our department. In 12 patients (7.5%), the closure of the OAC was insufficient, and a second operation was necessary. Excluding all severe and complicating cases such as tumor-related defects or previously treated cases, the overall success rate for closure of the OAC was nearly 98%. No late complications occurred, and all patients were free of pain or any limitations after the 6-month follow-up period. CONCLUSIONS According to the recommendations and anatomic limitations reported in published studies and discussed in the present report, the application of the buccal fat pad is a safe and reliable procedure for closing an OAC.

Complication rates in the operative treatment of mandibular angle fractures: a 10-year retrospective.

PURPOSE Large-scale studies assessing complication rates and correlation of complications are still missing considering different fracture locations in the mandible. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed. MATERIALS AND METHODS Three hundred twenty-two patients (259 men, 63 women) with 335 surgically treated mandibular angle fractures were included in this study. RESULTS Fractures were caused by fights (46.6%), falls (19.2%), traffic accidents (14.6%), sports (11.9%), wisdom tooth removal (7.3%), and 0.9% other causes. Successful treatment occurred in 93.69% of fractures with 1 open reduction and in 6.31% with 2 open reductions. Of surgically treated patients, 71.47% (238) were completely free of complications. A detailed complication correlation matrix is given in the text. Ninety-five fractures treated with 1 miniplate, 170 with 2 miniplates, and 70 with other osteosynthesis concepts were compared regarding osteosynthesis failure and pseudarthrosis. CONCLUSION Similar osteosynthesis failure rates were shown for 1 miniplate and 2 miniplates.

Influence of previous radiotherapy on free tissue transfer in the head and neck region: evaluation of 455 cases.

Objective/Hypothesis: The aim of this retrospective cohort study was to investigate the effect of prior radiotherapy (XRT) on the outcome of microvascular free tissue transfer in the head and neck region.

Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs)

OBJECTIVES Bisphosphonates are associated with osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) may be treated conservatively or by surgery. PATIENTS AND METHODS 108 patients underwent surgery and 88 patients were followed for a mean period of 337 days. Age, gender, dental procedures, underlying disease, and the role of bisphosphonate treatment in the success of surgery were evaluated retrospectively. RESULTS Surgical treatment improved the stage distribution from 19% stage I, 56% stage II and 25% stage III to 59% intact mucosa, 19% stage I and 13% stage II and 8% stage III. The improvement in the stage of disease achieved by surgery was statistically significant. Further relevant parameters that favor a positive outcome of surgery were the event triggering the outbreak of BRONJ (p=0.05) and the underlying disease (p=0.05). BRONJ in the maxilla necessitated repeat surgery significantly earlier than did BRONJ in the mandible (p=0.03). CONCLUSION Effective surgery might improve the outcome of BRONJ, although prevention still is the most important aspect of this condition.