Daniel Zweifel

Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery.

PURPOSE Trigeminocardiac reflex (TCR) in craniomaxillofacial surgery can lead to severely life-threatening situations. At least mild forms are probably much more common than the existing surgical literature suggests. Therefore, the aim of this presentation of cases and literature review was to evaluate the predisposing factors leading to a classification of risk factors for potential TCR and to give information concerning preventive measures and management procedures. PATIENTS AND METHODS All surgery reports from the Department of Cranio-Maxillofacial and Oral Surgery in the University Hospital in Zurich between 2003 and 2008 were searched for severe intraoperative cardiovascular complications, and a literature review was performed for publications concerning asystole or bradycardia during maxillofacial surgical procedures. RESULTS Three incidents were revealed in which severe bradycardia--in 2 cases followed by asystole--had occurred. All incidents were successfully managed. CONCLUSION All craniomaxillofacial surgeons involved in orbital surgery in general and in the treatment of midface fractures, eyelid surgery, and orthognathic procedures in particular should be aware of the possibility of the TCR and should be familiar with its prevention and therapy.

Are Virtual Planning and Guided Surgery for Head and Neck Reconstruction Economically Viable

PURPOSE Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved. MATERIALS AND METHODS All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded. RESULTS During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US

Tophaceuos Calcium Pyrophosphate Dihydrate Deposition Disease of the Temporomandibular Joint: The Preferential Site?

47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US

Unilateral facial swelling in an infant

5,098 to US

Scapular Free Vascularised Bone Flaps for Mandibular Reconstruction: Are Dental Implants Possible?

1,231.50 with a prebent plate and from US

Intraoperative three-dimensional cone beam computed tomographic imaging during reconstruction of the zygoma and orbit

6,980 to US

To Wear a Helmet When Air boarding

3,113.50 for a milled plate. CONCLUSIONS Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable.

Denosumab as a Treatment Alternative for Central Giant Cell Granuloma: A Long-Term Retrospective Cohort Study

a p Calcium pyrophosphate dihydrate deposition disease (CPPD) is a metabolic disorder characterized by noninfectious joint inflammation with intraor periarticular calcification. In 1962, Kohn et al were the first to describe the association of CPPD crystals in the synovial fluid of the knees of patients with cartilage calcifications visible on standard radiographs, termed “chondrocalcinosis,” and acute symptoms commonly associated with gout. Most population-based research uses chondrocalcinosis as the basis for the presence of CPPD, and this is strongly associated with an increase in age. Of the patients older than 60 years, 6% to 15% demonstrate radiologic signs of chondrocalcinosis. For those older than 80 years, the prevalence increases to 30% to 40%. Despite the increasing awareness, most manifestations are likely to be underdiagnosed. Ryan et al proposed the term CPPD deposition disease, because the symptoms can vary widely from asymptomatic to acute or chronic manifestations. Acute synovitis associated with CPPD crystal deposits is termed “pseudogout,” and pyrophosphate arthropathy characterizes the long-term end point with structural joint alterations. CPPD deposition disease is most commonly found in the intra-articular fibrocartilage of the knee, triangular ligament of the wrist,

Contrast-enhanced 18F-FDG-PET/CT for differentiating tumour and radionecrosis in head and neck cancer: our experience in 37 patients.

The melanotic neuroectodermal tumour of infancy (MNTI) is an uncommon, usually benign neoplasm which is most commonly found in the maxilla. We describe the case of a 6-month-old boy who was referred with a swiftly increasing swelling of the left cheek. After imaging and biopsy, MNTI was confirmed, and surgical resection was performed. Literature demonstrates that most MNTIs occur in the head and neck area and most of those occur in the maxilla. Although most cases are benign, 6.5% are malignant with metastatic disease. Treatment and outcome are discussed in detail. The case highlights the importance of making the diagnosis MNTI early on in order to achieve an optimal outcome.

Oral manifestation of Langerhans cell histiocytosis: a case report

ABSTRACT Objectives Free fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction. Material and Methods We retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula) transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU). Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test. Results Ten patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001). There was a statistical significant increase in bone density in cortical (P < 0.001) and cancellous (P = 0.004) bone. Conclusions Dental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.