Jan de Lange

Incidence and disease-free survival after surgical therapy of central giant cell granulomas of the jaw in The Netherlands: 1990–1995

The central giant cell granuloma (CGCG) of the jaw is a rare benign tumor with an unknown etiology. Epidemiologic data on CGCGs in a general population are not available, nor are data on the overall outcome of surgical therapy. In this article, an overview of these aspects in the Dutch population from January 1, 1990, until January 1, 1995, is presented.

Regression of central giant cell granuloma by a combination of imatinib and interferon: a case report

Central giant cell granuloma is a benign lesion of the jaws which is sometimes aggressive locally. The most common treatment is curettage,which has a high recurrence rate, particularly in more aggressive lesions. Other treatments such as interferon (IFN) and calcitonin have been described. We report a patient with Stickler syndrome and an aggressive central giant cell granuloma in the mandible. Initial treatment with calcitonin was not successful. A combination of IFN and imatinib, given for 9 months, initiated regression of the lesion that continued after treatment had ceased.

Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis

The effects of propranolol in the treatment of anxiety disorders have not been systematically evaluated previously. The aim was to conduct a systematic review and meta-analysis of randomised controlled trials, addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders. Eight studies met the inclusion criteria. These studies concerned panic disorder with or without agoraphobia (four studies, total n = 130), specific phobia (two studies, total n = 37), social phobia (one study, n = 16), and posttraumatic stress disorder (PTSD) (one study, n = 19). Three out of four panic disorder trials qualified for pooled analyses. These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia. Also, no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation. In conclusion, the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders.

Ophthalmologic complications after intraoral local anesthesia: case report and review of literature

Intraoral administration of local anesthetics is one of the most common dental procedures. Ophthalmologic complications can occur after maxillary as well as mandibular local anesthetic injections and may be underreported and sometimes misinterpreted. A review of the literature from the years 1936-2011 shows 131 cases with this type of complication. This case report presents a patient with right lateral rectus muscle palsy and blurred vision after bimaxillary anesthesia. Signs, symptoms, and pathophysiologic hypotheses of these complications are presented.

Alternative Pharmacologic Therapy for Aggressive Central Giant Cell Granuloma: Denosumab

In the search for new pharmacologic therapies for central giant cell granuloma (CGCG), proteins that are essential to osteoclastogenesis are intriguing potential targets. In the present case report, we describe a 25-year-old patient with an aggressive CGCG of the maxilla, who was successfully treated with the antiresorptive agent denosumab, after other pharmacologic treatment had failed to achieve regression or stabilization of the tumor. Denosumab could be a promising alternative to potentially mutilating surgery for CGCG. However, more research is needed before definite conclusions can be drawn about the potential role of this agent in the treatment of CGCG.

Reconstruction of an atrophic maxilla: comparison of two methods

We have evaluated the survival of dental implants in extremely atrophic edentulous maxillas after autogenous bone grafting. We compared two techniques: the Le Fort I down-grafting procedure and conventional raising of the sinus floor with onlay bone grafting. Twenty-seven consecutive patients had their atrophic maxillas reconstructed, 10 of whom were treated with a Le Fort I osteotomy with down-grafting and interpositioning of bone, and 17 by raising the sinus floor and onlay grafts. All implants were placed 5-6 months after grafting. There was no difference in the survival of implants between the two groups. The choice of grafting technique will therefore be based primarily on the interarch relations and the need for soft tissue support.

Subjective Alveolar Nerve Function After Bilateral Sagittal Split Osteotomy or Distraction Osteogenesis of Mandible

PURPOSE The present retrospective cohort study compared the subjective inferior alveolar nerve (IAN) function after distraction osteogenesis (DOG) and bilateral sagittal split osteotomy (BSSO) in mandibular advancement surgery. MATERIALS AND METHODS Treatment consisted of correction of a retrognathic mandible using DOG (30 patients) or BSSO (35 patients). Subjective IAN function was recorded using a questionnaire 1 year after surgery. A total of 130 IANs were evaluated. RESULTS In 37 nerves (28.5%), an IAN disturbance was observed. In this group of 37 nerves, BSSO had been performed in 26 (70.3%) and DOG in 11 (29.7%). After eliminating confounders (eg, age, amount of advancement, gender), no significant difference (odds ratio 0.652, 95% confidence interval 0.221 to 1.920) was found. Age was significantly related to subjective IAN disturbances for women but not for men. This was seen in women older than 22 years and increased for women older than 36 years to an odds ratio of 22.8 (95% confidence interval 2.580 to 201.488). Satisfaction also correlated with age, independent of gender. CONCLUSION No difference was found in subjective IAN disturbances after 1 year between DOG and BSSO for lengthening the mandible.

Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review

INTRODUCTION The pathogenesis of upper airway collapse in people with obstructive sleep apnea (OSA) is not fully understood. The aim of this study was to systematically review the literature in order to assess the most relevant anatomical characteristics of the upper airway related to the pathogenesis of OSA by analyzing the three-dimensional upper airway anatomy. METHOD A PICO (population/patient, intervention, comparison, outcome) search strategy, focusing on the upper airway anatomy of people with OSA, was conducted using the following databases: MEDLINE (PubMed), Excerpta Medica database (EMBASE), Web of Science, and Cochrane Library. The studies in which three-dimensional images were made from the participants who were awake and in the supine position during quiet breathing were selected in this systematic review. RESULTS Of the 758 unique retrieved studies, eight fulfilled the criteria for this systematic review. The minimum cross-sectional area of the upper airways of people with OSA, which is influenced by many factors such as hard and soft tissues surrounding the upper airway, was significantly smaller than that of those without OSA. CONCLUSION Within the limitation of the selected studies, this systematic review suggested that a small minimum cross-sectional area is the most relevant anatomical characteristic of the upper airway related to the pathogenesis of OSA.

Sublingual microvascular perfusion is altered during normobaric and hyperbaric hyperoxia

Hyperoxia and hyperbaric oxygen therapy can restore oxygen tensions in tissues distressed by ischemic injury and poor vascularization and is believed to also yield angiogenesis and regulate tissue perfusion. The aim of this study was to develop a model in which hyperoxia-driven microvascular changes could be quantified and to test the hypothesis that microcirculatory responses to both normobaric (NB) and hyperbaric (HB) hyperoxic maneuvers are reversible. Sublingual mucosa microcirculation vessel density, proportion of perfused vessels, vessel diameters, microvascular flow index, macrohemodynamic, and blood gas parameters were examined in male rabbits breathing sequential O2/air mixtures of 21%, 55%, 100%, and return to 21% during NB (1.0 bar) and HB (2.5 bar) conditions. The results indicate that NB hyperoxia (55% and 100%) produced significant decreases in microvascular density and vascular diameters (p<0.01 and p<0.05, respectively) accompanied by significant increases in systolic and mean arterial blood pressure (p<0.05, respectively) with no changes in blood flow indices when compared to NB normoxia. HB normoxia/hyperoxia resulted in significant decreases in microvascular density (p<0.05), a transient rise in systolic blood pressure at 55% (p<0.01), and no changes in blood vessel diameter and blood flow indices when compared to NB hyperoxia. All microcirculation parameters reverted back to normal values upon return to NB normoxia. We conclude that NB/HB hyperoxia-driven changes elicit reversible physiological control of sublingual mucosa blood perfusion in the presence of steady cardiovascular function and that the absence of microvascular vasoconstriction during HB conditions suggests a beneficial mechanism associated with maintaining peak tissue perfusion states.

Hyperbaric oxygen therapy accelerates vascularization in keratinized oral mucosal surgical flaps.

Hyperbaric oxygen therapy (HBOT) is thought to promote vascular regeneration in wounds. The purpose of this study was to investigate the role of HBOT in advancing vascular regeneration in healing oral mucosal surgical flaps.