József Piffkó

Correction of a severe facial asymmetry with computerized planning and with the use of a rapid prototyped surgical template: a case report/technique article.

Management of significant facial asymmetry presents a challenge due to the geometric complexity of the bony and other facial structures. Manual model surgery is an essential part of treatment planning but it can be complicated, time-consuming and may contain potential errors. Computer-aided surgery has revolutionized the correction of maxillofacial deformities. The aim of this study was to report a case of facial asymmetry when computerised simulation surgery was performed instead of manual model surgery and a virtually planned wafer splint was fabricated. A 26-year-old male was presented with a severe right-sided hemimandibular elongation. Following presurgical orthodontics high-resolution computer tomography scan was performed. The stack images were reformatted into a three-dimensional structure. Virtual Le Fort-I osteotomy was performed and the symmetry of the maxilla was corrected with the help of a three-dimensional planning software. A virtual intermediate surgical wafer was designed and produced with three-dimensional rapid prototyping technology. The mandible was rotated into the correct position following virtual bilateral sagittal split osteotomy to visualize the movements of the osteotomised mandibular segments. The two-jaw procedure was performed according to the virtual plan. The facial symmetry was improved significantly and stable occlusion was achieved. This complex case shows the advantages of computer-aided surgical planning and three-dimensional rapid prototyping for the correction of facial asymmetries.

Assessing the Accuracy of Cone-Beam Computerized Tomography in Measuring Thinning Oral and Buccal Bone

The aim of this study was to assess the accuracy and reliability of cone-beam computerized tomography (CBCT) in measuring thinning bone surrounding dental implants. Three implants were inserted into the mandible of a domestic pig at 6 different bone thicknesses on the vestibular and the lingual sides, and measurements were recorded using CBCT. The results were obtained, analyzed, and compared with areas without implants. Our results indicated that the bone thickness and the neighboring implants decreased the accuracy and reliability of CBCT for measuring bone volume around dental implants. We concluded that CBCT slightly undermeasured the bone thickness around the implant, both buccally and orally, compared with the same thickness without the implant. These results support that using the i-CAT NG with a 0.2 voxel size is not accurate for either qualitative or quantitative bone evaluations, especially when the bone is thinner than 0.72 mm in the horizontal dimension.

Secondary correction of nasal deformities in cleft lip and palate patients: surgical technique and outcome evaluation

BackgroundNasal deformity associated with cleft lip and palate is a highly challenging reconstructive problem in rhinoplasty. In the literature, several operative solutions and evaluation methods have been described, however these do not offer a standard procedure for the surgeon. Our aim was to standardize our surgical technique—as much as the uniqueness of each case allowed it—based on the most frequent deformities we had faced; and to evaluate our results via a postoperative patient satisfaction questionnaire.Between 2012 and 2014 12 consecutive patients with combined cleft lip and palate deformities underwent secondary nasal and septal correction surgery with the same method by the same surgeon. The indications of surgery were, on one hand, difficult nasal breathing and altered nasal function (tendency for chronic rhinosinusitis) and on the other hand the aesthetic look of the nose. No exclusion criteria were stated. In our follow-up study we evaluated our results by using a modified Rhinoplasty Outcome Evaluation (ROE) questionnaire: patients answered the same four questions pre- and postoperatively. Data were statistically analyzed by t-test.ResultsBased on the questionnaire, all patients experienced improvement of nasal breathing function, improved appearance of the nose and less stigmatization from the society. According to the t-test, all scores of the four questions improved significantly in the postoperative 4–6 months, compared with the preoperative scores.ConclusionsIn our opinion with our standardized surgical steps satisfactory aesthetic and functional results can be achieved. We think the modified ROE questionnaire is an adequate and simple method for the evaluation of our surgical results.

A Novel Method for In Vivo Visualization of the Microcirculation of the Mandibular Periosteum in Rats

The periosteum plays an important role in bone physiology, but observation of its microcirculation is greatly limited by methodological constraints at certain anatomical locations. This study was conducted to develop a microsurgical procedure which provides access to the mandibular periosteum in rats.

Estrogen-dependent efficacy of limb ischemic preconditioning in female rats†

Our aim was to examine the effects of ischemic preconditioning (IPC) on the local periosteal and systemic inflammatory consequences of hindlimb ischemia‐reperfusion (IR) in Sprague–Dawley rats with chronic estrogen deficiency (13 weeks after ovariectomy, OVX) in the presence and absence of chronic 17beta‐estradiol supplementation (E2, 20 µg kg−1, 5 days/week for 5 weeks); sham‐operated (non‐OVX) animals served as controls. As assessed by intravital fluorescence microscopy, rolling and the firm adhesion of polymorphonuclear neutrophil leukocytes (PMNs) gave similar results in the Sham + IR and OVX + IR groups in the tibial periosteal microcirculation during the 3‐h reperfusion period after a 60‐min tourniquet ischemia. Postischemic increases in periosteal PMN adhesion and PMN‐derived adhesion molecule CD11b expressions, however, were significantly reduced by IPC (two cycles of 10′/10′) in Sham animals, but not in OVX animals; neither plasma free radical levels (as measured by chemiluminescence), nor TNF‐alpha release was affected by IPC. E2 supplementation in OVX animals restored the IPC‐related microcirculatory integrity and PMN‐derived CD11b levels, and TNF‐alpha and free radical levels were reduced by IPC only with E2. An enhanced estrogen receptor beta expression could also be demonstrated after E2 in the periosteum. Overall, the beneficial periosteal microcirculatory effects of limb IPC are lost in chronic estrogen deficiency, but they can be restored by E2 supplementation. This suggests that the presence of endogenous estrogen is a necessary facilitating factor of the anti‐inflammatory protection provided by limb IPC in females. The IPC‐independent effects of E2 on inflammatory reactions should also be taken into account in this model.

Surgical Management of Progressive Hemifacial Atrophy With De-Epithelialized Profunda Artery Perforator Flap: A Case Report

Progressive hemifacial atrophy (PHA) is a rare disorder characterized by slow, unilateral atrophy of the soft tissues and bones of the craniofacial region. The defect becomes more pronounced with age, leading to esthetic and functional deficits. However, the proper timing and method of surgical reconstruction are still debated. The correction of this defect markedly influencing the quality of life of the patient can be achieved with less invasive to more invasive surgical approaches. A 21-year-old female patient with hemifacial atrophy and extensive alopecia presented to our clinic. Considering the body type and the expectations of the patient, a profunda artery perforator flap was applied for the reconstruction and esthetic improvement of the facial region. The facial asymmetry attenuated after the reconvalescence period. This case shows that in the up-to-date surgical treatment of severe PHA, the use of microvascular free flaps may provide a better approach when trying to achieve an acceptable esthetic result. This is the first time that a profunda artery perforator flap was used to restore facial asymmetry caused by PHA.

Effect of the Combination of Low-Speed Drilling and Cooled Irrigation Fluid on Intraosseous Heat Generation During Guided Surgical Implant Site Preparation: An In Vitro Study

Purpose: Investigating the effect of the combination of low-speed drilling and cooled irrigation fluid on intraosseous temperature rise during guided and freehand implant surgery. Materials and Methods: Bovine ribs were used as bone specimens. Grouping determinants were as follows: drill diameter (2.0, 2.5, 3.0, and 3.5 mm), irrigation fluid temperature (10°C, 15°C, and 20°C), and surgical method (guided and freehand). Drilling speed was 800 rpm. Results were compared with previous ones using 1200 rpm. Temperature measurements were conducted using K-type thermocouples. Results: No mean temperature change exceeded 1.0°C if irrigation fluid cooled to 10°C was used, regardless of the drill diameter or the surgical method, with the highest elevation being 2.10°C. No significant reduction was measured when comparing groups using 15°C and 20°C irrigation fluids, regardless of both drill diameter and surgical method. Conclusion: The use of irrigation fluid being cooled to 10°C combined with low-speed drilling (800 rpm) seems to be a safe method for implant site preparation and drilling through a drilling guide in terms of temperature control.

Intraosseous generation of heat during guided surgical drilling: an ex vivo study of the effect of the temperature of the irrigating fluid

We measured the rise in the intraosseous temperature caused by freehand drilling or drilling through a surgical guide, by comparing different temperatures of irrigation fluid (10°C, 15°C, and 20°C), for every step of the drilling sequence (diameters 2.0, 2.5, 3.0, and 3.5mm) and using a constant drilling speed of 1200rpm. The axial load was controlled at 2.0kg. Bovine ribs were used as test models. In the guided group we used 3-dimensional printed surgical guides and temperature was measured with a thermocouple. The significance of differences was assessed with the Kruskal-Wallis analysis of variance. Guided drilling with 10°C irrigation yielded a significantly lower increment in temperature than the 20°C-guided group. When compared with the 20°C freehand group, the reduction in temperature in the 10°C guided group was significantly more pronounced at all diameters except 3.5mm. Finally, when the 10°C-guided group was compared with the 15°C groups, the temperature rise was significantly less at 2.5 and 3.0mm than with the guided technique, and at 3.0mm compared with the freehand technique. We suggest that the use of 10°C pre-cooled irrigation fluid is superior to warmer fluid for keeping temperature down, and this reduces the difference between guided and freehand drilling.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report

BackgroundThe surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome.Case presentationIn this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence.ConclusionsIt is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.

Az epidermolysis bullosa szájüregi tünetei és annak ellátása

The aim of this comprehensive article is to provide guidelines for the daily treatment of patients with epidermolysis bullosa, thus contributing to the attainment of their higher quality of life through the improvement of their oral health. Moreover, it is our intention to facilitate the cooperation among Hungarian general practitioners, dermatologists and dentists. Relying on recent research findings of the international literature, we intend to help general practitioners or dermatologists treating epidermolysis bullosa patients on a daily basis by identifying symptoms that require consulting an oral professional on the one hand, and to present the most important prevention strategies and further treatments advised for dentists on the other. Focusing on various aspects of dental treatment, we specify how a dentist can treat the patient without causing additional wounds or pain, and what kinds of therapy are justified by this approach. Orv Hetil. 2017; 158(40): 1577-1583.Absztrakt: Jelen osszefoglalo mű celja, hogy utmutatot adjon az epidermolysis bullosa mindennapi ellatasaban, a betegek oralis egeszsegenek es ezen keresztul eletminőseguk szinvonalanak emeleseben, valamint tamogassa a magyar altalanos orvosok, bőrgyogyaszok es a fogorvosok kozotti kooperaciot. A nemzetkozi irodalom alapjan segitseget szeretnenk nyujtani abban, hogy a beteget gondozo bőrgyogyasz vagy a haziorvos mikor vonjon be szajureggel foglalkozo szakembert, illetve a fogorvosnak, hogy milyen fő prevencios vagy azon tulmutato teendői vannak. A fogorvosi kezeles kulonboző aspektusain keresztul bemutatjuk, hogy egy fogorvos milyen modon lathatja el a pacienseket tovabbi sebek vagy fajdalom okozasa nelkul, valamint milyen beavatkozasokat es hogyan tud szamukra megvalositani. Orv Hetil. 2017; 158(40): 1577–1583.