Katarzyna Bogusiak

Characteristics and epidemiology of zygomaticomaxillary complex fractures.

Objectives: The aim of this study was to analyze the characteristics, namely, cause, type, site of fracture, and epidemiology data, of zygomaticomaxillary complex (ZMC) fractures. Materials and Methods: Hospital records and computed tomographic scans of 468 patients, treated for ZMC fractures at the Department of Craniomaxillofacial and Oncological Surgery between January 1990 and December 1995 and between January 2000 and December 2007, were selected and analyzed according to several factors including age, sex, cause, type, site of fracture, alcohol use before injury treatment modalities, complications, and mean treatment delay. Results: A total of 468 patients (400 males and 68 females; male-to-female ratio, 5.88:1) were included in this study. Their ages ranged from 15 to 85 years (mean ± SD age, 37.1 ± 14.83 y). Type B, by Zingg classification, was the most common type of ZMC fractures and accounted for 73.1% of cases. Assaults (64.5%), traffic accidents (13.9%), falls (13.0%), sports accidents (5.8%), and work accidents (2.8%) were noted. More than one-third of all the patients experienced injury after alcohol consumption. Of these patients, 96.6% were treated surgically. The most favored technique was miniplate osteosynthesis. The complication rate associated with the inaccurate reduction of the fractures was the most common. In this group of complications, minor asymmetry was the most common and occurred in 35 patients. Mean treatment delay was 42.7 hours. It ranged from 0.25 to 1080 hours, and the lowest value was observed in work accidents (2.7 hours). Conclusions: Facial trauma can result in fractures limited to 1 component of the tetrapod structure but more commonly results in a tetrapod fracture involving all 4 buttresses. Males are the most common victims of ZMC fractures, and assault remains the major cause of ZMC injuries in Poland, like in most developed countries. Alcohol involvement among trauma patients is high, especially in case of assaults and falls. Each patient with ZMC fracture should be evaluated individually.

Treatment strategy in Goldenhar syndrome.

AbstractGoldenhar syndrome is a rare congenital defect characterized by ocular symptoms including (epibulbar dermoids, microphthalmia, anophthalmia, eyes asymmetry/dysmorphy, cleft eyelid, exophthalmia, strabismus), auricular symptoms (dacryocystitis), preauricular appendages, preauricular fistulas, ear asymmetry, microtia, atresia of the external auditory canal), craniofacial deformities (cleft face, cleft lip, cleft palate, macrostomia, bifid tongue, hypoplasia of the mandible, hypoplasia of the maxilla, asymmetry of the mandible and maxilla, malocclusion, tooth discrepancies, agenesis of third molars and second premolars, supernumerary teeth, enamel and dentin malformations, delay in tooth development), and skeletal abnormalities (cleft spine, microcephaly, dolichocephaly, plagiocephaly, vertebral defects) or abnormalities of internal organs. The degree of abnormalities vary from severe to mild. In this article, we present a long-term observation of a patient with Goldenhar syndrome. During the patient’s life, the intensification of anomalies varied. We describe preoperative and postoperative orthodontic treatment and surgical correction procedures of maxillofacial deformation.

Noise in subtraction images made from pairs of intraoral radiographs: a comparison between four methods of geometric alignment.

OBJECTIVES To compare noise levels in subtraction images produced by four methods of geometric alignment. METHODS 50 pairs of intraoral radiographs (Digora Optime; Soredex, Tuusula, Finland) were used in this study. Two programs were used to correct geometric differences: ToothVis 1.4 (TV) and DentalStudio 2.0 (DS). Three reference points were manually positioned in both programs (methods 1 and 2); four (method 3) and ten (method 4) reference points were positioned within TV in each of the 50 pairs of images. The standard deviation (SD) of the histogram defining the distribution of grey shades in the subtraction image was used as the statistical parameter for evaluation of homogeneity, i.e. the noise in the subtracted images. RESULTS The mean and median shade of grey values were lower for images after geometric correction in TV (126.6\126.8, 126.9\126.8 and 126.1\126.7, for three- four- and ten-point alignment, respectively) than those performed with the positioning module of DS (128.7\127.5) (P<0.05). For the SD, the mean values were significantly lower with TV (4.6, 4.0 and 3.3 for three-, four- and ten-point alignment, respectively) than with DS (6.8). The range of SD values was the largest for four-point alignment with TV (0.7-15.4), smaller for three-point alignment with DS (1.5-15.4) and three-point alignment with TV (0.5-13), and the smallest with ten-point alignment in TV (0.5-8.7). CONCLUSIONS The SD of the grey-shade histogram showed that subtraction images produced with ToothVis 1.4 software were statistically less noisy than images produced with Dental Studio 2.0 software. There is a relationship between the number of reference points chosen and the noise in the subtraction images.

Analysis of surgical treatment of patients with carotid artery stenosis endarterectomy versus stenting.

Abstract The aim of this paper is to characterize a group of patients with internal carotid artery stenosis and to analyze the outcome of internal carotid artery stenosis treatment. The outcome of treatment of 230 patients with internal carotid artery stenosis hospitalized from 1st January 2004 to 31st August 2006 was analyzed. Twenty nine percent of the patients were selected for medical treatment, 70.4% received surgical or endovascular treatment (83.3% of all invasive procedures were endarterectomies, versus 16.7% stenting). The peri-procedural stroke-death rate was 4.9% of patients [3.7% after CEA and 11.1% after CAS (N.S.)]. Statistical analysis disclosed that endarterectomy was associated with a longer in-hospital stay (p < 0.001). In conclusion: Both surgical methods, endarterectomy and stenting are equivalent in safety and present comparable clinical outcomes in selected subgroups of patients (classified to the specific procedure on the basis of the type of atherosclerotic plaque).

Goldenhar syndrome: current perspectives

BackgroundProgress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques.Data sourcesBased on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia.ResultsThe spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed.ConclusionsPatients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient’s age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.

Short Text Messages (SMS) as an Additional Tool for Notifying Medical Staff in Case of a Hospital Mass Casualty Incident

OBJECTIVE The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital. METHODS A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident. RESULTS The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes. CONCLUSIONS Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident.

Characteristics and risk factors of bike related accidents: Preliminary analysis

BACKGROUND The growing popularity of cycling not only enhances self-efficacy, physical well-being and improves quality of life, but it also leads to the increasing number of bike-related injuries. OBJECTIVES The aim of this study was to characterize the population of cyclists in Poland, assess the occurrence of safety behaviors among them and to precise the risk factors for bike accidents. Additionally, we analyzed bike-related injuries. MATERIAL AND METHODS The survey was based on a 39-item questionnaire created for this study. We collected data concerning the demographical status of respondents, their cycling preferences, attitude toward safety behaviors during cycling, and the characteristics of bike-related injuries. Our research covered 729 people who declared themselves as cyclists (302 women - average age: 31.5 ±10.3 years; 427 men - average age: 32.6 ±10.7 years). RESULTS In the study, 71.3% of the interviewees declared that they did not always wear helmets. Women more often than men claimed that they did not always use head protection (p < 0.001). Among 729 people, 277 suffered from bike-related injuries. In this group, we noted 870 accidents that resulted in 1,671 different injuries. In our study, wearing helmets did not influence the region of trauma nor its type (p < 0.05). We noted 811 injuries of the upper extremities and 541 of the lower extremities. CONCLUSIONS Young men constitute the main group of cyclists in Poland. The risk factors for bike-related accidents in our study proved to be: educational level (secondary education and incomplete higher education), number of children (having at least 3 children), frequency of using a bike (the more often, the more injuries), type of bike used (mountain bikes and fold-up bikes), and frequency of using a helmet (using helmets was correlated with a higher rate of injuries). The upper and lower extremities were the most common location of injuries.

Implantoprosthetic rehabilitation of a patient with severe form of hemophilia B: a case report

Abstract The preparation of patients with hemophilia before surgical operations and dental procedures constitutes a significant clinical challenge. This article presents the implantoprosthetic rehabilitation of a patient with severe hemophilia B (factor IX activity <1%). The patient was prepared for the surgical procedure with recombinant factor IX concentrate (Rixubis) during the clinical surgery study. Tooth extraction and the implantation of four dental implants in the mandible were planned: one dental implant of 3.7 mm diameter and 10 mm length in the place of tooth 35, and another of 3.2 mm diameter and 10 mm length in the place of tooth 37. The next two implants were implemented 1 month later: one implant 3.7 mm in diameter and 10 mm in length in the place of tooth 46, and another implant 3.2 mm in diameter and 10 mm in length in the area of tooth 44. Appropriate substitution of the missing coagulation factor, together with the use of local hemostatic therapy, allowed dental implantation to be performed without excessive blood loss in this patient with severe hemophilia B.

Penetrating trauma of the face and facial skeleton – a case series of six patients

Penetrating traumas of the facial skeleton are relatively rare; however, they can be dangerous and even life-threatening. The epidemiology of facial skeleton trauma is diverse and depends on the affected region, age, and the kind of foreign body that caused the injury. In Poland, the most common cause of penetrating traumas are accidents and assaults, and only rarely accidents are related to improper use of firecrackers or fireworks. The aim of this study is to present a literature review and our own experience with penetrating traumas of the face and the facial part of the cranium. Six cases with severe wounds and fractures of the facial skeleton were treated between the years 2000 and 2012 in our department. The applied treatment methods depended mainly on the general condition of the patients. In all cases, we achieved acceptable functional and aesthetic outcomes.

Three-dimensional imaging in maxillofacial and plastic surgery

Recent advances in technology have made threedimensional imaging and analysis possible. Different three-dimensional technologies such as 3-D cephalometry, morphoanalysis, moiré topography, multislice CT-assisted imaging, cone beam CT and MRI scanning, 3-D laser scanning and photographic modalities have been developed. None of these imaging techniques can alone capture and represent the true relationship between facial skeleton, soft tissue and dentition. Only image fusion models of different imaging techniques can create a 3-D virtual head displaying all of these elements. On the basis of such accurate 3-D face/head reconstruction a realistic prediction model of soft and hard tissues changes can be created. Introduction For the past decades, plastic, maxillofacial surgeons and orthodontists used photographs and conventional radiographs for treatment planning. These methods determined current understanding Wprowadzenie Przez ostatnie dziesięciolecia chirurdzy plastyczni oraz chirurdzy szczękowo-twarzowi, a także ortodonci, wykorzystywali zdjęcia i konwencjonalną radiografię jako podstawę służącą