Sven Erik Nørholt

Pediatric condylar fractures: A long-term follow-up study of 55 patients

Fifty-five patients between 5 and 20 years old who were previously treated conservatively for a fracture of the mandibular condyle were recalled for follow-up examination with a mean postoperative observation time of 10.1 years. Anamnestic information was obtained from a questionnaire, and clinical and radiologic examinations were performed. Anamnestic and clinical dysfunction indices were obtained. When the patients were divided into four different age groups it was found that the dysfunction index values increased significantly with increasing age at the time of trauma. Radiologic abnormalities such as reduced ramus height, deviation of the mandibular midline, and irregular shape of the condyle were seen frequently, but could not be correlated with the severity of dysfunction. No cases of ankylosis or serious asymmetry were found. The results support the opinion that conservative treatment is sufficient in pediatric patients, but in older age groups the results of conservative treatment are less satisfactory.

A retrospective analysis of 279 patients with isolated mandibular fractures treated with titanium miniplates.

PURPOSEnThis article addresses the suitability of semirigid fixation for the treatment of mandibular fractures.nnnMATERIALS AND METHODSnBetween 1986 and 1991, 279 patients with 447 isolated mandibular fractures were treated with miniplate fixation using the tension-band principle of Champy et al. The time from trauma to treatment, etiology, number and location of the fractures, and the presence of preoperative infection and neurosensory disturbances were recorded. Postoperative complications such as infections, neurosensory disturbances, malocclusion, and nonunions also were recorded, as well as the reasons for removal of the miniplates.nnnRESULTSnPostoperative infection occurred in 10 patients (3.6%). These infections were controlled by antibiotics and the miniplates were removed after the acute phase. Occlusion disturbances were noted postoperatively in 13 patients (4.7%), and they were corrected by minimal occlusal grinding in the majority of cases. Neurosensory disturbances were noted preoperatively in 26.9% of the patients and 12 months postoperatively in 1.4% of the patients. Forty-seven plates (8.1%) in 32 patients (11.5%) were removed for a variety of reasons. No cases of nonunion occurred.nnnCONCLUSIONnSemirigid fixation of mandibular fractures with miniplates is a viable treatment option for the management of such injuries.

Pain control after dental surgery : a double-blind, randomised trial of lornoxicam versus morphine

&NA; Lornoxicam is a new non‐steroidal anti‐inflammatory drug of the oxicam class. This randomised, double‐blind, placebo controlled trial compared the analgesic efficacy and tolerability of intramuscular (IM) injections of lornoxicam (4, 8, 16 and 20 mg) with morphine (10 and 20 mg) and placebo in 252 patients with mainly moderate to severe pain following surgical removal of an impacted mandibular third molar. Patients treated with lornoxicam or morphine experienced a significantly greater cumulative pain relief over the 4‐h post‐injection period (TOTPAR0–4) than placebo recipients. This effect appeared to be dose‐dependent, with patients in the lornoxicam 4 mg or morphine 10 mg groups recording significantly lower TOTPAR0–4 scores than patients in the higher dosage group of these drugs. No significant difference was detected between the morphine 20 mg group and the lornoxicam 8, 16 and 20 mg groups. Lornoxicam was well tolerated at all doses and was associated with a significantly lower incidence of adverse events than morphine 10 or 20 mg. Thus, the analgesic efficacy of IM lornoxicam at doses ≥4 mg is superior to placebo, and doses ≥8 mg are at least as effective as IM morphine 20 mg. Furthermore, lornoxicam possesses a more favourable tolerability profile than morphine and thus represents an attractive alternative for the treatment of moderate to severe acute pain.

A Randomized, Double‐Blind, Placebo‐Controlled, Dose‐Response Study of the Analgesic Effect of Lornoxicam After Surgical Removal of Mandibular Third Molars

The aim of the present study was to investigate the dose‐effect relationship of single doses of 4 to 32 mg of lornoxicam (LNX), a new nonsteroidal antiinflammatory drug belonging to the oxicam group, compared with placebo and 10 mg ketorolac (KET) in the treatment of pain after oral surgery. Also, it was the aim of the study to evaluate the relationship between adverse events and different doses of LNX.

Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses

This study sought to evaluate the outcome of patients treated with fibula grafts for partial mandibular reconstruction and implant-supported prosthesis at a Danish university hospital. Patient inclusion criteria were: partial mandibular resection, reconstruction with a fibula graft, and treatment during the period 1998-2011. Patients with incomplete medical records were excluded. Thirty-six patients were included, of whom 16 were treated with an implant-supported prosthesis. Relevant presurgical, intraoperative, and postoperative parameters were registered. The fibula graft survival rate at the last follow-up (mean follow-up 22 months, range 0-89 months) was 97%. Half of the patients experienced non-severe complications such as loosening of osteosynthesis material, fistulae, and graft exposure. One of 37 fibula grafts in the 36 patients was removed due to infection. The implant survival rate was 96%; three of 67 implants were lost due to infection. Eight implants were not included in the prosthetic rehabilitation. Fibula graft surgery for mandibular reconstruction was found to be a reliable treatment modality with a high survival rate. Rehabilitation with implant-supported prostheses was characterized by high survival rates and few complications. The results obtained are comparable to those of previous studies.

Factors influencing intraoperative blood loss in orthognathic surgery

This retrospective study aimed to identify factors of importance for intraoperative blood loss relative to total blood volume in patients undergoing orthognathic surgery. The study included 356 patients treated consecutively at a Danish university hospital between 1 January 2010 and 31 December 2012. Inclusion criteria were (1) patient age ≥18 years and (2) patient undergoing a three-piece Le Fort I osteotomy, a bilateral sagittal split osteotomy, or a combination of the two. The patient-specific relative blood loss was calculated as a percentage by dividing the intraoperative blood loss by the estimated preoperative total blood volume, and then correlated with body mass index (BMI), age, sex, operating time, and treatment modality in a multivariate stepwise regression analysis. Operating time (P<0.001), BMI (P<0.001), and treatment modality (P<0.001) had a significant impact on relative blood loss; no significant effect of age or sex was observed. The coefficient of determination of relative blood loss was R(2)=0.34. In conclusion, this study introduces relative blood loss as a patient-specific measure of intraoperative blood loss. Average relative blood loss in this patient sample was 6.5%. Extensive surgery, a prolonged operating time, and reduced BMI significantly increase the intraoperative relative blood loss in patients undergoing orthognathic surgery.

Relative blood loss and operative time can predict length of stay following orthognathic surgery

The aim of this study was to investigate the length of stay (LOS) following orthognathic surgery and thereby to establish a benchmark. The secondary aim was to identify predictors of postoperative LOS following orthognathic surgery. Patients were treated consecutively during the period 2010 to 2012. Inclusion criteria were (1) patient age ≥18 years, and (2) surgery involving a three-piece Le Fort I osteotomy, or a bilateral sagittal split osteotomy (BSSO), or bimaxillary surgery. A total of 335 patients were included. The following data were recorded: height, weight, body mass index (BMI), age, sex, operative time, intraoperative blood loss, and type of surgery. LOS was defined as the duration of time from date of surgery to date of discharge. The average LOS was 1.3 days following Le Fort I osteotomy, 1.3 days following BSSO, and 1.8 days following bimaxillary surgery. In the multivariate regression model (R(2)=0.11), predictors of a prolonged LOS were operative time (P<0.001) and relative blood loss (P=0.002). No significant effect of age, BMI, sex, or treatment on LOS was observed. The short duration of LOS found in this study supports the possibility of increasing outpatient pathways for selected patients.

A Retrospective Study of Cleft lip and palate Patients´ Satisfaction after Maxillary Distraction or Traditional Advancement of the Maxilla

ABSTRACT Objectives To compare cleft lip and palate patients satisfaction with aesthetics and functional parameters after conventional advancement of the maxilla or by the use of distraction osteogenesis. Material and methods Case series observational study. Group of distraction osteogenesis (DO) consisted of 15 patients treated with distraction osteogenesis while group conventional (CONV) included 10 patients treated with traditional advancement of the maxilla. Patients were asked to fill out a questionnaire about their subjective evaluation of satisfaction with facial aesthetics and functional parameters on a continuous visual analog-scale (VAS) when the treatment was finished. Results The total response rate was 76%. Preoperatively the two groups did not differ significantly according to group characteristics. At follow-up both groups were satisfied with aesthetics and functional parameters. The DO group was less satisfied with the duration of the treatment than the CONV group. There were no statistically significant differences among the groups regarding functional parameters or facial aesthetics. Conclusions Cleft lip and palate patients experienced a high level of satisfaction with functional parameters and aesthetics as a result of surgical maxillary advancement. The patients treated with distraction osteogenesis were less satisfied with the duration of the treatment. Further studies are needed.

Novel 3-D Analysis for the Assessment of Cleft Dimensions on Digital Models of Infants With Unilateral Cleft Lip and Palate

Objective: To present a 3-D standardized analysis of cleft dimensions. Materials: Thirty-one plaster casts of unilateral cleft lip and palate (UCLP) infants were laser scanned. Landmarks and coordinate system were defined. Linear distances and surfaces were measured, and the ratio between cleft and palatal area was calculated (3-D infant cleft severity ratio [3D ICSR]). The digitally measured areas were compared with silicone membranes, adapted to the plaster casts, and analyzed by optic microscopy. Main Outcome Measures: Repeatability, reproducibility, and validity. Results: Bland-Altman plots showed minor bias for anterior cleft width (0.16 mm), arch length (0.23 mm), and palatal surface (−9.18 mm2). The random error was maximum 0.78 mm for linear measurements and 12.1 mm2 for area measurements, reliability of 3D ICSR was 0.99 (intraclass correlation coefficient), differences between measurements on digital and plaster models were less than 2%. Conclusions: The method offers valid and reproducible 3-D assessment of cleft size and morphology. 3-D infant cleft severity ratio can be used as baseline value for surgical planning and may have a role in predicting dentofacial development.

Assessment of dentofacial growth deviation in juvenile idiopathic arthritis: Reliability and validity of three-dimensional morphometric measures

Introduction Patients with juvenile idiopathic arthritis (JIA) and involvement of the temporomandibular joint (TMJ) often experience abnormal facial growth. Three-dimensional (3D) assessment of dentofacial growth deviation has become more common with advancement and commercialization of imaging technologies. However, no standardized guidelines exist for interpretation of 3D imaging in patients with JIA. The aim of this study was to propose and validate morphometric measures for the 3D radiographic assessment of dentofacial growth deviation in patients with JIA to enhance: 1) Description of dentofacial growth deviation; 2) Treatment planning; 3) Longitudinal follow-up. Methods The study was conducted in a standardized sequential-phased approach involving: 1) Preliminary decision-making; 2) Item generation; 3) Test of content-validity; 4) Test of reliability; 5) Test of construct validity; 6) Establishment of final recommendations. Results Twenty-one morphometric measures were evaluated. Based on results of reliability and validity-testing including subjects with JIA (n = 70) and non-JIA controls (n = 19), seven measures received a “high recommendation” score. Those measures were associated with posterior mandibular height, occlusal cant, mandibular asymmetry, mandibular inclination, and anterior/posterior lower face height. Nine other measures were “moderately recommended” and five received a “somewhat recommendation” score. Conclusion Seven morphometric measures were considered very useful in the 3D assessment of growth deviation in patients with TMJ disease associated with JIA. These variables can be used to standardize the description of dentofacial deformities and to plan corrective interventions.