Cranio-Maxillofacial Surgery

Comprehensive assessment of tranexamic acid during orthognathic surgery: A systematic review and meta-analysis of randomized, controlled trials Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Haoming Zhao, Shaopeng Liu, Zuping Wu, Huaqiang Zhao, Chuan Ma Abstract The objective of this study was to comprehensively assess the use of tranexamic acid (TXA) during orthognathic surgery. A systematic review and meta-analysis of randomized controlled trials addressing these issues were carried out. Three electronic databases, included PubMed, Web of Science, and Cochrane Library, were searched until April 30, 2018. Eligible studies were restricted to randomized, controlled trials (RCTs). Weighted mean differences (WMD) for blood loss, operation time, haematocrit, quality of surgical field, and odds ratio (OR) for transfusion rates were pooled for the included studies. Eight randomized, controlled trials were included for analysis. Compared with the control group, the TXA group showed a reduction in intraoperative blood loss of 165.03 ml (p < 0.00001; 95% CI, −200.93 to −129.13 ml), a reduction in the drop of haematocrit of 2.32 g/dl (p < 0.00001; 95% CI, −3.38 to −1.26 g/dl), and an improved quality of surgical field (p < 0.00001; MD, −1.01; 95% CI, −1.23 to −0.80). Tranexamic acid has a limited effect on reducing operative time (p < 0.00001; MD, −16.18 min; 95% CI, −19.60 to −12.75 min) and on decreasing the transfusion rates (p = 0.02; OR = 0.33; 95% CI, 0.13 to 0.83).

Announcements Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s):

Cartilage regeneration using decellularized cartilage matrix: Long-term comparison of subcutaneous and intranasal placement in a rabbit model Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Achim von Bomhard, Alexander Elsaesser, Ricarda Riepl, Katharina Pippich, Joseph Faust, Silke Schwarz, Ludwig Koerber, Roman Breiter, Nicole Rotter Abstract Autologous cartilage as donor tissue for various surgical reconstructions such as nasal septum regeneration is limited and associated with donor site morbidity. Our goal was to evaluate a new resorbable chondroconductive biomaterial made of decellularized porcine nasal septum cartilage compared with autologous native auricular cartilage as the gold standard. In order to examine the material and determine its long-term outcome further, we used subcutaneous implantation and septal implantation in an orthotopic rabbit model. In addition to non-seeded decellularized xenogenic cartilage, chondrocyte-seeded decellularized xenogenic cartilage was implanted as a septal replacement. After a three- or six-month period, the formation of newly synthesized cartilage extracellular matrix was evaluated immunohistochemically, whereas septal integrity and biocompatibility were evaluated histologically. The formation of the implanted neoseptum and form stability was analyzed by using 7-Tesla Magnetic Resonance Imaging. Good biocompatibility with no excessive rejection was demonstrated in all groups. Long-term stable and reliable septal reconstruction could be achieved in the study groups with or without cell seeding with autologous auricular chondrocytes. Autologous cell seeding was advantageous only with regard to septal perforations. Thus, cell seeding provides a benefit regarding long-term stability. However, because of slightly better biocompatibility, less pronounced septum deviation and the markedly lower effort involved, the non-seeded scaffold is favoured for possible clinical application.

Evaluation of Cd8+ and natural killer cells defense in oral and oropharyngeal squamous cell carcinoma Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Edilmar Moura Santos, Felipe Rodrigues de Matos, Everton Freitas de Morais, Hébel Cavalcanti Galvão, Roseana de Almeida Freitas Abstract Purpose The aim of this study was to evaluate the population of CD8+ and natural killer (NK) cells in samples of oral (OSCC) and oropharyngeal (OPSCC) squamous cell carcinoma. Patients and methods Fifty-four cases squamous cell carcinoma (42 OSCC and 12 OPSCC) were immunohistochemically treated by CD8 and CD57 monoclonal antibodies. It was evaluated the relationship of CD8+ and NK cells with tumor size, lymph node metastasis (LNM), clinical staging (CS), overall survival (OS) and disease-free survival (DFS). Results Only CD8 was higher expressed in both tumors T1 and T2 than T3 and T4, as well as in tumours without LNM and with CS II or III (P < 0.05). There was no association with OS and DFS of both biomarkers. Conclusions These findings suggest that the differential CD8+ cells infiltration in OSCC and OPSCC might reflect a distinctive tumor microenvironment with a favorable local cytotoxic immune response against neoplastic cells.

An in vitro long-term study of cryopreserved umbilical cord blood-derived platelet-rich plasma containing growth factors—PDGF-BB, TGF-β, and VEGF Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Kyoko Baba, Yasuharu Yamazaki, Yumiko Sone, Yoshika Sugimoto, Kazuno Moriyama, Takayuki Sugimoto, Kennichi Kumazawa, Yasuhito Shimakura, Akira Takeda Abstract Purpose Umbilical cord blood-derived platelet-rich plasma (UCB-PRP) containing growth factors has attracted attention as a biomaterial useful for regenerative medicine. The osteoblastic differentiation of umbilical cord-derived mesenchymal stromal cells (UC-MSCs) can be induced by UCB-PRP. Materials and methods Nine samples of UC and UCB were used to conduct an in vitro study that determined the contents of three growth factors (i.e., platelet-derived growth factor, transforming growth factor β-1, and vascular endothelial growth factor) and that examined, by staining with Alizarin red, their ability to induce the osteoblastic differentiation of UC-MSCs at the baseline, 3 months, and 3 years of cryopreservation. Results The contents of growth factors in cryopreserved UCB-PRP were markedly elevated compared to those found in UCB at baseline. The samples of UCB that were added with cryopreserved UCB-PRP and those with bone morphogenetic protein-2 were stained granularly with Alizarin red, thus indicating the presence of calcium. The samples of UCB that were not added with UCB-PRP were not stained with Alizarin red. The above-mentioned contents and ability were maintained at 3 years of cryopreservation. Cryopreserved UCB-PRP possibly and advantageously induced the osteoblastic differentiation of UC-MSCs. Conclusion The potential clinical application of cryopreserved UCB-PRP to regenerative medicine was suggested.

Enhancing adhesion and alignment of human gingival fibroblasts on dental implants Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Oral Cenk Aktas, Wolfgang Metzger, Ayman Haidar, Yahya Açil, Aydin Gülses, Jörg Wiltfang, Catharina Marques Sacramento, Frank Philipp Nothdurft Abstract Background Promoting the directional attachment of gingiva to the dental implant leads to the formation of tight connective tissue which acts as a seal against the penetration of oral bacteria. Such a directional growth is mostly governed by the surface texture. Material and methods In this study, three different methods, mechanical structuring, chemical etching and laser treatment, have been explored for their applicability in promoting cellular attachment and alignment of human primary gingival fibroblasts (HGFIBs). Results The effectiveness of mechanical structuring was shown as a simple and a cost-effective method to create patterns to align HGIFIBs. Conclusion Combining mechanical structuring with chemical etching enhanced both cellular attachment and the cellular alignment.

Clinical outcomes of pterygoid implants: Systematic review and meta-analysis Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Rafael Zetehaku Araujo, Joel Ferreira Santiago Júnior, Camila Lopes Cardoso, Anthony Froy Benites Condezo, Rosenvaldo Moreira Júnior, Marcos Martins Curi Abstract The aim of this systematic literature review was to analyze clinical outcomes of pterygoid implant for the treatment of patients with atrophic posterior maxillae and to provide clinical recommendations for this dental implant technique. An extensive search of electronic databases (PubMed/Medline, Science Direct, Lilacs, Embase, and Cochrane Library) was conducted, for articles published between January 1995 and January 2018, to identify literature presenting clinical outcomes of pterygoid implants in the treatment of patients with atrophic posterior maxillae. The systematic review was performed in accordance with PRISMA/PICO statement guidelines, and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk of implant failure was analyzed within a 95% confidence interval (95% CI). After screening 331 abstracts from the electronic databases, 36 full-text articles were accessed for eligibility, and a total of 6 studies were included in this systematic review (after applying the inclusion and exclusion criteria). All studies were retrospective in nature and were classified with a poor level of evidence. A total of 634 patients received 1.893 pterygoid implants, with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04–0.077. This study demonstrates that pterygoid implants can be successfully used in patients with atrophic posterior maxilla. However, the results should be interpreted with caution, given the presence of uncontrolled confounding factors in the included studies.

A rare odontogenic cyst: Gingival cyst of the adult. A series of 20 new cases from a single center Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Stephanie Kenig Viveiros, Rodrigo Finger de Carvalho Pinho, Marcos Custódio, Suzana Cantanhede Orsini Machado de Sousa, Decio dos Santos Pinto Abstract Gingival cyst of the adult (GCA) is a rare entity and comprises around 0.3% of all odontogenic cysts. Due to its rarity, there are a few retrospective studies on it. Therefore, the aim of this study was to present casuistic data of a 20-year retrospective study performed in a Brazilian oral pathology reference center. All cases diagnosed as gingival cyst of the adult in the last 20 years were retrieved from the files of the Oral Pathology Service. Data from the lesions and patients were tabulated and presented descriptively. From a total of 68,229 oral biopsies, 7,023 were odontogenic cysts, and among these only 20 cases were diagnosed as gingival cyst of the adult, resulting in the largest series of gingival cyst of the adult, from a single center, in the last 15 years. Most cases occurred in women, and although 53% affected the anterior mandible, 40% occurred in the anterior maxilla, which contrasts with the previous literature. Despite being a rare lesion GCA should be considered in the clinical differential diagnosis of gingival lesions presenting either in the maxilla or mandible.

Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat? Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Carolin Goetz, Nora-Maria Burian, Jochen Weitz, Klaus-Dietrich Wolff, Oliver Bissinger Abstract Background Temporary tracheotomies are often used in oral microvascular flap reconstruction surgery to secure postoperative airway management and avoid emergency tracheotomies. Even when planned electively, a tracheotomy can cause severe and life-threatening complications. The aim of this study was to evaluate the complications of tracheotomies performed on oral cancer patients with microvascular flap reconstructions and differentiated patterns, which could lead to postoperative complications. Methods 150 patients, treated in the Department of Oral and Maxillofacial Surgery from March 2017 to August 2018, were included in this study. Patient records and perioperative data were analysed and the following specific items were evaluated: time after surgery until removal of the tracheal cannula, complications, cause and point of time of reinsertion of the cannula, anticoagulative treatment, ASA grade (American Society of Anaesthesiologists), TNM stage, and patient-specific data. Results 30 patients (20%) developed tracheotomy-associated complications, most commonly pneumonia (50%). There was a significant correlation between the time period until removal of the cannula and the occurrence of complications such as pneumonia and bleeding. Conclusion The results of our study lead us to recommend continuing to perform temporary tracheotomies in oral cancer surgery with microvascular flap reconstruction. The overall complication rate is low and postoperative airway management can be performed in a safe and controlled manner. Nevertheless, the time period for the inserted cannula should be kept as short as possible.

The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the observational studies Publication date: April 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 4 Author(s): Mohamed E. Awad, Amara Altman, Radwa Elrefai, Peter Shipman, Stephen Looney, Mohammed Elsalanty Abstract Background Vascularized fibular flaps are considered the gold standard for the reconstruction of segmental defects in the mandible. This review compares the complication and success rates of these techniques between primary and secondary reconstruction, as well as between lateral and antero-lateral defects. Type of studies reviewed A systematic review and meta-analysis were conducted according to PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. The authors performed an independent comprehensive search using PubMed, Ovid MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and COS Conference Papers Index according to established inclusion and exclusion criteria. The methodological index for nonrandomized studies (MINORS) was used to assess the quality of the included studies. Meta-analysis was conducted to compare the type of reconstruction and location of the defect. Results Seventy-eight studies, involving 2461 patients, were eligible. 83.7% of the included patient received primary reconstruction with vascularized fibular flap. The overall flap success rate was 93%. There was improvement in MINORS quality score over time with positive correlation with the publication year (r = 0.5549, P < 0.0001, CI 0.3693 to 0.6979). Meta-analysis indicated no significant association in flap success between primary and secondary reconstruction, or lateral and antero-lateral defects. Conclusion Based on the available studies, this review found no evidence of difference in success or complication rates between primary and secondary reconstruction or between lateral and anterolateral defects. High-quality clinical studies are required to analyze the outcome of these techniques, especially regarding the impact of chemotherapy, radiation therapy, implant-supported dental prostheses, and preoperative planning, on the outcome of reconstruction.