Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

2021 ◽  
pp. 194338752110225
Author(s):  
Matthew E. Pontell ◽  
Eva B. Niklinska ◽  
Stephane A. Braun ◽  
Nolan Jaeger ◽  
Kevin J. Kelly ◽  
...  
Keyword(s):  
Mixed Dentition ◽  
Surgical Removal ◽  
Mandibular Fractures ◽  
Rigid Fixation ◽  
Complication Rates ◽  
Facial Growth ◽  
Age Related ◽  
Significant Difference ◽  
Mandible Fractures ◽  
Unerupted Teeth

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

Surgical treatment of multiple brain metastases

1993 ◽  
Vol 79 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Rajesh K. Bindal ◽  
Raymond Sawaya ◽  
Milam E. Leavens ◽  
J. Jack Lee
Keyword(s):  
Brain Metastases ◽  
Survival Time ◽  
Prognostic Indicators ◽  
Survival Duration ◽  
Surgical Removal ◽  
Complication Rates ◽  
Multiple Brain Metastases ◽  
Significant Difference ◽  
Group A ◽  
Group B

✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.

scholarly journals Concepts and Challenges in the Surgical Management of Edentulous Mandible Fractures: A Case Series

2019 ◽  
Vol 3 (1) ◽  
pp. s-0039-1693038
Author(s):  
Venkatesh Anehosur ◽  
Twinkle Thakker ◽  
Nikhil Nagraj ◽  
Niranjan Kumar
Keyword(s):  
Mineral Content ◽  
Bone Fractures ◽  
Case Series ◽  
Mandibular Fractures ◽  
Rigid Fixation ◽  
Functional Rehabilitation ◽  
Edentulous Mandible ◽  
High Incidence ◽  
Choice Of Treatment ◽  
Mandible Fractures

Functional rehabilitation of complex edentulous or atrophic mandibular fractures is surgically demanding. The high incidence of bone fractures in geriatric age group is secondary to the loss of bone mineral content with age. So far, there is no consensus regarding the best treatment for repair of fractures of the severely atrophic mandible. Thus, the choice of treatment for such fractures should be based on the degree of atrophy, considering its inverse relationship to the amount of rigid fixation required. Hence, open reduction and internal fixation (ORIF) is considered to be a reliable method for treating the edentulous mandible fractures. The authors present a case series of patients treated with ORIF with load bearing (LB; reconstruction plate) and load sharing (LS; miniplates) principles. No complications related to infection, plate exposure, fibrous union, nonunion, and trismus, were observed.

Isolated Tympanic Plate Fracture Frequency and Its Relationship to Mandibular Trauma

2014 ◽  
Vol 65 (4) ◽  
pp. 360-365 ◽  
Author(s):  
Canan Altay ◽  
Nezahat Erdoğan ◽  
Ozan Batkı ◽  
Erdem Eren ◽  
Sedat Altay ◽  
...  
Keyword(s):  
Ct Images ◽  
Maxillofacial Trauma ◽  
Mandibular Fractures ◽  
Condylar Process ◽  
Plate Fracture ◽  
Maxillofacial Fractures ◽  
Significant Difference ◽  
Mandible Fractures ◽  
The Right ◽  
Communications System

PurposeThis study evaluated the prevalence of isolated tympanic fractures and their correlation with mandibular fractures by using maxillofacial computed tomography (CT).Materials and MethodsWe retrospectively evaluated the maxillofacial CT of 1590 patients who presented to our emergency department with maxillofacial trauma between December 2010 and December 2012. Maxillofacial CT was used as the criterion standard for evaluating patients with maxillofacial fractures. The CT images were evaluated by using an electronic picture archiving and communications system and interpreted independently by 2 radiologists.ResultsThe maxillofacial CT images revealed mandibular fractures in 167 of the patients and isolated tympanic plate fractures in 35 of these 167 patients. Four patients (11%) had a bilateral tympanic plate fracture, and 31 patients (89%) had unilateral tympanic plate fracture. Of all the tympanic plate fractures, 19 (54%) were on the right side and 16 (46%) were on the left side ( P > .05). In our results, a significant correlation between the presence of a right-sided tympanic plate fracture and fracture of the ipsilateral condylar process was found ( P = .036). However, a statistically significant difference between the presence of a tympanic plate fracture and other mandible fractures, additional soft-tissue findings, or the number of fractures was not determined ( P > .05). Sex had no impact on the presence of tympanic plate fracture ( P > .05).ConclusionThe frequency of isolated tympanic plate fractures in maxillofacial trauma is low, but it is an important anatomic location. Condyle fractures are significantly associated with isolated tympanic plate fractures. The presence of these injuries should raise suspicion of a concomitant isolated tympanic plate fracture.

Transoral versus Extraoral Reduction of Mandible Fractures: A Comparison of Complication Rates and other Factors

2003 ◽  
Vol 128 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Vincent S. Toma ◽  
Robert H. Mathog ◽  
Roger S. Toma ◽  
Robert J. Meleca
Keyword(s):  
Open Reduction ◽  
Operative Time ◽  
Surgical Approaches ◽  
Mandibular Fractures ◽  
Complication Rates ◽  
Body Angle ◽  
Advantages And Disadvantages ◽  
Surgeon Experience ◽  
Mandibular Body ◽  
Mandible Fractures

OBJECTIVE: This retrospective study evaluates results and complications of the transoral and extraoral approaches for open reduction and internal fixation of mandibular body, angle, and ramus fractures. Our aim was to describe advantages and disadvantages of the techniques and to develop criteria for choosing between surgical approaches. STUDY DESIGN AND SETTING: A retrospective chart review was performed on patients with mandible fractures occurring between August 1999 and October 2001 at a level I trauma center. Only mandibular body, angle, and ramus fractures requiring open reduction were selected for this study. Cases were evaluated for cause, age, gender, dentition, site and extent of fractures, surgical approach, postoperative complications, operative time, and postoperative occlusion. RESULTS: Of the 227 patients with mandibular fractures, 78 had body, angle, or ramus fractures requiring open reduction. Of these, 36 were treated extraorally, and 42 were treated transorally. Criteria for selecting one procedure over another often involved training and surgeon experience and those factors normally considered important in defining the difficulty of treatment and prognosis of the patient. Seven of the 42 patients were converted from a transoral to an extraoral approach because of inadequate exposure. Similar complication rates occurred for the transoral and extraoral approaches, but because of the time required for converting from the transoral to extraoral approach, the average operative time was found to be increased in patients undergoing the transoral approach. CONCLUSION AND SIGNIFICANCE: Decisions regarding treatment approaches for open reduction of mandible fractures often relate to surgeon experience and training, modified by factors that can affect uncomplicated healing such as fracture locations and displacement, comminution of the fracture, infection, dentition, and atrophic changes of the mandible. In some cases, the choice is affected by availability of equipment and experience of operating room personnel. More difficult cases involving an edentulous, atrophic mandible or comminution should be considered for extraoral exposure.

Cataract Surgery in High Hyperopia

2018 ◽  
Vol 235 (04) ◽  
pp. 413-415
Author(s):  
Nicolas Waldmann ◽  
Nadine Gerber ◽  
Warren Hill ◽  
David Goldblum
Keyword(s):  
Cataract Surgery ◽  
Age Related Macular Degeneration ◽  
Complication Rates ◽  
Spherical Equivalent ◽  
Single Centre ◽  
Age Related ◽  
Significant Difference ◽  
Corrected Distance Visual Acuity ◽  
Before And After ◽  
High Hyperopia

Abstract Background Although cataract surgery is a well-established and standardised procedure, it can be demanding and associated with higher complication rates in high hyperopia. We present clinical data for highly hyperopic patients who underwent cataract surgery over a 12-year period (2005 – 2016) and at a single centre. Patients and Methods Out of a total of 11 434 cataract operations, 41 highly hyperopic eyes (SN60AT ≥ 31 dpt) were included for analysis. We compared the target spherical equivalent to the final postoperative spherical equivalent for five different formulas. We also reviewed the best corrected distance visual acuity (BCDVA) before and after surgery and any complications. Results LogMAR BCDVA increased significantly from a mean of 0.5 before to 0.37 after surgery (p = 0.02). The main reasons for the reduced final BCDVA were glaucoma, Fuchs corneal endothelial dystrophy, and age-related macular degeneration. One eye suffered a radial capsule tear and received a sulcus implanted intraocular lens (IOL). There was no statistically significant difference between formulas with respect to aberration of the final spherical equivalent. Conclusions Patients with high hyperopia often have ocular comorbidities. Such eyes may be surgically challenging, resulting in reduced benefits from cataract surgery compared to normal eyes.

scholarly journals An Evaluation of Buccal Shield Treatment

2007 ◽  
Vol 77 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Kambiz Moin ◽  
Samir E. Bishara
Keyword(s):  
Treatment Time ◽  
Statistical Tests ◽  
Normal Growth ◽  
Mixed Dentition ◽  
Dental Arch ◽  
Arch Width ◽  
Bodily Movement ◽  
Age Related ◽  
Significant Difference ◽  
Width Measurements

Abstract Objective: To evaluate the short-term effects of the buccal shield modification of the lip-bumper design and on various mandibular dental arch parameters and to determine whether the changes in arch widths are due to the tipping or bodily movements of the teeth involved. Materials and Methods: This study included 45 consecutively treated patients (29 girls and 16 boys) from a private orthodontic practice. Student's and paired t-tests were used to test the null hypothesis of no change over time for the various measurements. Linear regression analyses were used to determine whether treatment time was a significant predictor of arch width expansion. Significance for all statistical tests was predetermined at P ≤ .05. Results: Student's t-test results indicated the presence of a significant (P &lt; .0001) increase in all the arch parameters measured. The greatest mean expansion was observed at the first (5.0 ± 2.2 mm) and second (3.4 ± 2.2 mm) premolar width measurements. The changes in arch width parameters were significantly (P &lt; .0001) greater than the normal age-related changes in the corresponding parameters. There was no significant difference between arch width expansion of the occlusal vs gingival levels, indicating a bodily and not tipping movement. Only 30% of the lower incisors demonstrated an increase in their proclination beyond normal values. Conclusion: When using the buccal shield appliance, the mandibular arch width parameters can be expanded in the mixed dentition with bodily movement of teeth. The expanded arch width dimensions are greater than what would be expected as a result of normal growth.

The influence of osteopathic correction on the rate of various rhythms of the body

2019 ◽  
pp. 64-71 ◽  
Author(s):  
A. E. Chernikova ◽  
Yu. P. Potekhina
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Age Groups ◽  
Biomechanical Properties ◽  
Dispersion Analysis ◽  
The Body ◽  
Body Tissues ◽  
Age Related ◽  
Significant Difference ◽  
Before And After

Introduction. An osteopathic examination determines the rate, the amplitude and the strength of the main rhythms (cardiac, respiratory and cranial). However, there are relatively few studies in the available literature dedicated to the influence of osteopathic correction (OC) on the characteristics of these rhythms.Goal of research — to study the influence of OC on the rate characteristics of various rhythms of the human body.Materials and methods. 88 adult osteopathic patients aged from 18 to 81 years were examined, among them 30 men and 58 women. All patients received general osteopathic examination. The rate of the cranial rhythm (RCR), respiratory rate (RR) heart rate (HR), the mobility of the nervous processes (MNP) and the connective tissue mobility (CTM) were assessed before and after the OC session.Results. Since age varied greatly in the examined group, a correlation analysis of age-related changes of the assessed rhythms was carried out. Only the CTM correlated with age (r=–0,28; p<0,05) in a statistically significant way. The rank dispersion analysis of Kruskal–Wallis also showed statistically significant difference in this indicator in different age groups (p=0,043). With the increase of years, the CTM decreases gradually. After the OC, the CTM, increased in a statistically significant way (p<0,0001). The RCR varied from 5 to 12 cycles/min in the examined group, which corresponded to the norm. After the OC, the RCR has increased in a statistically significant way (p<0,0001), the MNP has also increased (p<0,0001). The initial heart rate in the subjects varied from 56 to 94 beats/min, and in 15 % it exceeded the norm. After the OC the heart rate corresponded to the norm in all patients. The heart rate and the respiratory rate significantly decreased after the OC (р<0,0001).Conclusion. The described biorhythm changes after the OC session may be indicative of the improvement of the nervous regulation, of the normalization of the autonomic balance, of the improvement of the biomechanical properties of body tissues and of the increase of their mobility. The assessed parameters can be measured quickly without any additional equipment and can be used in order to study the results of the OC.

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

scholarly journals Age-Related Biology of Early-Stage Operable Breast Cancer and Its Impact on Clinical Outcome

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1417
Author(s):  
Binafsha M. Syed ◽  
Andrew R. Green ◽  
Emad A. Rakha ◽  
David A.L. Morgan ◽  
Ian O. Ellis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Histological Grade ◽  
Survival Rates ◽  
Growth Factor Receptor ◽  
Progesterone Receptors ◽  
Biological Characteristics ◽  
Cancer Specific Survival ◽  
Age Related ◽  
Significant Difference

As age advances, breast cancer (BC) tends to change its biological characteristics. This study aimed to explore the natural progression of such changes. The study included 2383 women with clinically T0-2N0-1M0 BC, managed by primary surgery and optimal adjuvant therapy in a dedicated BC facility. Tissue micro-arrays were constructed from their surgical specimens and indirect immunohistochemistry was used for analysis of a large panel (n = 16) of relevant biomarkers. There were significant changes in the pattern of expression of biomarkers related to luminal (oestrogen receptor (ER), progesterone receptors (PgR), human epidermal growth factor receptor (HER-2), E-cadherin, MUC1, bcl2 CK7/8, CK18 and bcl2) and basal (CK5/6, CK14, p53 and Ki67) phenotypes, lymph node stage, histological grade and pathological size when decade-wise comparison was made (p < 0.05). The ages of 40 years and 70 years appeared to be the milestones marking a change of the pattern. There were significantly higher metastasis free and breast cancer specific survival rates among older women with ER positive tumours while there was no significant difference in the ER negative group according to age. Biological characteristics of BC show a pattern of change with advancing age, where 40 years and 70 years appear as important milestones. The pattern suggests <40 years as the phase with aggressive phenotypes, >70 years as the less aggressive phase and 40–70 years being the transitional phase.

scholarly journals Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

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