Postoperative evaluation in mandibular prognathism treated by bilateral sagittal split osteotomy

The present study was undertaken to evaluate the postoperative relapse from the period of unwiring to 1 year postoperatively and its correlation to the amount of mandibular setback and change in vertical dimension after mandibular bilateral sagittal split osteotomy. Twenty-seven patients were evaluated cephalometrically by the time preoperatively, 6 weeks, 6 months and 1 year postoperatively. It was found that 1) the average amount of mandibular setback at pogonion point, 6 weeks postoperatively, is 7.6mm backward and 1.9mm downward, 2) the average amount of horizontal relapse at pogonion point, 6 months and 1 year postoperatively, are 1.9mm and 2.3mm respectively. 86% of the horizontal relapse, 1 year postoperatively, occurs in the first 6 months after removal of intermaxillary fixation, 3) the average amount of vertical relapse at pogonion point, 6 months and 1 year postoperatively, are 0.9mm and 1.1mm upward. 82% of the vertical relapse, 1 year postoperatively, occurs in the first 6 months after removal of intermaxillary fixation, 4) the amount of 1 year postoperatively horizontal relapse is significantly correlated both with the amount of horizontal mandibular set back and vertical downward change (r = 0.58, 0.67, p < 0.001), whereas the amount of vertical relapse is with the vertical downward change only, but horizontal setback isn't.     

Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy

DESIGN: A retrospective review of women undergoing computed tomography (CT) as part of the investigation and management of pathologically proven ovarian cancer in a single specialist gynaecological cancer centre. OBJECTIVE: To ascertain CT appearances and prognostic significance of splenic involvement in ovarian cancer. RESULTS: We found a 10.3% frequency of splenic metastasis in a series of 321 patients with ovarian cancer. Thirty-three women had splenic metastases demonstrated on CT. Twenty-three women had surface lesions with an irregular scalloped shape and broad contact with the splenic surface; 17 of these women had lesions at presentation. Ten women had parenchymal lesions, five at presentation and five at relapse, typically with a rounded shape surrounded by normal splenic tissue. Four out of 10 cases with parenchymal involvement showed lesion progression during chemotherapy. However, lesion progression occurred in only one of 23 cases with surface disease (P < 0.025, Fisher's exact test). In 16 cases with disease involving both spleen and liver, the response to chemotherapy was the same in both organs. CONCLUSION: We have found a higher frequency of splenic metastasis from ovarian cancer during life than previously reported. Parenchymal lesions are significantly less likely to respond to treatment than surface lesions but are more commonly a feature of relapsed disease. We have demonstrated that splenic metastases behave similarly to liver metastases in ovarian cancer. We suggest that the presence of splenic parenchymal metastasis is indicative of FIGO stage IV disease. This finding has implications for proposed cytoreductive surgery.     

Comparison between the rigidity of bicortical screws and a miniplate for fixation of a mandibular setback after a simulated bilateral sagittal split osteotomy

PURPOSE: This investigation compared the biomechanical stability of three bicortical screws with that of a single four-hole miniplate after 5-mm mandibular setback after a bilateral sagittal split osteotomy (BSSO) in cadaver mandibles. MATERIALS AND METHODS: Thirty human cadaver hemimandibles underwent BSSO followed by two different rigid fixation techniques. All specimens had no third molar, bony pathology, or evidence of mandibular fracture, and there was no history of renal disease or hyperparathyroidism. The specimens were randomly divided into two groups. In group I, three bicortical screws were placed at the superior border, and in group II, one four-hole miniplate was secured on the external oblique ridge with four monocortical screws. The bony height of the mandible was recorded. Maximum resistance load (MRL), the greatest load recorded just before a sudden decrease in load level (bone or fixation failure), was recorded when the mandibles were tested in a compression machine. Multiple regression analysis was used to evaluate the differences in bone height and the MRL between groups I and II. RESULTS: The mean bone height in groups I and II were 28.64 +/- 2.50 mm and 28.72 +/- 4.08 mm, respectively. The mean MRL in group I (20.49 +/- 7.22 kg) was greater than in group II (17.41 +/- 7.81 kg). The multiple regression analysis showed no significant difference in the bone height and the MRL between group I and group II (beta = 2.3492, P = .4114). CONCLUSION: There was no statistically significant difference in stability provided the two techniques.     

A new repositioning system for the proximal segment in sagittal split ramus osteotomy of the mandible

Intrathoracic extra-medullary hematopoiesis is a compensatory mechanism usually seen in thalassemia. The authors report a case with multiple mediastinal localisations fortuitously discovered. CT has allowed diagnosis and led percutaneous biopsy.     

Blood flow changes after orthognathic surgery: maxillary and mandibular subapical osteotomy

Subapical osteotomies were performed in the left quadrant of the mandibles and maxillas of five dogs and six monkeys. Two indirect methods, the isotope fractionation (diffusible tracer) and particle distribution (nondiffusible tracer--15mu microspheres) were used to quantitate local blood flow. To examine the effect of the surgery, blood flows in the alveolar bone, mucosa, and dental pulp of the segmented left quadrant and the corresponding tissues in the right quadrant were calculated and compared. It was assumed that the blood flows to the nonoperated right quadrant could serve as the controls to those observed in the osteotomized segment. The fractional decrease in blood flows to tissues in the operated sides were similar in both experimental animals. The decrease was largest in the dental pulp, ranging from 54% to 82% on the average, and least for the mucosal tissue, ranging from 18% to 40%. Blood flows decreased by 48% to 74%, on the average, in the alveolar bone. In some animals, blood flow to mucosal tissue that served as the pedicle was actually greater than the blood flow in the corresponding tissue on the right side. After surgery, the cardiac output in the dogs averaged about 156 ml/min/kg as calculated from both the diffusible and nondiffusible data. In the monkeys in which only the microspheres were injected, the cardiac output averaged 99 ml/min/kg. The arterial blood pressure dropped 8 to 13 mm Hg on the average (dog, 108 to 100 mm Hg; monkeys, 94 to 81 mm Hg). The heart rate also decreased slightly in dogs, 158 to 139 beats/min on the average; however, it increased slightly after the surgery in the monkeys, 144 to 161 beats/min. Blood losses during surgery were replaced wtih lactated Ringer's solution and the transient decreases in blood pressure of about 20 to 35 mm Hg were not sufficient to produce any shut down of renal blood flow.     

Postoperative stability after sagittal split ramus osteotomy with condylar-positioning appliance and screw fixation: asymmetric versus symmetric cases

BACKGROUND AND OBJECTIVE: Myelodysplastic syndrome progenitor cells can be grown and expanded in long term bone marrow liquid cultures in the presence of multiple cytokines. In this study we investigated the pattern of differentiation and response to growth factors in six cases of myelodysplastic syndrome (MDS) with well-defined cytogenetic abnormalities by means of conventional cytogenetics and fluorescence in situ hybridization (FISH). METHODS: Bone marrow cells were grown in stroma-free liquid cultures in the presence of SCF, IL-3, IL-6 and GM-CSF. RESULTS: IN three cases a CFU-GM expansion comparable to normal controls was observed, together with a decrease or increase of cells with abnormal karyotype. Two cases showed no response to growth factor stimulation, morphological signs of terminal myeloid differentiation and increase (one case) or decrease (one case) in the percentage of abnormal FISH signals along the cultures. In one additional case, while CFU-C expansion was present, clearcut leukemic transformation was observed in the culture, together with a sharp decrease in the percentage of abnormal FISH signals, indicating a leukemic transformation of MDS progenitor cells with a normal karyotype. INTERPRETATION AND CONCLUSIONS: Our data indicate that FISH analysis is generally a poor indicator of clonality in MDS; nevertheless, determining the kinetics of cytogenetically abnormal clones in liquid bone marrow cultures may provide insight as to the growth abnormalities of MDS progenitor cells and may be useful prior to in vivo growth factor administration.     

A new condylar positioning appliance for two-jaw osteotomies (Le Fort I and sagittal split ramus osteotomy)

We have presented a new appliance for easy, rapid, and exact repositioning of the proximal segment of the mandible in two-jaw osteotomies (Le Fort I and sagittal split ramus osteotomy).     

A follow-up study on changes in mastication after insertion of mandibular bilateral free end saddle denture by EMG]

The purpose of this study was to investigate changes in the mandibular shortened arch, whose occlusal deficit had been reconstructed by removable partial denture, during mastication by using the EMG analyzing system. A total of 5 shortened dental arch patients was provided with RPDs, and observed by a sophisticated masticatory analyzing system using EMG, before and one day, about 2 weeks, 3 months, after denture insertion. The conclusions were as follows: i) The elements of the shortened arch during mastication, that is, the duration, interval, and cycletime, were prolonged at the time of insertion of RPD, but 3 months after denture insertion, they were shortened to almost the same state as before treatment. ii) Prosthetic treatment for shortened dental arch improved revitalization of functional musculatures, and their rhythmicity of functional procedure. iii) The functional tongue room for optimal bolus position in mastication was provided by insertion of mandibular bilateral free end saddle removable partial denture.     

The Kalish osteotomy. A review and retrospective analysis of 265 cases

One hundred seventy-two patients (265 feet) were reviewed following correction of hallux abducto valgus surgery, using the Kalish modification of the Austin bunionectomy. Fifty-three cases were followed up on an average of 2.5 years from 1986 through 1992. The statistical results support the use of this osteotomy with rigid internal fixation for the reduction of the intermetatarsal angle, hallux abductus angle, and tibial sesamoid position. Patients are weightbearing immediately and are usually back in soft shoes or sneakers 2 weeks after surgery. Surgical techniques and complications of this procedure are discussed to help surgeons use this procedure in correcting hallux abducto valgus deformities.     

The assessment of fracture of the mandibular condyle by use of computerized tomography. Incidence of sagittal split fracture

A survey was carried out to clarify the incidence of sagittal splitting fracture of the mandibular condyle using computerized tomography. There were 33 patients, between 11 and 67 years of age, with displaced or dislocated mandibular condylar process fractures (41 cases), seen at our clinic between 1986 and 1992. The incidence of no displacement was 4.9%; deviation and displacement, 34.1%; dislocation, 46.3%; and complete avulsion, 4.9%. A sagittal splitting fracture of condyle occurred with an incidence of 9.8%. Conservative treatment was effective in the treatment of sagittal splitting fracture. Therefore, classification of fracture of mandibular condyle should include the sagittal split fracture, and investigations should include computerized tomography.     

Experimental analysis of functional stability of sagittal split ramus osteotomies secured by miniplates and position screws

PURPOSE: This study determined the relative functional stabilities of various miniplate systems and configurations used to stabilize sagittal split ramus osteotomies (SSROs) and compared them with conventional internal screw fixation. MATERIALS AND METHODS: The biomechanical model was a reproducible prototype of a mandible sagittal osteotomy with consistent material and geometric properties. After advancing the distal segment by 7 mm, each set of mandible analogs (1 set = 3 analogs) was fixed bilaterally by one of three miniplate systems applied in various configurations, and tested with and without a supplemental 2.4-mm bicortical screw applied in the retromolar region. Reduced analogs were placed in a straining frame, and simulated masticatory loads were applied alternatively to the mandibular first molars. Ensuing osteotomy site displacements were measured by transducers attached to a computer-based data acquisition program. A coordinate transformation procedure was used to convert the component displacements captured by the individual transducers into a common "instability factor" to reflect fixation stability for each construct and loading condition. Instability factors for the individual constructs were compared with each other and with those obtained from analogs reduced exclusively with 2.4-mm position screws. RESULTS: Osteotomies stabilized with a combination of miniplates and position screws were more stable than those stabilized exclusively with miniplates (P < .0001). Post-hoc comparisons of mean instability factors (Dunnet's method) showed the miniplate-position screw combinations to be more stable than the 2.4-mm position screw system used as standard (P < .05). Miniplate systems alone were the least stable of the test constructs, with differential rates of failure between the individual miniplate systems. CONCLUSIONS: Exclusive use of miniplate fixation may not provide the consistent stability necessary for early functional restoration after SSROs. The addition of a position screw in the retromolar region substantially enhances the fixation stability of miniplate systems. The use of miniplates with retromolar position screws offers both technical and stability advantages over conventional miniplate or internal screw fixation. The fixation stability of the miniplate-position screw combination is independent of the type of miniplate system used.     

Age-related changes in sympathetic modulation of sensory nerve activity in rat skin

OBJECTIVES: Sensory nerves play an important role in mediating neurogenic inflammation and subsequent tissue healing. A decrease in sensory nerve function with increasing age has been reported to correlate with poor tissue healing. Sympathetic nerves are known to modulate sensory nerve function, and changes in this modulation could also have important implications with ageing. The aims of this study were to examine the effect of different frequency electrical stimulation (ES) on the microvascular responses obtained to sensory nerve activation in young, aged and capsaicin-pretreated rats and modulation of these responses by sympathetic efferents. METHODS: Using laser Doppler flowmetry, vascular responses to antidromic ES of the sciatic nerve were monitored in the base of vacuum-induced blisters in the hind footpad. The non-selective alpha-adrenoceptor antagonist phentolamine (3 mg/kg, i.v.) was administered 20 min prior to ES. RESULTS: At high frequency ES (20V, 2ms, 15Hz for 1 min), the vascular response in old rats was significantly reduced (46 percent decrease, p < 0.05) compared to young control. At low frequency ES (20 V, 2 ms, 5 Hz for 1 min) however, older rats produced similar vascular responses to the young. Capsaicin-pretreated rats showed significantly reduced vascular responses to both high and low frequency ES, regardless of age. Pretreatment with phentolamine significantly increased the microvascular response in young rats at high (87 percent) and low (36 percent) frequency ES. In contrast, phentolamine significantly increased the ES-induced response in old rats at high frequency only (147 percent increase). CONCLUSIONS: The results suggest that the aged sensory nerve responds preferentially to low frequency ES and that sympathetic efferents exert an inhibitory modulatory effect on the vascular response evoked by sensory nerve stimulation. There are age-related changes in sympathetic modulation of sensory nerve-mediated responses which is dependent on stimulation frequency.     

A retrospective study of changes in physical symptoms and body image after reduction mammaplasty

Reduction mammaplasty is performed typically to alleviate the painful physical symptoms of macromastia. Women who suffer from macromastia also frequently present to the plastic surgeon with heightened body image dissatisfaction and maladaptive behavioral changes in response to their breast size. Numerous investigations have demonstrated improvement in physical symptoms after breast reduction surgery. Studies have also suggested that psychological improvement occurs postoperatively; however, they have not used well-validated, standardized psychological measures. The present study is a retrospective analysis of the physical and psychological status of women who underwent reduction mammaplasty. One hundred ten patients who underwent a reduction mammaplasty between 1982 and 1996 were mailed a packet of questionnaires designed to assess current physical symptoms and body image. Sixty-one of the 110 patients (55 percent) responded. The vast majority reported substantial improvement or elimination of neck, back, shoulder, and breast pain, grooving from bra straps, poor posture, skin irritation, and social embarrassment. In addition, they reported significantly less dissatisfaction with their breasts as compared with a sample of breast reduction patients assessed preoperatively. Symptom relief and improved body image occurred independently of preoperative body weight, as we found few significant differences between obese and non-obese women concerning the resolution of physical symptoms or improvement in body image. Results provide further evidence of the efficacy of reduction mammaplasty not only for relief of physical symptoms but also for alleviation of body image dissatisfaction.     

The influence of the osteotomy slope on bony changes after advancement genioplasty

PURPOSE: The purpose of this study was to develop a prediction method for advancement genioplasty that would result in accurate preoperative cephalometric planning of the osteotomy slope and that could be transferred to the patient during the surgical procedure. PATIENTS AND METHODS: Serial cephalometric tracings of 20 patients who underwent advancement genioplasty were retrospectively analyzed. The osteotomy slope angle was defined as the angle between the osteotomy and a line perpendicular to the occlusal plane. The measured angle was compared with the calculated angle deduced from the horizontal and vertical genial postoperative changes. RESULTS: The measured osteotomy slope angle closely resembled the calculated angle. CONCLUSIONS: The close similarity between the calculated and measured osteotomy slope angles in this study shows that simple mathematical calculations can be applied clinically to aid surgeons in achieving a more predictable result. The osteotomy slope can be determined early in the prediction stage as a calculated figure based on the desired horizontal and vertical movements of the chin and can be transferred to the patient's chin during the surgical stage.     

The "Z" osteotomy versus the Kalish osteotomy for the correction of hallux abducto valgus deformities: a retrospective analysis

A retrospective analysis of hallux abducto valgus surgery performed between 1990 and 1995 where the "Z" osteotomy and Kalish osteotomy were utilized was performed. Objective and subjective data were collected to determine the effectiveness of the Z osteotomy versus the Kalish osteotomy. Twenty cases of hallux abducto valgus where the Z osteotomy was utilized were evaluated on the basis of intermetatarsal angle correction and alleviation of preoperative symptoms. The same evaluation was performed on 21 cases where the Kalish osteotomy was utilized. There did not appear to be an appreciable difference in intermetatarsal angle correction between the two osteotomies; however, the Kalish osteotomy did alleviate preoperative symptoms to a greater degree compared with the Z osteotomy.     

An experimental study on the recovery of the lingual nerve after injury with or without repair

BACKGROUND: The advantage of radionuclide angiographic techniques used to measure right ventricular ejection fraction (RVEF) is geometry independence, but the weakness is right atrial (RA) overlap. To minimize the effect of RA counts on right ventricular time activity curve (TAC), two regions of interest (ROI), one drawn for the end-diastolic image and one for the end-systolic image, are used for the calculation of RVEF from equilibrium gated blood pool scans (GBPS) and from gated first-pass studies with an Anger camera. A multicrystal camera offers both temporal separation of the bolus to the right side of the heart and good count statistics; therefore first-pass studies performed on a multicrystal camera theoretically should yield the most accurate measurements of RVEF, but few studies have been performed to validate RVEF against a reliable gold standard. METHODS AND RESULTS: To develop and validate an accurate method to measure RVEF from multicrystal first-pass data, 25 patients underwent sequential cine-MRI, first-pass radionuclide angiography, and gated equilibrium imaging. Five additional healthy volunteers underwent cine-MRI alone. Right and left ventricular volumes were measured from serial short axis cine-MRI views according to Simpson's rule. Three methods were used to calculate RVEF from first-pass data: a single ROI method, a dual ROI method, and a method in which a single ROI is applied to RA subtracted first-pass dynamic data. Five additional healthy volunteers underwent cine-MRI alone. When right ventricular stroke volume was plotted versus left ventricular stroke volume for the 5 volunteers and the 15 patients without valvular regurgitation, the regression line was not significantly different from the line of identity, supporting the accuracy of cine-MRI to measure RVEF. The RVEF by cine-MRI ranged from 34% to 59%; first-pass RVEF with a single ROI from 26% to 48%; first-pass RVEF with two ROIs from 31% to 59%; first-pass RVEF with RA subtracted single ROI from 29% to 60%; and RVEF from GBPS with multiple ROIs from 28% to 55%. The regressions for all three of the first-pass methods versus cine-MRI were significant (p < 0.01) as was the regression for the equilibrium GBPS versus cine-MRI but the correlation was weaker. The regressions for the 2-ROI method and for the RA subtracted single ROI method were not significantly different from the line of identity, whereas the regressions for both the single ROI method and for equilibrium GBPS were significantly different from the line of identity (p < 0.01). CONCLUSIONS: Cine-MRI can be used to validate radionuclide algorithms. Of the four radionuclide methods for measuring RVEF that were assessed, the first-pass 2-ROI method and the first-pass RA subtracted single ROI are the most accurate, the first-pass single ROI method underestimates RVEF, and the RVEF values measured from GBPS are less accurate.     

Emotional and motivational changes after bilateral lesions of the globus pallidus.

This study investigated motivational changes in a 44 year-old man (PJ) who developed considerable reduction in spontaneous activity and speech, flat affect, social withdrawal, loss of interest, inability to "feel," and lack of concern regarding his medical condition after bilateral, focal, anoxic lesions of the globus pallidus. PJ and 30 male controls performed a task designed to parse hedonic evaluation, or liking, from incentive motivation, or wanting. Affective stimuli were presented on a computer screen and subjects controlled viewing time by pressing keys. PJ's liking and wanting of unpleasant stimuli was similar to that of controls. In response to pleasant stimuli, PJ showed normal ratings of wanting and hedonic appreciation, but significantly reduced viewing time or made no responses. Active withdrawal from liked stimuli could constitute the basic mechanism underlying poor motivation and social withdrawal associated with globus pallidus damage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regeneration of sudomotor and sensory nerve fibres after digital replantation and microneurovascular toe-to-hand transfer

We analyzed the informations concerning the late postoperative evolution for 405 (60%) of 760 patients with colon cancer operated between 1968-1996 in the Surgical Clinic from Tg.-Mure? and we found a global 5-year survival rate of 35.57%. The conclusion after this study was that the most important worsening prognostic factors were the advanced stage evolution of the tumor and the occlusion. The females had a better prognosis than the males. The rural patients had a better prognosis than the urban. In our study the younger age isn't a worsening factor for survival. The patients with a longer history of the symptoms had an unexpected better survival rate than the others. Localization of the tumors at the site of the descending colon and flexures is an important negative prognostic factor. The penetrating feature of the tumor is more important than the lymphatic invasion for prognosis. Subtotal colectomy performed for stenotic tumors of the left colon, even in emergency for occlusions gave us one of the best 5-year survival rate (75%). The histopathologic type of undifferentiated carcinoma and the mucinous adenocarcinoma are associated with the poorest survival rate. The lymphoma has a better survival rate than the carcinoma. The perioperative blood transfusion, even though is associated with a low survival rate it is not an important prognostic factor.