Biomedical subjects

Emeka Nkenke

Publications and source records attributed to Emeka Nkenke.

At least 19 recordsLinked to original sources

PubMed2006

Expression of ets-1 is not affected by N-ras or H-ras during oral oncogenesis.

PURPOSE: To determine whether ras-activated cascades lead to activation of ets-1 expression in sequential histological stages of oral oncogenesis in an experimental animal model. METHODS: Thirty-seven Syrian golden hamsters were divided into three experimental groups (A, B, C) and one control group. The hamsters' buccal pouches in experimental groups were treated with 0.5% 9, 10-dimethyl-1, 2-benzanthracene (DMBA) for 14 weeks and were excised at 10, 14, 19 weeks, respectively. The biopsies were classified pathologically (normal mucosa, hyperkeratosis, hyperplasia, dysplasia, early invasion, well and moderately differentiated carcinoma) and studied immunohistochemically. The two-tailed Student's t test was performed for each animal group and for each histological category. RESULTS: The ets-1 expression increased in early stages of oral tumor formation and invasion. The expression of N-ras gradually decreased during oral oncogenesis, as previously observed with H-ras. CONCLUSIONS: Neither N-ras nor H-ras affects ets-1 expression in contrast to other types of cancer in which N-ras and ets-1 are implicated in the same signalling pathway. Therefore, the existing pathway implicating these proteins might be somehow altered in oral cancer. It seems that ets-1 is a good prognostic marker for invasiveness and progression of oral cancer.

9,10-Dimethyl-1,2-benzanthracene↗

PubMed2006

Evaluation of speech intelligibility for children with cleft lip and palate by means of automatic speech recognition.

OBJECTIVE: Cleft lip and palate (CLP) may cause functional limitations even after adequate surgical and non-surgical treatment, speech disorders being one of them. Interindividually, they vary a lot, showing typical articulation specifics such as nasal emission and shift of articulation and therefore a diminished intelligibility. Until now, an objective means to determine and quantify the intelligibility does not exist. METHOD: An automatic speech recognition system, a new method, was applied on recordings of a standard test to evaluate articulation disorders (psycholinguistic analysis of speech disorders of children PLAKSS) of 31 children at the age of 10.1+/-3.8 years. Two had an isolated cleft lip, 20 a unilateral cleft lip and palate, 4 a bilateral cleft lip and palate, and 5 an isolated cleft palate. The speech recognition system was trained with adults and children without speech disorders and adapted to the speech of children with CLP. In this study, the automatic speech evaluation focussed on the word accuracy which represents the percentage of correctly recognized words. Results were confronted to a perceptive evaluation of intelligibility that was performed by a panel of three experts. RESULTS: The automatic speech recognition yielded word accuracies between 1.2 and 75.8% (mean 48.0+/-19.6%). The word accuracy was lowest for children with isolated cleft palate (36.9+/-23.3) and highest for children with isolated cleft lip (72.8+/-2.9). For children with unilateral cleft lip and palate it was 48.0+/-18.6 and for children with bilateral cleft lip and palate 49.3+/-9.4. The automatic evaluation complied with the experts' subjective evaluation of intelligibility (p<0.01). The multi-rater kappa of the experts alone differed only slightly from the multi-rater kappa of experts and recognizer. CONCLUSION: Automatic speech recognition may serve as a good means to objectify and quantify global speech outcome of children with cleft lip and palate.

Adolescent↗

PubMed2006

Nasolabial symmetry following Tennison-Randall lip repair: a three-dimensional approach in 10-year-old patients with unilateral clefts of lip, alveolus and palate.

AIM: To assess the degree of facial symmetry in patients suffering from unilateral cleft lip, alveolus and palate (UCLAP) by determining differences between the cleft and the non-cleft hemifaces from 3D surface data. PATIENTS AND METHODS: In twenty-two 10-year-old UCLAP patients, who had the lip repaired using the Tennison-Randall technique and did not undergo further revisional surgery, differences were determined between landmarks, surface areas of the upper lip vermilion and nostrils and virtual volumes of midface, nose and upper lip for cleft and non-cleft sides, separately, after having established a plane of symmetry calculated from optical 3D facial surface data. RESULTS: Statistically significant differences could be found between cleft and non-cleft sides for the nasal landmarks G(lat), G(sup) and La(med), the nostril angle and the virtual volume of the nose (p(Glat)=0.011, p(Gsup)<0.0005, p(Lamed)=0.002, p(nostril angle)=0.036 and p(nose volume)<0.0005, resp.). CONCLUSION: Analysis of 3D data shows that complete nasal symmetry is difficult to achieve with Tennison-Randall's lip repair without revisional surgery. Further trials on larger populations of patients will allow a more comprehensive and consistent analysis of the consequence of different methods for cp repair in order to identify the techniques with the best outcome in terms of facial symmetry.

Cephalometry↗

PubMed2006

Intraoperative noncontact, nonionizing, optical 3D exophthalmometry during repositioning of dislocated globes: first results.

PURPOSE: This study reports on the intraoperative use of noncontact, nonionizing, optical 3-dimensional (3D) exophthalmometry during the repositioning of dislocated globes as a result of trauma. PATIENTS AND METHODS: Ten patients (4 female, 6 male, 41.4+/-15.2 years) with a relative enophthalmos of the globe as a result of zygomatic fractures were included in the study. Preoperatively, en- and exophthalmometry data were assessed from axial CT slices and optical 3D imaging. 3D data were analyzed twice for the assessment of measurement errors. Intraoperatively, optical en- and exophthalmometry was carried out to control the globe position. Surgery was considered successful when the relative en- or exophthalmos no longer exceeded 2 mm. Optical 3D en- and exophthalmometry data were reassessed 5 days and 3 months after surgery. RESULTS: Method error was 0.184 mm for optical 3D en- and exophthalmometry. The preoperatively assessed en- and exophthalmometry data determined from axial CT scans and from optical 3D images did not differ significantly statistically (P=.538). When the preoperative en- and exophthalmometry data were compared to the values assessed at the end of surgery, a significant improvement in globe position was found (P=.005). Although a relative en- or exophthalmos of 2 mm was not exceeded in any of the patients 3 months after surgery, en- and exophthalmometry data differed significantly statistically from the data assessed at the end of the operation (P=.005). CONCLUSIONS: Intraoperative optical en- and exophthalmometry is an effective means to support the surgeon in objectively optimizing the globe position with small measurement errors.

Adult↗

PubMed2006

Is there a need for autogenous blood donation in orthognathic surgery?

BACKGROUND: The present study sought to determine the frequency of blood transfusion and to evaluate the need for autogenous blood donations in patients undergoing bimaxillary orthognathic surgery. METHODS: According to an inclusion and exclusion protocol, 65 patients were selected for further analysis. Twenty-six patients donated a total of 45 units of autogenous blood; the remaining 39 patients did not. Medical records were reviewed retrospectively. RESULTS: Donors tended to have lower preoperative, intraoperative, and postoperative hemoglobin values, as well as lower hematocrit and leukocyte counts. Only the difference in mean preoperative leukocyte count, however, was statistically significant (donor: 6500/microl versus nondonor: 7400/microl; p = 0.021). The rate of transfusion was 2.5 percent for nondonors and 13 percent for donors of autogenous blood. Six donors had to be transfused a total of 8 units of autogenous blood, whereas only one of 39 nondonors received an allogenic blood transfusion. This difference turned out to be significant according to Fisher's exact test (p = 0.013). None of the donors received allogenic blood transfusion. CONCLUSIONS: In the authors' analysis, preoperative autogenous blood donation appears to be effective in reducing exposure to allogenic blood. Donors of autogenous blood, however, were transfused significantly more often than nondonors were. Neither intraoperative blood loss nor hematological values justify a preoperative donation of autogenous blood on a regular basis.

Adult↗

PubMed2006

Indications for immediate loading of implants and implant success.

It was the aim of this review to compare the survival and success rates of immediately loaded dental implants with those of conventionally loaded dental implants, based on prospective controlled studies and prospective studies without controls. Studies on immediate loading were identified in the current literature by electronic and hand searches. Only clinical data on root-form or cylindrical threaded oral implants were included. For immediate loading of oral implants in the edentulous and partially dentate, mandible and maxilla controlled studies could be found. All of these studies were based on limited patient numbers. Therefore, definitive conclusions could not be drawn concerning survival and success rates of immediately loaded implants compared with conventionally loaded implants. The compilation of the current literature shows that prospective controlled studies as well as prospective studies without controls using several different approaches to immediate loading have demonstrated high implant survival and success rates. However, more high-level evidence-based studies are needed to demonstrate the relative merits of immediate loading compared with conventional loading in all potential applications.

Dental Implantation, Endosseous↗

PubMed2006

Determination of facial symmetry in unilateral cleft lip and palate patients from three-dimensional data: technical report and assessment of measurement errors.

OBJECTIVE: To assess measurement errors of a novel technique for the three-dimensional determination of the degree of facial symmetry in patients suffering from unilateral cleft lip and palate malformations. DESIGN: Technical report, reliability study. SETTING: Cleft Lip and Palate Center of the University of Erlangen-Nuremberg, Erlangen, Germany. PATIENTS: The three-dimensional facial surface data of five 10-year-old unilateral cleft lip and palate patients were subjected to the analysis. Distances, angles, surface areas, and volumes were assessed twice. MAIN OUTCOME MEASURES: Calculations were made for method error, intraclass correlation coefficient, and repeatability of the measurements of distances, angles, surface areas, and volumes. RESULTS: The method errors were less than 1 mm for distances and less than 1.5 degrees for angles. The intraclass correlation coefficients showed values greater than .90 for all parameters. The repeatability values were comparable for cleft and noncleft sides. CONCLUSION: The small method errors, high intraclass correlation coefficients, and comparable repeatability values for cleft and noncleft sides reveal that the new technique is appropriate for clinical use.

Anthropometry↗

PubMed2005

Computed tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible.

The aim of this work was to compare the potential of computed tomography angiography (CTA) with that of digital subtraction angiography (DSA) in vascular mapping of the external carotid artery (ECA) branches for planning of microvascular reconstructions of the mandible with osteomyocutaneous flaps. In 15 patients CTA and DSA were performed prior to surgery. Selective common carotid angiograms were acquired in two projection for both sides of the neck. Sixteen-slice spiral computed tomography was performed with a dual-phase protocol, using the arterial phase images for 3D CTA reconstruction. Thin-slab maximum intensity projections and volume rendering were employed for postprocessing of CTA data. The detectability of the different ECA branches in CTA and DSA was evaluated by two examiners. No statistically significant differences between CTA and DSA (p=0.097) were found for identifying branches relevant for microsurgery. DSA was superior to CTA if more peripheral ECA branches were included (P=0.030). CTA proved to be a promising alternative to DSA in vascular mapping for planning of microvascular reconstruction of the mandible.

Angiography, Digital Subtraction↗

PubMed2005

Expression of bone morphogenic protein 2/4, transforming growth factor-beta1, and bone matrix protein expression in healing area between vascular tibia grafts and irradiated bone-experimental model of osteonecrosis.

PURPOSE: For the surgical treatment of osteoradionecrosis after multimodal therapy of head-and-neck cancers, free vascular bone grafts are used to reconstruct osseous structures in the previously irradiated graft bed. Reduced, or even absent osseous healing in the transition area between the vascular graft and the irradiated graft bed represents a clinical problem. Inflammatory changes and fibrosis lead to delayed healing, triggered by bone morphogentic protein 2/4 (BMP2/4) and transforming growth factor (TGF)-beta(1). Given the well-known fibrosis-inducing activity of TGF-beta(1), an osteoinductive effect has been reported for BMP2/4. However, the influence of irradiation (RT) on this cytokine expression remains elusive. Therefore, the aim of the present in vivo study was to analyze the expression of BMP2/4, TGF-beta(1), collagen I, and osteocalcin in the transition area between the bone graft and the graft bed after RT. METHODS AND MATERIALS: Twenty Wistar rats (male, weight 300-500 g) were used in this study. A free vascular tibia graft was removed in all rats and maintained pedicled in the groin region. Ten rats underwent RT with 5 x 10 Gy to the right tibia, the remainder served as controls. After 4 weeks, the previously removed tibia grafts were regrafted into the irradiated (Group 1) and nonirradiated (Group 2) graft beds. The interval between RT and grafting was 4 weeks. After a 4-week osseous healing period, the bone grafts were removed, and the transition area between the nonirradiated graft and the irradiated osseous graft bed was examined histomorphometrically (National Institutes of Health imaging program) and immunohistochemically (avidin-biotin-peroxidase complex) for the expression of BMP2/4, TGF-beta(1), collagen I, and osteocalcin. RESULTS: Absent or incomplete osseous healing of the graft was found in 9 of 10 rats after RT with 50 Gy and in 1 of 10 of the rats with nonirradiated osseous grafts. Histomorphometrically, the proportion of osseous healing in the transition area was 17% in Group 1 and 48% in Group 2 (p = 0.001). Compared with the nonirradiated rats, reduced enchondral and perichondral ossification was found in the healing area after RT, with a reduction of BMP2/4 and osteocalcin expression. TGF-beta(1) and collagen I expression in the transition area to the irradiated osseous graft bed was significantly increased compared with that in the nonirradiated osseous graft bed. CONCLUSION: After RT, osseous healing of vascular bone grafts is significantly reduced and may be a result of radiation-induced inhibition of BMP2/4 and osteocalcin expression. In addition, induction of TGF-beta(1) and collagen I expression occurs. Because the effects of the TGF-beta superfamily are manifold and partially unknown, additional research directions could be in the exogenous application of BMP2/4 and inhibition of TGF-beta(1) by antibody treatment to search for appropriate therapeutic approaches for improving osseous healing in the irradiated graft bed.

Animals↗

PubMed2005

Statistical face models for the rediction of soft-tissue deformations after orthognathic osteotomies.

This paper describes a technique to approximately predict the facial morphology after standardized orthognathic ostoetomies. The technique only relies on the outer facial morphology represented as a set of surface points and does not require computed tomography (CT) images as input. Surface points may either be taken from 3D surface scans or from 3D positions palpated on the face using a tracking system. The method is based on a statistical model generated from a set of pre- and postoperative 3D surface scans of patients that underwent the same standardized surgery. The model contains both the variability of preoperative facial morphologies and the corresponding postoperative deformations. After fitting the preoperative part to 3D data from a new patient the preoperative face is approximated by the model and the preiction of the postoperative morphology can be extracted at the same time. We built a model based on a set of 15 patient data sets and tested the predictive power in leave-one-out tests for a set of relevant cephalometric landmarks. The average prediction error was found to be between 0.3 and 1.2 mm at all important facial landmarks in the relevant areas of upper and lower jaw. Thus the technique provides an easy and powerful way of prediction which avoids time, cost and radiation required by other prediction techniques such as those based on CT scans.

Computer Simulation↗

PubMed2005

Evaluation of speech disorders in children with cleft lip and palate.

BACKGROUND: We investigated the reliability of nasopharyngoscopy and auditory perception, two common clinical methods employed in examining the speech pathology of children with cleft lip and palate. PATIENTS AND METHODS: Nasopharyngoscopy was performed to assess velopharyngeal closure function and nasopharyngeal morphology. The auditory examination evaluated nasality and other speech disorders such as articulatory tension, shift in articulation, and sigmatism. The study was based on the audio and video recordings of twelve patients (9.5 +/- 0.5 years) after surgical rehabilitation of their cleft lip and palate. The speech sample consisted of reading a standardized sequence of words. The recordings were analyzed by several examiners with different experience in the evaluation procedure at two time-points. Inter-rater and intra-rater reliability was determined by Cohen's Kappa coefficient and by estimation of the 95% intervals of confidence. RESULTS: Analysis of the visual and auditory-perceptual findings by the experienced raters was highly reliable. However, the less experienced raters' results showed greater variability, as did morphological evaluation in both groups. Comparison between visual and auditory evaluations concerning hypernasality resulted in little correlation. CONCLUSIONS: These two subjective methods of evaluation are recommended because of their high reliability with experienced raters. Our results suggest that "experience" is an essential criterion in determining the structural quality of the morphological and functional assessment of typical speech pathologies in children with cleft lip and palate. In addition, the data demonstrate the necessity of special multidisciplinary rehabilitation teams in so-called cleft centers.

Child↗

PubMed2005

Restricted-expressed proliferation-associated protein (Repp86) expression in squamous cell carcinoma of the oral cavity.

PURPOSE: To determine the expression of repp86 (restricted-expressed protein of 86 kDa theoretical molecular mass), a proliferation- associated protein expressed in S-, G(2)- and M-phases of the cell cycle, in samples of normal mucosa as well as squamous cell carcinoma of the oral cavity (OSCC). PATIENTS AND METHODS: The repp86 labeling index (LI) was determined imunohistochemically in ten samples of normal oral mucosa and 59 samples of OSCC. Repp86 LI was correlated with tumor stage, histopathologic grading, and the expression of Ki-67 and topoisomerase IIalpha. RESULTS: Repp86 was detectable in all tissues analyzed. The mean LI was 4.7% for normal mucosa and 18.4% for squamous cell carcinoma (p < 0.0001). Repp86 expression was not related to tumor size, lymph node invasion, or histopathologic grading but was positively correlated with Ki-67 index (r = 0.48; p < 0.01) as well as with topoisomerase IIalpha (r = 0.39; p < 0.01). Ki-67 and topoisomerase IIalpha levels were also significantly correlated with each other (r = 0.34; p < 0.05). CONCLUSION: These results indicate that repp86 expression can be an additional proliferation marker among Ki-67 and topoisomerase IIalpha in OSCC. Further research will be directed at the evaluation of the prognostic value of repp86 expression in OSCC as well as in leukoplakia and early-stage OSCC.

Adult↗

PubMed2005

Untreated 'blow-in' fracture of the orbital floor causing a mucocele: report of an unusual late complication.

BACKGROUND: Several severe complications have been described with blow-in fractures. Therefore, immediate surgical treatment of these fractures has been recommended. To date, there is only minimal knowledge on long-term complications of blow-in fractures that have remained untreated. The present case report describes a late complication of an untreated blow-in fracture of the orbital floor. CASE: A 37-year-old male was involved in a car accident 16 years before. At that time, a non-dislocated midfacial fracture was diagnosed and remained untreated because of the lack of clinical symptoms. Four months before surgery an exophthalmos of the left globe began to develop. CT examination revealed a consolidated blow-in fracture of the left orbital floor and an opaque mass around the dislocated bony fragments. By an infraorbital approach the bony fragments and the surrounding mass were removed. Histological examination of the removed material revealed a cystic structure lined with respiratory epithelium. Therefore, the diagnosis 'post-traumatic mucocele in the orbit caused by dislocated respiratory epithelium from the maxillary sinus' was made. CONCLUSION: Even if blow-in fractures do not cause complications immediately after trauma, late complications like mucoceles can occur after several symptom-free years. Therefore, early reconstruction should be intended even in asymptomatic cases of blow-in fractures with minimal displacement of the bony fragments.

Accidents, Traffic↗

PubMed2005

Hemoglobin value reduction and necessity of transfusion in bimaxillary orthognathic surgery.

PURPOSE: It has been the aim of the present clinical study to assess the reduction of the hemoglobin value and the frequency of blood transfusions during bimaxillary orthognathic surgery and to discuss the clinical consequences. PATIENTS AND METHODS: Fifty-six patients (31 female, 25 male; mean age, 28.6 +/- 13.0 years; range, 14 to 66 years) were operated on. Twenty-nine patients predeposited blood before surgery. As a threshold for intraoperative or postoperative transfusion, a hemoglobin value of 7.5 g/100 mL was chosen. RESULTS: Perioperatively, the hemoglobin values of the patients who predeposited blood decreased significantly after blood donation. The hemoglobin value reduced postoperatively by 2.6 +/- 1.4 g/100 mL in the non-donors and by 2.6 +/- 1.1 g/mL in the donors. None of the patients who did not predeposit blood received homologous blood transfusions intraoperatively or postoperatively. In the group of patients who predeposited blood, 3 were transfused intraoperatively. They received 1 or 2 units of autologous blood. CONCLUSION: The individual statistics of the department show that there was only a limited reduction of the intraoperative and postoperative hemoglobin values as a consequence of bimaxillary orthognathic surgery. The increased safety of homologous blood and the minimal transfusion rates support abandonment of routine predepositing of autologous blood and the acceptance of homologous blood in the rare case of transfusion in bimaxillary surgery.

Adolescent↗

PubMed2005

Clinical fit of all-ceramic three-unit fixed partial dentures, generated with three different CAD/CAM systems.

In this study, the hypothesis was tested that the marginal and internal fit of CAD/CAM fabricated all-ceramic three-unit fixed partial dentures (FPDs) can be as good as in metal-ceramic FPDs. Twenty-four all-ceramic FPDs were fabricated and randomly subdivided into three equally sized groups. Eight frameworks were fabricated using the Digident CAD/CAM system (DIGI), another eight frameworks using the Cerec Inlab system (INLA). Vita Inceram Zirkonia blanks were used for both groups. In a third group frameworks were milled from yttrium-stabilized Zirconium blanks using the Lava system (LAVA). All frameworks were layered with ceramic veneering material. In addition, six three-unit metal-ceramic FPDs served as control group. All FPDs were evaluated using a replica technique with a light body silicone stabilized with a heavy body material. The replica samples were examined under microscope. The medians of marginal gaps were 75 microm for DIGI, 65 microm for LAVA and INLA and 54 microm for the conventional FPDs. Only the DIGI data differed significantly from those of the conventional FPDs. Within the limits of this study, the results suggest that the accuracy of CAD/CAM generated three-unit FPDs is satisfactory for clinical use.

Aluminum Oxide↗

PubMed2004

Effects of platelet-rich plasma on bone healing in combination with autogenous bone and bone substitutes in critical-size defects. An animal experiment.

OBJECTIVES: An animal study was carried out to investigate the influence of platelet-rich plasma (PRP) on the regeneration of bony defects. MATERIAL AND METHODS: Critical-size defects in the forehead region of a mini-pig were filled with randomly distributed combinations of autogenous bone, tricalcium-phosphate granules (CeraSorb), bovine spongious blocks (BioOss) and a bovine bone inducing collagenous sponge (Colloss) with and without PRP in two preparations (Cusasan, 3i). The animals were killed after 2, 4 and 12 weeks. The specimens were evaluated microradiographically and immunohistologically. RESULTS: Autologous bone (38 +/- 9.9%) and Colloss (52.6 +/- 4.0%) showed the highest remineralization rates at 2 weeks. The initial high expression of BMP-2 in the Colloss-group gives evidence of an early initiation of bony regeneration. At 2 weeks PRP ad modum 3i was able to enhance bone healing significantly (P=0.028) only when applied in combination with autogenous bone (62.8 +/- 1.6%). Four weeks after surgery, both PRP preparations did no longer increase bony regeneration in the autogenous groups. The osteoconductive effect of Bio-Oss (38.7 +/- 5.5%) and CeraSorb (41+/-4.9%) was remarkable as well 4 weeks after surgery. Nevertheless, the addition of PRP hardly influenced bony regeneration, ceramic degradation or cytokine expression when bone substitutes were applied. At 12 weeks, the level of reossification had adjusted similarly in all groups. CONCLUSION: PRP did not add additional benefit when xenogenic bone substitutes were used. However, a significant effect on bone regeneration was found in the autogenous group initially when PRP is added.

Animals↗

PubMed2004

Life-threatening thrombotic thrombocytopenic purpura associated with dental foci. Report of two cases.

OBJECTIVES: Thrombotic thrombocytopenic purpura (TTP) is a rare haematological disease of unknown aetiology. This thrombotic microangiopathy is characterized by microvascular lesions with platelet aggregation. It is found in adults and can be associated with pregnancy, cancer, autoimmune diseases, bone marrow transplantation, drugs and bacterial as well as viral infections. The therapy requires a multi-disciplinary team approach involving dentistry. Even if TTP is immediately treated in an adequate manner, it still shows a mortality of up to 20%. AIM: To define a specific treatment concept for periodontal disease and decayed teeth in patients suffering from TTP based on the experiences gained from two cases. CONCLUSION: The two patient cases revealed a possible association of TTP with dental foci. Because of the severity and mortality of this disease, both prognosis evaluation and treatment standards of periodontologically compromised or decayed teeth have to be strictly followed in patients suffering from TTP. In order to avoid recurrence of TTP, it seems important to remove radically teeth of questionable prognosis.

Adult↗

PubMed2004

Submental cutaneous sinus tract as a result of progressive peri-implantitis: a case report.

BACKGROUND: The aim of the present case report was to define diagnosis and treatment options of a submental cutaneous sinus tract as a result of a progressive peri-implantitis around mandibular dental implants in a patient with a history of oral squamous cell carcinoma. METHODS: Before the removal of the submental fistula, a panoramic radiograph and a computed tomography of the head and neck were assessed to identify the implants responsible for the cutaneous sinus tract and to exclude the presence of a tumor recurrence and lymph node metastases. The involved implants were removed, as there was a communication along them between the oral cavity and the cutaneous sinus tract resulting from progressive peri-implantitis. A histological examination of the excised fistula was carried out. RESULTS: The histological examination excluded a recurrence of the oral squamous cell carcinoma. The fistula completely consisted of granulation tissue without epithelialization. After affected implants were removed, the wound healing was uneventful. CONCLUSIONS: A panoramic radiograph is mandatory to identify the involved implants. Computed tomography, and excision of the fistula and a histological examination should be performed only in patients with a history of oral squamous cell carcinoma. Since the cutaneous sinus tract showed no epithelialization, it healed spontaneously after the removal of the responsible implants. Because of the large bony defect caused by progressive peri-implantitis leading to a communication of the oral cavity with the cutaneous sinus tract, more conservative treatment options with preservation of the implants could not be adopted in the present case.

Carcinoma, Squamous Cell↗