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Biomedical subjects

S Sindet-Pedersen

Publications and source records attributed to S Sindet-Pedersen.

At least 55 records · Page 3Linked to original sources
PubMed1992

Zygomatic fractures and infraorbital nerve disturbances. Miniplate osteosynthesis vs. other treatment modalities.

The present paper reviews the results obtained with different modalities of treatment employed in isolated fractures of the zygomatic complex. Seventy-three patients were re-examined with respect to infraorbital nerve function. The results obtained suggest that the incidence of hypoaesthesia of the infraorbital nerve following fracture of the zygomatic complex can be reduced if rigid fixation is applied on the infraorbital rim. The zygomatic bone is a protruding part of the human skeleton and is therefore easily affected by trauma to the facial region. The etiology and clinical appearance of fractures of the zygomatic complex are well known and previously described in detail (Afzelius and Rosen 1980, Ellis et al. 1985, Jungell and Lindqvist 1987). Fractures of the zygomatic complex are rarely fractures of the zygoma itself but of its connection to the skull and facial skeleton, e.g. the frontozygomatic suture, the zygomatico-maxillary suture, the zygomatic arch and the infraorbital rim. A fracture of the infraorbital rim usually involves the infraorbital foramen or bone close to it. Such a fracture also extends into the orbital floor through or adjacent to the infraorbital canal. Dislocation of the fractured zygomatic complex may thus result in injury to or compression of the infraorbital nerve. Such an injury may cause numbness/hypoaesthesia/dysaesthesia in the distribution of the nerve. Accordingly, reduced infraorbital nerve function is a frequently reported sequela of fractures of the zygomatic complex. Thus impaired infraorbital nerve function prior to treatment has been reported to occur in approximately 80% of such cases (Table 1). With respect to persistent impaired function of the infraorbital nerve, the literature demonstrates varying results following different types of treatment, ranging from 22% to 50% persistent hypoaesthesia (Table 1). Interestingly, the return of infraorbital nerve function continues with an extended observation period between treatment and follow-up and it has been claimed that infraorbital nerve function may continue to improve even after one year following injury/surgery (Afzelius and Rosen 1980). Cases with persistent and disturbing impaired function of the infraorbital nerve may be considered for decompressive nerve surgery or microsurgical reconstruction of the infraorbital nerve (Mozsary and Middleton 1983). The present report is a retrospective study and aimed to evaluate the recovery of infraorbital nerve function obtained with different modalities of treatment of isolated fractures of the zygomatic complex.

Bone Plates↗
PubMed1992

Treatment of mandibular fractures with or without intermaxillary fixation--a comparative study.

The aim of the present study was to evaluate titanium miniplates for treatment of mandibular fractures compared to routine treatment of the department (control). The study included 74 dentate patients with fractures within the tooth bearing regions of the mandible. Two groups of patients were studied:(A), 42 patients with unilateral fractures of the angle or anterior to the mental foramen and (B), 32 patients with bilateral fractures of the mandible. Patients with unilateral fractures were randomized for the control group (n = 20) or the experimental group (n = 22). Group B included two groups of patients, a control group of 16 consecutive patients previously treated, and an experimental group of 16 consecutive prospectively studied patients. All patients in the control groups received open reduction and IMF for 5 weeks. Fractures of the angle were stabilized with an 0.4 stainless-steel wire superior border osteosynthesis, whereas fractures anterior to the mental foramen were treated with a stainless steel plate osteosynthesis. Patients in the experimental groups were treated with IMF only during surgery, thereafter the IMF was released. In fractures of the angle, one titanium mini-plate was used, whereas two were employed in fractures anterior to the mental foramen. The results were comparable in both groups with respect to occlusion and complications. We conclude that the titanium mini-plates offer sufficient stabilization of mandibular fractures to allow treatment without post-reduction IMF. This technique is associated with a low complication rate and reduced morbidity as compared to conventional treatment.

Adolescent↗
PubMed1991

The transmandibular implant: a 13-year survey of its use.

During the period from August 1976 until July 1989 the transmandibular implant was introduced in a total of 31 oral and maxillofacial surgery departments in the Netherlands and 1,466 patients were treated. This study includes 1,356 treated patients from 28 departments. The treatment course of 1,201 patients (89.6%) was uneventful. Of the 157 complications, 58 related to the anatomic contour of the mandible, 49 to the surgery, 25 to the prosthetic reconstruction, 8 to the psychosocial attitude of the patient, 8 to the use of medication, 5 to trauma, and 4 to the presence of a skin graft. Treatment of the complications included removal of the implant in 44 patients; in 106 patients the complication was treated satisfactorily. In the remaining 7 patients, hypesthesia was present. The reasons for the removal of the 44 implants were infection (11), operative error (5), premature loading of the implant (3), insufficient width of the mandible after a visor osteotomy (1), loss of osseointegration caused by the prosthesis (14), psychological problems (4), trauma (3), drug-related gingival hyperplasia (2), and inexplicable pain (1). The present survey shows a consistent success rate of 96.8%.

Adult↗
PubMed1991

Autogenous mandibular bone grafts and osseointegrated implants for reconstruction of the severely atrophied maxilla: a preliminary report.

The purpose of this study is to present results obtained with a new procedure for reconstruction of the severely atrophied maxillary alveolar ridge that involves the use of intramembranous corticocancellous bone grafts obtained from the mandibular symphysis fixed to the residual bone by endosseous implants. A total of 107 implants were installed in grafted regions in 26 patients. The follow-up period ranged from 6 to 32 months, with a mean of 16 months. In partially edentulous patients the bone grafts were fixed with implants to the residual bone as 1) onlay graft to the alveolar ridge (8 implants in 4 patients); 2) grafts to the nasal and/or sinus floor after a transoral exposure and elevation of the mucosa of the maxillary sinus and/or the nasal mucosa (33 implants in 11 patients); or 3) a combination of these two (5 implants in 2 patients). In totally edentulous patients, implants and grafts were used as a combination of grafting to both the alveolar ridge and nasal and/or sinus floor sites (61 implants in 9 patients). One hundred of 107 implants showed normal clinical and radiologic healing, whereas 7 implants in 4 patients (6.5%) were lost prior to loading. Seventeen patients have had the implants and bone grafts loaded by a prosthodontic reconstruction from 6 to 26 months (mean, 14 months) without loss of any implants. Postoperative marginal resorption of the onlay bone graft of less than 15% was observed. These findings suggest, that the previously observed rapid resorption of endochondral iliac crest onlay bone grafts and the number of lost implants can be significantly reduced if bone from the mandibular symphysis firmly anchored with titanium implants is used.

Adolescent↗
PubMed1991

Haemostasis in oral surgery--the possible pathogenetic implications of oral fibrinolysis on bleeding. Experimental and clinical studies of the haemostatic balance in the oral cavity, with particular reference to patients with acquired and congenital defects of the coagulation system.

Activation and inhibition of the haemostatic system was reviewed including the interaction between the four biological systems involved in haemostasis: the vessel wall, the platelets, the coagulation system and the fibrinolytic system. The haemostatic mechanism is initiated at the site of injury through local activation of surfaces and release of tissue thromboplastin, resulting in formation and deposition of fibrin. The coagulation process is regulated by physiological anticoagulants. Activation of fibrinolysis is triggered by the presence of fibrin, and the role of tissue-type plasminogen activators (t-PA) at the site of fibrin formation in particular is emphasized. The process is regulated by physiological inhibitors, of which alpha 2-antiplasmin, histidine-rich glycoprotein and plasminogen activator inhibitor are reported to be of major physiological significance. The role of fibrinolysis in the regulation of the dynamic haemostatic balance is discussed, elucidated through examples of congenital deficiencies of the coagulation and the fibrinoytic system. Pharmacological inhibitors of fibrinolysis (i.e. epsilon-aminocaproic acid and tranexamic acid) and their possible effect on the haemostatic system are described. The systemic effects on the fibrinolytic system of surgery and oral surgery is reviewed, and it is concluded, that oral surgery has insignificant effects on blood fibrinolysis. In contrast, oral surgery induces changes of fibrinolysis in the oral environment; initially the fibrinolytic activity of saliva is reduced, due to the presence of inhibitors of fibrinolysis originating from the blood and the wound exudate. When bleeding and exudation cease, the fibrinolytic activity of the saliva will increase. Plasminogen and plasminogen activator, identified as t-PA are present in the oral environment under physiological conditions. Plasminogen is secreted in the saliva and the sources of t-PA include oral epithelial cells and gingival crevicular fluid. The presence of plasminogen and t-PA in the oral environment implies that when fibrin is present (i.e. after surgery), fibrinolysis is triggered. Haemorrhagic complications to oral surgery in patients without known defects of the coagulation system is reviewed. It is concluded that the investigations conducted to the present day do not permit final conclusions with respect to the pathophysiological role of defects in the coagulation and the fibrinolytic systems for the development of bleeding after oral surgery. Further investigations are necessary in order to clarify these aspects, and should include extensive laboratory analyses to reveal rare congenital defects such as factor XIII- and alpha 2-antiplasmin deficiencies.(ABSTRACT TRUNCATED AT 400 WORDS)

Anticoagulants↗
PubMed1990

Reconstruction of the severely resorbed maxilla with bone grafting and osseointegrated implants: a preliminary report.

This article describes a surgical procedure for rehabilitation of the severely atrophic maxillary alveolar ridge by bone grafting to the maxillary sinus and nasal floor followed by installation of implants in the grafted regions at a second operation. Five treated cases are presented. Further data are considered necessary to evaluate the procedure before it can be recommended for routine use.

Adult↗
PubMed1990

Reconstruction of alveolar clefts with mandibular or iliac crest bone grafts: a comparative study.

The aim of this study was to compare the results of treatment obtained with mandibular symphyseal and iliac crest bone grafts used for reconstruction of alveolar clefts. The study included 40 patients with unilateral cleft lip palate (UCLP): 20 consecutive patients whose defects were reconstructed with mandibular bone grafts (MBG) and 20 randomly selected UCLP patients who underwent reconstruction with iliac crest bone (ICB). The age at surgery varied from 8 to 13 years (mean age MBG group, 9.1 years; ICB group, 10.3 years), and the postoperative observation period varied from 12 to 33 months (mean, 19 months). Transverse expansion of the maxilla was not completed until after the bone grafting in the group of patients receiving MBGs, whereas it was completed before surgery in the ICB group. The observed marginal bone level on cleft-related teeth was similar in both groups. No periodontal complications were present in any of the patients, and the amount of attached gingiva was similar in both groups. In the MBG group, 15% of the canines were retained, whereas 20% of the canines were retained in the ICB group. The only complication that developed was in a patient from the MBG group, in whom a partial dehiscence of the donor site was observed. The results of this study demonstrate that reconstruction of alveolar clefts with MBG or ICB has a comparable prognosis. The use of MBGs in these patients has several advantages compared with ICB, including reduced operating time, reduced morbidity, reduced hospitalization time, and finally, a cutaneous scar at the iliac crest can be avoided.

Adolescent↗
PubMed1990

Intermaxillary fixation of mandibular fractures with the bracket-bar.

An alternative method for intermaxillary fixation of mandibular fractures using a bracket-bar bonded to the teeth is described. The technique is easy to use, improves gingival health, reduces anaesthesia time and reduces the risk of transmitting blood-borne diseases to the surgeon through perforating injuries from wires.

Dental Bonding↗
PubMed1990

The possible role of oral epithelial cells in tissue-type plasminogen activator-related fibrinolysis in human saliva.

We studied the fibrinolytic activities of the following subfractions of unstimulated human whole saliva on plasminogen-rich fibrin plates: (1) submandibular saliva, (2) parotid saliva, and (3) smears of buccal epithelial cells from ten healthy males. A cell-bound plasminogen activator could be demonstrated in the sediments of all three subfractions of whole saliva. The incorporation of antibodies (goat IgG) against human two-chain tissue-type plasminogen activator (t-PA) could quench the assessed fibrinolytic activities, whereas additional experiments suggested the absence of urokinase-like and F XII-dependent activators of fibrinolysis. The determinations in growth medium from buccal-epithelial cell culture of t-PA antigen by means of enzyme-linked immunosorbent assay showed the presence of t-PA. These clinical and experimental findings suggest that buccal-epithelial cells produce t-PA, while the activity of t-PA in parotid and submandibular saliva is very low.

Cells, Cultured↗
PubMed1990

[Comparative study of treatment of keratocysts by enucleation, enucleation combined with cryotherapy or fixation of the cyst membrane with Carnoy's solution followed by enucleation: a preliminary report].

Comparative study of treatment of keratocysts by enucleation, enucleation combined with cryotherapy or treatment with Carnoy's solution followed by enucleation: a preliminary report. The aim of this preliminary report was to compare the effect on the recurrence rate of keratocysts treated by enucleation (group E, 14 cysts), enucleation combined with cryotherapy (group EK, 14 cysts) or a fixing agent (Carnoy's solution) followed by enucleation (group CE, 10 cysts). A total of 32 patients with 38 keratocysts are included in the study. In group E 5 recurrences (36%) was developed after 17, 34, 36, 37 and 39 months postoperatively, whereas 5 recurrences (36%) after 22, 24, 24, 25 and 59 months was registered in group EK. Due to a rather high incidence of side effects to cryotherapy this treatment technique can not be recommended. No recurrences has been found in group CE, and usually complete bone healing has occurred after 6 to 12 months postoperatively. Due to the use of the strong fixing agent we recommend treatment by this method performed under general anaesthesia to secure an immobile surgical field. In accordance with recent studies, the results indicate that fixation before enucleation has revolutionized the art of treating keratocysts with respect to recurrence rate.

Adolescent↗
PubMed1990

[Arthroscopy and arthroscopic surgery of the temporomandibular joint].

Diagnostic arthroscopy and arthroscopic surgery of the TMJ has during the recent years been introduced in the treatment of internal derangements, preauricular pain and osteoarthrosis of the TMJ. In closed lock cases and in cases with preauricular pain a satisfactory result of treatment has been described in 80-90% of cases, where there was lacking effect of conservative treatment with splints and physiotherapy. The refinement in the technique has made it possible to use rotating instruments, cauterisation and to perform suturing through the arthroscopic cannula and in this way reduce the need for open joint surgery. Due to the technique only few complications have been reported. In the Department of Oral and Maxillofacial Surgery in the University Hospital of Aarhus arthroscopy of the TMJ was introduced 1 1/2 year ago and 22 patients with the clinical diagnosis closed lock or preauricular pain or a combination of these has been treated during this period. The results are satisfactory in most cases and are comparable with previously published results.

Arthroscopy↗
PubMed1990

[Use of titanium osteosynthesis in maxillofacial traumatology and orthognathic surgery].

This paper reviews the clinical use of titanium miniplate osteosynthesis in maxillofacial traumatology and orthognathic surgery. These materials were originally developed for treatment of mandibular fractures, but the application has within recent years been extended to other fractures of the facial skeleton and orthognathic surgery. The osteosynthesis increase stability in many situations, and may reduce or eliminate the need for post-operative intermaxillary fixation, by which morbidity, hospitalization period and period of sick-leave can be reduced. In orthognathic surgery, the stability of the miniplate osteosynthesis increase the demand for precision during surgery as compared to conventional fixation with wire osteosynthesis and intermaxillary fixation. Further refinements of the technique are, however, necessary in the future, as the current techniques does not always allow a sufficient reproduction of the position of the condylar segment.

Bone Plates↗
PubMed1990

[Treatment of edentulousness by use of osteointegrated implants i e Brånemark].

The aim of the study was to evaluate and compare the results of treatment achieved with the Brånemark implantsystem in patients treated in our hospital and patients treated in surgical practice. This study includes 96 patients who received a total of 457 implants. Fifty-two patients were treated in the hospital with 304 implants and 44 patients were treated in practice with 153 implants. Most of the patients treated in the hospital received fixed bridges after a total jaw implant reconstruction. In this group complicating medical diseases and severely altered jaw anatomy have influenced the treatment results for which reason 37 (12%) of implants installed were lost. Treatment of partially edentulousness and single tooth loss with implants was dominating in the group of patients treated in surgical practice. In this group only 3 (2%) implants installed were lost. The results of the present study are comparable with other published reports and indicates that Brånemark implants has a predictably good prognosis. Furthermore, this study has shown that implant treatment significantly improve the prosthodontic function in patients suffering from edentulousness.

Dental Implantation, Endosseous↗
PubMed1990

Osteoradionecrosis, pathogenesis, treatment and prevention.

The present paper discuss the development of osteoradionecrosis (ORN) in the jaws. ORN is the end stage of tissue injury induced by irradiation. The most prominent etiologic factor of ORN seems to be the effect of radiation on endothelial cells lining the vessels. These cells are, as tumor cells, highly radiosensitive, and radiation leads to a vascular damage resulting in hypoxic, hypovascular and hypocellular tissues. Wound healing in such tissues is impaired since nutritional demands of the wound, including oxygen, cannot be supplied due to the degenerative changes in the blood vessels. The paper furthermore describes the scientific basis for the use of hyperbaric oxygen therapy (HBO) in ORN. HBO increase the vascularity in the tissues injured by radiation, and thus tissue viability and healing capacity is increased reducing the risk for spontaneous or traumainduced ORN. Protocols for the treatment of patients with ORN are presented and prophylactic guidelines are described.

Adult↗