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Clinical Oral Investigations Apr 2024The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation. (Clinical Trial)
Clinical Trial
OBJECTIVE
The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation.
MATERIALS AND METHODS
Thirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups.
RESULTS
There were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05).
CONCLUSION
Taste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions.
CLINICAL RELEVANCE
Maxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly.
THE TRIAL REGISTRATION NUMBER (TRN)
NCT06103422/Date of registration: 10.17.2023 (retrospectively registered).
Topics: Humans; Mandible; Orthognathic Surgery; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Quinine; Taste; Taste Perception
PubMed: 38558265
DOI: 10.1007/s00784-024-05626-1 -
Journal of Orthopaedic Surgery and... Feb 2021Knee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing....
BACKGROUND
Knee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing. The aim of this study was to describe a single-stage procedure associating corrective osteotomy with total knee arthroplasty (TKA), and to determine the outcome at mid- to long-term follow-up.
METHODS
A total of seven patients (seven knees) with knee osteoarthritis and supracondylar deformity were included in this study. Six patients were female, and one was male, with the median age of 62 years (range, 37-76 years). All patients were treated with single-stage TKA and femoral osteotomy. Osteotomy was fixed with long cemented stem. Hospital of Special Surgery (HSS) scores, collateral ligament laxity, and range of motion (ROM) were clinically evaluated preoperatively and at each follow-up. Radiographic parameters including the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical proximal tibial angle (mMPTA), and joint line congruence angle (JLCA) were also measured. The occurrence of perioperative complications was recorded.
RESULTS
The median follow-up time was 91 months (range, 38-104 months). At the last follow-up, all components were stable and no patients required revision. Nonunion of the osteotomy occurred in one patient. In all patients, the lower limb mechanical alignment improved greatly. The mean angle of MAD was restored from 10.49±6.05 cm preoperatively to 1.11±4.97 cm postoperatively. The 90° mLDFA was almost acquired in all cases, with the postoperative value of 90.79±2.40°. After operation, the mMPTA improved from 84.18±6.13° to 91.33±3.13°. The JLCA changed from 2.94±1.61° to -0.71±3.50°. The median HSS score improved from 45 (range, 34-56) preoperatively to 90 (range, 82-97) postoperatively, with the outcome of all patients rated good to excellent. The median ROM improved from 70° (range 0-110°) preoperatively to 105° (range 90-125°) postoperatively. No instability of knee joint was observed. Complications included an intraoperative split fracture of distal femur and one case of wound exudation resulting from fat liquefaction.
CONCLUSIONS
For knee osteoarthritis with femoral supracondylar deformity, single-stage TKA and corrective osteotomy was feasible but technically demanding. The use of long cemented stem for osteotomy fixation can provide reliable rotational control of the bone segments.
Topics: Adult; Aged; Arthroplasty, Replacement, Knee; Female; Femur; Humans; Joint Deformities, Acquired; Male; Middle Aged; Osteoarthritis, Knee; Osteotomy
PubMed: 33610184
DOI: 10.1186/s13018-021-02293-w -
The Knee Jan 2023To investigate the impact medial opening wedge high tibial osteotomy (MOWHTO) has on the progression of patellofemoral (PF) OA, patella height, contact pressure within... (Review)
Review
BACKGROUND (INCLUDING AIMS OF THE STUDY)
To investigate the impact medial opening wedge high tibial osteotomy (MOWHTO) has on the progression of patellofemoral (PF) OA, patella height, contact pressure within the PF joint and clinical outcomes.
METHODS
A systematic review was conducted in January 2022 according to PRISMA guidelines. The ICRS cartilage grade of the PF joint at the initial MOWHTO surgery and at second look surgery was compared and relative risk of progression of PF OA was calculated. Evaluation of patella height was assessed by Caton-Deschamps index, Blackburne-Peel index or Insall-Salvati index pre and post MOWHTO. Cadaveric studies assessing contact pressures in the PF after MOWHTO were included.
RESULTS
Forty-two studies comparing 2419 patients were included. The mean age was 53.1 years (16-84), 61.3% female. The risk of progression of PF OA was highest in the uniplanar and biplanar MOWHTO with proximal tubercle osteotomy groups (RR = 1.28-1.51) compared to biplanar MOHWTO with distal tubercle osteotomy (RR = 0.96-1.04). Patella height was not affected after biplanar MOWHTO with distal tubercle osteotomy (p < 0.001). Cadaveric studies demonstrate that PF contact pressures increase with more severe corrections (15°) but suggest biplanar MWOHTO and distal tubercle osteotomy induces lower contact pressures within the PF joint than other MOWHTO techniques. Significant over correction is associated with worse clinical outcomes and anterior knee pain.
CONCLUSION
Biplanar MOWHTO and distal tubercle osteotomy has minimal effect on the contact pressures in the PF joint resulting in less severe progression of PF OA and has minimal impact on patella height.
Topics: Humans; Female; Middle Aged; Male; Osteoarthritis, Knee; Patellofemoral Joint; Knee Joint; Tibia; Osteotomy; Patella; Cadaver; Retrospective Studies
PubMed: 36512892
DOI: 10.1016/j.knee.2022.11.023 -
BMC Musculoskeletal Disorders Jun 2023Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with...
BACKGROUND
Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear.
PURPOSE
To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings.
STUDY DESIGN
Systematic review.
METHODS
According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057).
RESULTS
Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up.
CONCLUSION
HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients' prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions.
LEVEL OF EVIDENCE
III.
Topics: Humans; Knee Joint; Menisci, Tibial; Arthroplasty, Replacement, Knee; Rupture; Osteoarthritis; Knee Injuries; Osteotomy; Arthroscopy; Retrospective Studies; Magnetic Resonance Imaging
PubMed: 37280599
DOI: 10.1186/s12891-023-06520-9 -
Cartilage Mar 2024Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The...
Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The pathophysiology is multifactorial and may involve trauma, altered foot biomechanics, systemic disorders, and arterial insufficiency. The most typical location is the second metatarsal head, but Freiberg disease may also occur in other lesser toes. Nonoperative treatment is best applied in the early stage of the disease; if this is ineffective, surgical treatment is recommended. Currently available surgical procedures include debridement, osteotomy, osteochondral grafting, microfracture, interposition arthroplasty, implant arthroplasty, and metatarsal shortening arthroplasty. In this article, we propose a treatment algorithm for Freiberg disease based on the current literature and expert opinion.
Topics: Female; Adolescent; Humans; Metatarsal Bones; Osteotomy; Fractures, Stress; Arthroplasty; Debridement
PubMed: 37815268
DOI: 10.1177/19476035231205676 -
European Journal of Trauma and... Feb 2024Three-dimensional (3D) printed patient-specific instruments (PSI) have been introduced to increase precision and simplify surgical procedures. Initial results in femoral...
PURPOSE
Three-dimensional (3D) printed patient-specific instruments (PSI) have been introduced to increase precision and simplify surgical procedures. Initial results in femoral and tibial osteotomies are promising, but validation studies on 3D planning, manufacturing of patient-specific cutting blocks and 3D evaluation of the attained results are lacking.
METHODS
In this study, patient-specific cutting blocks and spacers were designed, fabricated, and used to perform a high tibial osteotomy (HTO). After segmentation of CT data sets from 13 human tibiae, 3D digital planning of the HTO was performed with a medial opening of 8 mm. These 3D models were used to fabricate patient-specific cutting blocks and spacers. After the surgical procedure, accuracy was evaluated measuring 3D joint angles and surface deviations.
RESULTS
The lowest mean deviation was found to be 0.57° (SD ± 0.27) for the MPTA. Medial and lateral tibial slope deviated from the 3D planning by an average of 0.98° (SD ± 0.53) and 1.26° (SD ± 0.79), respectively, while tibial torsion deviated by an average of 5.74° (SD ± 3.24). Color analysis of surface deviations showed excellent and good agreement in 7 tibiae.
CONCLUSION
With 3D cutting blocks and spacers, the 3D planning of the HTO can be translated into reality with small deviations of the resulting joint angles. Within this study, the results of the individual steps are examined for errors and thus a critical evaluation of this new and promising method for performing patient-specific HTOs is presented.
Topics: Humans; Tibia; Osteotomy; Femur; Postoperative Period; Knee Joint; Osteoarthritis, Knee
PubMed: 35879618
DOI: 10.1007/s00068-022-02060-4 -
Journal of Oral and Maxillofacial... Nov 2021Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to...
PURPOSE
Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to non-segmental osteotomies. The purpose of the present study was to propose and validate an automated approach for 3D assessment of the accuracy and postoperative outcome of segmental bimaxillary surgery.
METHODS
A semi-automatic approach was developed and validated for virtual surgical analysis (VSA) of segmental bimaxillary surgery using a pair of pre- and postoperative (2 weeks) cone-beam computerized tomography (CBCT) scans. The output of the VSA, the accuracy of the surgical outcome, was calculated as 3D translational and rotational differences between the planned and postoperative movements of the individual bone segments. To evaluate the reliability of the proposed VSA, intra-class correlation coefficients (ICC) were calculated at a 95% confidence interval on measurements of 2 observers. The VSA was deemed reliable if the ICC was excellent (> 0.80) and the absolute difference of the repeated intra- and inter-observer translational and rotational measurements were significantly lower (p < 0.05) than a hypothesized clinical relevant threshold of 1 voxel (0.45 mm) and 1 degree, respectively.
RESULTS
A total of 10 subjects (6 male; 4 women; mean age 24.4 years) with skeletal class 2 and 3, who underwent segmental bimaxillary surgery, 3-piece Le Fort I, bilateral sagittal split osteotomy and genioplasty, were recruited. The intra- and inter-observer reliability was excellent, ICC range [0.96 - 1.00]. The range of the mean absolute difference of the repeated intra- and inter-observer translational and rotational measurements were [0.07 mm (0.05) - 0.20 mm (0.19)] and [0.11˚ (0.08) - 0.63˚ (0.42)], respectively. This was significantly lower than the hypothesized clinical relevant thresholds (P < .001).
CONCLUSION
The validation showed that the VSA has excellent reliability for quantitative assessment of the postoperative outcome and accuracy of segmental bimaxillary surgery.
Topics: Adult; Cone-Beam Computed Tomography; Female; Humans; Imaging, Three-Dimensional; Male; Orthognathic Surgery; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Reproducibility of Results; Young Adult
PubMed: 34245697
DOI: 10.1016/j.joms.2021.06.003 -
The Journal of Craniofacial Surgery Oct 2022Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and...
OBJECTIVE
Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons.
MATERIALS AND METHODS
The CMF ROBOT system was integrated with the force feedback system to ensure the collaborative control. Force-velocity control algorithm based on force feedback was designed for this control method. In the preliminary experimental test, under the collaborative control mode based on force feedback and optical navigation, the craniomaxillofacial surgical robot entered the osteotomy line area according to the preoperative surgical plan, namely, right maxillary Le Fort I osteotomy, left maxillary Le Fort I osteotomy, and genioplasty.
RESULTS
The force sensor was able to collect and record the resistance data of the cutting process of the robot-assisted craniomaxillofacial osteotomy assisted in real time. The statistical results showed that the repeatability of collaborative control mode was acceptable in bilateral maxillary Le Fort I osteotomies (right, P =0.124>0.05 and left, P =0.183>0.05) and unfavorable in genioplasty ( P =0.048<0.05).
CONCLUSION
The feasibility of robot-assisted craniomaxillofacial osteotomy under the collaborative control method based on the force feedback and optical navigation was proved in some extent. The outcome of this research may improve the flexibility and safety of surgical robot to meet the demand of craniomaxillofacial osteotomy.
Topics: Feedback; Genioplasty; Humans; Maxilla; Osteotomy, Le Fort; Robotics
PubMed: 35864585
DOI: 10.1097/SCS.0000000000008684 -
Orthopaedic Surgery May 2021For patients with non-traumatic osteonecrosis of the femoral head (ONFH), core decompression (CD) and bone grafts (BG) are mainly performed in the West, while osteotomy... (Comparative Study)
Comparative Study Review
Difference in Therapeutic Strategies for Joint-Preserving Surgery for Non-Traumatic Osteonecrosis of the Femoral Head between the United States and Japan: A Review of the Literature.
For patients with non-traumatic osteonecrosis of the femoral head (ONFH), core decompression (CD) and bone grafts (BG) are mainly performed in the West, while osteotomy is found to be predominant in Japan. It is not well recognized how the surgical procedures for joint preservation in patients with ONFH are completely different between the United States and Japan. This paper identifies the contexts and the differences in treatment strategies for ONFH between the two countries. We compared the surgical trends of the two countries over three periods, 1997-2001, 2002-2006, and 2007-2011 (the US data for the third period was 2007-2008), based on a 2014 US paper and a 2013 national publication in Japan. We compared the details of surgery for non-traumatic ONFH under the same conditions in the two reports. For the period 1997-2001, the rates of surgeries for ONFH in the US were as follows: total hip arthroplasty (THA), 86%; CD, 10%; and osteotomy, 0.4%. In Japan, THA was 61%, osteotomy 38%, and CD 0%. For the recent period, 2007-2011 (US 2007-2008), the rate of THA was 91%, CD 6%, and osteotomy 0.1%, in the US, compared to a THA rate of 73%, CD 0%, and osteotomy 26% in Japan. The results for the interim period (2002-2006) were between the old and new data. The use of joint-preserving surgery for ONFH differs greatly between the US and Japan. The first-line joint-preserving surgery was CD in the US and osteotomy in Japan. Each procedure was rarely done in the other country. From about 2000 to 2010, the percentage of THA increased in both countries. The proportion of joint-preserving surgery (CD in the US and osteotomy in Japan) declined. The decrease in joint-preserving procedures may be largely attributed to improved long-term outcomes of THA due to technological advances. There is also a reluctance for young ONFH patients to undergo joint-preserving procedures, such as osteotomy, that require long-term hospitalization.
Topics: Arthroplasty, Replacement, Hip; Decompression, Surgical; Femur Head Necrosis; Humans; Japan; Osteotomy; United States
PubMed: 33821555
DOI: 10.1111/os.12979 -
Journal of Orthopaedic Surgery and... Jun 2021The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO).
METHODS
PubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software.
RESULTS
A total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] - 332.74 to - 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI - 1.34 to - 0.63, P < 0.00001; POD 2 95% CI - 1.07 to - 0.68, P < 0.00001; POD 5 95% CI - 1.46 to - 0.84, P < 0.00001), drain output (POD total 95% CI - 195.86 to - 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22).
CONCLUSIONS
This meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.
Topics: Blood Loss, Surgical; Female; Hemoglobins; Humans; Male; Osteotomy; Postoperative Complications; Safety; Tibia; Tranexamic Acid; Treatment Outcome
PubMed: 34116690
DOI: 10.1186/s13018-021-02512-4