Publications by authors named "Emil Dediol"

34 Publications

DNA Methylome Distinguishes Head and Neck Cancer from Potentially Malignant Oral Lesions and Healthy Oral Mucosa.

Int J Mol Sci 2020 Sep 18;21(18). Epub 2020 Sep 18.

Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia.

There is a strong need to find new, good biomarkers of head and neck squamous cell carcinoma (HNSCC) because of the bad prognoses and high mortality rates. The aim of this study was to identify the potential biomarkers in HNSCC that have differences in their DNA methylome and potentially premalignant oral lesions, in comparison to healthy oral mucosa. In this study, 32 oral samples were tested: nine healthy oral mucosae, 13 HNSCC, and 10 oral lesions for DNA methylation by the Infinium MethylationEPIC BeadChip. Our findings showed that a panel of genes significantly hypermethylated in their promoters or specific sites in HNSCC samples in comparison to healthy oral samples, which are mainly oncogenes, receptor, and transcription factor genes, or genes included in cell cycle, transformation, apoptosis, and autophagy. A group of hypomethylated genes in HNSCC, in comparison to healthy oral mucosa, are mainly involved in the host immune response and transcriptional regulation. The results also showed significant differences in gene methylation between HNSCC and potentially premalignant oral lesions, as well as differently methylated genes that discriminate between oral lesions and healthy mucosa. The given methylation panels point to novel potential biomarkers for early diagnostics of HNSCC, as well as potentially premalignant oral lesions.
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http://dx.doi.org/10.3390/ijms21186853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554960PMC
September 2020

Regarding Incidence of Inadequate Perforators and Salvage Options for the Anterior Lateral Thigh Free Flap.

Laryngoscope 2020 06 19;130(6):E387. Epub 2020 Feb 19.

Department for ENT and Maxillofacial Surgery, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina.

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http://dx.doi.org/10.1002/lary.28573DOI Listing
June 2020

The Effects of Dextran on Postoperative Thrombosis and Hemodilution in Microvascular Head and Neck Reconstruction.

Ann Plast Surg 2020 07;85(1):38-42

Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia.

Background: Free tissue transfer is an integral part of reconstructive head and neck surgery today. Although increased experience and refinements in techniques have minimized flap loss, pharmacological agents have been used to prevent thrombus formation and flap failures, despite their questionable effectiveness. The aim of this study is to investigate the use of dextran 40 in thrombosis prophylaxis, as well as its effects on blood coagulability and flap survival.

Methods: This is a retrospective analysis of 176 free flaps performed at University Hospital Dubrava, Zagreb, Croatia, during a 4-year period. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols. All patients were treated with low-molecular-weight heparin as deep vein thrombosis prevention, until patient mobilization. Group 1 was on dextran 40 protocol, whereas group 2 did not receive additional treatment. Primary outcome of the study was determined as flap loss rate, whereas secondary outcome was evaluated as the rate of thrombosis or hemorrhage. The hemodilution potential of dextran 40 was examined through blood count laboratory values.

Results: Total flap survival rate was 90.34%. There were 16 free flap losses and 1 partial loss overall. Anastomoses were re-explored in a total of 27 cases, of which 17 were salvaged. There were 29 events of hemorrhage or arterial or venous thrombosis: 17 in group 1 and 12 in group 2. A sum of 26 incidences of other postoperative complications was recorded, 13 in each group. Hemodilution status showed a statistically significant reduction in erythrocyte count and hemoglobin and hematocrit levels in the group receiving dextran 40, on postoperative days 1 and 3, but no such effect was observed on postoperative platelet count.

Conclusions: Although dextran 40 has been shown to have a valuable effect on hemodilution, which is beneficial in microsurgery, it did not demonstrate better outcomes in terms of flap survival. Because it can cause serious systemic complications, it is better not to administer it routinely. However, its important influence on reduction in erythrocyte count and hemoglobin and hematocrit levels should be further investigated.
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http://dx.doi.org/10.1097/SAP.0000000000002148DOI Listing
July 2020

Rigid Fiber-Optic Device Intubation in a Child With Temporomandibular Joint Ankylosis.

J Craniofac Surg 2020 Mar/Apr;31(2):e193-e194

Department of Maxillofacial Surgery, University Hospital Dubrava.

The authors present a case of rigid fiber-optic device intubation in an 8-year-old boy with posttraumatic temporomandibular joint ankylosis. For this intention, a 5 mm diameter Bonfils fiberscope was used. Such practice has never been described before in pediatric patients with temporomandibular joint ankylosis. The procedure was successful and without complications. Therefore, the authors conclude that this method represents a useful alternative in difficult airway management in children with limited mouth opening.
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http://dx.doi.org/10.1097/SCS.0000000000006139DOI Listing
July 2020

Management of maxillofacial trauma in the elderly: A European multicenter study.

Dent Traumatol 2020 Jun 9;36(3):241-246. Epub 2020 Jan 9.

Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia.

Background/aims: Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017.

Results: A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P < .000005).

Conclusions: Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.
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http://dx.doi.org/10.1111/edt.12536DOI Listing
June 2020

Surgical management of unilateral body fractures of the edentulous atrophic mandible.

Oral Maxillofac Surg 2020 Mar 17;24(1):65-71. Epub 2019 Dec 17.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery.

Methods: This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications.

Results: A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases.

Conclusions: Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.
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http://dx.doi.org/10.1007/s10006-019-00824-8DOI Listing
March 2020

The epidemiology of edentulous atrophic mandibular fractures in Europe.

J Craniomaxillofac Surg 2019 Dec 29;47(12):1929-1934. Epub 2019 Nov 29.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented.

Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay.

Results: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries.

Conclusions: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.
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http://dx.doi.org/10.1016/j.jcms.2019.11.021DOI Listing
December 2019

How important is cephalic vein for venous drainage of the forearm.

Authors:
Emil Dediol

J Plast Reconstr Aesthet Surg 2019 12 25;72(12):2064-2094. Epub 2019 Sep 25.

Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Medical School, University of Zagreb, Croatia. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2019.07.036DOI Listing
December 2019

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Sep 13;128(3):199-204. Epub 2018 Dec 13.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objectives: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures.

Study Design: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1.

Results: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures.

Conclusions: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.
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http://dx.doi.org/10.1016/j.oooo.2018.12.009DOI Listing
September 2019

The "European Mandibular Angle" research project: the analysis of complications after unilateral angle fractures.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jul 28;128(1):14-17. Epub 2019 Feb 28.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objective: The aim of this study was to analyze the complications and outcomes of surgical treatment of angle fractures managed at departments of maxillofacial surgery in several European countries.

Study Design: Patients hospitalized with unilateral isolated angle fractures between 2013 and 2017 were included. The following data were recorded: gender and age of patients, fracture etiology, presence of the third molar, maxillomandibular fixation, osteosynthesis technique, and complications.

Results: In total, 489 patients were included in the study. The Champy technique was found to be the most frequently chosen osteosynthesis technique. Sixty complications were observed, at a rate of 12.3%. Complications were associated with the absence of third molars (P < .05). Instead, the Champy technique was associated with fewer complications (P < .05), in comparison with the other adopted techniques.

Conclusions: The management of angle fractures still represents a challenging task with a significant complication rate. The Champy technique still seems to be a valid option for the treatment of such injuries.
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http://dx.doi.org/10.1016/j.oooo.2019.02.027DOI Listing
July 2019

Genome-wide miRNA profiling reinforces the importance of miR-9 in human papillomavirus associated oral and oropharyngeal head and neck cancer.

Sci Rep 2019 02 19;9(1):2306. Epub 2019 Feb 19.

Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia.

Head and neck cancer is the sixth most common malignancy worldwide, predominantly developing from squamous cell epithelia (HNSCC). The main HNSCC risk factors are tobacco, excessive alcohol use, and the presence of human papillomavirus (HPV). HPV positive (+) cancers are etiologically different from other HNSCC and often show better prognosis. The current knowledge regarding HNSCC miRNA profiles is still incomplete especially in the context of HPV+ cancer. Thus, we analyzed 61 freshly collected primary oral (OSCC) and oropharyngeal (OPSCC) SCC samples. HPV DNA and RNA was found in 21% cases. The Illumina whole-genome small-RNA profiling by next-generation sequencing was done on 22 samples and revealed 7 specific miRNAs to HPV+ OSCC, 77 to HPV+ OPSCC, and additional 3 shared with both; 51 miRNAs were specific to HPV- OPSCC, 62 to HPV- OSCC, and 31 shared with both. The results for 9 miRNAs (miR-9, -21, -29a, -100, -106b, -143 and -145) were assessed by reverse transcription-quantitative polymerase chain reaction on the whole study population. The data was additionally confirmed by reanalyzing publicly available miRNA sequencing Cancer Genome Atlas consortium (TCGA) HNSCC data. Cell signaling pathway analysis revealed differences between HPV+ and HPV- HNSCC. Our findings compared with literature data revealed extensive heterogeneity of miRNA deregulation with only several miRNAs consistently affected, and miR-9 being the most likely HPV related miRNA.
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http://dx.doi.org/10.1038/s41598-019-38797-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381209PMC
February 2019

The "European zygomatic fracture" research project: The epidemiological results from a multicenter European collaboration.

J Craniomaxillofac Surg 2019 Apr 30;47(4):616-621. Epub 2019 Jan 30.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Purpose: Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.

Results: A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005).

Conclusion: The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.
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http://dx.doi.org/10.1016/j.jcms.2019.01.026DOI Listing
April 2019

The "European Mandibular Angle" Research Project: The Epidemiologic Results From a Multicenter European Collaboration.

J Oral Maxillofac Surg 2019 Apr 27;77(4):791.e1-791.e7. Epub 2018 Dec 27.

Full Professor, Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Purpose: The aim of this study was to analyze the demographic variables and causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.

Materials And Methods: This study was based on a multicenter systematic database that allowed the recording of data from all patients with mandibular angle fractures between January 1, 2013, and December 31, 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, and osteosynthesis.

Results: The study included 1,162 patients (1,045 male and 117 female patients). A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (P < .0000005). Furthermore, assaults were associated with the presence of voluptuary habits (P < .00005), a younger mean age (P < .00000005), male gender (P < .00000005), and left-sided angle fractures (P < .00000005).

Conclusions: Assaults and falls actually represent the most frequent causes of angle fractures. The presence of a third molar may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.
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http://dx.doi.org/10.1016/j.joms.2018.12.013DOI Listing
April 2019

Combined Karapandzic-Abbé/Estlander/Stein flap for subtotal and total lower lip reconstruction.

J Plast Reconstr Aesthet Surg 2019 Mar 22;72(3):484-490. Epub 2018 Nov 22.

Department of Plastic and Reconstructive Surgery, The Christie NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, United Kingdom.

Background: Lower lip reconstruction remains a challenging task due to multi-functional and high aesthetic requirements that have to be achieved for successful outcome. This is particularly true to near-total lower lip defects, encompassing over 70% of lower lip loss due to cancer, trauma or burns. Despite the fact that numerous flaps and their modifications have been described over the past century, only a few valuable techniques and concepts withstood the test of time for sub-total lower lip defects, each having their own drawbacks. We describe a new approach to these defects combining bilateral Karapandzic and Abbe/Estlander/Stein flaps, not reported so far, and present our long term outcomes.

Methods: From 2012 to 2016, five patients with T4 lower lip squamous cell carcinoma (SCC) underwent near-total and total lower lip resection and reconstruction with a combination of bilateral Karapandzic flap and double Abbé/Estlander/Stein flaps from the upper lip.

Results: Our patients were between 44 and 88 years old (mean 66.6). All flaps healed uneventfully in all patients. Patients were followed up between 18 and 60 months (mean follow up 33.6 months). There were no local tumor recurrencies. All patients were able to eat perorally whilst reconstructed lips were fully functional. No drooling was observed and aesthetic outcomes were excellent.

Conclusions: Combined bilateral Karapandzic and Abbe/Estlander/Stein flaps can produce excellent functional and aesthetic outcomes in near total and total lower lip reconstructions and should be considered a reliable reconstructive option in patients with more then 70% of lower lip loss.
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http://dx.doi.org/10.1016/j.bjps.2018.11.005DOI Listing
March 2019

Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap.

J Reconstr Microsurg 2017 Oct 6;33(8):e3-e4. Epub 2018 Mar 6.

Department of Traumatology, University Hospital Dubrava, Zagreb, Croatia.

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http://dx.doi.org/10.1055/s-0038-1635087DOI Listing
October 2017

Development of a Valid and Reliable Instrument for the Assessment of Quality of Life in Adolescents with Clefts - Detection of Potential Mental Health Issues.

Psychiatr Danub 2017 Sep;29(3):360-368

Private practice, Žitna 8, 44000 Sisak, Croatia,

Background: The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence.

Subjects And Methods: Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava.

Results: In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function.

Conclusion: According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy.
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http://dx.doi.org/10.24869/psyd.2017.360DOI Listing
September 2017

The Modification of Rotation - Advancement Flap Made in 1950.

Acta Stomatol Croat 2017 Mar;51(1):60-64

Professor,DM, MSc, PhD at the School of Medicine, University of Zagreb, Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia.

The early techniques of cleft lip repair involved the straight-line technique, the triangular flap technique or some kind of geometric line (triangular, quadrangular closure). A turning point in cleft lip surgery was in 1955 when doctor. Millard presented his method: the rotation-advancement technique or flap, at the First International Congress of Plastic Surgery in Stockholm. Today, the technique, with or without some modifications, is used by more than 85% of cleft surgeons around the world. We are presenting a patient with complete unilateral cleft lip and palate who underwent surgery sixty-five years ago. The scar on his lip was similar to rotation advancement line. Cheiloplasty was performed by Professor Šercer in 1950, five years before Millard's publication. Professor Ante Šercer was an internationally recognized Croatian scholar in the area of ear, nose and throat diseases. He also gave a significant contribution to surgical management of velopharyngeal insufficiency and plastic surgery of the nose and ear.
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http://dx.doi.org/10.15644/asc51/1/8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506253PMC
March 2017

Extended Karapandzic Flap Technique for Reconstruction of Lower Lip and Chin Defect.

J Oral Maxillofac Surg 2018 01 23;76(1):213-220. Epub 2017 Jun 23.

Professor, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb; Dental School, University of Zagreb, Zagreb, Croatia.

Purpose: Near total defect of the lower lip adjacent to the chin remains a reconstructive challenge for surgeons in function and esthetics. The objective of this study was to present a modified extended Karapandzic technique for reconstruction of near total defects of the lower lip adjacent with the chin.

Materials And Methods: From 2000 to 2013, patients with lip cancer or oral cavity cancer who required subtotal lower lip and chin resection and subsequently underwent reconstruction with an extended Karapandzic flap were included in this retrospective study. Patient demographics, histopathology, tumor stage, localization, tumor extension, method of reconstruction, and postoperative complications were extracted from patients' documentation.

Results: Reconstruction of the lower lip and chin was performed in 21 patients using a combination of double local extended Karapandzic flaps with microvascular free flaps for intraoral and mandibular reconstruction. There was no flap necrosis; the main complications were fistula and exposure of the osteosynthesis plate. All lips were functional and the esthetic result was pleasing. All patients returned to a peroral diet, although a variable degree of microstomia was present.

Conclusion: The extended Karapandzic flap technique provides superior results for esthetic and functional lip reconstruction and chin reconstruction compared with any other regional or free flap. Free flaps should be reserved for oral cavity and mandibular reconstruction, if needed.
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http://dx.doi.org/10.1016/j.joms.2017.06.015DOI Listing
January 2018

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 May 24;119(5):499-504. Epub 2014 Dec 24.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.

Study Design: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.

Results: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.

Conclusions: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.
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http://dx.doi.org/10.1016/j.oooo.2014.12.012DOI Listing
May 2015

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Apr 11;119(4):385-91. Epub 2014 Dec 11.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.

Study Design: Demographic and injury data were recorded for each patient who was a victim of an assault.

Results: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.

Conclusions: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.
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http://dx.doi.org/10.1016/j.oooo.2014.12.004DOI Listing
April 2015

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

J Craniomaxillofac Surg 2015 Jan 22;43(1):62-70. Epub 2014 Oct 22.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.
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http://dx.doi.org/10.1016/j.jcms.2014.10.011DOI Listing
January 2015

A Diagnostic Conundrum: Ectopic Nasal Ossification, Submucosal Alveolar Cleft, Absent Posterior Atlantal Arch, and Corpus Callosum Lipoma.

Cleft Palate Craniofac J 2015 11 7;52(6):761-5. Epub 2014 Oct 7.

A 19-year-old woman was referred for nasal breathing and aesthetic concerns regarding her nose. A computed tomography scan revealed a massive osseous shield anterior to the piriform aperture. Furthermore, there was a submucosal median alveolar cleft, and the posterior arch of C1 was missing. The magnetic resonance imaging brain scan revealed a curvilinear lipoma of corpus callosum. The ectopic nasal bone was removed by open rhinoplast,y and nasal function and aesthetics were restored. The described features defy conventional clinical diagnosis and severity classifications and present a diagnostic conundrum somewhere between a mild form of frontonasal dysplasia, oculoauriculofrontonasal syndrome, and Pai syndrome.
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http://dx.doi.org/10.1597/14-108DOI Listing
November 2015

Inflammatory pseudotumor presenting as a facial swelling.

Coll Antropol 2012 Nov;36 Suppl 2:143-6

University of Zagreb, Dubrava University Hospital, Department of Maxillofacial Surgery, Zagreb, Croatia.

We present a case of inflammatory pseudotumor (IPT) presenting as a facial swelling after an accidental hit on a right side of a face. As swelling did not resolve, dental examination and teeth extraction were done by a dentist presuming the swelling was misdiagnosed with infection of dental origin. Swelling grew even bigger and patient was referred to Department of Maxillofacial Surgery. CT scan of the face and FNA of the lesion was ordered. A homogenous tumor mass in the right infraorbital region in front of anterior wall of the maxillary sinus was seen on CT The result of the FNA was reactive hyperplasia of the lymph node. Since the lesion was easily accessible surgical exploration and complete extirpation was done. Pathohistological analysis indicated a low grade B-cell Non Hodgkin lymphoma. PCR showed policlonality of B cells discarding the diagnosis of lymphoma. Pathohistological review showed diffuse intramuscular, perineural and perivascular infiltration with small lymphocytes without formation of germinative centers. Imunohistochemistry was positive for CD20 and CD3. Taking into account all features the diagnosis of IPT was established. Diagnosis of IPT is a diagnosis by exclusion, combining clinical, radiological and pathohistological characteristics. Lack of clear histologic criteria makes differential diagnosis extremely difficult. Our case is unique regarding localisation of head & neck IPT no case presenting on the face in infraorbital region has been described in the literature. Although IPT is very rare in general and especially on the face, one should be aware of it when considering differential diagnosis of facial swelling.
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November 2012

Pleomorphic adenoma in ectopic salivary gland tissue in the neck.

Coll Antropol 2012 Nov;36 Suppl 2:133-6

University of Zagreb, School of Medicine, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia.

A case of pleomorphic adenoma originating from ectopic salivary gland tissue (ESGT) of the upper neck is reported. A 34-year-old male patient was referred to our Department for a painless swelling in the right submandibular region. Preoperative evaluation (clinical examination, fine-needle aspiration cytology (FNAC) and imaging studies) was performed and the finding was that of pleomorphic adenoma in ESGT A modified "S" incision with extension to the submandibular region was performed and the tumour was extirpated. The histopathological report confirmed our initial diagnosis. No recurrence was obtained during a four-year follow-up period. Isolated neck mass may be overlooked as ectopic salivary gland tissue neoplasm (ESGTN). Proper preoperative assessment and optimal surgical treatment are the keys for successful management of these rare tumours. The distinction between metastatic lesion from a head and neck tumour and ESGTN may present considerable diagnostic problem. A review of the literature on ESGT and associated tumours with emphasis on clinical features, diagnosis and treatment is also presented.
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November 2012

The role of head and neck cancer anatomic subsites in evaluating the prevalence of human papillomavirus.

Oral Surg Oral Med Oral Pathol Oral Radiol 2013 Mar 14;115(3):416-7. Epub 2012 Dec 14.

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http://dx.doi.org/10.1016/j.oooo.2012.09.092DOI Listing
March 2013

Brown class III maxillectomy defects reconstruction with prefabricated titanium mesh and soft tissue free flap.

Ann Plast Surg 2013 Jul;71(1):63-7

Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia.

Background: Midface reconstruction is one of the most challenging tasks for the reconstructive surgeon. We present a technique for the reconstruction of the midface after total maxillectomy with preservation of orbital contents.

Methods: Skeletal reconstruction is achieved with a preoperatively bent titanium sheet mesh on a universal skeletal model. The alveolar ridge, the anterior wall of the maxillary sinus, the zygomatic prominence, the lower orbital rim, and the orbital floor are reconstructed with a titanium mesh. A soft tissue free flap, preferably anterolateral thigh free flap, is harvested as well. A part of the flap is deepithelized and put in front of the mesh to prevent exposure, and the other part is used for palatal reconstruction.

Results: Four male and 1 female patients were reconstructed with titanium mesh. Four free flaps were raised: 3 anterolateral thigh and 1 latissimus dorsi. All free flaps survived. All patients received postoperative irradiation with 64 Gy. Median follow-up was 12 months; no major complications occurred. Mesh was exposed in only 1 case, which was managed successfully with resuspension of the heavy latissimus dorsi myocutaneous flap. Midface projection and height, globe position, ocular movements, and vision where satisfactory in all cases.

Conclusions: Midface reconstruction with titanium mesh and soft tissue free flap is a reliable and safe method for functional and aesthetic reconstruction after maxillectomy.
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http://dx.doi.org/10.1097/SAP.0b013e318246e895DOI Listing
July 2013

Advanced atherosclerosis of the vascular pedicle of radial forearm free flap in head and neck diabetic patient.

J Plast Surg Hand Surg 2013 Feb 11;47(1):73-4. Epub 2012 Jun 11.

Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia.

This study reports a case of severe atherosclerosis of the radial artery encountered during raising of a radial forearm free flap in a 56-year-old head and neck diabetic patient which precluded the use of the flap. This is a condition which most reconstructive surgeons are not aware of.
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http://dx.doi.org/10.3109/2000656X.2012.675882DOI Listing
February 2013

True or false facial artery aneurysm.

Authors:
Emil Dediol

Oral Surg Oral Med Oral Pathol Oral Radiol 2012 Feb 19;113(2):152; author reply 152-3. Epub 2011 Sep 19.

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http://dx.doi.org/10.1016/j.tripleo.2011.06.039DOI Listing
February 2012

The role of three-dimensional computed tomography in evaluating facial trauma.

Authors:
Emil Dediol

Plast Reconstr Surg 2012 Feb;129(2):354e-355e

Department of Maxillofacial Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, Croatia,

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http://dx.doi.org/10.1097/PRS.0b013e31823aee2fDOI Listing
February 2012