nach oben

Oral and Maxillofacial Surgery

Erschienen in:

31.01.2018 | Review Article

Prosthetic versus surgical rehabilitation in patients with maxillary defect regarding the quality of life: systematic review

verfasst von: M. Y. Sharaf, S. I. Ibrahim, A. E. Eskander, A. F. Shaker

Erschienen in: Oral and Maxillofacial Surgery | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess the ability of prosthetic rehabilitation versus surgical rehabilitation in improving the QOL for patients with maxillary defects.

Material and methods

A systematic search of PubMed, Scopus data base, Cochrane database, Ovid database, and Latin America & Caribbean database for articles published before September 2017 was performed by two independent reviewers. A manual search of articles published from January 2000 to September 2017 was also conducted. Only English studies were included which evaluate the QoL in patients with head and neck cancers. Any confusion between the two independent reviewers was resolved by means of a moderated discussion between the reviewers.

Results

Five studies fulfilled the inclusion criteria for this study. Many parameters were used regarding evaluation of QOL as the EORTC Head and Neck 35 assessment, UW-QOL, OHIP-14, VAS, OFS, MHI, HAD, Body Satisfaction Scale, Oral symptom check list, Swallowing, Diet consist, Pain control, Postoperative complication, and Speech. Two studies supported the surgical line of treatment for improving the QOL as compared to the prosthetic one; another two studies showed a statistically insignificant improvement in the patients’ QOL with the surgical line, while only one revealed insignificant difference in QoL with both lines of treatment.

Conclusions

Surgical rehabilitation provides a better line of treatment in improving the QOL for patients with maxillary defects. On the other hand, prosthetic has proved effectiveness in the immediate post-surgical times as temporary strategy, and it has represented a good alternative when the surgical obturation is compromised.

Glinski B, Zabek M, Urbanski J (2006) Principles of diagnosis and treatment of patients with head and neck squamous cancer. Contemp Oncol (Pozn) 6:263–267

Yanamoto S, Yamada S, Takahashi H et al (2014) Benefits of maxillectomy with internal dissection of the masticator space by transmandibular approach in the surgical management of malignant tumours of the upper gingiva and hard palate: a clinical review of 10 cases. Int J Oral Maxillofac Surg 11:1319–1325CrossRef

Nagy J, Braunitzer G, Antal M et al (2014) QOL in head and neck cancer patients after tumor therapy and subsequent rehabilitation: an exploratory study. Qual Life Res 1:135–143CrossRef

Yucel A, Cinar C, Aydin Y et al (2000) Malignant tumors requiring maxillectomy. J Craniofac Surg 11:418–429CrossRefPubMed

Brown JS, Rogers SN, McNally DN, Boyle M (2000) A modified classification for the maxillectomy defect. Head Neck 2000 22(1):17–26. https://doi.org/10.1002/(SICI)1097-0347(200001)22:1<17::AID-HED4>3.0.CO;2-2

Baliarsing AS, Vinay VK, Neelima AM, Dilip KB (2010) Reconstruction of maxillectomy defects using deep circumflex iliac artery-based composite free flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:8–13CrossRef

Cordeiro PG, Santamaria EA (2000) Classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 105(7):2331–2346. https://doi.org/10.1097/00006534-200006000-00004 CrossRefPubMed

Futran ND, Mendez E (2006) Developments in reconstruction of midface and maxilla. Lancet Oncol 7(3):249–258. https://doi.org/10.1016/S1470-2045(06)70616-7 CrossRefPubMed

Muzaffar AR, Adams WP Jr, Hatorg JM, Rohrich RJ, Byrd HS (1999) Maxillary reconstruction: functional and aesthetic considerations. Plast Reconst Surg 104(7):2172–2183. https://doi.org/10.1097/00006534-199912000-00035 CrossRefPubMed

10.

Funk GF, Karnell LH, Christensen AJ (2012) Long-term health related quality of life in survivors of head and neck cancer. Arch Otolaryngol Head Neck Surg 138(2):123–133. https://doi.org/10.1001/archoto.2011.234 CrossRefPubMed

11.

Zabora J, Brintzenhofeszoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28CrossRefPubMed

12.

Argerakis GP (1990) Psychosocial considerations of the post-treatment of head and neck cancer patients. Dent Clin N Am 34:285–305PubMed

13.

Hammerlid E, Persson L, Sulivan M, Westin T (1999) Quality-of-life effects of psychosocial intervention in patients with head and neck cancer. Otolaryngol Head Neck Surg 120:507–516CrossRefPubMed

14.

Depprich R, Naujoks C, Lind D, Ommerborn M, Meyer U, Kübler NR, Handschel J (2011) Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic therapy with obturator prostheses. Int J Oral Maxillofac Surg 40(1):71–79. https://doi.org/10.1016/j.ijom.2010.09.019 CrossRefPubMed

15.

Irish J, Sandhu N, Simpson C, Wood R, Gilbert R, Gullane P, Brown D, Goldstein D, Devins G, Barker E (2009) Quality of life in patients with maxillectomy prostheses. Head Neck 31(6):813–821. https://doi.org/10.1002/hed.21042 CrossRefPubMed

16.

Rogers SN (2009) Quality of life for head and neck cancer patients—has treatment planning altered? Oral Oncol 45(4-5):435–439. https://doi.org/10.1016/j.oraloncology.2008.11.006 CrossRefPubMed

17.

Dalgorf D, Higgins K (2008) Reconstruction of the midface and maxilla. Curr Opin Otolaryngol Head Neck Surg 16(4):303–311. https://doi.org/10.1097/MOO.0b013e328304b426 CrossRefPubMed

18.

Rieger JM, Tang JA, Wolfaardt J, Harris J, Seikaly H (2011) Comparison of speech and aesthetic outcomes in patients with maxillary reconstruction versus maxillary obturators after maxillectomy. J Otolaryngol Head Neck Surg 40(1):40–47PubMed

19.

Kornblith AB, Zlotolow IM, Gooen J, Huryn JM, Lerner T, Strong EW, Shah JP, Spiro RH, Holland JC (1996) Quality of life of maxillectomy patients using an obturator prosthesis. Head Neck 18(4):323–334.

20.

Sharma AB, Beumer J III (2005) Reconstruction of maxillary defects: the case for prosthetic rehabilitation. J Oral Maxillofac Surg 63(12):1770–1773. https://doi.org/10.1016/j.joms.2005.08.013 CrossRefPubMed

21.

Okay DJ, Genden E, Buchbinder D, Urken M (2001) Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J Prosthet Dent 86(4):352–363. https://doi.org/10.1067/mpr.2001.119524 CrossRefPubMed

22.

Brown JS, Shaw RJ (2010) Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol 11(10):1001–1008. https://doi.org/10.1016/S1470-2045(10)70113-3 CrossRefPubMed

23.

Nguyen CT, Driscoll CF, Coletti DP (2011) Reconstruction of a maxillectomy patient with an osteocutaneous flap and implant-retained fixed dental prosthesis: a clinical report. J Prosthet Dent 105(5):292–295. https://doi.org/10.1016/S0022-3913(11)60054-1 CrossRefPubMed

24.

Marx RE (2009) Reconstruction of defects caused by bisphosphonate-induced osteonecrosis of the jaws. J Oral Maxillofac Surg 67(5):107–119. https://doi.org/10.1016/j.joms.2008.12.007 CrossRefPubMed

25.

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F, American Association of Oral and Maxillofacial Surgeons (2014) American Association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jawse2014 update. J Oral Maxillofac Surg 72(10):1938–1956. https://doi.org/10.1016/j.joms.2014.04.031 CrossRefPubMed

26.

Chiapasco M, Abati S, Ramundo G, Rossi A, Romeo E, Vogel G (2000) Behavior of implants in bone grafts or free flaps after tumor resection. Clin Oral Implants Res 11(1):66–75. https://doi.org/10.1034/j.1600-0501.2000.011001066.x CrossRefPubMed

27.

Bodard AG, Bemer J, Gourmet R et al (2011) Dental implants and free fibula flap: 23 patients. Rev Stomatol Chir Maxillofac 112:1–4CrossRef

28.

Iizuka T, Hafliger J, Seto I, Rahal A, Mericske-Stern R, Smolka K (2005) Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer. Clin Oral Implants Res 16(1):69–79. https://doi.org/10.1111/j.1600-0501.2004.01076.x CrossRefPubMed

29.

WHOQOL (1995) The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 41:1403–1409CrossRef

30.

WHOQOL (1996) What quality of life? The WHOQOL group. World Health Organization quality of life assessment. World Health Forum 17:354–356

31.

Felce D, Perry J (1995) Quality of life: its definition and measurement. Res Dev Disabil 16(1):51–74. https://doi.org/10.1016/0891-4222(94)00028-8 CrossRefPubMed

32.

Wang F, Huang W, Zhang C, Sun J, Qu X, Wu Y (2016) Functional outcome and quality of life after a maxillectomy: a comparison between an implant supported obturator and implant supported fixed prostheses in a free vascularized flap. Clin Oral Impl Res 00:1–7

33.

Miller SA, Forrest JL (2001) Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions. J Evid Base Dent Pract 1(2):136–141. https://doi.org/10.1016/S1532-3382(01)70024-3 CrossRef

34.

Moher D, Liberati A, Tetzlaff J, Altman DG (2010) PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007 CrossRefPubMed

35.

Welch V, Petticrew M, Tugwell P, Moher D, O’Neill J, Waters E et al (2012) PRISMA-equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med 9:1–7CrossRef

36.

Rieger J, Bohle Iii G, Huryn J, Tang JL, Harris J, Seikaly H (2009) Surgical reconstruction versus prosthetic obturation of extensive soft palate defects: a comparison of speech outcomes. Int J Prosthodont 22(6):566–572PubMed

37.

Borlase G (2000) Use of obturators in rehabilitation of maxillectomy defects. Ann R Australas Coll Dent Surg 15:75–79PubMed

38.

Rieger JM, Wolfaardt JF, Jha N, Seikaly H (2003) Maxillary obturators: the relationship between patient satisfaction and speech outcome. Head Neck 25(11):895–903. https://doi.org/10.1002/hed.10299 CrossRefPubMed

39.

Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM (2010) Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 32(7):860–868. https://doi.org/10.1002/hed.21264 PubMed

40.

Lethaus B, Lie N, de Beer F, Kessler P, de Baat C, Verdonck HW (2010) Surgical and prosthetic reconsiderations in patients with maxillectomy. J Oral Rehabil 37(2):138–142. https://doi.org/10.1111/j.1365-2842.2009.02031.x CrossRefPubMed

41.

Hertrampf K, Wenz HJ, Lehmann KM, Lorenz W, Koller M (2004) Quality of life of patients with maxillofacial defects after treatment for malignancy. Int J Prosthodont 17(6):657–665PubMed

42.

Riaz N, Warriach RA (2010) Quality of life in patients with obturator prostheses. J Ayub Med Coll Abbottabad 22:121–125PubMed

43.

Kreeft AM, Krap M, Wismeijer D, Speksnijder CM, Smeele LE, Bosch SD, Muijen MSA, Balm AJM (2012) Oral function after maxillectomy and reconstruction with an obturator. Int J Oral Maxillofac Surg 41(11):1387–1392. https://doi.org/10.1016/j.ijom.2012.07.014 CrossRefPubMed

44.

Chigurupati R, Aloor N, Salas R, Schmidt BL (2013) Quality of life after maxillectomy and prosthetic obturator rehabilitation. J Oral Maxillofac Surg 71(8):1471–1478. https://doi.org/10.1016/j.joms.2013.02.002 CrossRefPubMed

45.

Kumar P, Alvi HA, Rao J, Singh BP, Jurel SK, Kumar L, Aggarwal H (2013) Assessment of the quality of life in maxillectomy patients: a longitudinal study. J Adv Prosthodont 5(1):29–35. https://doi.org/10.4047/jap.2013.5.1.29 CrossRefPubMedPubMedCentral

46.

Said MM, Otomaru T, Yeerken Y, Taniguchi H (2017) Masticatory function and oral health-related quality of life in patients after partial maxillectomies with closed or open defects. J Prosthet Dent 118(1):108–112. https://doi.org/10.1016/j.prosdent.2016.11.003 CrossRefPubMed

47.

Costa H, Zenha H, Sequeira H, Coelho G, Gomes N, Pinto C, Martins J, Santos D, Andresen C (2015) Microsurgical reconstruction of the maxilla–algorithm and concepts. Br J Plast Surg 68:89–104

48.

Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L, McPheeters LM, Santaguida PL, Shamliyan T, Singh K, Tsertsvadze A, Treadwell JR (2012) Assessing the risk of bias of individual studies in systematic reviews of health care interventions. Agency for Healthcare Research and Quality Methods Guide for Comparative Effectiveness Reviews. March 2012. AHRQ Publication No. 12- EHC047-EF. Available at: http://www.effectivehealthcare ahrq.gov/ehc/products/322/998/MethodsGuideforCERs_Viswanathan_ IndividualStudies.pdf

49.

Genden EM, Okay D, Stepp MT, Rezaee RP, Mojica JS, Buchbinder D, Urken ML (2003) Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: a preliminary report. Arch Otolaryngol Head Neck Surg 129(7):775–780. https://doi.org/10.1001/archotol.129.7.775 CrossRefPubMed

50.

Rogers SN, Lowe D, McNally D, Brown JS, Vaughan ED (2003) Health-related quality of life after maxillectomy: a comparison between prosthetic obturation and free flap. J Oral Maxillofac Surg 61(2):174–181. https://doi.org/10.1053/joms.2003.50044 CrossRefPubMed

51.

Pompa G, Brauner E, Jamshir S, De Angelis F, Giardino R, Di Carlo S (2017) Quality of life in patients rehabilitated with palatal obturator without reconstruction versus fixed implant-prosthesis after reconstruction of maxillectomy defects. J Int Dent Med Res 10:1–8

52.

Murphy J, Isaiah A, Wolf JS, Lubek JE (2015) Quality of life factors and survival after total or extended maxillectomy for sinonasal malignancies. J Oral Maxillofac Surg 73(4):759–763. https://doi.org/10.1016/j.joms.2014.11.002 CrossRefPubMed

53.

Brauner E, Valentini V, Jamshir S, Guarino G, Battisti A, Fadda MT, Pompa G (2016) Retrospective review of 78 rehabilitated head and neck postoncological patients: a new classification method. Minerva Stomatol 65:17–38PubMed

54.

Australian Government, NHMRC. How to use the evidence: assessment and application of scientific evidence. Available at: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp69.pdf. Accessed April 24,2015

55.

Martín-Ares M, Barona-Dorado C, Guisado-Moya B, Martínez-Rodríguez N, Cortés-Bretón-Brinkmann J, Martínez-González JM (2015) Prosthetic hygiene and functional efficacy in completely edentulous patients: satisfaction and quality of life during a 5-year follow-up. Clin Oral Implants Res 20:1–6

56.

Awad MA, Lund JP, Shapiro SH, Locker D, Klemetti E, Chehade A, Savard A, Feine JS (2003) Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: a randomized clinical trial in a senior population. Int J Prosthodont 16(4):390–396PubMed

57.

Dings JP, Mizbah K, Bergé SJ, Meijer GJ, Merkx MA, Borstlap WA (2014) Secondary closure of small- to medium-size palatal defects after ablative surgery: reappraisal of reconstructive techniques. J Oral Maxillofac Surg 72(10):2066–2076. https://doi.org/10.1016/j.joms.2014.04.036 CrossRefPubMed

58.

Rana M, Kanatas A, Herzberg PY, Khoschdell M, Kokemueller H, Gellrich NC, Rana M (2015) Prospective study of the influence of psychological and medical factors on quality of life and severity of symptoms among patients with oral squamous cell carcinoma. Br J Oral Maxillofac Surg 53(4):364–370. https://doi.org/10.1016/j.bjoms.2015.01.019 CrossRefPubMed

59.

Gellrich NC, Schimming R, Schramm A, Schmalohr D, Bremerich A, Kugler J (2002) Pain, function, and psychologic outcome before, during, and after intraoral tumor resection. J Oral Maxillofac Surg 60(7):772–777. https://doi.org/10.1053/joms.2002.33244 CrossRefPubMed

60.

Kollbrunner J, Zbären P, Quack K (2001) Quality of life stress in patients with larger tumors of the mouth. A descriptive study of psychosocial effects of illness and primary surgery therapy in 3 parts d1: quantity and quality of life. HNO 49(12):985–997. https://doi.org/10.1007/s001060170003 CrossRefPubMed

61.

Aarstad AK, Beisland E, Aarstad HJ (2012) Personality, choice of coping and T stage predict level of distress in head and neck cancer patients during follow-up. Eur Arch Otorhinolaryngol 269(9):2121–2128. https://doi.org/10.1007/s00405-011-1884-4 CrossRefPubMed

62.

van der Sloot PG (2003) Hard and soft palate reconstruction. Curr Opin Otolaryngol Head Neck Surg 11(4):225–229. https://doi.org/10.1097/00020840-200308000-00001 CrossRefPubMed

63.

Batchelor AG, Palmer JH (1990) A novel method of closing a palatal fistula: the free fascial flap. Br J Plast Surg 43(3):359–361. https://doi.org/10.1016/0007-1226(90)90089-I CrossRefPubMed

64.

Boyes-Varley JG, Howes DG, Davidge-Pitts KD, Branemark I, McAlpine JA (2007) A protocol for maxillary reconstruction following oncology resection using zygomatic implants. Int J Prosthodont 20:521–531PubMed

65.

Hu YJ, Hardianto A, Li SY, Zhang ZY, Zhang CP (2007) Reconstruction of a palatomaxillary defect with vascularized iliac bone combined with a superficial inferior epigastric artery flap and zygomatic implants as anchorage. Int J Oral Maxillofac Surg 36(9):854–857. https://doi.org/10.1016/j.ijom.2007.04.011 CrossRefPubMed

66.

Weischer T, Schettler D, Mohr C (1997) Titanium implants in the zygoma as retaining elements after hemimaxillectomy. Int J Oral Maxillofac Implants 12:211–214PubMed

67.

Leles CR, Leles JL, de Paula Souza C, Martins RR, Mendonc EF (2010) Implant-supported obturator overdenture for extensive maxillary resection patient: a clinical report. J Prosthodont 19:240–244CrossRefPubMed

68.

Schliephake H, Jamil MU (2002) Prospective evaluation of quality of life after oncologic surgery for oral cancer. Int J Oral Maxillofac Surg 31(4):427–433. https://doi.org/10.1054/ijom.2001.0194 CrossRefPubMed

69.

Shepherd KL, Fisher SE (2004) Prospective evaluation of quality of life in patients with oral and oropharyngeal cancer: from diagnosis to three months post-treatment. Oral Oncol 40(7):751–757. https://doi.org/10.1016/j.oraloncology.2004.01.018 CrossRefPubMed

70.

Rogers SN, Lowe D, Humphris G (2000) Distinct patient groups in oral cancer: a prospective study of perceived health status following primary surgery. Oral Oncol 36:529–538CrossRefPubMed

71.

Allison PJ, Locker D, Feine JS (1997) Quality of life: a dynamic construct. Soc Sci Med 45:221–230CrossRefPubMed

72.

Breetvelt IS, Dam V (1991) FS (1991) under reporting by cancer patients: the case of response-shift. Soc Sci Med 32(9):981–987. https://doi.org/10.1016/0277-9536(91)90156-7 CrossRefPubMed

Titel: Prosthetic versus surgical rehabilitation in patients with maxillary defect regarding the quality of life: systematic review
verfasst von: M. Y. Sharaf
S. I. Ibrahim
A. E. Eskander
A. F. Shaker
Publikationsdatum: 31.01.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Oral and Maxillofacial Surgery / Ausgabe 1/2018
Print ISSN: 1865-1550
Elektronische ISSN: 1865-1569
DOI: https://doi.org/10.1007/s10006-018-0679-9

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Purpose

Material and methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2018

Sialolith removal in the submandibular region using surgical diode laser: report of two cases and literature review

Is amalgamated ligno-bupivacaine an answer to complicated minor oral surgical anesthesia? A randomized split-mouth double-blind clinical trial

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience

Letter to the editor: “Considerations in computer-aided design for inlay cranioplasty: technical note”

Most cited publications in oral and maxillofacial surgery: a bibliometric analysis

Considerations in computer-aided design for inlay cranioplasty: technical note

Update Chirurgie