Background Several techniques have been proposed to reconstruct deficient alveolar ridges including bone blocks, ridge splitting and guided bone regeneration (GBR). GBR has been successfully established in restoring horizontal bone deficiency. However, yet still there is a debate regarding the ideal barrier for GBR. Purpose To evaluate the quantity and the quality of the bone gained using collagen membrane with 1:1 mixture of autogenous and anoraganic bovine bone mineral compared to titanium mesh with the same mixture of bone for GBR of horizontally deficient maxillary ridges. Materials and Methods Two different grafting techniques were evaluated, 10 patients receiving GBR using native collagen membrane using 1:1 autogenous and anorganic bovine bone mineral (ABBM) bone mixture, and 10 patients receiving GBR using titanium mesh with same mixture of bone. Results Statistical analysis showed a significant increase in alveolar bone width in both techniques with a mean bone gain of 4.0 mm for Collagen group and 3.7 mm for titanium mesh group. Bone area percent was almost 28% for both groups. For Ti‐mesh group, six sites soft tissue healing was uneventfully with no signs of wound dehiscence. However, four cases showed mesh exposure first 3 patients showed this exposure 3 weeks postoperatively while the fourth patient showed exposure 4 months postoperatively. The mean graft resorption in the Collagen and mesh group 6 months postoperative was considered nonsignificant. Conclusions GBR with both collagen membrane and titanium mesh using a 1:1 mixture of autogenous and ABBM is a viable technique for horizontal augmentation of deficient maxillary alveolar ridges. Titanium mesh is a more technique sensitive compared to collagen membrane. Soft tissue dehiscence and difficulty during second stage removal should limit its use in augmentation of horizontally deficient maxillary ridges.
Background: The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes. Methods: A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation. Results: No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively. Conclusions: Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.
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Background The optimal timing, surgical technique and the influence of Down syndrome on outcome of surgical repair of Complete Atrio-Ventricular Canal Defect (CAVC) remains uncertain. We reviewed our experience in repair of CAVC to identify the influence of these factors on operative outcome. Methods A prospective study included 70 patients who underwent repair of CAVC at Ain Shams university hospitals, academy of cardiothoracic surgery during the period from July 2016 to October 2019. Age at surgery (less than 6 months old versus later), surgical technique used [(modified single patch versus double patch technique), (use of posterior annuloplasty for repair of left AV valve or not)] and association of Down syndrome were evaluated for their impact on the outcome of surgical repair using multivariate analysis. Patients were followed up for 6 months; primary end point was mortality and secondary end point was reappearance of LAVV regurgitation. Results No significant difference between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Down patients showed significant difference in the occurrence of postoperative compared to non-Down patients (LAVVR grade 2 + = 8.9% vs 24%, P value =0.005) respectively. Surgical repair by Modified single patch technique showed significant reduction in cross clamp time (mean = 47.6 ± 9.227 min vs 73.55 ± 21.087 min, P value 0.00), shorter bypass time (mean = 71.13 ± 13.507 min vs 99.19 ± 27.092 min, P value =0.00) and shorter duration of ICU stay (mean =3.2 ± 1.657 days vs 5.3 ± 2.761 days, P value=0.01) as compared to double patch technique. Posterior annuloplasty used for repair of LAVV compared to closure of cleft only resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVVR 2+ 43% vs 7%, P value=0.03) and at 6 months of follow up. (LAVVR 2+ 35.4% vs 0%, P value=0.01) respectively. Conclusion early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair, Down syndrome was not found to be a risk factor for early intervention. Modified single patch and double patch techniques for repair, can be used both with comparable results even in large VSD component (8mm and larger), finally, repair of common AV valve by cleft closure with posterior LAV annulplasty showed better results with significant decrease in postoperative LAV regurgitation and early mortality in comparison to closure of cleft only.
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