Browsing by Author "Snäll, Johanna"
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Löfgren, Maja; Hirvikangas, Roope; Snäll, Johanna; Uittamo, Johanna (2019)Objectives Odontogenic infections are potentially life threatening especially in immunocompromised patients. The study aimed to investigate predisposing factors for the severity of odontogenic infections, particularly hospital admission and inflammatory parameters. Materials and Methods A prospective clinical study and a questionnaire survey were designed and implemented. The outcome variable was hospitalization, and secondary outcome variables were inflammatory parameters C-reactive protein (CRP) value, white blood cell (WBC) count and body temperature. The primary predictor variables were treatment delay, preceding visits to health services before referral to hospital, focus of infection identified before referral, site of infection focus, postoperative infection because of elective tooth extraction, and previous treatment of infection. Explanatory variables were age, gender, current smoking, heavy alcohol use, disease history and education. Results A total of 88 patients were included to the analysis. Patients’ disease history in general was not significant for hospitalization or infection parameters. Lower education level associated with hospitalization (p=0.033) and leucocytosis was significantly higher in basic level educated patients (p=0.036). In addition, leucocytosis correlated significantly with mandibular infections (p=0.008), previously unidentified infection focus (p=0.010), and with infection due to an elective tooth extraction (p=0.026). Elderly patients were not more prone to more severe infections. Neither gender, current smoking nor heavy alcohol use proved significant for infection severity. Conclusions and clinical relevance Lower education elevates the risk for hospitalization and severe odontogenic infections. Lack of regular dental care or economic challenges can explain this finding.
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Periodontitis in Tonsil Cancer Patients : A Comparative Study in Accordance With Tumour p16 Status Keinänen, Arvi; Marinescu-Gava, Magdalena; Hagström, Jaana; Uittamo, Johanna; Marttila, Emilia; Snäll, Johanna (2018)Tutkimuksen tavoitteena oli arvioida parodontiumin tilannetta nielurisasyöpäpotiailla ja verrata sitä muun muassa p16 statukseen. Tutkimusaineistona käytimme retrospektiivisessä tutkimuksessa Helsingin yliopistollisen sairaalan Pää- ja kaulakeskuksessa 1.1.2013–31.12.2017 hoidettuja primäärisiä nielurisasyöpäpotilaita, joilta löytyi hoitojen yhteydessä otettu Hampaiston ja leuan panoraamatomografia eli PTG-kuva. Tutkimusaineistona käytettiin Helsingin yliopistollisen sairaalan potilastietokantaa. Tutkimuksen potilaiden valintaan käytettiin ICD koodia C09. Poissulkukriteereinä olivat aikaisemmin sairastettu pään tai kaulan alueen syöpä, PTG-kuvan puuttuminen, määrittämätön p16 status, tupakointi tai alkoholin käytön historian puuttuminen, pään tai kaulan alueelle annettu sädehoito ja hampaattomuus. Prediktoreina oli marginaalisen cortexin tasaisuus, marginaalinen luukato, marginaalinen luukato ilman marginaalisen corteksin tasaisuutta sekä hampaiden lukumäärä. Parodontiumin tilannetta verrattiin p16 statukseen, ikään, sukupuoleen, tupakointiin ja alkoholin käyttöön. Tutkimuksessamme mukaan otetuista 115 potilaasta (p16-negatiivinen, n=24; p16-positiivinen, n=91), tupakointi (p<0.0001), runsas alkoholinkäyttö (p<0.0001) ja hampaiden lukumäärä (p=0.0001) assosioivat tilastollisesti merkittävästi p16 statuksen kanssa. Tupakointi (OR=7.3) ja runsas alkoholin kulutus (OR=10.1) nostivat riskiä p16-negatiiviseen syöpään. Nielurisasyöpäpotilailla oli usein parodontiittiin viittaavia radiologisia löydöksiä. Tutkimuksessamme p16-negatiivinen syöpäpotilailla oli vähemmän hampaita kuin potilailla, joilla oli p16-positiivinen syöpä. Vähäinen hampaiden määrä voi mahdollisesti viitata huonompaan suuhygienian tasoon p16-negatiivinen syöpäpotilailla. Muut parodontaalilöydökset olivat yleisiä molemmissa ryhmissä ilman tilastollista merkitsevyyttä. Runsas alkoholin käyttö ja tupakointi olivat tärkeimmät riskitekijät p16-negatiiviseen nielurisasyöpään.
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Stråhlman, Frida; Haapanen, Aleksi; Snäll, Johanna; Oksa, Marko (2020)Surgical treatment of condylar fractures is a much-discussed topic and a number of different techniques are used. We sent out a survey to maxillofacial trauma surgeons in the Nordic countries to gather information about regional differences in surgical praxis and post-operative treatment. A review of the literature was also conducted regarding the success-rate of different fixation plates. The survey yielded significant differences in the primary choice of fixation plate for the case of a subcondylar fracture presented, the most popular choices being two straight four-hole miniplates (27.8 %), a seven-hole lambda plate (25.0 %) as well as one straight four-hole miniplate (22.1 %). There was also division between respondents regarding choice of mono- versus bicortical screws (52.8 % versus 47.2 %) and post-operative dietary recommendations (soft diet ranging from two to eight weeks). The literature shows ample evidence favouring the use of two straight four-hole titanium miniplates for internal fixation over the use of a single straight four-hole miniplate, however newer three-dimensional plate designs are constantly being developed and have thus far shown promising results. We conclude that for optimal prognosis the single straight plate should not be used, only evidence-based treatment methods should be implemented. While there is some evidence to support the use of different three-dimensional plate designs, further research should be conducted before these can be seen as a viable choice for the standard double plating system.
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Zygomatico-orbital fracture dislocation in surgical treatment : novel 3D software automated analysis Lehtinen, Valtteri; Pyötsiä, Krista; Snäll, Johanna; Toivari, Miika (2020)Purpose The human capability to detect the degree of zygomatico-orbital (ZMO) fracture dislocation in surgical treatment is unknown. The aim of the study was to examine the association between ZMO fracture dislocation and injury etiology and treatment. Methods The investigators implemented a retrospective cross-sectional study and enrolled a sample composed of patients with an isolated unilateral ZMO fracture and analyzed fracture dislocation from CT (computed tomography) images with an automatic algorithm. The primary predictor variable was mean surface point-to-point dislocation (the mean distance of dislocation for all surface points in isolated ZMO fracture segments between the original position and after virtual repositioning). The primary outcome was the treatment choice (operative versus nonoperative). Other studied variables were gender, age group, injury mechanism, clinical asymmetry, and human-evaluated dislocation in CT images. Descriptive and bivariate statistics were computed, and the threshold for statistical significance was set at P < .05. Results The sample consisted of 115 subjects with a mean age of 66.3 years, 66.1% of whom were male, and the most common cause of injury was falling on the ground (49.6%). Operative treatment was required for 58 (50.4%) subjects. There was a significant association between mean dislocation and operative treatment. The mean dislocation of operatively vs. nonoperatively treated fractures was 2.39 mm vs. 1.05 mm (P < .001). Mean fracture dislocation was greatest in injuries caused by assault (2.41 mm) and smallest in MVAs (1.08 mm) and ground-level falls (1.25 mm). The threshold of human eye detection for ZMO fracture dislocation was 1.97 mm. Conclusion The results of the present study demonstrate that the threshold for operative treatment of ZMO fracture dislocation is over 2 mm, which the human eye is able to detect. True dislocation is greater in younger than elderly patients and in injuries caused by assault compared to falling.
Now showing items 1-4 of 4