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Hirsch, Jan M.
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Publications (10 of 68) Show all publications
Thor, A., Palmquist, A., Hirsch, J.-M., Rännar, L.-E., Dérand, P. & Omar, O. (2016). Clinical, Morphological, and Molecular Evaluations of Bone Regeneration With an Additive Manufactured Osteosynthesis Plate. The Journal of craniofacial surgery (Print), 27(7), 1899-1904
Open this publication in new window or tab >>Clinical, Morphological, and Molecular Evaluations of Bone Regeneration With an Additive Manufactured Osteosynthesis Plate
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2016 (English)In: The Journal of craniofacial surgery (Print), ISSN 1049-2275, E-ISSN 1536-3732, Vol. 27, no 7, p. 1899-1904Article in journal (Refereed) Published
Abstract [en]

There is limited information on the biological status of bone regenerated with microvascular fibula flap combined with biomaterials. This paper describes the clinical, histological, ultrastructural, and molecular picture of bone regenerated with patient-customized plate, used for mandibular reconstruction in combination with microvascular osteomyocutaneous fibula flap. The plate was virtually planned and additively manufactured using electron beam melting. This plate was retrieved from the patient after 33 months. Microcomputed tomography, backscattered-scanning electron microscopy, histology, and quantitative-polymerase chain reaction were employed to evaluate the regenerated bone and the flap bone associated with the retrieved plate. At retrieval, the posterior two-thirds of the plate were in close adaptation with the underlying flap, whereas soft tissue was observed between the native mandible and the anterior one-third. The histological and structural analyses showed new bone regeneration, ingrowth, and osseointegration of the posterior two-thirds. The histological observations were supported by the gene expression analysis showing higher expression of bone formation and remodeling genes under the posterior two-thirds compared with the anterior one-third of the plate. The observation of osteocytes in the flap indicated its viability. The present data endorse the suitability of the customized, additively manufactured plate for the vascularized fibula mandibular reconstruction. Furthermore, the combination of the analytical techniques provides possibilities to deduce the structural and molecular characteristics of bone regenerated using this procedure.

Keywords
Additive manufacturing; electron beam melting; histology; mandible reconstruction; microvascular osteomyocutaneous fibula flap; ultrastructure
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-303419 (URN)10.1097/SCS.0000000000002939 (DOI)000386352100125 ()27513773 (PubMedID)
Funder
Swedish Research Council, K2015-52X-09495-28-4
Available from: 2016-09-19 Created: 2016-09-19 Last updated: 2017-11-21Bibliographically approved
Nyström, I., Olsson, P., Nysjö, J., Nysjö, F., Malmberg, F., Seipel, S., . . . Carlbom, I. B. (2016). Virtual Cranio-Maxillofacial Surgery Planning with Stereo Graphics and Haptics. In: Ritacco, Lucas E., Milano, Federico E., Chao, Edmund (Ed.), Computer-Assisted Musculoskeletal Surgery: Thinking and Executing in 3D (pp. 29-42). Springer International Publishing
Open this publication in new window or tab >>Virtual Cranio-Maxillofacial Surgery Planning with Stereo Graphics and Haptics
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2016 (English)In: Computer-Assisted Musculoskeletal Surgery: Thinking and Executing in 3D / [ed] Ritacco, Lucas E., Milano, Federico E., Chao, Edmund, Springer International Publishing , 2016, p. 29-42Chapter in book (Refereed)
Abstract [en]

Computer-Assisted Surgery (CAS) is a new tool for performing complex procedures in a predictable and safe way. This book is designed to serve as a comprehensive review of Computer-Assisted Surgery, covering the current status of both research and applications.

CAS includes Virtual Preoperative Planning (VPP) and Intraoperative Virtual Navigation (IVN), which are a set of technologies used to measure oncological margins in 3-Dimensions (3D), to locate small intraosseous tumors and apply controlled resections preserving anatomical structures. During VPP, patient acquired multimodal images are processed and an interactive virtual scenario is created. This can then be used as a  platform to  measure oncological distances and preplan osteotomies in safe areas. IVN is a procedure which allows the execution of the VPP with a mean error of less than 3mm.

For the student, medical doctors, research and development scientists or new researchers, the protocols are central to the performance of Computer-Assisted technologies.  

Place, publisher, year, edition, pages
Springer International Publishing, 2016
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-268677 (URN)10.1007/978-3-319-12943-3 (DOI)978-319-12942-6 (ISBN)978-3-319-12943-3 (ISBN)
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2016-01-19
Leiggener, C. S., Krol, Z., Gawelin, P., Buitrago-Téllez, C. H., Zeilhofer, H.-F. & Hirsch, J.-M. (2015). A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibula microvascular flaps. Journal of Plastic Surgery and Hand Surgery, 49(2), 95-101
Open this publication in new window or tab >>A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibula microvascular flaps
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2015 (English)In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 49, no 2, p. 95-101Article in journal (Refereed) Published
Abstract [en]

The free fibula osteoseptocutaneous flap is the standard for reconstruction of extensive mandibular defects. The procedure must be precise to achieve the required functional and aesthetic results. The aim of the present study was to calculate retrospectively the exact differences in surgical outcome based on preoperative and postoperative Computed Tomography data sets. Ten patients with unilateral reconstructions of the mandible with a fibula based on conventional planning were analyzed quantitatively, applying mirroring techniques with direct comparison of the theoretically optimum with the actual reconstruction. The results showed that there is a significant discrepancy between what is actually achieved and the theoretical optimum. The result of the present retrospective analysis shows that there is room for further improvement of the outcome in complex mandible reconstruction cases.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-225956 (URN)10.3109/2000656X.2014.920711 (DOI)000351350700006 ()24909821 (PubMedID)
Available from: 2014-06-10 Created: 2014-06-10 Last updated: 2017-12-05Bibliographically approved
Jalouli, M. M., Jalouli, J., Öhman, J., Hasseús, B., Hirsch, J. M. & Sand, L. (2015). Association of Human Papilloma Virus infection in healthy oral mucosa, oral dysplasia and oral squamous cell carcinoma. Journal of Oral Health and Dental Management, 14(5)
Open this publication in new window or tab >>Association of Human Papilloma Virus infection in healthy oral mucosa, oral dysplasia and oral squamous cell carcinoma
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2015 (English)In: Journal of Oral Health and Dental Management, ISSN 1583-5588, Vol. 14, no 5Article in journal (Refereed) Published
Abstract [en]

Aims: Human papillomavirus (HPV) is an important risk factor for development of oral cancer; however, the integrational status of the virus into the host DNA association between HPV infection and oral squamous cell carcinoma (OSCC) is still uncertain has not been investigated to the same extent. The objective of the present study was to investigate the prevalence of consensus HPV, and HPV-16 and its integration status, in healthy oral mucosa, oral epithelial dysplasia (OED), and OSCC samples.Materials and Methods: The study material consisted of 26 fresh, normal oral mucosa samples, and 53 and 27 paraffin-embedded OED and OSCC samples, respectively. The specimens were DNA extracted and investigated for the presence of HPV, and HPV-16 and its integration status, by polymerase chain reaction (PCR) and DNA sequencing.Results: Thirty-eight (72%) of the 53 paraffin-embedded OED samples, 16 (59%) of the 27 OSCC samples, and 12 (46%) of the 26 control samples were found to be HPV-DNA positive, with nested PCR (NPCR). Further, HPV-16 was detected in 31 (82%), 15 (94%), and 0 (0%) HPV-positive OED cases, HPV-positive OSCC cases, and controls, respectively. Integration was observed in 26/31 (84%) and 13/15 (87%) of the HPV-16-positive OED and OSCC cases, respectively. A statistically significant difference was found comparing prevalence of HPV-16 in controls with that in both OED and OSCC samples (P<0.005). A statistically significant difference was also found comparing prevalence of integrated and episomal viral forms comparing OED and OSCC samples (P<0.005).Conclusion: The high prevalence of HPV and high-risk HPV-16 in OED and OSCC samples suggests a potential aetiologic role for the virus in OSCC.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-265748 (URN)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01
Jalouli, M., Jalouli, J., Ibrahim, S. O., Hirsch, J.-M. & Sand, L. (2015). Comparison Between Single PCR and Nested PCR in Detection of Human Papilloma Viruses in Paraffin-embedded OSCC and Fresh Oral Mucosa. In Vivo, 29(1), 65-70
Open this publication in new window or tab >>Comparison Between Single PCR and Nested PCR in Detection of Human Papilloma Viruses in Paraffin-embedded OSCC and Fresh Oral Mucosa
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2015 (English)In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 29, no 1, p. 65-70Article in journal (Refereed) Published
Abstract [en]

Background: Infection with human papilloma virus (HPV) has been implicated as one of the risk factors for the development of oropharyngeal cancer. Many different HPV tests exist, and information regarding their specific technical, analytical, and clinical properties is increasing. Aim: This study aimed to compare the level of detection of HPV using two reliable polymerase chain reaction (PCR) methods, nested PCR (NPCR) and single PCR (SPCR), in archival paraffin-embedded oral squamous cell carcinoma (OSCC) samples and fresh oral mucosa specimens. Materials and Methods: The presence of HPV genome in two groups of tissue samples was analyzed: (i) 57 paraffin-embedded OSCC samples from Sudan and (ii) eight healthy fresh oral mucosal samples from Swedish volunteers. The specimens were tested by SPCR with primer pair MY9/MY11 and NPCR using GP5+/GP6+ primer sets. Results: Eighteen (32%) out of the 57 paraffin-embedded OSCC samples, and five (62%) out of the eight fresh clinically healthy samples were found to be HPV-positive with NPCR. With SPCR, four (7%) out of the paraffin-embedded OSCC samples were HPV-positive. A statistically significant difference between HPV-positive and -negative samples was found when comparing NPCR and SPCR in OSCC and fresh oral mucosa (p<0.0001). The comparative test between SPCR and NPCR showed 100% sensitivity and 69% specificity for OSCC. Conclusion: The use of the GP5+/GP6+ nested PCR increased the positivity rate, efficiency rate and sensitivity of HPV detection in oral samples significantly and should be considered as the method of choice.

Keywords
HPV, nested PCR, single PCR, paraffin embedded, OSCC, fresh oral mucosa
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-245198 (URN)000348134300011 ()25600532 (PubMedID)
Available from: 2015-02-25 Created: 2015-02-25 Last updated: 2017-12-04Bibliographically approved
Huo, J., Dérand, P., Rännar, L.-E., Hirsch, J.-M. & Gamstedt, E. K. (2015). Failure location predictoin by finite element analysis for an additive manufactured mandible implant. Medical Engineering and Physics, 37(9), 862-869
Open this publication in new window or tab >>Failure location predictoin by finite element analysis for an additive manufactured mandible implant
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2015 (English)In: Medical Engineering and Physics, ISSN 1350-4533, E-ISSN 1873-4030, Vol. 37, no 9, p. 862-869Article in journal (Refereed) Published
Abstract [en]

In order to reconstruct a patient with a bone defect in the mandible, a porous scaffold attached to a plate, both in a titanium alloy, was designed and manufactured using additive manufacturing. Regrettably, the implant fractured in vivo several months after surgery. The aim of this study was to investigate the failure of the implant and show a way of predicting the mechanical properties of the implant before surgery. All computed tomography data of the patient were preprocessed to remove metallic artefacts with metal deletion technique before mandible geometry reconstruction. The three-dimensional geometry of the patient's mandible was also reconstructed, and the implant was fixed to the bone model with screws in Mimics medical imaging software. A finite element model was established from the assembly of the mandible and the implant to study stresses developed during mastication. The stress distribution in the load-bearing plate was computed, and the location of main stress concentration in the plate was determined. Comparison between the fracture region and the location of the stress concentration shows that finite element analysis could serve as a tool for optimizing the design of mandible implants.

National Category
Applied Mechanics
Identifiers
urn:nbn:se:uu:diva-262683 (URN)10.1016/j.medengphy.2015.06.001 (DOI)000361409100005 ()
Available from: 2015-09-18 Created: 2015-09-18 Last updated: 2017-12-04Bibliographically approved
Olsson, P., Nysjö, F., Rodríguez-Lorenzo, A., Thor, A., Hirsch, J.-M. & Carlbom, I. B. (2015). Haptics-assisted Virtual Planning of Bone, Soft Tissue, and Vessels in Fibula Osteocutaneous Free Flaps. Plastic and Reconstructive Surgery - Global Open, 3(8), Article ID e479.
Open this publication in new window or tab >>Haptics-assisted Virtual Planning of Bone, Soft Tissue, and Vessels in Fibula Osteocutaneous Free Flaps
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2015 (English)In: Plastic and Reconstructive Surgery - Global Open, ISSN 2169-7574, Vol. 3, no 8, article id e479Article in journal (Refereed) Published
Abstract [en]

Background: Virtual surgery planning has proven useful for reconstructing head and neck defects by fibula osteocutaneous free flaps (FOFF). Benefits include improved healing, function, and aesthetics, as well as cost savings. But available virtual surgery planning systems incorporating fibula in craniomaxillofacial reconstruction simulate only bone reconstruction without considering vessels and soft tissue.

Methods: The Haptics-Assisted Surgery Planning (HASP) system incorporates bone, vessels, and soft tissue of the FOFF in craniomaxillofacial defect reconstruction. Two surgeons tested HASP on 4 cases they had previously operated on: 3 with composite mandibular defects and 1 with a composite cervical spine defect. With the HASP stereographics and haptic feedback, using patient-specific computed tomography angiogram data, the surgeons planned the 4 cases, including bone resection, fibula design, recipient vessels selection, pedicle and perforator location selection, and skin paddle configuration.

Results: Some problems encountered during the actual surgery could have been avoided as they became evident with HASP. In one case, the fibula reconstruction was incomplete because the fibula had to be reversed and thus did not reach the temporal fossa. In another case, the fibula had to be rotated 180 degrees to correct the plate and screw placement in relation to the perforator. In the spinal case, difficulty in finding the optimal fibula shape and position required extra ischemia time.

Conclusions: The surgeons found HASP to be an efficient planning tool for FOFF reconstructions. The testing of alternative reconstructions to arrive at an optimal FOFF solution preoperatively potentially improves patient function and aesthetics and reduces operating room time.

Place, publisher, year, edition, pages
Wolters Kluwer, 2015
National Category
Medical Image Processing Surgery
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-260771 (URN)10.1097/GOX.0000000000000447 (DOI)
Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2016-01-20Bibliographically approved
Jalouli, M., Jalouli, J., Hasséus, B., Öhman, J., Hirsch, J. M. & Sand, L. (2015). Nested PCR for detection of HSV-1 in oral mucosa. Medicina Oral, 20(6), E664-E669
Open this publication in new window or tab >>Nested PCR for detection of HSV-1 in oral mucosa
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2015 (English)In: Medicina Oral, ISSN 1698-4447, E-ISSN 1698-6946, Vol. 20, no 6, p. E664-E669Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It has been estimated that 15%-20% of human tumours are driven by infection and inflammation, and viral infections play an important role in malignant transformation. The evidence that herpes simplex virus type 1 (HSV-1) could be involved in the aetiology of oral cancer varies from weak to persuasive. This study aimed to investigate by nested PCR (NPCR) the prevalence of HSV-1 in samples from normal oral mucosa, oral leukoplakia, and oral squamous cell carcinoma (OSCC).

MATERIAL AND METHODS: We investigated the prevalence of HSV-1 in biopsies obtained from 26 fresh, normal oral mucosa from healthy volunteers as well as 53 oral leukoplakia and 27 OSCC paraffin-embedded samples. DNA was extracted from the specimens and investigated for the presence of HSV-1 by nested polymerase chain reaction (NPCR) and DNA sequencing.

RESULTS: HSV-1 was detected in 14 (54%) of the healthy samples, in 19 (36%) of the oral leukoplakia samples, and in 14 (52%) of the OSCC samples. The differences were not statistically significant.

CONCLUSIONS: We observed a high incidence of HSV-1 in healthy oral mucosa, oral leukoplakia, and OSCC tissues. Thus, no connection between OSCC development and presence of HSV-1 was detected.

Keywords
HSV-1; nested PCR; PCR
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-265746 (URN)10.4317/medoral.20630 (DOI)000369435500004 ()26449432 (PubMedID)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01Bibliographically approved
Sand, L., Jalouli, M., Jalouli, J., Ibrahim, S., Hasseus, B., Ohman, J. & Hirsch, J.-M. (2015). Virus and tobacco use in premalignant and malignant oral lesions. Paper presented at 20th World Congress on Advances in Oncology and 18th International Symposium on Molecular Medicine, October 8-10, 2015 Metropolitan Hotel, Athens, Greece. International Journal of Molecular Medicine, 36(Supplement: 1), S27-S27
Open this publication in new window or tab >>Virus and tobacco use in premalignant and malignant oral lesions
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2015 (English)In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 36, no Supplement: 1, p. S27-S27Article in journal, Meeting abstract (Other academic) Published
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-266289 (URN)000361863000091 ()
Conference
20th World Congress on Advances in Oncology and 18th International Symposium on Molecular Medicine, October 8-10, 2015 Metropolitan Hotel, Athens, Greece
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2017-12-01Bibliographically approved
Ramadhan, A., Gavelin, P., Hirsch, J. M. & Sand, L. (2014). A retrospective study of patients with mandibular fractures treated at a Swedish University Hospital 1999-2008. Annals of maxillofacial surgery, 4(2), 178-181
Open this publication in new window or tab >>A retrospective study of patients with mandibular fractures treated at a Swedish University Hospital 1999-2008
2014 (English)In: Annals of maxillofacial surgery, ISSN 2231-0746, Vol. 4, no 2, p. 178-181Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Fracture of the mandible is one of the most common fractures of the maxillofacial skeleton. However, the etiology, gender, and age distribution vary between different regions and countries, and the purpose of this study was to evaluate the current trend of patients with mandibular fractures at the Department of Oral and Maxillofacial Surgery, in Uppsala, Sweden.

AIM:

The aim of this retrospective study was to analyze patients with mandibular fractures treated in the University Hospital of Uppsala (the county capital of Uppland) Sweden during a 10-year period (1999-2008).

MATERIALS AND METHODS:

This study was designed as a retrospective study of patients admitted to the Department of Oral and Maxillofacial Surgery at Uppsala University Hospital, Sweden. The location of fractures was evaluated clinically by the surgeon and on the X-rays. We classified the data according to gender, age, etiology, day of the week, month of the year, fracture site, and method of treatment of the fractures.

RESULTS:

Records were collected from patient charts from 266 patients. One hundred eighty-seven patients (70%) with mandibular fractures were of male gender, and 132 patients (50%) were aged 16-30 years. Interpersonal violence constituted the most common etiological factor for mandibular fractures (24%), followed by falls (23%). Forty-nine percentages of the patients were treated surgically, and 51% were treated conservatively. There was an increase of the annual incidence of fractures toward the end of the period, even though not statistically significant.

CONCLUSIONS:

Mandibular fractures occurred primarily among younger men between 16- and 30-year-old. Condyle fractures were the most common fracture site and 50% of the patients required surgery. Summer months and weekends were the most common time of mandibular fractures.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-248227 (URN)10.4103/2231-0746.147119 (DOI)25593868 (PubMedID)
Available from: 2015-03-31 Created: 2015-03-30 Last updated: 2015-03-31Bibliographically approved
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