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Zur Minimierung des perioperativen Risikos transfusionsassoziierter Komplikationen wird im Rahmen von Dysgnathieeingriffen in der Regel eine praoperative Eigenblutspende durchgefuhrt. Mit der vorliegenden Studie wurde die Notwendigkeit dieser Masnahme kritisch hinsichtlich gesundheitlicher, okonomischer und juristischer Fragestellung untersucht. Im Zeitraum von 1994 bis 2002 wurden in der Klinik fur Mund-, Kiefer- u. Gesichtschirurgie in Bonn 178 Dysgnathieoperationen durchgefuhrt. Alle Patienten (101 weibliche, 77 mannliche) wurden uber die Moglichkeit einer Eigenblutspende (EBS) aufgeklart. 83% nahmen das Angebot wahr, wobei fur einen monognathen Eingriff zwei und fur eine bignathe Operation in der Regel drei bis vier Erythrozytenkonzentrate vorgesehen waren. 99 Patienten wurden monognath im Unterkiefer, 27 Patienten im Oberkiefer operiert. In 52 Fallen erfolgte ein bignathes Vorgehen. Der mittlere Blutverlust bei einer monognathen Operation im Unterkiefer betrug 756 ml, im Oberkiefer 858 ml und bei einer bignathen Operation 1391 ml. Bei 13 Patienten wurde ein absoluter Hamoglobinwert von 7,5 g/dl unterschritten und in 12 Fallen Eigenblut retransfundiert. Insgesamt wurden 57,7% der gespendeten Erythrozytenkonzentrate verworfen. Die Kenntnis des Vorhandenseins von Eigenblut verleitete zur fruheren Gabe von Erythrozytenkonzentraten im Vergleich zur Fremdblutgabe und muss kritisch hinterfragt werden. Eine Eigenblutspende sollte aus medizinischer Sicht weiterhin bei bignathen Eingriffen durchgefuhrt, jedoch bei monomaxillaren Eingriffen auf Einzelfalle mit besonderem Risiko beschrankt werden.

Das Ameloblastom ist der haufigste epitheliale odontogene Tumor im Bereich des Kieferknochens. Es wachst lokal infiltrierend und neigt zu Rezidiven. Falle einer malignen Transformation und das Auftreten von Fernmetastasen sind beschrieben. Immunhistochemische Untersuchungen zeigen eine erhohte Expression von P53-Protein in Ameloblastomen. Mutationen des tp53-Tumorsuppressorgens wurden in einer Vielzahl menschlicher Tumoren nachgewiesen. In der vorliegenden Studie wurden histologische Gewebeschnitte auf die Expression von P53-Protein untersucht und das tp53-Gen betroffener Patienten einer Mutationsanalyse unterzogen. Die Tumor-DNS von 29 Ameloblastompatienten wurde auf Mutationen in den Exons 5 bis 8 des tp53-Tumorsuppressorgens mittels PCR, SSCP- und Sequenzanalyse untersucht. Schnittpraparate dieser Tumoren wurden immunhistochemisch auf eine Uberexpression von P53-Protein uberpruft. Erstmalig konnten zwei tp53-Mutationen (6,9%) in Ameloblastomen nachgewiesen werden. 58,6% der Tumoren zeigten eine Immunreaktivitat fur P53-Protein. Es bestand eine statistisch signifikante positive Korrelation (Fisher’s Exact-Test p

We did a morphometric analysis of 130 histological sections of basal cell carcinoma (BCC) of the face to find out whether morphometric variables in the structure of the nuclei of BCC cells could serve as predictors of the biological behaviour. We considered the following variables: maximum and minimum diameters, perimeter, nuclear area and five form factors that characterise and quantify the shape of a structure (axis ratio, shape factor, nuclear contour index, nuclear roundness and circumference ratio). We did a statistical analysis of primary and recurring tumours and four histology-based groups (multifocal superficial BCCs, nodular BCCs, sclerosing BCCs and miscellaneous forms) using a two-sided t test for independent samples. Multifocal superficial BCCs showed significantly smaller values for the directly measured variables (maximum and minimum diameters, perimeter and nuclear area). Morphometry could not distinguish between primary and recurring tumours.

Complications Arthroscopy of the temporomandibular joint is an invasive procedure that can entail potential complications. Based on many years of personal experience and taking data from the literature into account, this article discusses functional, surgical, and anesthesiological complications of arthroscopy of the temporomandibular joint. The majority of these complications can be avoided by heeding specific knowledge of topography, careful manipulation, and corresponding surgical experience. Informing the patient The information given to the patient prior to the intervention should cover not only hemorrhaging, swelling, and wound infection, but also damage to (branches of) the facial nerve, the risk of perforation of the auditory canal as well as the possibility of temporary occlusal disturbances.

The temporomandibular joint is rarely affected by crystal deposition disease (gout and pseudogout). Only the temporomandibular joint was affected in a 69-year-old patient with calcium pyrophosphate dihydrate deposition disease (pseudogout). This case is described here. Clinically presenting as painless swelling, computed tomography and magnetic resonance imaging showed signs of a chronic destructive arthritis. The evidence for calcium pyrophosphate dihydrate crystals was provided by histological examination. Diagnostic criteria, differential diagnosis and possibilities for treatment are discussed on the basis of our own experience and the literature.

Problem: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer – some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria. Patients: 165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. Results: The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%. Conclusion: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.

Two mini-pigs and 6 micropigs were fitted with a dentally fixed device for osteodistraction of the mandible. Following bilateral osteotomy and after a latency period of 7 days, the apparatus was activated 1 mm per day. A 9 mm lengthening of the mandible was achieved. After a retention period of 6 weeks, the device was removed followed by a consolidation period of 6 weeks. During the experiment, the callus and bone formation and potential dental and periodontal reactions were radiologically examined. Polychrome sequential labelling was performed by injecting calcein green and xylenol orange for histological assessment of bone. The animals were killed at the 14th postoperative week and the area of distraction and the roots of the adjacent teeth were histologically studied. After 12 weeks, the osteogenesis in the distraction gap was complete, showing lamellar bone. No detrimental effects at the roots or in the periodontium of the adjacent teeth were seen. Thus, lengthening or widening of the mandible using a tooth-borne distraction device seems feasible in selected cases.

The case is presented of a 47-year-old woman with an 8-week history of persistent right ear discomfort and a 2-week history of unilateral parotid swelling, as well as peripheral paresis of the facial nerve. The case points to the difficulties encountered when Wegener's granulomatosis presents in an unusual and varied way which mimics a malignant tumour of the parotid gland. To our knowledge, the association of parotid gland involvement and facial palsy in Wegener's granulomatosis has not previously been described in the literature.

We present three cases of cervical teratoma, two of which were detected prenatally by ultrasound. The two cases diagnosed prenatally showed rapid early growth, which indicated the aggressive nature of the tumour and assisted the parents' decision to terminate the pregnancy. The third case was undiagnosed prenatally and the child was born after a normal pregnancy and uncomplicated vaginal delivery. She recovered well after excision of the teratoma.

Objective. The primary diagnosis of synovial chondromatosis of the temporomandibular joint is extremely rare. Often many months, or even years pass before the diagnosis is confirmed. Study Design. Eight patients with synovial chondromatosis were treated by arthrotomy. In addition to the definitive diagnosis, histologic classification according to the stages proposed by Milgram was undertaken and confirmed with the literature. Results. The predominant symptoms of synovial chondromatosis, including pain, swelling, restricted movement of the mandible, and crepitation, were evaluated. Nevertheless, more than 80% of the patients were previously primarily treated on the basis of other tentative diagnoses. Conclusion. Synovial chondromatosis of the temporomandibular joint should be included in the differential diagnosis of chronic swelling and pain in the preauricular region, and the patient should be sent for appropriate diagnostics and therapy at an early stage. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:31-8)

211 patients (88 female, 123 male, mean age 63 years) presented with 279 basal cell carcinomas (191 primary tumours, 88 recurrent tumours) in the head and neck area that were excised. The resected margins were examined microscopically and the defect repaired at a second operation. The excision margin was 1-2 mm. The recurrence rate was 3%, which is lower than is achieved by other methods, and unaffected structures are optimally conserved.