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For the augmentation of maxillo-facial soft tissue deficiencies, microsurgical 'pure' fat transplants have proven effective. In this paper, we present the 'de-epithelialized' scapular flap and discuss its significance in comparison with other microvascular fat transfers. Consistency of transplant vessels and minimal dependence of volume on the overall nutritional condition are its specific advantages. The transplant can be securely fixed at the retained corium.

In a prospective study we examined the effect of preoperative chemotherapy with cisplatinum and 5-fluorouracil (5FU) in 40 patients with a carcinoma of the oral cavity. Histopathological grading, cell kinetic and immuno-histochemical parameters of the mucosa were determined at two different locations. Prior to therapy histological dysplasias "close" to the tumour were observed in the mucosa of 75% of the patients. Dysplastic changes of the mucosa "far" from the tumour were also found in more than one third of the patients. Our results show that more advanced dysplasias improve under the influence of preoperative systemic chemotherapy only temporarily. Moreover, new dysplasias which appeared during chemotherapy and persisted after its termination are probably induced.

In a prospective study we examined the effect of preoperative chemotherapy with cisplatinum and 5-fluorouracil (5-FU) in 40 patients with advanced carcinoma of the oral cavity. Histopathologic grading, cell kinetics and immunohistochemical parameters of the mucosa were determined at two different locations. Prior to therapy, histologic dysplasias in the mucosa "close" to the tumor were observed in 75 percent of the patients. Dysplastic changes of the mucosa "far" from tumor were also found in more than one-third of the patients. Our results show that more advanced dysplasias improve only temporarily under the influence of preoperative systemic chemotherapy. Moreover, new dysplasias appearing during chemotherapy and persisting after its termination are probably induced. The results point to a possible carcinogenic potential of the combined chemotherapy schema used.

Poor oral hygiene is believed to play a role as a risk factor for head and neck cancer, especially for oral cancer. Only few epidemiologic data exist about dental status and oral hygiene in these patients. We performed a case-control study involving 100 patients with squamous cell carcinoma of the upper aerodigestive tract and 214 age- and sex-matched control subjects with no known tumorous disease. In the tumor patients, oral hygiene and dental status proved to be significantly worse: the majority of the tumor patients seldom or never brushed their teeth and the frequency of dental visits was significantly lower. Tartar of 3 mm or more was found in 40.9% of the tumor patients and in 22% of the control subjects. In the tumor group, the incidence of decayed teeth was significantly higher compared with the control subjects. Chronic inflammation of the gingiva was observed in 28% of the tumor patients vs. 13.5% in the control group. Oral hygiene was negatively correlated with alcohol as well as with tobacco consumption. The social status of subjects also correlated with oral hygiene, which was found to be worst in subjects from the lower social strata. The present study revealed a poor dental status and oral hygiene in patients with head and neck cancer. The pathogenetic mechanism being associated with this suspected risk factor remains to be investigated.

Reconstruction of the soft palate after tumor surgery can present a challenge in closing the defect created and achieving a sufficient functional result. We present a new technique for primary reconstruction after partial or total resections of the soft palate. The method is based on the combination of a cranially pedicled pharyngeal mucosa muscle flap with an oral mucosal transposition flap. If partial resection of the lateral pharyngeal wall is also required, the method can be combined with a masseter crossover flap. Our present experience has shown that the surgical technique used will result in an uncomplicated and rapid primary two-layer reconstruction of the soft palate with a comparatively low postoperative complication rate and satisfactory functional results in speaking and swallowing.

A method for primary reconstruction of the soft palate following radical tumor resection is described. The resulting defects can be repaired with 2 layers of tissue by combination of a cranial pedicled pharyngeal flap and a cranial pedicled intraoral cheek transposition (IOCT-) flap. For additional resection of the lateral pharyngeal wall the technique can be combined with a masseter crossover flap. The method allows satisfying restoration of swallowing and speech with relatively small operative effort.

A method for primary reconstruction of the dorsal oral cavity after tumor resection of T2 or small T3 tumors is presented. By combination of the masseter muscle flap with a cranial pedicled intraoral cheek transposition (IOCT) flap, a reconstruction of the defects with two layers of tissue is possible. This easy and functional reconstruction method is especially useful for high-risk patients because of the markedly reduced operating time.

Based on the results of 150 patients with primary tumors or the suspicion of malignant lesions of the locomotor system the perspectives and limits of the sonographic diagnosis under the therapeutic aspects of interdisciplinary oncologic cooperation is demonstrated. As the ideal adjunct to conventional roentgenograms, ultrasound is the first-line imaging procedure in the fields of primary diagnosis, follow-up, post-therapeutic care as well as tumor exclusion for methodic, patient-related and economic/logistic reasons. Its consequent application will markedly reduce the number of more invasive and expensive methods.

A randomised, prospective study was conducted to compare the efficiency and safety of methods for intravenous conscious sedation in patients undergoing oral surgery under local analgesia. 150 systemically healthy patients (ASA Class I and II) participated. Three groups were formed: group 1 received 0.05 mg/kg midazolam; group 2 0.05 mg/kg midazolam, 1.5 mg/kg tramadol, 50 mg alizaprid; group 3 0.05 mg/kg midazolam, 0.2 mg/kg nalbuphine, 50 mg alizaprid. Blood pressure, heart rate and oxygen saturation were measured throughout the procedure. The results confirmed that the use of nalbuphine (group 3) allows a reduction in the mean dosage of midazolam required to produce satisfactory sedation and effected a more rapid recovery time compared to group 12 and 2. With the combination nalbuphine and alizaprid nausea and vomiting could be reduced for the most part compared to group 2.

Biochemical Markers (alpha-1-acid glycoprotein, ferritin, transferrin) and tumor associated markers (TPA, CEA, SCC-antigen) are described. Concerning the screening of oral carcinoma, the use of tumor markers is to be considered with criticism. The SCC-antigen seems to be the most useful for detection of recurrence in the follow-up. But no tumor marker can replace exact physical and ultrasound examinations.

A rare case of chronic granulomatous disease with manifestation in the mandible is presented. A 10-year-old boy showed the clinical picture of osteomyelitis without paresthesia (Vincent syndrome). Diagnosis was done by the nitroblue tetrazolium test (NBT) and by demonstration of a complete cytochrome-b deficiency of the granulocytes. In septic granulomatosis a continuous application of Sulfamethoxazol-Trimetoprim is recommended for prophylaxis of infection. For treatment of infection further antibiotics who pass into the granulocytes like rifampicin and fosfomycin are necessary. Oral surgical procedures request a careful tissue handling and a tight wound closure.

Conditions and selections of patients undergoing oral surgery under intravenous conscious sedation are reviewed. The practicability of several medicaments and combinations are discussed. Intravenous conscious sedation in combination with local anesthesia is an alternative during unpleasant surgical and dental procedures, and in several cases, can replace general anesthesia. A sufficient monitoring as well as a good trained staff makes the methods safe and allows to reduce complications.

A method for the primary reconstruction of the posterior oral cavity following T2 and small T3 tumor surgery is described. The combination of a masseter flap with a cranially pedicled intraoral buccal transposition flap results in a double layer for the repair of defects. Because of its simplicity and hence a shorter operation time, this functionally satisfactory reconstructive procedure should be used particularly for high-risk patients.

The possibilities offered by panoramic zonography (MT program) in the diagnosis of the midface are outlined. The imaging quality of various anatomical structures is demonstrated both on the anatomical model and in clinical use. The benefits and limitations of this procedure are discussed. Zonography is a reliable instrument adding to the range of basic diagnostic procedures in the midfacial region.

The m. masseter crossover flap according to Tiwari combined with a buccal mucosa transposition flap represents an excellent technique for a primary two-layered closure of defects due to surgical removal of T2- and small T3-tumors of the posterior part of the lateral floor of the mouth, the posterior edge of the tongue, the retromolar trigone, the soft palate and the tonsilar region. Especially advantageous are the low postoperative morbidity, the low rate of postoperative complications, and good functional and cosmetic results. The surgical expenditure is little and recommends the use of this technique also in patients with reduced operability.

A method of surgical support of a rapid maxillary expansion is described. Specific osteotomies are performed on the attached region of the maxillary zygomatic process and the dorsal and middle part of the hard palate. The results of 14 patients are demonstrated. Almost all patients underwent surgical correction of sagittal and/or vertical jaw relations after a subsequent harmonization. This surgical orthodontic expansion proved to be an efficient and low pain method of preoperative correction of transverse maxillary deficiencies and facilitated the following skeletal surgery.

Damage of the auriculo-temporal nerve with consecutive Frey's syndrome (gustatory sweating) can occur with fractures of the temporomandibular joint (TMJ) as a result of the anatomic proximity. A case of marked gustatory sweating as a rare complication of a mandibular joint fracture and alternation of therapy are reported.

The experience of a method for surgical support of a rapid maxillary expansion is described. The attached region of the maxillary zygomatic process and the dorsal and middle part of the hard palate are osteomized. The results of 18 patients are demonstrated. Almost all patients underwent surgical correction of the sagittal and/or vertical jaw discrepancies later. This surgical-orthodontic expansion proved to be an effective and low pain method for preoperative correction of transverse maxillary deficiencies and facilitated the subsequent skeletal surgery. After the treatment mentioned above in cases with a correct position of the maxilla in relation to the skull base a Le-Fort-I-Osteotomie was not necessary.

The radiological diagnosis of fractures of the mandibular condyle may be quite difficult. In a study of 237 patients the value of panoramic zonography is evaluated. Advantages of the new method are orthoradial projection, examination in a supine position, and good visibility of the anatomical structures in the TMJ-S and TMJ-PA program. Radiation doses in conventional radiography are 40-60 times higher than in panoramic zonography. High resolution CT should be reserved for special indications.

A method for the primary reconstruction of soft palate after radical tumor excision is described. By combination of a cranial pedicled pharynx flaps and a cranial pedicled intraoral buccal transposition flap is it possible to close the resulting defect in a double layer. In additional resection of the combination of the method with a M. masseter-transposition flap is possible. By the method it is possible to have a satisfactory reconstruction of swallowing and speech functions with only small operative troubles.

The diagnostic value of plasma concentration of the squamous cell carcinoma antigen was examined in 75 cases of pretherapeutic squamous cell carcinoma of the oral cavity. A pathologic plasma level was found in 32% of the tumour patients at time of diagnosis. The incidence of elevated SCC- values was inversely correlated to the tumour grading. A direct correlation of the sonographically measured total tumour volume was seen. As predominantly more extended tumours show pathologic values, SCC-Antigen is not a marker for the screening in the diagnosis of the early cancer of oral cavity. That emphasizes the importance of the precise clinical examination of each patient. In cases of elevated pretherapeutic values SCC-Antigen is very useful for therapy--monitoring and follow-up.

The results in 53 patients with tumours of the oral cavity and oropharyngeal region who received Cisplatinum/5-FU indicate that ultrasound monitoring of preoperative antineoplastic chemotherapy is a valuable, effective, and economical/imaging method which improves the early adjustment of the therapy concept to response rates at the C2-level.

The concept of autologous transfusion in displacement osteotomies in oral and maxillofacial surgery is presented. Considerately and specifically applied, autotransfusion is the safest mode of blood transfusion and may replace homologous transfusion in a planned operation involving a high amount of blood loss. Although autotransfusion requires considerably more organization and man hours, costs may be saved by avoiding the wide range of complications associated with homologous transfusions. Yet, homologous transfusion, that has its justified value particularly in emergency procedures, will never be fully replaced by autotransfusion.

An increased squamous cell carcinoma antigen (SCC) value was found in 33.3% of the patients with carcinomas of the oral cavity. In those patients in whom the tumor recurred, this percentage increased to 75%. Although elevated in 43.4% of the tumor patients, CEA values failed to drop after treatment like the SCC antigens did. Nor was there, in contrast to the SCC antigens, any evident correlation with tumor volume. Thus, pathologic CEA values must be attributed to non-tumor specific concomitant diseases. Ca 19-9, Ca 125 and Ca 15-3 exhibited poor sensitivity. According to the results of our studies the only valid tumor markers are SCC antigens, particularly for monitoring treatment.

24 patients with osteogenic sarcomas of the jaws were entered in a retrospective study. 79.2% of the cases had local relapses or distant metastases, usually within the first 2 years following surgery. With primary surgical treatment the 5 year disease free survival rates in cases with maxillary manifestations ranged at 22.1% and with mandibular sarcomas at 18.2%. Thus, prognosis for osteogenic sarcomas of the jaws is to be assessed as being no more favorable than for sarcomas of the extremities. A review of the literature shows that aggressive pro- and postoperative chemotherapy must be postulated apart from radical tumor resection to improve the survival rates.

A 61-year-old female patient suffering from neuralgiform facial pain developed a PVP granuloma, after she had received peripheral conduction anesthesia treatment with a local anesthetic containing polyvinylpyrrolidone over many years. The clinical symptoms and treatment of this pseudotumor as well as the features distinguishing it from real tumors, particularly chordomas, are indicated.

A method for simple primary reconstruction of the anterior floor of the mouth is described. Intraoral malar transposition flaps are a suitable procedure to cover tumor defects (up to T2) satisfactorily.

A placebo-controlled double-blind study of 100 patients with impacted and/or dislocated lower wisdom teeth was conducted to examine the tolerance and antiphlogistic efficacy of bromelaine--a mixture of proteolytic enzymes from ananas comosus. Treatment was started 1 day prior to third molar surgery with a daily dose of 3 x 80 mg and was continued for a total of 6 days. On the 1st day following surgery, linear measurement (distance: tragus-pogonion) showed swelling to be 7.5% lower under drug treatment than in the placebo group. Two-dimensional image evaluation increased this difference to 15.9%, which however still failed to attain the significance level of 20%. Between the 3rd and the 7th postoperative day no differences were found between the two groups regarding the extent of soft tissue swelling or the speed of edema resolution.

Basing on the experience with 558 patients suffering from tumours or suspicious lesions in the head and neck region, sonographic pointers that have been inadequately noted so far, are pointed out to improve diagnosis, follow-up, and post-therapeutic care. Among the possibilities offered by sonography are: to confirm or exclude bony involvement of the mandible in tumours of the oral cavity and the oropharynx, to objectify the results of antineoplastic chemotherapy, to offer possibilities to optimize radiotherapy, as well as to show criteria for the early detection of a relapse under consideration of the primary therapy.

Based on an unusual case of bilateral mandibular condyle fracture the diagnostic problems are described. If conventional X-ray, panorama-tomograms and bilateral tomograms of both temporomandibular joints do not exactly show the fracture dislocation and the relation of the fragments CT scans should be taken.

The catheters were inserted by puncture or venous cut down of the subclavian-jugular-or the brachial vein. Misplacement of the catheter and its complications are analysed. Mortality rate of 1771 central venous catheters (1968 to 1977) is 0,2%.

Using the method described, a defect prosthesis can be fastened with the help of operatively prepared retention sites and transnasal anchorage after total upper jaw resection. The technical process of manufacture is outlined and the result demonstrated in photographs.

Between March 1985 and March 1988 109 patients with tumours of the oral cavity and the oropharyngeal region underwent 123 examinations by orthopantomography and realtime sonography for primary staging and/or diagnosis of a recurrent disease. In 105 cases the preoperative results could be compared to intraoperative and histopathological findings. Realtime sonography as a noninvasive, inexpensive and efficient method offered the ideal diagnostic adjunct to the orthopantomogram. Not only size, shape and structure of the soft tissue tumour could be accurately defined; whatsmore it was possible to demonstrate its relation to bony structures and to a high degree of sensitivity cortical invasion and periosteal reaction. The limitations of the method especially the risk of false positive findings after invasive diagnostic and therapeutic procedures are pointed out.