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Purpose This retrospective study analyzes deviations between preoperative planning and postoperative outcome in orthognathic surgery using 2D Onyx Ceph®-cephalometric analyzing and planning system. Materials and methods A total of 100 patients with a mean age 25.1 of years were included in this study. In 33 patients a bilateral sagittal split osteotomy and in seven patients a Le Fort I osteotomy was performed. A total of 60 patients were treated by a bimaxillary approach. Onyx Ceph® was used as cephalometric planning software (Onyx Ceph®), followed by mock operations. Postoperative cephalograms were obtained after 3.3 days and compared to preoperative planning cephalograms for sagittal (SNA, SNB, ANB) and vertical (ArGoMe, ML-NSL, NL-NSL) angle measurements. Real and absolute mean deviation were documented. Results Absolute mean deviation (degrees) between postoperative and planned jaw movement was lower for the sagittal parameters SNA (0.58), SNB (1.15) and ANB (1.05) compared to the vertical parameters NL-NSL (1.47), ML-NSL (1.96) and ArGoMe (3.20). SNA, SNB and ANB showed constant deviations independent from the extent of jaw movement. With regard to the vertical parameters ML-NSL, ArGoMe and NL-NSL the extent of the postoperative rotational jaw movement was not as much as planned, particularly for vertical shifts of more than 4°. Conclusion By using the 2D Onyx Ceph® cephalometric software for orthognathic surgery, the deviations between planned and actual movements are within an acceptable and predictable range. Planning of extensive vertical alterations may result in greater deviations after surgery.

Purpose: When failing front teeth are replaced by implants, vestibular bone deficiencies frequently require augmentation, even though the amount of missing alveolar volume may vary. The objective of this study was to analyze the horizontal alveolar ridge dimension after implant placement and simultaneous augmentation, and to compare it to the condition at the contralateral natural site. Materials and Methods: Forty-eight patients with a failing maxillary incisor received an immediate or early implant (Straumann Bone Level), according to a randomized study protocol. The vestibular wall of the implant site was reconstructed and moderately overcontoured with bovine hydroxyapatite and a collagen membrane (BioOss, BioGide, Geistlich). Provisional restoration followed either immediately, or after a 6-week healing period. To investigate the vestibular volume 6 months after surgery, a plaster model of the maxilla was scanned with cone beam computed tomography (CBCT; Morita 3D) and evaluated using coDiagnostiX software (Dental Wings). Statistical analysis comprised one- and two-sample t tests. Results: The ridge volume was not significantly influenced by the treatment schedule. The vestibular segments had a mean ± SD volume of 207.9 ± 102.5 mm3 for the implant sites, and 202.1 ± 101.5 mm3 for the corresponding natural sites (P = .28). The difference in vestibular volume between implant sites and natural tooth sites was 10.4 ± 36.2 mm3 for immediate implantation, and 0.00 ± 31.1 mm3 for early implantation (P = .32). Comparing immediate and early restoration, a difference of 0.4 mm3 and 12.5 mm3 between the implant and contralateral site was found (P = .23). Conclusion: Six months after treatment, no significant differences between the alveolar volumes at augmented implant sites and natural sites were found. Moderate buccal overcontouring may have been beneficial to achieve a symmetrical contour. Long-term follow-up investigation will document if the restored volume remains stable over time.

Langerhans cell histiocytosis (LCH, histiocytosis X, ICD-O 9751/1) refers to a neoplastic proliferation of Langerhans cells. The course of the disease determines the treatment and prognosis. Solitary forms (eosinophilic granuloma) and limited multilocational lesions may be treated successfully with local surgical intervention and intralesional corticosteroid injection. Presentation of our own case will review LCH, a very rare disease entity in oral–facial surgery and will document that intralesional corticosteroid injection is a less invasive alternative to the classical surgical curettage and local radiation therapy. In a 10-year-old boy, a progressive, pressure-sensitive swelling had developed within 1 week in the left paramandibular and submandibular area. Dental status was good. Diagnostic imaging demonstrated a diffusely contoured osteolysis caudal to tooth germ 37 with infiltration of the adjacent chewing muscles. Histological evaluation of the intraoral biopsy sample established an LCH. Having excluded a multifocal form of LCH, treatment with intralesional injection of methylprednisolone 200 mg was chosen. Symptoms of pain were quickly relieved and the swelling receded. Follow-up visits 6 weeks, 3 months, and 6 months after corticosteroid injection revealed continuous regression of mandibular osteolysis. OPG and MRI after 17 months demonstrated a good osseous consolidation in the left mandibular angle area, but a still discernible bone marrow edema. Development of the intralesional tooth germ 37 appeared normal. Local surgical interventions continue to be central to the range of accepted therapeutic measures. However, the increasing numbers of reports on the successful treatment of solitary LCH by intralesional corticosteroid injection suggest that this treatment option should be considered especially in children to preserve tooth germs.

Background Large oral lesions comprise the risk that an incisional biopsy does not reveal the most aggressive site in spite of carefully selecting the place of biopsy.

Based on own retrospective studies a condylar head add-on system for immediate, temporary reconstruction in patients undergoing ablative surgery requiring the removal of the manibular condyle has been developed in cooperation with the Department of Oral and Maxillofacial Surgery of the University of Tennessee, USA, and the Association for the Study of Internal Fixation (AO/ASIF). The design of the new condylar head add-on system and its use in an anatomical dissection study on a human cadaver are introduced and discussed. The condylar replacement is made of commercial pure titanium and is conceived as an add-on system. It consists of a reconstruction plate (2.4 Uni-LOCK-System) und an adaptable condylar head that can be fitted on either side. The offset of the condylar head in a medial direction allows anatomically correct positioning of the implant. The slanted oval head shall provide a large contact area while maintaining function of the mandibular joint. The height-adjustable positioning of the condylar head add-on with four different fixations plates facilitates an intraoperative vertical correction of the condylar head without necessary bending of a new reconstruction plate. A condylar head add-on used on both sides and combined with the frequently used 2.4 Uni-LOCK-plate benefits from reduced storekeeping and turns out to be advantageous from an economic point of view. An international, prospective multi-center study evaluating the intraoperative applicability of the new condylar head add-on system and its functional as well as aesthetic results during the first two postoperative years has started in September 2006.

The objective of this study was to evaluate postoperative complications after removal or retention of the third molar in the line of mandibular angle fractures. This retrospective study included the data of 98 patients with a molar in the line of a mandibular angle fracture treated with internal reduction and mini-plate fixation at our department over 9 years. Patients were classified into two groups: tooth removal during osteosynthesis (n = 45) and tooth retention (n = 55). The primary target criterion was the incidence of minor (outpatient treatment, local measures) and major (surgical revision, rehospitalisation) complications. Time between trauma and surgery was 1.4 days (range 0 to 12), and the average follow-up 291 days (range 66 to 863). Regarding the eruption status, 26 of 52 (50.0 %) impacted third molars, 11 of 19 (57.9 %) incompletely erupted and 8 of 27 (29.6 %) completely erupted molars had been removed during open reduction. Overall, 17 (17.3 %) patients had postoperative minor (n = 7) or major (n = 10) complications, in detail 10/45 (22.0 %) patients after tooth removal and 7/55 (13 %) patients after tooth retention (p = 0.286). Complication rates between impacted and incompletely erupted third molars (impacted molars 15.0 %, incompletely erupted molars 10.0 %) did not differ significantly, but completely erupted molars had a complication rate of 26.0 %. Mandibular angle fractures with a completely erupted third molar show the highest complication rate after open reduction and osteosynthesis. Retention of a non-infectious third molar facilitates open reduction and does not increase the complication risk. The study helps with the decision of removing or retention of a third molar during surgical treatment of a mandibular angle fracture.

A 3-point skeletal anchorage with taping screws for distraction osteogenesis after a Le Fort III osteotomy was applied for the first time in a severely mentally impaired patient where intraoral devices had to be avoided. All 3-force application points included the center of resistance, which allowed an optimal control on the resulting moment. A novel device for skeletal long-term retention into the nasal dorsum prevented a relapse, whereas adjustment of the midface position was observed. Fusioned three-dimensional computed tomography analysis revealed real movements not accessible by a conventional cephalometry.

Background Kimura's disease is a rare inflammatory disease that mainly affects Asians and most often occurs in the deep lymph nodes of the head and neck. We report on a rare case of Kimura's disease in the hard palate of a white man. Method A 56-year-old white man was seen with a rapidly growing mass in the upper jaw. A complete tumor resection with hemimaxillectomy was performed. The tumor, which showed signs of inflammation, was located within the bone and the soft tissue. Results Kimura's disease was diagnosed by histopathologic examination of the resected tumor. Conclusion This case demonstrates that Kimura's disease, though rare, is not limited to the Asian population. We present a case of a tumor in a white man. This adds another possibility for uncertain differential diagnoses of rapidly growing tumor masses. © 2009 Wiley Periodicals, Inc. Head Neck 33:138–140, 2011

A 22-year-old man presented for orthodontic surgery because of mandibular prognathism. Clinical symptoms suggested acromegaly, and diagnosis was verified by an endocrinologist as well as by radiograph. Bilateral mandibular prognathism often represents the first and most striking physical characteristic of acromegaly; usually, it is also the main reason why patients seek help from orthodontists or maxillo-facial surgeons. This case report recapitulates the clinical and histopathological findings in pituitary growth hormone (GH) adenomas and emphasises their importance in surgical orthodontic planning. Mandibular prognatism, macroglossia and abnormal growth of hands and feet represent strong indicators for the diagnosis of acromegaly. This disease and its complications not only affect the entire body but increase mortality if the pituitary gland tumour remains untreated.

Large oral lesions comprise the risk that an incisional biopsy does not reveal the most aggressive site in spite of carefully selecting the place of biopsy.The first incisional biopsy of a large, clinically suspect, oral lesion could not identify the subepidermal spread of a recurrent oral squamous cell carcinoma. Atypical cells obtained by a simultaneous brush biopsy prompted a renewed, incisional biopsy which finally established the diagnosis of a recurrent, oral squamous cell carcinoma.The presented case emphasizes the value of brush biopsy in the follow-up of oral squamous cell carcinoma, especially in examination of oral lesions covering a large area.