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Wegener's granulomatosis (WG) is a rare granulomatous vasculitis which used to run a fatal course. At present, it is possible to control or sometimes even cure the disease with immunosuppressives. Successful treatment depends largely on early diagnosis. Based on a review of the literature, the diagnostic relevance of hyperplastic gingivitis (HG) is discussed. HG should be considered an early sign of WG in contrast to oral ulcers.

Wegener's granulomatosis (WG) is a rare granulomatous vasculitis which used to run a fatal course. At present, it is possible to control or sometimes even cure the disease with immunosuppressives. Successful treatment depends largely on early diagnosis. Based on a review of the literature, the diagnostic relevance of hyperplastic gingivitis (HG) is discussed. HG should be considered an early sign of WG in contrast to oral ulcers.

After reviewing a group of more than 400 patients with parotid tumours, we feel that clinical examination, screening ultrasound scanning and pre-operative CT-scan are our most important diagnostic tools. Our treatment concept is based on direct posterior dissection of the main trunk of the facial nerve, total conservative parotidectomy with ablation of all glandular tissue especially in pleomorphic adenomas so that recurrency can be avoided, intra- and postoperative histological examination and filling in the post-operative soft tissue depression in all cases where intra-operative histological examination excludes malignancy. Primary post-parotidectomy defect substitution techniques using the platysma (Roscic) and the sternocleidomastoid muscle (Rausch) as well as a SMAS- and temporoparietal fascia- or galea-flap are illustrated. We currently use the combination of the Rauch- and Roscic- techniques in a way that a sternocleidomastoideus muscle rotation-flap together with a platysma-SMAS-fat-flap entirely cover the defect. We believe that the substitution-plasty, primarily performed for aesthetic reasons, acts as a mechanical barrier for the misdirected regeneration of the nervs to the skin and the sweat glands, and thus tends to avoid Frey's Syndrome. Using our technique concept, we feel that any disadvantage is counter-balanced by the absence of recurrences, no permanent facial paralysis, relatively good aesthetic results and lower incidence of Frey's Syndrome.

The frequency and importance of collum mandibulae fractures is indicated, especially in connection with the sequels of conservative-functional therapy, and the different classifications and types of fractures are described. The non-surgical approach is evaluated as a treatment. Its inconvenient and sometimes unsatisfactory results necessitate the surgical treatment of certain types of collum mandibulae fractures. Absolute en relative indications for osteosynthetic treatment of condylar fractures are noted, the proposed surgical technique is discussed. The importance of a universal preauricular incision continued in an incision for parotidectomy and resulting in a standard incision or a combined preauricular-submandibular incision, is pointed out. Surgical technique for intra and extra capsular collum fractures is illustrated. Our preference goes to functional stable osteosynthesis using titanium mini-plates and the often obligatory dissection of the facial nerve. The so called "condylar shave" or remodelling condylotomy in analogy with the DAUTREY-operation is a therapeutic contingency in case of bilateral collum mandibulae fractures with unilateral low condylar fracture where classical mini-plate osteosynthesis is done, and intracapsular multi-fractured condylar head on the other side where the condylar shave or rubble clearing is performed The attitude towards children is discussed. The result of this surgical technique is illustrated through the follow-up of 73 surgical treatments of collum fractures in 59 patients. We conclude that surgical osteosynthetic treatment of collum mandibulae fractures with a strict indication in case of dislocated and luxated fractures should be included in the therapeutic range of modern maxillo-facial traumatology.

In the treatment of fractures of the mandible, considering its biomechanics and topography, it is not enough to achieve just a horizontal compression with the osteosynthesis plate, as was previously the goal, since compression in parts far away from the osteosynthesis plate is equally essential. This double function is attainable by means of a new arrangement of the screw holes. The photoelastic experiment is performed to demonstrate that compression forces which develop in the two types of plates differ according to the arrangement of the screw holes. "Whereas there is practically no change in compression forces in plates with a horizontal screwing mechanism, a new traction strapping plate shows clearly the development of compression forces in areas far away from the plate.

In recent years close consideration of the biomechanical principles of treatment of mandibular fractures has led to the use of operative as well as conservative methods. Since this combined method of treatment appeared cumbersome, a new kind of osteosynthesis plate was developed for functionally stable internal fixation of mandibular fractures, without the necessity of additional fixation elements. After consideration of the biomechanics of the mandible, an even greater indication for the use of the lag-screw osteosynthesis is found. Use of both the tension band plate and the lag screw makes it possible to perform the operation intraorally. This is a further indication for the use of the operative internal fixation of fractures in the treatment of mandibular fractures, since it has many advantages for the patient.

1. An 7112 Fallen werden die Veranderungen des Herzgewichtes von der Geburt bis zum 110. Lebensjahre untersucht. 2. Das mittlere Herzgewicht nimmt bis zur 9. Lebensdekade standig zu, vom 30. Lebensjahre an bei Mannern um 1 g, bei Frauen um 1,5 g jahrlich. Eine geringe Verminderung des mittleren Herzgewichtes ist erst in der 10. und 11. Dekade nachweisbar. 3. Das relative Herzgewicht nimmt von 0,55% im mittleren Lebensalter bis auf 0,8% in den hochsten Altersstufen zu. 4. Eine Altersatrophie des Herzens konnte nicht nachgewiesen werden. Herzgewichte unter 200 g kommen bei jungeren Erwachsenen haufiger vor als bei alten. Die Minimalgewichte des Herzens sind bis zur 8. Lebensdekade kleiner als im hoheren Lebensalter. 5. Extreme Herzhypertrophien kommen bis zur 9. Lebensdekade vor. Herzhypertrophien zwischen 500 und 600 g werden auch bei uber 100jahrigen beobachtet. 6. Die Variabilitat der Herzgewichte nimmt mit dem Alter nicht zu, sondern ab. 7. Bei Mannern und Frauen entspricht der Anstieg des Herzgewichtes zwischen dem 30. und 80. Lebensjahre genau dem altersbedingten Anstieg des mittleren arteriellen Blutdruckes. 8. Die latente Altersinsuffizienz entsteht nicht durch eine Diskrepanz zwischen Blutdruckanstieg und Gewichtswachstum des Herzens.

During the Caldwell-Luc antrum operation, there is a resultant bone defect in the area of the canine fossa. Scarry tissue from the cheek seals this defect, narrows or sometimes obliterates the antrum completely and thereby disturbs the normal physiology of the mid-face. We report about a new procedure in which the facial fenestration is primarily reconstructed by means of a trap-door like bone flap with adherent soft tissue. In this way the normal volume of the antrum remains unchanged. The irritation of the infraorbital nerve through the scar tissue which is otherwise observed after the Caldwell-Luc operation is avoided.

Kraniofaziale Weichteildefekte verlangen funktionell und asthetisch besonders zufriedenstellende Rekonstruktionen. Wo ausreichendes Weichteilgewebe zur Verfugung steht, wie z.B. im Bereich der unteren Gesichtspartie und am Hals, empfiehlt sich die Anwendung der Nahlappenplastik oder in besonders gelagerten Fallen Fernlappenplastiken zum Ausgleich von Defekten. Gewebsverluste in Regionen mit harter Unterlage konnten allerdings nur durch sehr aufwendige Weichteilmobilisation rekonstruiert werden. Eine recht gute Alternative bietet in solchen Fallen daher die Vollhauttransplantation [3, 4, 7, 10]. Bei groseren Hautdefekten ist die Adaption eines Hauttransplantates durch konventionelle Nahttechnik sehr zeitaufwendig.

The importance of a thorough dental and oral examination before kidney transplantation is stressed and the number and type of dental and oral pathology in 13 cases of kidney transplantation without prior oral evaluation are presented.

Osteosynthesis with lag screws is an essential supplement to osteosynthesis with metal plates. It is especially suitable in association with a neutralization plate for stabilization of short lamellar fractures. Wide lamellar fractures can be functionally stabilized with two or, in rare cases, three screws.

The result of the inadvoidable removal of bone in the canine fossa during antral fenestration is a large bone defect. Scar tissue grows across this defect and sometimes obliterates and interferes with the antral physiology. This paper presents our experience with the reconstruction of the defect by means of the osteotomised canine fossa bone with adhering soft tissues. In this way the antral volume remains unchanged and irritation of the infraorbital nerve often caused by the scar tissue of the facial fenestration as well as other pathological sequelae after the Caldwell-Luc operation are avoided.

Zur Therapie der Osteomyelitis im Kieferbereich gibt es klar definierte Grundsatze. Nur in Ausnahmefallen sind Kieferresektionen angezeigt. Das radikal-chirurgische Vorgehen fuhrt zu erheblichen Defektheilungen des Knochens und derben narbigen Kontrakturen des Weichgewebes. Daraus resultieren Formveranderungen und Funktionsbeeintrachtigungen, die durch Gesichtsasymmetrien und Einschrankungen der Mundoffnung gekennzeichnet sind. Die rekonstruktive Therapie ist fur diese Falle ebenso problematisch, wie die Spatbehandlung der nach Osteomyelitis im Kindesalter aufgetretenen Wachstumsstorungen mit gleicher klinischer Symptomatik. Unabhangig von der Pathogenese kommt es bei beiden Patientengruppen zu einseitigen Langenunterschieden der Mandibula, deren Ausgleich sich durch die Straffheit des den Knochen umgebenden Weichgewebes auserordentlich schwierig gestaltet. Erfahrungsgemas last sich ein groseres knochernes Transplantat zur Verlangerung der Unterkieferspange nur einsetzen, wenn gleichzeitig eine ausgedehnte Weichteilmobilisation vorgenommen wird. Um die dadurch entstehende zusatzliche Narbenbildung zu umgehen, erscheint es sinnvoll, das Gewebe nach Setzen einer Diastase im Knochen vor der Transplantation kontinuierlich aufzudehnen.