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Recent data suggest that recombinant human erythropoietin (rhEPO) modulates tumour growth and therapy response. The purpose of the present study was to examine the modulation of radiotherapy (RT) effects on tumour microvessels by rhEPO in a rat colorectal cancer model. Before and after 5 x 5 Gy of RT, dynamic contrast-enhanced -magnetic resonance imaging was performed and endothelial permeability surface product (PS), plasma flow (F), and blood volume (V) were modelled. Imaging was combined with pO(2) measurements, analysis of microvessel density, microvessel diameter, microvessel fractal dimension, and expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1 alpha (HIF-1alpha), Bax, and Bcl-2. We found that RT significantly reduced PS and V in control rats, but not in rhEPO-treated rats, whereas F was unaffected by RT. Oxygenation was significantly better in rhEPO-treated animals, and RT induced a heterogeneous reoxygenation in both groups. Microvessel diameter was significantly larger in rhEPO animals, whereas VEGF expression was significantly lower in the rhEPO group. No differences were observed in HIF-1alpha, Bax, or Bcl-2 expression. We conclude that rhEPO results in spatially heterogeneous modulation of RT effects on tumour microvessels. Direct effects of rhEPO on neoplastic endothelium are likely to explain these findings in addition to indirect effects induced by increased oxygenation., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

Although arthrography of the TMJ is nowadays considered as old-fashioned, the technique remains a valuable alternative in cases where MRI is contraindicated. The authors discuss the technique of inferior joint space arthrography and present a review of typical arthrographic cases of the most common types of TMJ pathology.

One of the major disadvantages of sagittal arthrotomography of the temporomandibular joint is its limited capability to detect sideways (medial or lateral) disk displacement. Several arthrographic signs, suggesting sideways disk displacement have been described in recent reports. The most important one is the edge sign. In doubtful cases, arthro-CT can be used for depiction of medial or lateral disk displacement.

The diagnosis and treatment of facial pain remains a great challenge for oral and maxillofacial surgeons. By taking an exact anamnesis--especially a pain anamnesis--and by starting specific examinations the patient can quickly be recommended to a qualified therapist. The pain syndromes are classified according to the IASP (International Association for the Study of Pain). The pain syndromes the maxillofacial surgeon is most frequently confronted with--idiopathic trigeminal neuralgia, atypical facial pain and the temporomandibular joint--are described. The necessity of a multidisciplinary examination is emphasized and the different diagnostic investigations are illustrated, particularly in the case of myo-arthropathy. Beside the analysis of temporomandibular joint dysfunction, a radiologic examination is performed. In some cases the advise of a neurologist, ophthalmologist or otolaryngologist may be indicated.

Clinical, arthrographic and surgical findings in 20 patients who showed persisting TMJ-pain or dysfunction after an acute traumatic event were reviewed and compared to findings in a control group of 65 patients who did not remember an acute post-traumatic onset of symptoms. Anterior disk displacement (82%), disk perforation (65%) and rotational anteromedial disk displacement (34%) were the most common abnormalities encountered. Other important abnormalities were joint adhesions and capsule perforation. When compared with the control group, all these abnormalities occurred more often in traumatised joints. Arthrography was found to be highly accurate in detecting most types of abnormalities found during surgery. Arthrography is reported to be more effective than MRI in detecting disk perforations, adhesions and capsule perforations, which points to its continuing importance as an imaging tool for evaluating post-traumatic temporomandibular joint disorders.

After having made a definitive diagnosis in patients with orbito-frontal pathology, the choice of incision is an important factor to achieve good intra-operative exposure of the region, as well as to obtain a good functional and aesthetic result. In the majority of cases we prefer to utilize the incisions commonly used for blepharoplasty, especially the transconjunctival approach popularized by Tessier. Other more classic accesses such as the superolateral, infra-orbital and intra-oral incisions, are reserved for treatment of cases of orbitomalar (communition) fractures. We feel there are limited indications for use of incisions through the eyebrows with medial extensions for exposure of isolated lesions of the medial orbital wall, orbital roof, and the anterior wall of the frontal sinus. However they may become very useful as the primary incisions in the treatment of open fractures of the orbital region. The bicoronal incision, a classical approach in neurosurgery, is also being used by us in cases of tumors and complicated middle face fractures which appear to extend to the orbito-frontobasal region in 40% of our patients. In addition it provides excellent access for post-traumatic reconstruction of orbito-frontal bone defects and impacted fractures. A combination of different incisions: bicoronal, peri-orbital and intra-oral, may be indicated for the correction of syndromal anomalies such as Treacher-Collins, for treatment of complicated facial fractures, or for pure aesthetic surgery procedures, such as the "mask-lift" introduced by Tessier.

The primary or secondary reconstruction of the facial access after Caldwell-Luc and the more selective resection of sinusal mucous membranes can be important in the therapy and prevention of postoperative complications such as neuralgic facial pain, formation of cysts and chronic sinusitis. The different osteoplastic sinus operations are described and the use of a pedicled bonelid is illustrated. The most common accepted ethiology of post-operative pain is based on the formation of scar-tissue. Postoperative pain is first being treated conservatively, while in case of persisting pain an exploration with dissection of the infra-orbital nerve and reconstruction of the facial defect can be indicated. In a retrospective study of 36 patients the results of our surgical therapy are illustrated.

Complications of fronto-basal trauma can, as a function of their severity, be divided into three classes: life-threatening situations, functional complications and cosmetic defects or facial deformities. They find their origin in the type of trauma, the extent of the lesions of bone and soft tissues, as well as in their timely management and quality of treatment. The etiology of the most common complications and their significance are covered with accent on inadequate primary treatment, insufficient repair of dural lesions, inadequate drainage, unstable osteosynthesis, insufficient treatment of scalp- and frontal defects, and finally the lack of antibiotic prophylaxis. The major complications of frontobasal trauma such as chronic cerebral spinal fluid fistulae and pneumocephalus are reviewed. Attention is also given to the importance of adequate drainage in cases of chronic ethmoidofrontal sinusitis, and on the treatment of osteomyelitis and sinus cysts. The therapeutic possibilities in patients with tissue deficits, i.e. reconstruction of frontal skull defects using autologous hip and rib material, as well as split calvarial bone grafts is discussed.

In this text we briefly want to discuss the role of the arthrographic examination of the temporomandibular joint for detection of disc pathology. We will mention the normal anatomy and function of the temporomandibular joint, the technique for performing arthrograms and the classification of the most frequent disc pathology. This will be illustrated by some arthrographic examples of anterior disc displacement without reduction, disc perforation, and medial disc displacement. Finally the advantages of arthrography in comparison with other investigation techniques will be discussed.

The article illustrates the importance of face lifting and S.M.A.S. tightening as an adjunct to the aesthetic aspect of maxillo facial surgery, for instance in combination with extreme mandibular set back or advancement in adults. The theory and basic techniques of the face lifting procedure and the S.M.A.S. tightening technique are described. A clinical example is presented. The indications pre- and postoperative management and complications have been mentioned.

Liposuction is a relatively recent surgical technique used in body contouring plastic surgery to correct fatty dysharmonies. It is of particular interest to the maxillo-facial surgeon to treat submental fat excess. This relatively easy technique is described, using a few clinical examples. Indications in maxillo-facial surgery are the correction of "double chin" deformity and increased submental fullness after orthognathic surgical procedures as mandibular setback, as well as an adjunct to rhytidectomy.

The therapy of chronic facial pain still poses an important challenge. A therapeutical scheme in four steps has been developed. This scheme enables modification of the pain therapy depending on localisation, intensity and former treatment. It consists of the following steps: 1. Transcutaneous electrical nerve stimulation. 2. Medication 3. Extracranial glycerol blocking of the trigeminal nerve 4. Neurosurgical treatment with thermocoagulation, chemical glycerol-rhizotomy and microsurgical decompression. The different therapeutical steps have no influence on each other.

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.

This study analyses the possibilities of somato-sensory evoked potentials following trigeminal stimulation in order to classify pain sensations provoked by the trigeminal nerve. 43 patients suffering from trigeminal neuralgia, atypical facial pain and from pain due to carcinoma were investigated. Pain sensations correlated with the responses of the evoked potentials--usually with increased latencies. However, it was not possible to point out specific correlative pathological peaks for individual diseases. Therefore, the judgement of TSEP alterations requires knowledge of each patient's clinical symptoms.

The outline of therapeutic priorities in case of maxillo-facial traumatism may be divided in three different stages according to the need of acute urgent, urgent and necessary intervention. Acute urgent therapy is called for when the bleeding of the arteria carotis externa or the maxillary artery cannot be quenched or when the superior airways are obstructed by the soft tissues of the tongue or the floor of the mouth. A description of the therapeutic attitude in such cases is given. Urgent therapy should be given within 8 hours after the accident and mostly consists in the immobilisation of bony injuries and definite care of soft tissue lacerations. Necessary therapy includes the final surgical treatment such as osteosynthesis by titanium mini-plates. More specific problems like frontobasal fractures and fractures of the orbital floor are described separately.

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.

After a survey of the literature about etiological and physiopathological data or hypothesis, the different therapeutic possibilities are quoted. According to our experience we describe the occurrence of the Auriculotemporal Syndrome in a total of 157 parotidectomies performed in our clinic during the past seven years. One single post-traumatic case is commented. About 30% of our post-parotidectomic patients were incommodated by the syndrome, more specifically as an aggravating transpiration in the temporal region during meals. The greater number of patients experienced a distinct improvement applying a simple Scopolamin-salve; as a result we prefer this conservative therapy to a more aggressive treatment. However, whether we could prevent the appearance of the syndrome by using a more subtle surgical technique particularly in the region of the preauricular blood vessels, remains an open question.

The characteristics of the basal cell naevus syndrome are multiple basal cell naevi and basal cell carcinomas, cysts of the jaws, anomalies of ribs and vertebra, intracranial calcification and striking deformities of the skull, usually with a positive family anamnesis. We will discuss symptomatology, histopathology and therapy. A flemish family, where the syndrome occurs with the mother and her four children, three of whom are admitted in hospital nearly simultaneously with sinusitis maxillaris, are discussed in extenso. Also, the occurrence of the syndrome's stigmata in other members of the family is noted.