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Background: Germ cell tumors (GCTs) of the head and neck region are rare but may pose significant problems for perinatal management as well as surgical and adjuvant therapy., Procedure: Thirty-two prospectively reported patients from the German MAKEI studies (Maligne Keimzelltumoren) were analyzed with regard to perinatal management and long-term survival., Results: Twenty-three tumors were diagnosed around birth and four during the first 3 months of life. All were primarily diagnosed as teratomas, but in two tumors, yolk sac tumor (YST) foci were identified. Another pure teratoma was diagnosed at 12 months. Four tumors were diagnosed after the first year of life and showed YST as leading histology. Most neonates presented with huge tumors causing external airway obstruction. All tumors were resected (complete resection, 16/26 patients with complete surgical information; incomplete resection, 10/26 patients). Eight tumors including five of six YSTs were treated with chemotherapy. In total, six patients relapsed. Relapse rate was higher after incomplete (5/10 patients) than after complete resection (1/16 patients). Accordingly, more relapses were observed in pharyngeal than in neck tumors due to incomplete resection. Nevertheless, half of the patients with incomplete resection remained in remission. One patient with YST died after multiple relapses., Conclusions: GCTs of the head and neck region require a multidisciplinary approach in specialized centers. Most patients with antenatal tumor growth are identified by ultrasound and delivered preterm by cesarian section. After delivery, immediate intubation and ventilation aim for respiratory stabilization, followed by elective resection. With this approach, outcome was favorable., ((c) 2008 Wiley-Liss, Inc.)

Purpose: In this article, the question of whether adjuvant hyperbaric oxygen therapy (HBO) has a positive effect when treating chronically recurrent mandibular osteomyelitis in children and adolescents is discussed., Patients and Methods: Over a period of 5 years, 4 cases were observed, 3 of which were submitted to adjuvant HBO. Details on the modalities of this type of treatment and the simultaneous intravenous administration of high doses of antibiotics are reported., Results: All 3 patients have been free of any symptoms from 20 to 74 months (mean, 41 months) and therefore may most likely be regarded as healed., Conclusion: The small number of cases does not allow a final statement on the extent to which HBO contributed to the positive outcome. However, in our opinion, HBO is a most promising therapeutic option. Finally, the problems involved in prospective randomized studies of this rare disease are discussed in detail.

After a short description of the history of eyelid reconstruction, the causes of defects are discussed. For the primary and secondary treatment of thermic injuries, a full-skin graft is recommended and the indication of combined skin-cartilage transplants is mentioned. For deep defects, numerous methods of eyelid reconstruction are available. The differentiated indication for manifold initial situations is discussed in detail. The most important techniques are described on the basis of various examples.

Late results and complications following rigid internal fixation of mandibular fractures-a 10 year survey. From 1984 to 1993 541 fractures of the mandible in 332 patients have been treated by rigid internal fixation with the mandibular compression system (MCS). In 0.8% we saw serious complications like pseudarthrosis or osteomyelitis. In a retrospective study 105 patients with 171 fractures of the mandible could be examined 4.1 years after osteosynthesis. In case of preoperative normesthesia of the inferior alveolar nerve in 74.1% of the fractures nomesthesia was still present, 18.1% of the fractures showed hypesthesia and 4.2% showed complete anesthesia. In case of already preoperatively existent hypesthesia in 81.8% of the fractures normesthesia and in 8.2% hyp- or paresthesia were seen. There were no anesthesias seen in this group. 3.6% of the fractures showed mild occlusal disharmonies.

Results and significance of secondary reconstruction of mandibular and maxillary defects. The results of 14 patients with 12 mandibular and 2 maxillary defects following tumour surgery with irradiation and/or chemotherapy, osteomyelitis, osteoradionecrosis or trauma, which were reconstructed secondarily, are presented. 12 flaps survived, 1 flap showed a partial and 1 flap a complete necrosis due to venous thrombosis. The major differences of secondary reconstruction of bone defects in the facial skeleton in comparison to primary reconstruction are the scar formation in the defect region and above all the reduced number and quality of recipient vessels in the neck area. The design of the flap should be exactly determined preoperatively. Of great importance is the examination of the recipient vessels in the neck area. Non-invasive methods are preferred.

The value of 2D- and 3D-computed assisted tomography in detecting and classifying midfacial fractures and craniofacial deformities acquired by gunshot injuries was assessed in 123 resp. 26 patients and compared with the postoperative results. In a comparative study 37 patients were prospectively examined by pluridirectional tomography. Examinations of a macerated skull were performed to optimize 3D investigation technique. High resolution CT proved to be the most reliable technique in detecting midfacial fractures and associated soft tissue injuries. 3D-imaging of bony surfaces allowed clear demonstration of fraction extent and fragment displacement without offering additional detail information. 3D-based computer-assisted manufacturing of individual models facilitated surgical planning of complex midfacial injuries.

Colour Doppler ultrasonography shows blood flow in real time and colour by combining the features of real time B mode ultrasound and Doppler. At each point in the image the returning signal is interrogated for both amplitude and frequency information. The resulting image shows all non-moving structures in shades of gray and moving structures in shades of red or blue depending on direction and velocity. The technique of colour Doppler ultrasonography and our experiences in 63 examinations are described. The clinical application of this new simple non-invasive method in maxillo-facial surgery is discussed.

In certain ares of the craniofacial skeleton the plate systems commonly used for rigid internal fixation seem to be over-dimensioned. The newly developed Micro System for internal fixation with extremely tiny plates and screws provides a firm three-dimensional fixation of segments with minimal interference with the overlying soft tissues. Fields of application are traumatology and craniofacial surgery in infants, fractures of the naso-ethmoidal region and the orbit, reconstruction of the skull, and the fixation of cartilage and bone grafts.