Search

Surgical treatment of cancers of the oral cavity often requires resection of the mandible, which sacrifices continuity, thereby implying considerable loss of function and aesthetics. The aim of the present study was to compare different methods of mandibular reconstruction for long-term results, complications, and factors associated with failure. During the 10-year period (1995-2005), 102 patients (73 men and 29 women, mean age 55 years, range 11-83) had a continuity resection of the mandible as described by Jewer et al. as follows: lateral continuity defect (n=53), central/lateral continuity defect (n=24), lateral/central/lateral continuity defect (n=14), central continuity defect (n=6), hemimandibular continuity defect (n=4) and central/hemimandibular continuity defect (n=1). The gap in the mandible was bridged with a titanium reconstruction plate in 73 patients, four of whom required a temporomandibular joint prosthesis. In 29 patients the mandibles were reconstructed with free autologous bone grafts fixed with miniplates. The overall 1-year success rate was 64%; 66% for the 73 patients who had miniplate/bone fixation and 63% in the 29 whose defects were bridged with a reconstruction plate. Complications were associated with the reconstruction plate in 39%. The most common complications were extraoral exposure (16%), intraoral exposure (10%), loose osteosynthesis screws (5%), fractures of the reconstruction plate (5%), and extra/intraoral exposure (1%). All fractures were noted at least 6 months postoperatively. There was no increased risk (p=0.67) depending on the osteosynthesis device used (miniplate or reconstruction plate). The risk of failure of the reconstruction plate was significantly higher in men (p=0.002) and smokers (p=0.004), whereas no increased risk was apparent for the anatomical site of the defect. Radiation reduced the 1-year success rate from 64% to 45% but not significantly so (p=0.67). There were no significant differences between the reconstruction methods. Alloplastic reconstruction devices are the treatment of choice for many patients.

PURPOSE AND RESULTS: The aim of this prospective study was to determine the incidence of postoperative bleeding after oral surgery under local anaesthesia performed in outpatients with haemostatic disorders within a 5-year period (2003-2007). One hundred twenty one (70 males, 51 females) out of 2,056 outpatients with different haemostatic disorders (acquired or hereditary) were included in this study. The following data were recorded: medical history and general condition; medications; indication for the surgical procedure; specification of local anaesthesia; applied surgical techniques, considering the kind of haemostatic disorder; and peri- or postoperative bleeding complications. Postoperative bleeding was observed in 12 patients (9.9%). In three cases, inpatient treatment became necessary. The management of two patients with a haemostatic disorder (von Willebrand s disease and haemophilia A) is presented in short case reports.In a heterogeneous group of 121 outpatients with known haemostatic disorders, a combination of a few haemostatic agents with appropriate operative technique enables an effective wound management. In cases of failed local interventions after postoperative bleeding, further diagnostic investigations are required.

Purpose The aim of the present study was to investigate radiographic and functional long-term results after condylar fractures have been reduced by an exclusively intraoral surgical approach. Patients and Methods A total of 25 (21 male, 4 female) consecutive patients with 30 condylar process fractures were retrospectively investigated. Clinical follow-up was performed in 19 patients (16 male, 3 female) with a total of 24 fractures. Median postoperative follow-up time was 19.7 months. Surgical indications followed specific parameters of fracture localization, dislocation, and ramus shortening. All patients were examined in accordance with the Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) and the Helkimo Index. Orthopantomograms (OPGs) were analyzed with use of the condylar morphologic scale (CMS), and mandibular ramus position and height were measured. Results Fractures were classified as condylar neck (n = 2) and basis fractures (n = 28), according to criteria of the Strasbourg Osteosynthesis Research Group (SORG). Mean age of patients was 33 years (standard deviation [SD], 13 yr). RDC/TMD measurements at follow-up showed a mean mouth opening of 48 mm (SD, 9), mandibular laterotrusion right of 11 mm (SD, 3.8), laterotrusion left of 10 mm (SD, 4.5), and protrusion with a mean of 5.83 mm (SD, 3). No joint clicking, weakness of the facial nerve, or joint or muscular pain was observed. Statistical analysis of the CMS showed significantly better postoperative ramus height (P Conclusion Reduction achieved by this technique allows reconstruction of anatomic ramus height in combination with excellent functional results.

Bisphosphonates are used as potent inhibitors in metastatic bone lesions. They can reduce skeletal burden and prevent bony metastases. They are integral in the treatment of some tumours like breast cancer, prostate cancer and multiple myeloma. As a side effect, these drugs also may cause severe jaw necrosis. Twenty-four patients with bisphosphonate-related jaw necrosis were analyzed in a clinical study. These necroses mostly appeared after administration of aminobisphosphonates. Recurrent avascular necroses were found after changing from Pramidronate to Zoledronate. All patients were treated by resection of necrotic bone. Repeated surgical interventions were required with about 25% of the patients. The management of patients with bisphosphonate-related jaw necrosis remains extremely difficult and includes surgical procedures as well as the eradicating of the necrotic bone including antibiotic therapy. The prevention of such complications consists in a minimization of dental surgical interventions and an avoidance of ulcers by dental prosthesis.

One of the operative complications during sagittal split osteotomy (SSO) in orthognatic surgery is a bad split, meaning an undesired fracture of the mandible during osteotomy. The aim of this study was to find out if there is a relation between the occurrence of bad splits during SSO and the presence of third molars, the patient's age, or the surgeon's experience. Clinical notes of 110 consecutive patients who had had a total of 220 SSOs using the Obwegeser/Dal Pont technique were evaluated and divided into three groups: 1 missing third molar (n=168); 2 retained or impacted third molar that was removed during the SSO (n=23); and 3 third molar left in place during SSO (n=29). There were a total of 12 (6%) bad splits. 9 (5%) in group 1, two (9%) in group 2, and one (3%) in group 3. There were no significant differences between groups 1-3, in particular the surgeon's qualification had no influence on the incidence. Older patients seemed more at risk of a bad split than younger ones.

Bei einer 47-jahrigen Patientin mit Gesichtsschmerzen, Beruhrungsempfindlichkeit der Kinn und Wangenregion rechts und Schluckbeschwerden lies sich der Processus styloideus beidseits palpieren. Beschwerdebild und der radiologische Befund einer beidseitigen knochernen Elongation des Griffelfortsatzes fuhrten zur Diagnose eines Eagle-Syndroms. An ein Eagle-Syndrom sollte bei der Kombination von Schluckbeschwerden, Kauschmerzen, Globusgefuhl, neuropathischen Rachenschmerzen oder Gesichtsschmerzen gedacht werden. Bei Versagen der konservativen Therapie und hohem Leidensdruck kann nach einer lokalanasthetischen Probeinjektion in ausgewahlten Fallen eine definitive operative Therapie erfolgen.

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant disorder with a shortened fragment of a D4Z4 repeat on chromosome 4q35. The infantile form of FSHD is relatively rare. Within this case report, we describe the orthognatic surgery in a patient with infantile FSHD to diminish the functional and esthetic disturbances in the orofacial region. We saw a 20-year-old female patient suffering from infantile FSHD with remarkable macroglossia and frontal open bite. Diagnosis was based on molecular genetic investigations. To improve the functions of the stomatognathic system, we performed a tongue reduction and a segment osteotomy in the frontal aspect of the mandible. The patient was satisfied with the functional and esthetic results. Lip competence and occlusion were significantly improved. Thus, orthognatic surgery can enhance oral function, facial esthetics, and general quality of life.

Objectives The ultrasonic osteotome, which was recently introduced, is an alternative to conventional methods of osteotomy. The aim of the present study was to establish the differences between three osteotomy techniques and to perform a quantitative roughness analysis of the osteotomized bone surfaces. Materials and methods Fresh bony samples of standardized size were taken from the rabbit skull. The techniques used were as follows: reciprocate micro-saw, Lindemann bur, ultrasonic osteotome with the two insert tips OT6 (rough) and OT7 (fine). The prepared surfaces were examined by light microscopy, environmental surface electron microscopy (ESEM) and by confocal laser scanning microscopy (CLSM). Results It was difficult to distinguish between cortical and cancellous bone after using the conventional osteotomy technique. The ultrasonic technique preserved the original structure of the bone. The values observed for superficial roughness were as follows: 3.97 microm (micro-saw), 5.7 microm (Lindemann bur), 2.48 microm (OT7) and 3 microm (OT6). There were statistical differences between the values of the bur and insert tip OT6 (P=0.015) as well as between the bur and insert tip OT7 (P=0.003). Conclusions In the present study micromorphological differences after using various osteotomy techniques could be clearly identified.

Bilateral sagittal split osteotomy (BSSO) is a standard procedure in orthognathic surgery. The aim of the present study was to perform a matched pair analysis (bad sagittal split versus regular sagittal split) regarding the functional and radiographic long-term results after BSSO. Of 110 cases of mandibular hypoplasy treated with BSSO, 7 cases of bad sagittal splits (Group A) were selected, clinically examined and matched to 7 cases where no bad split occurred (Group B). The Research Diagnostic Criteria for Temporo Mandibular Disorders (RDC/TMD), condylar morphology scale (CMS) and ramus height measurements using orthopantomograms were carried out in the follow-up period to observe the clinical and functional status and condylar resorbtion or remodelling. The mean follow-up time was 28.6 months. The RDC/TMD examination did not show a higher incidence of temporomandibular dysfunction, including pain or clicking in the bad split group. Patients without a bad split showed statistically significant (p0.05) better mouth opening. The CMS measurements were comparable in both groups. When compared with regular splits, bad splits, if treated in an appropriate manner, have a good chance of functional success, although, some mandibular movements can be compromised.

Dentin is one of the earliest bio-mineralization products to appear in the evolution of vertebrates. Dentin reactions to infection mimic earlier phylogenetic patterns, and carious lesions are divided into different zones which reflect the natural patho-morphological reaction of dentin to the carious attack. It was the aim of this study to investigate deep dentin carious lesions of human molars with combined polarization light microscopy, scanning electron microscopy and energy dispersive X-ray element analysis (EDX) for the determination of different zones of the carious lesions, their extent and the chemical content. Sixteen extracted teeth with deep dentin carious lesions were embedded in Technovit 9100 (Kulzer) and serial sections of 80 microm thickness were made. These sections were then examined with polarized light microscopy to identify the different zones of the lesions. The outlines of the zones were traced consecutively and 3D-reconstructions were made for the determination of the extent and calculation of the volumes of the different zones. From the volumes of the demineralizing dentin and the translucent zone a Dentin Demineralization Index (DDI) was calculated. Three sections of each lesion were then coated with carbon and studied with a scanning electron microscope. 3D-reconstruction of the teeth showed the rather stable translucent zone, interrupted by remnants of dead tracts, and very different volumes of demineralizing dentin. Therefore, with increasing size of the demineralizing dentin, the DDI increased. The chemical content was measured using energy dispersive X-ray analysis (EDX) in areas of intertubular dentin. The content of Ca, P, and C was significantly different in all zones. The Ca/P ratio was significantly different between sound dentin and demineralizing dentin. From the results we conclude that the mineral content of intertubular dentin of the translucent zone and demineralizing dentin is different from that of sound dentin, and the unique mineralization pattern of the translucent zone is a biological reaction to the carious attack. Because active dentin lesions exhibit many non-occluded open dentin tubules, further bacterial invasion or, in case of dentin treatment, the penetration of bonding agents towards the pulp is morphologically not prevented and therefore of clinical importance.