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The aim of this paper is to introduce an innovative workflow for staged reconstruction of the mandible, including the temporomandibular joint (TMJ), using a temporary, patient-specific spacer. In cases of partial mandibular resection including disarticulation, sometimes needed to treat inflammatory bone disease, the spacer is intended to retain symmetry of the hard tissues, to preserve the soft tissues, and to act as a bactericidal agent. When complete healing of the affected surrounding tissues has occurred, final reconstruction using a patient-matched total TMJ endoprosthesis, in combination with an autogenous free bone flap, can be performed as a second-stage procedure. The crucial steps of the workflow are virtual surgical planning, manufacturing of a two-part silicone mold, and chairside manufacturing of the spacer using an established bone cement with gentamycin. The method was first introduced in two patients suffering from therapy-resistant chronic osteomyelitis. The presented protocol of staged surgery allows a much safer and predictable reconstruction compared with immediate reconstruction. The workflow also minimizes the potential risk of endoprosthesis infection - one of the major risks of implant failure.

Internetseiten gewinnen zunehmend an Bedeutung als Quelle fur gesundheitsbezogene Informationen. Da Patienten Informationen sowohl zu den Krankheitsbildern als auch zu den Therapieoptionen im Internet suchen und bereits als Teil der Aufklarung sehen, scheint es essenziell zu sein, ein hinsichtlich Quantitat und Qualitat ausreichendes Informationsangebot bereitzustellen. Allerdings haben viele Erwachsene Schwierigkeiten damit, schriftliche Informationen richtig zu verstehen. Daher erschien es uns wichtig, das vorhandene Informationsangebot anhand eines Beispiels hinsichtlich seiner Lesbarkeit zu analysieren. Wir unterzogen die Internetseiten zum Themengebiet „Plattenepithelkarzinom der Mundhohle“, von 32 Abteilungen deutscher Unikliniken fur Mund‑, Kiefer- und Gesichtschirurgie einer systematischen Untersuchung. Die Analyse ergab, dass die Mehrheit der untersuchten Patienteninformationen das Niveau von wissenschaftlichen Publikationen hat und somit fur den Laien schlecht lesbar ist.

Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus. A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction. Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS. Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage. Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.

Odontogenic infections and subsequent developing abscess remain to be a potentially life-threatening event, due to septicemia, airway compression and spreading into sensitive anatomic tissues. C-reactive proten (CRP) and white blood cell (WBC) count are routinely blood-measured indicators for inflammation. Are CRP-levels and WBC-count predictive factors of the developement of odontogenic abscess?A 4-year retrospective study evaluated hospital records of 218 patients, diagnosed and inpatiently treated for acute odontogenic abscess. They received surgical incision, drainage and intravenous antibiotics. CRP-levels and WBC-counts were measured preoperativly.218 subjects were enrolled in this study. Patients hospitalized 10 days or more showed significantly higher CRP-levels (p =0.001) and WBC-counts (p = 0.006) on admission day than patients with lower LOS. CRP-levels of patients with LOS from 7-9 days were significantly lower (p = 0.47) than in people hospitalized 10 days or more. Abscess focus in the mandible shows significantly higher WBC-counts (p = 0.014). Multiple space infections present a significantly higher CRP (p = 0.003) and WBC (p0.001) on admission day.According to the presented data, CRP-levels and WBC-count can be regarded as predictive factors for LOS (length of stay in hospital) in patients with long term hospitalization (CRP:7-9 days and10 days; WBC:10 days). Further WBC and CRP are suitable to predict multiple space infections and localisation of the abscess (WBC) in certain limits.In predicting the developement of odontogenic abscess, CRP is more capable in providing exact statements regarding the LOS. However, WBC-counts are more suitable in predicting multiple space infections and localization of infection.

Fibrous dysplasia is a benign bone disease, presenting as monostotic or polyostotic lesions, or as part of a syndrome (McCune-Albright/Mazabraud). Its clinical course shows a variegated picture and the progression of its growth is unpredictable. In the workup of 39 fibrous dysplasia cases in the cranio-facial area, four cases presented fast growth tendencies, of which two patients with McCune-Albright syndrome showed malignant-like rapid growth. This local aggressive form is extremely rare, and the concept of this issue has not been clearly defined. With regard to the speed of growth a volumetric-time analysis in one of our cases demonstrated a 74 days tumor doubling rate with an exponential growth curve. According to the literature the aggressive form presented extra-cranially mainly at an adult age, whereas its appearance in our cranio-facial patient collective was much younger. Distinguishing nonmalignant and malignant aggressive forms is difficult and highly inconsistent in the literature. We therefore implemented a quantitative growth measure analysis to define aggressive forms based on progression and speed of growth and impartial of type of FD, localization or functional incapacity. Due to our study findings and literature review we state a prevalence of an aggressive form might be possibly about 5 %.

Introduction Osteonecrosis of the jaw (ONJ) is a severe complication of antiresorptive medication (AM) in the treatment of bone-affecting cancer-related conditions and osteoporosis. Aim of this study was to reveal whether patients treated with AM and show Medication Related OsteoNecrosis of the Jaw (MRONJ) are vitamin D deficient or not. Materials and methods A 2 year retrospective study evaluated hospital records of 63 patients who received AM. Patients were divided into two groups. One group (n = 45) consisted of patients who presented a stage 2 ONJ (eb+ = exposed bone). Second group patients (n = 18) (eb− = no exposed bone) presented for extraction of teeth. Serum levels of vitamin D (25-OHD) were analysed. P values ≤ 0.05 in t-test were regarded as statistically significant. Results Serum levels of 25-OHD were significantly higher in the eb(−) group (29.5 ng/ml), than in the eb(+) group (20.49 ng/ml). Blood levels of calcium were also significantly higher in eb(−) group (2.25 mmol/L; 0.11 SD) than in eb(+) group (2.175 mmol/L; 0.16 SD). Conclusion Prevalence of MRONJ in AM treated patients seems to be increased by low serum 25-OHD. A measurable tendency in the role of 25-OHD for the development of MRONJ was recorded and leads to the recommendation for a sufficient vitamin D substitution in patients treated with AM.

Background Cranioplasty of patients with craniosynostosis requires rapid, precise and gentle osteotomy of the skull to avoid complications and benefit the healing process. The aim of this prospective clinical study was to compare two different methods of osteotomy. Piezosurgery and conventional osteotomy were compared using an oscillating saw and high speed drill while performing cranioplasties with fronto-orbital advancement. Methods Thirty-four children who required cranioplasty with fronto-orbital advancement were recruited consecutively. The operations were conducted using piezosurgery or a conventional surgical technique, alternately. Operative time, blood count, CRP and transfusion rate, as well as soft tissue injuries, postoperative edema, pain development and secondary bone healing were investigated. Results The average age of patients was 9.7 months. The following indications for craniosynostosis were surgically corrected: trigonocephaly (23), anterior plagiocephaly (8), brachycephaly (1), and syndromic craniosynostosis (2). Piezosurgery was utilized in 18 cases. There were no group differences with regard to the incidence of soft tissue injuries (dura, periorbita), pain, swelling, blood loss or bony integration. The duration of osteotomy was significantly longer in the piezosurgery group, leading to slightly increased blood loss, while the postoperative CRP increase was higher using the conventional method. Conclusions The piezosurgery method is a comparatively safe surgical method for conducting osteotomy during cranioplasty. With regard to soft tissue protection and postoperative clinical course, the same procedural precautions and controls are necessary as those needed for conventional methods. The osteotomy duration is considerably longer using piezosurgery, although it is accompanied by lower initial postoperative CRP values.

Erhebliche Funktionsstorungen und Erkrankungen wahrend der Wachstumsphase konnen zu einer Wachtumsverminderung des Unterkiefers auf der betroffenen Seite und konsekutiv zu Bissstorungen und Gesichtskoliose fuhren, die oft erst im Laufe der Zeit auffallig wird. Prinzipiell wird versucht, eine operative Therapie wegen hoher Komplikationsdichte im Kindesalter in die Zeit nach der Wachstumsphase zu verschieben. Bei einer im spaten Kindesalter einsetzenden Uberschussbildung durch kondylare Hyperplasie kann auch im spaten Kindesalter eingegriffen werden. Schmerzhafte oder gerauschverursachende Diskusverlagerungen kommen in der Adoleszenz insbesondere im Zusammenhang mit mangelnder Stressverarbeitung als meist vorubergehendes Phanomen vor. Sie bedurfen neben einer abwartenden Haltung evtl. einer zahnarztlichen Therapie mit einer Aufbissschiene.

Unter den Fehlbildungen des Kiefer- und Gesichtsbereiches kann sich die Pierre Robin-Sequenz mit akuter Atemnot zeigen. Die heutige Therapie der Wahl versucht mit speziellen herausnehmbaren, intraoralen Gaumenplatten die Zungenhaltung zu stimulieren und so einen Wachstumsimpuls auf den hypoplastischen Unterkiefer zu geben; nur in seltenen Fallen ist Chirurgie notig. Lippen-Kiefer-Gaumenspalten stellen in ihren verschiedenen Auspragungen das groste Kontingent der Fehlbildungen des Kiefer- und Gesichtsbereiches; ihre Therapie ist multidisziplinar. Die chirurgischen Masnahmen werden in verschiedenen Schritten, je nach Auspragung, bis ins fruhe Erwachsenenalter durchgefuhrt. Ziel ist dabei die funktionelle und asthetische Rehabilitation der Patienten. Daneben gibt es eine Vielzahl syndromaler Fehlbildungen in Kiefer- und Gesichtsbereich, die sequenzielle plastisch-rekonstruktive Chirurgie erfordern.

Background Research shows disparities in cancer outcomes by ethnicity or socio-economic status. Therefore, it is the aim of our study to perform a matched-pair analysis which compares the outcome of German and non-German (in the following described as ‘foreign’) cancer patients being treated at the Center for Integrated Oncology (CIO) Köln Bonn at the University Hospital of Bonn between January 2010 and June 2016. Methods During this time, 6314 well-documented patients received a diagnosis of cancer. Out of these patients, 219 patients with foreign nationality could be matched to German patients based on diagnostic and demographic criteria and were included in the study. All of these 438 patients were well characterized concerning survival data (Overall survival, Progression-free survival and Time to progression) and response to treatment. Results No significant differences regarding the patients’ survival and response rates were seen when all German and foreign patients were compared. A subgroup analysis of German and foreign patients with head and neck cancer revealed a significantly longer progression-free survival for the German patients. Differences in response to treatment could not be found in this subgroup analysis. Conclusions In summary, no major differences in survival and response rates of German and foreign cancer patients were revealed in this study. Nevertheless, the differences in progression-free survival, which could be found in the subgroup analysis of patients with head and neck cancer, should lead to further research, especially evaluating the role of infectious diseases like human papillomavirus (HPV) and Epstein-Barr virus (EBV) on carcinogenesis and disease progression.

Das Internet gewinnt zunehmend an Bedeutung als Quelle fur gesundheitsbezogene Informationen. Fur die meisten Patienten gelten die Internetseiten von Krankenhausern und Universitaten als besonders zuverlassig. Die Lesbarkeit der verfugbaren Informationen gilt allerdings haufig als masig. Instrument zur Untersuchung der Lesbarkeit sind sog. Lesbarkeitsindizes, welche mittels objektiver Kriterien die Lesbarkeit von Texten ermitteln. Ziel war es, eine breite Datenlage uber die Lesbarkeit von Patienteninformation der deutschen Universitatskliniken in der Augenheilkunde zu erhalten. Hierfur wahlten wir 3 Augenerkrankungen mit potenziell irreversibler Schadigung aus. Die Internetseiten von 32 Abteilungen fur Augenheilkunde der jeweiligen Universitatskliniken wurden untersucht. Texte zu „Katarakt“, „Glaukom“ und „Amotio retinae“ wurden ermittelt und analysiert. Die Texte wurden einer systematischen Lesbarkeitsprufung mittels 5 anerkannter Lesbarkeitsindizes unterzogen (Hohenheimer Verstandlichkeitsindex [HVI], Amstad-Index [Amstad], Simple Measure of Gobbledygook [G‑SMOG-Index], Wiener Sachtextformel [W-STX] und LIX-Lesbarkeitsindex [LIX]) und mit dem Analyseprogramm „Text-Lab“ ( http://www.text-lab.de ) analysiert und ausgewertet. In insgesamt 59 Fallen (61,46 %) konnten Texte auf den Internetseiten der Kliniken ermittelt und analysiert werden. Es zeigte sich im Mittel bei allen Indizes eine schlechte Lesbarkeit (HVI: 7,91 ± 3,94; Amstad: 35,45 ± 11,85; Wiener Sachtextformel: 11,19 ± 1,93; G‑SMOG: 9,77 ± 1,42; LIX: 54,53 ± 6,67). In den meisten Fallen ist der Schwierigkeitsgrad der analysierten Texte mit dem wissenschaftlicher Publikationen vergleichbar. Es ist davon auszugehen, dass die Texte fur einen grosen Teil der Leser nur schwer lesbar sind. Eine Reevaluation der Texte und eine Bearbeitung hinsichtlich der Lesbarkeit waren wunschenswert.

Introduction Besides mastoid air filled cells, pneumatizations (PN) occasionally occur in the articular eminence (AE) of the temporomandibular joint (TMJ). These findings represent no pathological character but may increase the risk of perforating the AE during eminectomy with potential harming the skull base. Various classifications catagorize the degree of temporal PN without focussing solely on the AE. Panoramic radiograph (PR) and computed tomographie (CT) are both described as suitable for diagnosing PNs. Are the common ways of imaging capable for precise diagnosis and do we need a risk pattern for eminectomy? Methods A 4-year retrospective study evaluated high resolution computed tomographie (HRCTs) of 300 patients. We screened digitalized skull images for PN of the AE. The frankfort horizontal was determined as the reference mark for measurements. Images were assessed by a craniomaxillofacial surgeon and a radiologist. Results 300 patients (600 AEs) were investigated. We detected 60 PNs (10% of all AEs) in 44 patients (14.7%). We subdevided the findings according to the extent of PN. 10 AEs showed PNs of less than 20% (type 1); n=18: 21-40% (type 2); n=18: 41-70% (type 3). n=14: 71 to 100% (type 4). In 32 cases (72.7%) with 42 PNs a PR existed. Of the 42 AEs, corresponding PN could be detected in 21 cases (50%). Discussion PNs are a potential threat when performing TMJ surgery. Sufficient preoperative imaging is required to avoid severe endangerment for the patient. CT imaging is most suitable detecting PNs. PR seem to fail in diagnosing PNs of different degree. Our novel HRCT-based classification shows the distribution of PNs and provides a risk pattern. Conclusion HRCT exceeds the diagnostic accuracy of PR in detecting pneumatized AEs. PR is not capable for detecting PNs of different degree. A novel classification may increase the prediction of perforation risk. Restricting eminectomy to reduce height only to a certain amount reduces the risk of complications.

Increasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants.A 5-year retrospective study investigated records of 303 in-hospital patients with abscess of odontogenic origin. Time-to-event models were used to analyse data where the outcome variable is the time to the occurrence of a specific event. Here, the focus is on a statistical model for the prediction of LOS of patients.The group of all patients (n = 303) was analysed by considering seven characteristics of the patients (age, gender, spreading of infection, localization of infection focus, type of administered antibiotics, diagnosed diabetes mellitus, and existence of a remaining infection focus). Age (p = 0.049; rc = -0.007) and spreading of infection (p 0.001; rc = -0.965) showed a significant impact on the LOS. Subjects were divided into two groups. Group A (n = 185) consisted of patients who presented with a severe odontogenic infection and not yet removed infection focus; group B were patients having undergone outpatient operative tooth removal (n = 118). To group A patients' data, two new risk factors ("days between abscess incision and removal of infection focus" = dbir and "removal of infection focus during the same stay as abscess incision" = riss) replaced the risk factors "remaining infection focus." A significant impact on the LOS was detected for dbir (p 0.001; rc = -0.15) and riss (p 0.001; rc = -1.76). Our statistical model explicitly describes how the probability for discharge depends on the time and how specific characteristics affect the LOS. We observed a significantly higher LOS in older patients and subjects with infection spreading. In group A patients, dbir and riss had a highly significant impact on the LOS.Predicting the LOS may promote transparency to costs and management of patients under inpatient treatment. Our statistical model describes the probability of a discharge at time t compared to a discharge later than t (a LOS longer than t). Furthermore, the model enables a prediction of the LOS of each patient for practitioners in an easy way.

Even though modern surgical techniques are dominating reconstructive facial procedures, the capability to use facial epitheses for reconstruction is still an important skill for the maxillofacial surgeon. We present an international multicenter analysis to clarify which techniques are used to fixate facial prostheses. We contacted all maxillofacial departments in Germany, Austria, Switzerland and Norway which were registered with the German society for oral and maxillofacial surgery (DGMKG). These centers were asked via electronical mail to provide information on the type of epithesis fixation systems currently in use. The return rate from 58 departments was 43.1% (n = 25). Overall, implant fixation was the preferred fixation system (92%). Plates were the second most common fixation technique (32%). No centers reported the standard use of non-invasive fixation techniques for permanent epithesis fixation. The main retention systems in use were magnets (24/25), other retention systems are used much less often. The current preferred fixation technique for facial epitheses consists of implant-based, magnet-fixated epitheses. For nasal prostheses, a plate-based, magnet-fixated system is often used.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.

Background The genes Gremlin-1 (GREM1) and Noggin (NOG) are components of the bone morphogenetic protein 4 pathway, which has been implicated in craniofacial development. Both genes map to recently identified susceptibility loci (chromosomal region 15q13, 17q22) for nonsyndromic cleft lip with or without cleft palate (nsCL/P). The aim of the present study was to determine whether rare variants in either gene are implicated in nsCL/P etiology. Methods The complete coding regions, untranslated regions, and splice sites of GREM1 and NOG were sequenced in 96 nsCL/P patients and 96 controls of Central European ethnicity. Three burden and four nonburden tests were performed. Statistically significant results were followed up in a second case-control sample (n = 96, respectively). For rare variants observed in cases, segregation analyses were performed. Results In NOG, four rare sequence variants (minor allele frequency

Since introduction of the first fillers in the 1980s a multitude of substances has been developed and approved for facial contour augmentation and correction of skin defects. Here we present the interesting case of a patient who presented to us with a delayed infection 6 weeks after augmentation of the upper lip with a hyaluronic acid. We observed full convalescence after operative and high-dose antibiotic treatment of the abscesses. Generally speaking, complications after augmentation with resorbable fillers are rare. However, complications might occur even within unexpected time periods and therefore need our special attention.

Alloplastic temporomandibular total joint replacement (TJR) for end-stage disease, congenital disorders and following ablative oncological surgery has been shown to reduce pain and improve function. The purpose was to assess the maximum voluntary bite force and maximum interincisal opening (MIO) in patients undergoing alloplastic total temporomandibular joint replacement (TJR). Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients; 15 joints) and condylar instability (9 patients; 12 joints) had undergone alloplastic TMJ reconstruction. Maximum voluntary bite force and MIO were measured at pre-operatively (T0), 2 (T1), 6 (T2) and 12 (T3) months. For ordinal data comparison at different time-points, the Wilcoxon signed-ranks test was used. There was a significant improvement in maximum voluntary bite force for both, patients with condylar hypomobility ( P = 0.003) and condylar instability ( P = 0.007). Analysis of MIO revealed a significant improvement at T3 ( P = 0.002). Alloplastic TJR would appear to increase maximum voluntary bite force and MIO. Biomechanical integrity of the stomatognathic system and the ability of the patient to triturate food could be improved by alloplastic temporomandibular joint (TMJ) replacement.

Introduction The microbial flora of infections of the orofacial region of odontogenic origin is typically polymicrobial. Shortly after mass production of the first antibiotics, antibiotic resistant microorganisms were observed. Methods A 28-months retrospective study evaluated hospital records of 107 patients that were treated for head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage. Results There were 65 male (61%) and 42 female (39%) patients ranging in age from 5 to 91 years, with a mean age of 48 years (SD = 21). 52 patients underwent outpatient management and 55 patients inpatient management. A total of 92 bacterial strains were isolated from 107 patients, accounting for 0.86 isolates per patient. Overall 46 bacterial strains were isolated from patients that underwent outpatient and 34 bacterial strains that underwent inpatient treatment. 32.6% of the strains, isolated from outpatient treated individuals showed resistances against one or more of the tested antibiotics. Isolated strains of inpatient treated individuals showed resistances in 52.9%. Discussion According to this study's data, penicillin continues to be a highly effective antibiotic to be used against viridans streptococci, group C Streptococci and prevotella, whereas clindamycin was not shown to be effective as an empirical drug of choice for most odontogenic infections. Conclusion Microorganisms that show low susceptibility to one or more of the standard antibiotic therapy regimes have a significantly higher chance of causing serious health problems, a tendency of spreading and are more likely to require an inpatient management with admission of IV antibiotics. Penicillin continues to be a highly effective antibiotic to be used against viridans streptococci, group C Streptococci and prevotella, whereas clindamycin could not be shown to be effective as an empirical drug of choice for a high number of odontogenic infections.

BACKGROUND: Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is one of the most common of all congenital anomalies, and has a multifactorial etiology involving both environmental and genetic factors. Recent genome-wide association studies (GWAS) identified strong association between a locus on chromosome 10q25.3 and NSCL/P in European samples. One gene at 10q25.3, the ventral anterior homeobox 1 (VAX1) gene, is considered a strong candidate gene for craniofacial malformations. The purpose of the present study was to provide further evidence that VAX1 is the causal gene at the 10q25.3 locus through identification of an excess of rare mutations in patients with NSCL/P. METHODS: The 5′UTR, complete coding regions, and adjacent splice sites of the two known VAX1 isoforms were sequenced in 384 patients with NSCL/P and 384 controls of Central European descent. Observed variants were investigated with respect to familial cosegregation or de novo occurrence, and in silico analyses were performed to identify putative effects on the transcript or protein level. RESULTS: Eighteen single-base variants were found, 15 of them rare and previously unreported. In the long VAX1 isoform, predicted functionally relevant variants were observed more often in NSCL/P cases, although this difference was not significant (p = 0.17). Analysis of family members demonstrated incomplete cosegregation in most pedigrees. CONCLUSION: Our data do not support the hypothesis that highly penetrant rare variants in VAX1 are a cause of NSCL/P. To determine whether VAX1 is the causative gene at 10q25.3 further research, in particular into the biologic function of its long isoform, is warranted. Birth Defects Research (Part A), 2012. © 2012 Wiley Periodicals, Inc.

Purpose The purpose was to analyze the mandibular patterns (condylar range of motion during opening; incisal range of motion during opening, lateral excursion, and protrusion; velocity during opening and closing; mandibular rotation angle during opening and closing) in patients with alloplastic total joint replacement (TJR). Materials and Methods Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients, 15 joints) and condylar instability (9 patients, 12 joints) had undergone alloplastic TJR. Data were recorded preoperatively and 2, 6, and at least 12 months postoperatively. For ordinal data comparison at different time points, the Wilcoxon signed-ranks test was used. Results Analysis of the kinematic data at least 12 months postoperatively showed in patients with condylar hypomobility a statistically significant increase in all measured data except the incisal range of motion lateral excursion. In patients with condylar instability, the results showed a statistically significant decrease for incisal range of motion protrusion and laterotrusion. A slight increase in condylar range of motion, incisal range of motion linear distance, and velocity during opening and closing was found. Conclusions Even after successful alloplastic TJR, a complete restoration of normal joint function is not achievable. Nevertheless, the kinematic data indicate that alloplastic TJR results in an improved function in patients with joint hypomobility and in a decrease of abnormal hypermobility in patients with condylar instability.

Die Pravalenz der Angst vor zahnarztlichen und oralchirurgischen Behandlungen hat sich in den letzten 50 Jahren trotz des Fortschritts der Schmerzkontrolle und Etablierung weniger invasiver Prozeduren nicht geandert. Dies fuhrt bei Patienten zu Vermeidung einer entsprechenden Therapie und somit zu verminderter Mundgesundheit. Neben der Allgemeinanasthesie bietet die Sedierung die Moglichkeit, den Patienten vor unangenehmen Reizen abzuschirmen. Die Sedierung ist bei Einhaltung bestimmter Voraussetzungen auch ohne Hinzuziehung eines Facharztes fur Anasthesiologie durch den Operateur sicher durchfuhrbar. Der nachfolgende Artikel soll einen Uberblick uber die unterschiedlichen Sedierungsverfahren und deren praktische Anwendung liefern.

The objective of this study was to investigate the impact of human beta-defensins (hBDs) on oral squamous cell carcinoma (OSCC) proliferation and hBD expression in vitro. BHY-OSCC cell lines were stimulated with hBD-1, -2, and -3. Proliferation of BHY cells was ascertained and hBD-mRNA expression was evaluated by real-time PCR. Proliferation of BHY cells decreased by 25% in response to hBD-1 stimulation but increased after stimulation with hBD-2 and -3. HBD-1 stimulation enhanced hBD-3 expression, whereas HBD-2 stimulation decreased early hBD-3 expression. HBD-3 stimulation enhanced hBD-1 expression. HBDs profoundly impact on OSCC proliferation and hBD expression in vitro. Therefore, hBD-1 might function as a tumor suppressor gene in OSCCs, while hBD-2 and -3 might be protooncogenes.

Variants in the interferon regulatory factor 6 (IRF6) gene have repeatedly been associated with non-syndromic cleft lip with or without cleft palate (NSCL/P). A recent study has suggested that the functionally relevant variant rs642961 is the underlying cause of the observed associations. We genotyped rs642961 in our Central European case-control sample of 460 NSCL/P patients and 952 controls. In order to investigate whether other IRF6 variants contribute independently to the etiology of NSCL/P, we also genotyped the non-synonymous coding variant V274I (rs2235371) and five IRF6-haplotype tagging single nucleotide polymorphisms (SNPs). A highly significant result was observed for rs642961 (P = 1.44 x 10(-6)) in our sample. The odds ratio was 1.75 [95% confidence interval (CI): 1.38-2.22] for the heterozygous genotype and 1.94 (95% CI: 1.21-3.10) for the homozygous genotype, values that are similar to those reported in a previously published family-based study. Our results thus confirm the involvement of the IRF6 variant, rs642961, in the etiology of NSCL/P in the Central European population. We also found evidence suggestive of an independent protective effect of the coding variant V274I. In order to understand fully the genetic architecture of the IRF6 locus, it will be necessary to conduct additional SNP-based and resequencing studies using large samples of patients.

The variety of temporomandibular joint (TMJ) prostheses and condylar reconstruction plates available is in contradiction to their rare application. This emphasizes that alloplastic TMJ reconstruction is still evolving. This article reviews the history of TMJ reconstruction. Medline as well as public and private libraries have been searched. Current systems are reviewed. Prosthetic devices can be differentiated into fossa-eminence prostheses, ramus prostheses and condylar reconstruction plates, and total joint prostheses. Fossa and total joint prostheses are recommended when the glenoid fossa is exposed due to excessive stress (degenerative disorders, arthritis, ankylosis, multiply operated pain patients). Singular replacement of the condyle is preferred as a temporary solution in ablative surgery. The use of prosthetic devices for long-term replacement should be restricted to selected cases, taking care to retain the disk, in order to prevent penetration into the middle cranial fossa. The term 'condylar reconstruction plate' reflects this more clearly than 'ramus prosthesis' which suggests permanent reconstruction. Long-term studies comparing the functional and aesthetic results of the various prostheses and condylar reconstruction plates are not available, which leaves the choice to personal experience.

Resections of the temporomandibular joint (TMJ) have been carried out for about 150 years. This article reviews the beginning of TMJ surgery technique before 1945 by carrying out extensive inquiries in public and private libraries and collections. Before 1945 the technique of alloplastic reconstruction of the TMJ was mainly influenced by German and French surgeons. Reconstruction was limited to replacement of the condyle. The role of the TMJ within the orofacial system was not considered. Interposition of alloplastic implants, resection dressings and prostheses were the dominant technique. The main concerns were sterilisation, biocompatibility and implant fixation. No evidence-based data on outcomes are available from that time. By 1945 reconstruction of the TMJ involved the close cooperation of surgeons and dentists.

Contains fulltext : 52572.pdf (Publisher’s version ) (Closed access) BACKGROUND: Particularly in clinical studies, it has been found that rapid swelling of tissue expanders leads to high-pressure peaks that can cause hypoxia in the tissue and thus also skin damage. For this reason, the present study in animals investigated whether an osmotic expander with silicone shell is capable of expanding in tissue and bringing about useful tissue expansion without complications. It was also examined whether and what quantitative and qualitative differences there are between conventional osmotic expanders and the new expanders with silicone shell. METHODS: The expansion of osmotic expanders with silicone shell was compared with that of osmotic expanders without silicone shell in four mini pigs. The expander type used was an M1 rectangle with an initial volume of 6 ml. Five expanders were implanted in each pig, meaning that 20 expanders were measured. The volume of the expanders was measured directly after explantation. Indirect volume determination was performed by producing plaster casts for subsequent laser optical measurement. RESULTS: Comparison of the two curve profiles showed a much flatter profile for the expanders with silicone shell. The absolute values for the volumes of the expanders with silicone shell were likewise substantially lower. CONCLUSIONS: Controlled skin expansion is a technique of providing localized donor tissue for reconstructive surgery. The new expanders could be in a position to lower the rate of complications in tissue expansion.

Nonsyndromic cleft lip with/without cleft palate (nsCL/P) and nonsyndromic cleft palate only (nsCPO) are the most frequent subphenotypes of orofacial clefts. A common syndromic form of orofacial clefting is Van der Woude syndrome (VWS) where individuals have CL/P or CPO, often but not always associated with lower lip pits. Recently, ∼5% of VWS-affected individuals were identified with mutations in the grainy head-like 3 gene (GRHL3). To investigate GRHL3 in nonsyndromic clefting, we sequenced its coding region in 576 Europeans with nsCL/P and 96 with nsCPO. Most strikingly, nsCPO-affected individuals had a higher minor allele frequency for rs41268753 (0.099) than control subjects (0.049; p = 1.24 × 10(-2)). This association was replicated in nsCPO/control cohorts from Latvia, Yemen, and the UK (pcombined = 2.63 × 10(-5); ORallelic = 2.46 [95% CI 1.6-3.7]) and reached genome-wide significance in combination with imputed data from a GWAS in nsCPO triads (p = 2.73 × 10(-9)). Notably, rs41268753 is not associated with nsCL/P (p = 0.45). rs41268753 encodes the highly conserved p.Thr454Met (c.1361C>T) (GERP = 5.3), which prediction programs denote as deleterious, has a CADD score of 29.6, and increases protein binding capacity in silico. Sequencing also revealed four novel truncating GRHL3 mutations including two that were de novo in four families, where all nine individuals harboring mutations had nsCPO. This is important for genetic counseling: given that VWS is rare compared to nsCPO, our data suggest that dominant GRHL3 mutations are more likely to cause nonsyndromic than syndromic CPO. Thus, with rare dominant mutations and a common risk variant in the coding region, we have identified an important contribution for GRHL3 in nsCPO.

Als ungewohnliches und seltenes Krankheitsbild wird die Hyperplasie des Processus coronoideus haufig nicht oder zu spat diagnostiziert. Ziel dieser Studie war es, die Morphologie, Atiologie und das klinische Bild der Coronoidhyperplasie zu beschreiben sowie Diagnose und Therapie zu diskutieren. Es erfolgte die Analyse aller Falle mit histologisch gesicherter Hyperplasie des Processus coronoideus, die in unserem Zentrum zwischen 1995 und 2004 behandelt worden waren. Die Auswertung der Patientendaten erfolgte hinsichtlich Alter, Geschlecht, klinischer Symptome, Diagnostik und Therapie. Die so gewonnenen Daten wurden mit den Literaturangaben verglichen. Es wurden 14 neue Falle und 101 publizierte Falle rekrutiert, davon 96 mit bilateraler und 19 mit unilateraler Hyperplasie. Das mittlere Alter der Betroffenen bei Diagnosestellung betrug 23,7 Jahre. In Bonn wurden alle Patienten durch Coronoidektomie und entsprechende Physiotherapie behandelt. Eine Verbesserung der Mundoffnung konnte bei 86% unserer Patienten erzielt werden. Verglichen mit den zum Teil enttauschenden Ergebnissen in der Vergangenheit publizierter Studien im Hinblick auf Mundoffnung und Unterkiefermobilitat scheint durch unser Therapiekonzept eine Verbesserung moglich. Unsere Studie unterstreicht die Bedeutung von dreidimensionalen CT-Techniken bei der Diagnose und Operationsplanung, die Uberlegenheit der Coronoidektomie im Vergleich zur Coronoidotomie und die Bedeutung dynamischer Physiotherapie zur Pravention postoperativer Vernarbungen.

In this short communication, we suggest a slight modification of Albino Triaca's chin-wing osteotomy to vertically correct the inferior border of the mandible in a patient with horizontal growth-type facial asymmetry due to condylar hyperplasia.

The aim of the present study was to compare three different systems for preparing platelet concentrates: two commercially available bed-side techniques (Curasan system and PCCS) and a procedure used routinely in transfusion medicine. Platelet concentrates were prepared from venous blood of 12 healthy male volunteers using the three different systems. Platelet and leucocyte counts were performed and platelet derived growth factor and transforming growth factor beta were assayed by enzyme linked immunoassay. Handling was also considered. The three systems were able to collect 19.0 ± 16.6% (laboratory system), 41.9 ± 9.7% (Curasan system) and 49.6 ± 21.0% (PCCS) of the absolute number of platelets which were originally in the venous blood volume within the platelet concentrate. Due to the amount of plasma which is left in the platelet concentrate portion, the platelet concentration could be increased between 1.4 ± 1.3 times (laboratory system), 5.0 ± 2.3 times (PCCS) and 11.7 ± 2.4 times (Curasan system) compared to the venous blood. The amount of growth factors correlated with the number of platelets within the platelet concentrates. The two systems for intraoperative use are similar in their effects on the platelets. The absolute gain of platelets seems to be the highest with the PCCS; the highest concentration of platelets per µL is gained with the Curasan system. The laboratory system may offer an alternative if an intraoperative system is not available.

Ziel und Patienten. Die Darstellung der Sonoanatomie des fetalen Gesichts hat besondere Bedeutung erlangt, da sonographische Auffalligkeiten des Phanotyps den Einstieg in die Diagnostik syndromartiger oder chromosomal bedingter Krankheitsbilder ermoglichen. Von 1990–1999 wurde in der Klinik fur Pranatale Diagnostik und Therapie der Universitatsklinik Bonn bei 70 Feten sonographisch eine Spaltbildung diagnostiziert. Ziel der Studie war es, zu eruieren, ob die Art einer Spaltbildung mit der Pravalenz von assoziierten Anomalien bzw. mit der Karyotypisierung nach Amniozentese korreliert. Auserdem wurden die Arten der assoziierten Anomalien sowie das neonatale Outcome dieser 70 Feten nachuntersucht.

Objective The aim of this study was to determine the relationship between facial clefts, associated malformations and chromosomal abnormalities. Study design Sonograms of 70 fetuses with cleft lip with or without cleft palate were prospectively and retrospectively evaluated in our tertiary referral center for the nature of the cleft lip or palate and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of the 70 patients (90%). Results The frequency of additional anomalies and the mortality rate in this selected population varied with the type of cleft. None of the fetuses presenting an isolated cleft lip had additional anomalies and all survived. All fetuses presenting a median facial cleft had concurrent anomalies (particularly of the central nervous system (90%)) and a fatal outcome. Associated defects were more frequent in fetuses with bilateral clefts (72%) than in those with unilateral clefts (48%). Fetuses with a unilateral cleft lip with or without cleft palate had a better survival rate (52%) than those with a bilateral cleft lip with or without cleft palate (35%). The frequency and type of chromosomal abnormalities varied with the type of cleft. The highest rate of chromosomal abnormalities was found in fetuses with median clefts (82%). Conclusions Although no conclusions regarding the prevalence of chromosomal or other anomalies in patients with a cleft lip with or without cleft palate in the general population could be drawn, the study revealed a strong relationship between the type of facial cleft, associated malformations, chromosomal abnormalities and fetal outcome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Complications Arthroscopy of the temporomandibular joint is an invasive procedure that can entail potential complications. Based on many years of personal experience and taking data from the literature into account, this article discusses functional, surgical, and anesthesiological complications of arthroscopy of the temporomandibular joint. The majority of these complications can be avoided by heeding specific knowledge of topography, careful manipulation, and corresponding surgical experience. Informing the patient The information given to the patient prior to the intervention should cover not only hemorrhaging, swelling, and wound infection, but also damage to (branches of) the facial nerve, the risk of perforation of the auditory canal as well as the possibility of temporary occlusal disturbances.

The treatment of hypertrophy of the masseter and temporal muscles has to date been dominated by conservative and surgical measures. Local therapy with type A botulinum toxin permits an alternative method of treatment. After targeted, sometimes electromyographically controlled, intramuscular injection of the affected muscles, marked inactivity atrophy occurred in the muscles of seven patients over the course of 3 to 8 weeks. This atrophy remained constant over a follow-up period of up to 25 months, and no side effects were observed. Because of its minimal invasiveness, this technique seems to have an advantage over conventional surgical therapy. Consequently, treatment with type A botulinum toxin can be regarded as a sensible alternative to surgery in cases of hypertrophy of the masseter and/or temporal muscles.

Frey’s syndrome is a well-known sequel of operative procedures in the region of the parotid gland. It occurs frequently after conservative parotidectomies and occasionally after partial or radical excision of the parotid gland. The incidence depends on the size of the glandular compartment removed and on the accuracy of the diagnostic procedures used to verify the presence of the syndrome. Frey’s syndrome occurs less frequently after purulent parotitis, tumors, trauma, typhoid fever, and irritation of the auriculotemporal nerve by dislocated temporomandibular fractures. 1-3 Frey’s syndrome becomes symptomatic when undesirable sweating occurs in the cheek and retroauricular and temporal regions after eating. Symptoms also can occur in the distribution of the greater auricular nerve. There can be flushing and warmness, with overheating of the affected areas of the skin, which in some cases is associated with pain. Pain also can occur as a preliminary sign or be the only symptom. Typically, the symptoms occur several weeks or months after surgery. Gustatory sweating can be verified by using the iodine-starch test, 4 which shows the phenomenon on the basis of a color reaction. Follow-up examinations show that approximately 30% to 50% of postparotidectomy patients experience the symptoms described, and approximately 15% rate their symptoms as severe. 5,6 Pathophysiology The precise pathophysiology of Frey’s syndrome is still unclear. Hypothetical explanations are based on the dense parasympathetic innervation in the region of the parotid. 10 Parasympathetic secretory fibers from the glossopharyngeal nerve to the parotid gland pass through the tympanic nerve, superfical petrosal nerve, and otic ganglion (Jacobson’s anastomosis) to the auriculotemporal nerve, which branches off the trunk of the mandibular nerve. Frey’s syndrome can be explained by local terminal inhibition of the physiologic reflex 1,3 or by malinnervation attributable to misdirection of the parasympathetic fibers of the auriculotemporal nerve for the parotid gland in the process of postoperative regeneration. In the latter situation, fibers follow the sympathetic nerve paths and attach to the proximal sweat glands of the skin

BACKGROUND Frey syndrome was first described by Baillarger in 1853. Frey provided a detailed analysis and description as “auriculotemporal syndrome” in 1923. According to the literature, even the most recent therapeutic measures described for the treatment of patients with Frey syndrome have little chance of success and a high incidence of side effects. Thus, a type of treatment is desirable that can suppress the symptoms of Frey syndrome and can offer a good success rate, minimum invasiveness, and few side effects. METHODS The experience of the authors and data from the literature confirmed the efficacy of type A botulinum toxin treatment for patients with Frey syndrome up to a maximum observation period of 3 years. RESULTS In the current study, seven patients with severe, symptomatic Frey syndrome after parotidectomy were treated successfully with type A botulinum toxin. CONCLUSIONS The method of local, intracutaneous treatment with type A botulinum toxin for patients with Frey syndrome is effective, virtually side-effect free, and minimally invasive. Cancer 2000;89:1659–63. © 2000 American Cancer Society.

Fur die haufigsten Kiefergelenkerkrankungen stehen heute konservative Behandlungsverfahren mit hoher Erfolgswahrscheinlichkeit zur Verfugung. Zunehmend zielt diese Therapie auf die Zusammenhange zwischen der Funktion der Kiefergelenke und der Kaumuskulatur ab. Chirurgische Therapieverfahren kommen in Frage, wenn die konservative Therapie nicht zum Erfolg fuhrt oder von vornherein nicht sinnvoll ist. Dabei wird die offene Chirurgie zunehmend von minimalinvasiven Verfahren, z. B. der Arthroskopie, verdrangt. Eine enge Zusammenarbeit zwischen dem funktionsanalytisch und therapeutisch tatigen Zahnarzt und den Mund-Kiefer-Gesichts-Chirurgen in der Diagnostik und Therapie verbessert die Prognose bei solchen Erkrankungen.

We conducted a genome-wide association study for nonsyndromic cleft lip with or without cleft palate (NSCL/P) in 401 affected individuals and 1,323 controls, with replication in an independent sample of 793 NSCL/P triads. We report two new loci associated with NSCL/P at 17q22 (rs227731, combined P = 1.07 × 10−8, relative risk in homozygotes = 1.84, 95% CI 1.342.53) and 10q25.3 (rs7078160, combined P = 1.92 × 10−8, relative risk in homozygotes = 2.17, 95% CI 1.323.56).

Condylar hyperplasia (CH) is a local overgrowth of the condylar process of the temporomandibular joint (TMJ) of unknown etiology. Probably, growth factors like the insulin-like growth factors (IGFs) are involved in its pathogenesis. Specimens from 12 patients were investigated histologically and immunohistochemically to obtain the distribution of the IGFs-I and -II and the IGF1 receptor. The results revealed juvenile and adult subtypes. While generally IGF-II could only be detected weakly, in the juvenile cases strong immunostaining for IGF-I in cartilage and bone supposes an influence on pathological growth processes.

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