Chirurgia maxillofacialis & plastica最新文献

Malignant disease is undoubtedly an extraordinary situation demanding trust in the relation between the patient and the doctor. From the legal aspect, any treatment and especially the surgical one is an attack on the integrity of the patient and is not allowed without the agreement of the patients. The relationship between the patient and the doctor begins with at the first consultation and should not end after discharge from hospital. Periodical examinations, repeated admissions and treatment of the malignant disease sequelae, make the relationship between the patient and the doctor a lifelong one. Laws in different countries mostly regulate the relationship between the patient and the doctor as an contract. Therefore, in order to overcome unavoidable crises especially common with malignant disease, its long duration and treatment, an exact definition of the relationship between the patient and the doctor founded on confidence and understanding is necessary.

Three patients operated for labial commissure cancer with cheek flap reconstruction are presented. In two cases general anaesthesia and in one local analgesia was used. There was no local recurrence, dehiscence, contracture or interference with function. This could be a method of choice for reconstruction of small lesions on labial commissure. The site of the incision lines fully comply with the aesthetic demands as they simulate the natural lines of the face.

In this article the structure of gingivo-epithelial tissue and survey of research about its attachment to the tooth neck are presented. Some further research themes in this important and delicate field of stomatologic implantology are also discussed.

Cheilognathopalatoschises are a complex therapeutic problem not yet completely solved and demanding collaboration of a number of medical and paramedical branches. In a therapeutic team, an otorhinolaryngologist has an important role since he has to deal with impaired hearing, impaired nasal breathing, as well as with disturbed speech development. On the basis of an analysis of the state of hearing in children who were treated at the University Clinic for Otorhinolaryngology and Cervicofacial Surgery in Ljubljana, it was found that more than 76% of them suffered from hearing loss of different levels. Almost in all children with uni-or bilateral cheilognathopalatoschises nasal breathing was disturbed, due to deformities of alae and caudal border of septum. In all these children signs of chronic rhinitis were pronounced. A silent inflammation in the nose and in the epipharynx together with hyperplastic adenoids and disturbed function of the eustachian tube cause conduction hearing loss and recurrent otitis media, which hinders speech training. The authors are of the opinion that additional surgical interventions enabling nasal breathing and function of the middle ear should be implemented more frequently and sooner than up till now. All children with cleft-lip-palate should be permanently followed up by a group of subspecialized otorhinolaryngologists which would lead to a more successful and complete rehabilitation.

Hearing threshold in cleft lip/or palate was assessed in 316 ears by pure tone audiometry. Normal hearing threshold was found in almost a half (164/51,9%) of the ears examined. Hearing defects were most frequently observed in cases of complete unilateral cleft palate (48/60%), whereas they were least frequently recorded in cases of cleft lip (15/19,2%). Complete bilateral cleft lip and palate was associated with conduction deafness in 29 (42,9%) ears examined, thus occupying the last but one place according to the frequency of association between deafness and cleft defects. A hearing conduction gap or more than 40 dB was most frequently present in complete cleft lip and palate (7/5,6%), followed by cleft palate (4/5%). Submucous cleft palate was observed to be less frequently accompanied by conduction deafness (9/56,2%) as compared to complete cleft palate, despite a common feature of bone and muscle support discontinuity. Cleft lip was least frequently accompanied by conduction deafness, but it was still present to a relatively high percentage when compared to the cleft-free population.

The paper reports on the possibility of application of peracetic acid on live tissue by correcting those properties which presented the obstruction for its former application on live tissue. Using laboratory technique the degree of peracetic acid acidity was put to pH 5 and the concentration of 0.2% was determined by testing in vitro on the resistant hospital strains of Staphylococcus aureus and Pseudomonas aeruginosa. The prophylactic and therapeutic activity on artificially induced infection of wounds by above mentioned bacteria was investigated in experiments (rabbits n = 30). The prophylactic and therapeutical efficacy of peracetic acid of certain properties was proved by comparing it with the control group of wounds where physiological solution was used as a compress.

The authors proposes a special method for the placement of implants into edentulous areas of the jaw. It involves the use of a metal screw combined with a denaturated segment of human dental root. The root segment constitutes the transmucosal part of the implant. Other types of implants used on humans so far have failed to achieve biological tissue attachment in the gingivo-epithelial region. The root segment coated with acellular denaturated cement possesses optimal biochemical compatibility with gingivo-epithelial tissue. The study included 22 patients aged from 20-60 years whom the implants were tested in. The implants were inserted into healthy regions of edentulous jaws. Osseointegrati on was attained in all the cases. Tho years after the insertion healthy periodontal status was found in 12 implants, while four showed gingival pockets measuring up to 3 mm in depth on the proximal surfaces of the root segment. The remaining 16 implants were checked one year after placement. Pockets involving the proximal surfaces were found in three patients. Curettage was performed in all the seven patients with gingival pockets; re-attachment between in the root segment and gingivo-epithelial tissues was achieved in four of them. The success rate of the procedure, calculated from these results, is 90.6%. The failures in the series are attributed to inadequate oral hygiene.

In the past few years the abuse of ethical principles in plastic surgery has become increasingly noticeable. The reasons are various; it may be the desire to achieve personal recognition of plastic surgeons by means of different press articles or numerous yellow-press articles written by journalists whose only aim is to increase the circulation of their newspapers. In extreme cases the violation of medical secret or the surgeon's personality advertising is noticeable. Although this phenomenon is much more evident in the countries where plastic surgery is being performed at private clinics, it has in the past few years also become more obvious in our country. These ethical problems are present in plastic surgery because it is to often identified with aesthetic surgery. The fact that, with its more or less favorable results, it appears highly attractive to the public and thus get even the unwilling surgeon into the focus of various yellow-press articles and headlines. On the other hand, the very nature of the individual who specializes in this kind of surgery may be the principal basis for publicity. Such abuse of professional ethics is usually explained by claiming that the public should be properly informed, but in some cases it is but open advertising of the surgeon and his/her abilities. Establishing an ethical code which would entail all necessary moral sanctions in plastic surgery would act favorably to the protection of those plastic surgeons who perform their work according to the moral and ethical principles of their profession.