Deutsche Zeitschrift fur Mund-, Kiefer- und Gesichts-Chirurgie最新文献

A newly developed titanium implant system is useful for the fixation of facial prostheses. Due to the osteointegration of this material the system can also be used for the treatment of anatomically less favorable cases. The clinical results achieved to date are good.

The use of unexpanded mesh grafts as split-thickness or full-thickness skin grafts in defects of uneven or highly flexible areas of the face has been discussed as a very successful method. Due to improved diffusion the "take" of grafts is more than 90% when a proper bandage has been applied.

Following TMJ discectomy an interposed autogenous graft is to be preferred. In our study we examined the effect of short-term Silastic grafts on the surrounding tissue. When the silicone material was removed 12 weeks after surgery, foreign body granulations were present only in those cases where the Silastic surface had been mechanically roughened.

The possibilities offered by panoramic zonography (MT program) in the diagnosis of the midface are outlined. The imaging quality of various anatomical structures is demonstrated both on the anatomical model and in clinical use. The benefits and limitations of this procedure are discussed. Zonography is a reliable instrument adding to the range of basic diagnostic procedures in the midfacial region.

Ascher's syndrome is composed of the triad blepharochalasis, double lip and goitre. In many of the cases reported in the literature this typical constellation of symptoms is not complete; particularly the struma is not mandatorily involved. A 58-year-old patient with this rare disease who exhibited blepharochalasis and double upper and lower lip is presented. Additionally, subclinical hypothyroidism and alopecia areata totalis were found. In differential diagnosis other causes of double lips or enlargement of the lips must be considered.

In 240 patients the correlation between different patterns of pretreatment verbal information on local anesthesia and perioperative patient anxiety was studied. Emphasis has been placed on the importance of "local anesthesia" itself as an anxiety factor as compared with other dental treatment measures and on legal aspects. The 240 patients were randomized into 3 groups of 80 patients each receiving minimum, basic, or extended information on local anesthesia. Anxiety was measured using the STAI test before and after the delivery of information, after local anesthesia, and finally after dental treatment. The significance of different anxiety factors was assessed with a questionnaire. Local anesthesia, pain sensation, and drilling were found to be the main anxiety factors. Higher STAI scores were observed in women and prior to surgical treatment, and the scores increased after minimum and extended information. Anxiety decreased after basic information, and significantly so in patients with high preoperative STAI scores. Disregarding the forensic aspects, our results suggest that basic information prior to dental treatment could be a useful method for reducing anxiety and improving the patients' confidence in the dentist or surgeon.

After a first irradiation with 2 and 5 Gy blood samples were collected at 30 minutes' intervals for 24 hours in 19 tongue cancer patients to assess the activity of the glycosis enzyme glucose-6-phosphate isomerase (GPI) and the creatine kinase (CK). In all patients the GPI activity exhibited peaks at reproducible points in time. Observed for the very first time, this GPI peak had a height at 15 to 18 hours following radiation that correlated with the tumor volume and the irradiation dose. We refer to it as the oncoradiogenic enzyme peak. The frequency of the appearance of a late enzyme peak is significantly related to the presence of regional lymph node metastases. The radiobiological considerations regarding the potential causes for such post-irradiation increases in enzyme activity are discussed. The impact of demonstrating oncoradiogenic GPI peaks for optimizing radiotherapy is outlined.

In the past few years the following methods have been accepted as the treatment of choice in trigeminal neuralgia: transcutaneous electrical nerve stimulation (TENS), drug treatment--especially carbamazepine, controlled thermocoagulation, percutaneous retrogasserian rhizotomy with glycerol, microvascular decompression. The attending physician will prefer the treatment from which he expects the best results. However,the choice of treatment should take into consideration the age and general condition of the patient, the possible side effects, the quality of pain and treatments already performed.

The surgical management of patients on anticoagulant treatment is a controversial issue. The attending surgeon must consider the risk of embolism and hemorrhage to prevent possible complications. With the aid of the local haemostatic technique described in this article minor dental surgery can be safely carried out in patients with a prothrombin time corresponding to the International Normalized Ratio (INR) 2.0.

We investigated normal oral epithelium and 20 oral squamous cell carcinomas with antibodies against oncogene products (p21, EGF-R) and intermediate filaments (cytokeratins 4, -10/11, -13, -18, Vimentin). Antigen expressions in oral epithelium and squamous cell carcinomas were associated in different patterns with epithelial maturation. Dedifferentiation of the squamous cell carcinomas was accompanied by quantitative changes in the oncogene products and a more complex pattern of the cellular intermediate filament equipment.