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

Transplantation of the scapular bone vascularized by the thoracodorsal vessels offers some major advantages. This new myo-osseous grafting unit has the longest pedicle of all pedicled bone flaps used until now. It is particularly in difficult cases involving major parts of the maxillofacial region--as after neck dissection and irradiation--or distant regions such as the maxilla that its long pedicle and its anatomical configuration render the scapula an ideal graft.

A comprehensive discussion of our current understanding of lichen ruber of the oral cavity is given. The diagnostic and therapeutic experience gained in our clinic is communicated with particular emphasis being placed on the wide range of clinical pictures and on differential diagnosis. A treatment strategy is presented to illustrate our therapeutic approach.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma and is characterized by a variable morphology, which often creates difficulties in differential diagnosis. The clinical behavior and the pathologic features of 9 cases of MFH of the head and neck were studied. The cases presented demonstrate the poor prognosis of these lesions because of their strong tendency to recur locally and to form distant metastases, especially to the lungs.

Report on the treatment of a female patient, now 18 years old, with a bilateral continuous cleft of the lip, jaw and palate, in whom genuine ossification occurred at the jaw clefts. The upper lateral incisors and both upper canines have aligned themselves regularly in this jaw. Until now natural bone formation in a cleft jaw has been considered impossible.

Middle-ear findings in two groups with cleft lips and palate of the early childhood have been compared with each other. In 126 CLAP children of the Departments for Maxillofacial Surgery/ENT of the University of Hamburg tympanic cavity wash tubes (grommets) were inserted (26%) or myringotomy was done (10%) after persistence of middle ear effusions for more than 3 months. In contrast to this rather conservative approach, grommets were inserted as a primary treatment in 58 CLAP children of the Iowa Cleft Palate Center. Long-term follow-up revealed no marked middle-ear pathology in either of these groups. Repeated use of general anesthesia and the risk of othorrhoea (10-18%), however, speak against the routine practice of grommet insertion. From the otological point of view a wait-and-see strategy should be employed in the indication for grommet insertion in CLAP children after closure of the soft palate, just as it is done in the normal population (controlled intervention). Therapeutic grommet insertion performed in time will restore the normal physiology of the middle ear due to mucociliary clearance. Moreover, there is an immediate effect on the child's hearing ability thus contributing to physiological speech development. On the other hand, adequate treatment prevents defect healing sequelae such as middle-ear deafness, adhesions and cholesteatomas.

Our electron microscopic observations show alterations of the muscles near the cleft margins confirming the theory resulting from light microscopic and immunohistochemical findings that the myogenic structures surrounding cleft margins are inferior tissue that is capable neither of regeneration nor of normal function. The clinical implication derived from these observations is that the tissue in the vicinity of the clefts should be generously excised when doing cheiloplasties.

The birth of a child with a cleft lip or palate may give rise to quite severe reactions among those concerned. Due to lacking information of the physicians and nurses in the delivery wards on this type of disability the parents are left alone with their grief, frustration and fear. Often precious time is lost until the first necessary steps in treatment are taken. The great number of highly different concepts on cleft treatment and the feeling of being considered immature and incompetent by the professionals adds to the parents' uncertainty in a situation, in which they have to take important decisions on behalf of their child. The practical experience gained in counseling and supporting parents of cleft children has shown that unless medical, psychological, pedagogic and social measures are integrated into the therapeutic approach, not even the basic prerequisites for a satisfactory early management of these children are met. The responsibility for optimum treatment rests with all those involved. Optimizing the physician patient-parents interactions is thus regarded as a possibility for promoting a favorable physical, psychosocial and mental development. Interdisciplinary cooperation between professionals from various disciplines and the integration of the family in the treatment as well as improved information to support these joint efforts will open up new avenues for the future.

Double contrast arthrotomography combined with cinematography as a diagnostic instrument establishing functional and structural TMJ alterations is evaluated for its diagnostic value and reliability within the chain of diagnostic measures applied. In 131 patients double-contrast arthrotomography was followed by a comprehensive history of joint problems, and verification of the clinical findings as well as the arthrographic diagnosis and the post-arthrographic TMJ alterations. Our interest was focussed, among others, on the question whether arthrography alone would have any therapeutic effect or produce an alteration in TMJ function.

Bone scintiscans were performed in 11 patients with dislocation fractures of the mandibular condyle after reduction of the fractures and fixation of the condyles by tension bolt osteosynthesis. Since the storage of the radioisotope in the bone tissue is directly dependent on the blood circulation, these examinations allow conclusions as to the blood supply of the mandibular condyle head following reduction. No negative effects on blood supply resulting from the operative intervention could be observed.

The implications of immediate postnatal early orthodontic obturation for the development of cleft children and parental acceptance of the deformity are discussed and the practical procedure is explained.