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

In this study 3 cases diagnosed as necrotizing sialometaplasia (NS) of the palate are described and discussed together with 106 other cases cited in the literature. A benign, self-limiting, inflammatory lesion NS is reviewed focusing on age, sex, race, clinical and symptomatic features, etiology, and therapy. Clinically and histologically NS mimics malignancy. Male (mean age 49.8 yrs) to female (mean age 36.3 yrs) ratio is 1.95:1. The etiology of NS remains unknown, but it may be associated with local trauma, use of a denture, arteriosclerosis or allergy. Most investigators seem to favor an ischemic cause of NS. Lesions heal spontaneously without treatment within 1-3 months; the only invasive procedure required is a biopsy.

Adhesion of cells to other cells and to the matrix is the prerequisite for a multitude of cell interactions such as the emigration of circulating leukocytes to sites of inflammation, antigen-presentation, cell-mediated cytotoxicity, cell anchorage and differentiation. In the past few years, a large family of adhesion molecules has been defined which are receptors for these adhesion events. Using immunohistochemical techniques we analyzed the distribution pattern of adhesion molecules in the buccal mucosa of 12 patients with oral lichen planus reticularis and compared it with 12 specimens of normal oral mucosa. In lichen planus, a neo-expression of the antigens VLA-1, 3, 5 and 6, which are receptors for collagen, fibronectin and laminin, could be detected on T cells and macrophages infiltrating the basement membrane zone. ICAM-1, the specific ligand of LFA-1, normally only expressed by endothelial cells, showed a focal expression on basal keratinocytes at sites of intramucosal T cells. The abundance of adhesion molecules on leukocytes and keratinocytes in oral lichen planus is indicative of a special state of activation. It enables the leukocytes to penetrate the tissue, especially the basement membrane zone, to persist in this environment and to exercise their effector functions.

A review of the literature shows that intraoral lipomas are more common than they are generally believed to be. The clinical course of a case with unusual localization, size and clinical manifestation of an angiolipoma of the maxillary sinus is described. Differential diagnosis with other types of intraoral lipomas is made.

Measurements of the secretory rates of the palatine and the parotid glands, assessing the electrolyte content of all salivary fractions and combined clinical biotic studies underline the clinical importance of the minor salivary glands. The minor salivary glands are shown to be organs whose function is decisively involved in symptoms such as xerostomia, stomatodynia, and what is known as "denture intolerance". Moreover, proper secretion of the palatine glands is of crucial importance for the physical retention of maxillary full dentures. There are no connections between secretory rates of major and minor salivary glands. The effect of certain drugs on salivary production and thus on the symptoms of hyposalivation seems to be considerable. Treatment methods for inadequate salivary secretion are outlined. The adaptive tendency of properly functioning palatine glands appears to be high. The fact that atrophic and dystrophic processes can be functionally compensated to a relatively high degree speaks for the dynamic capability of the glandular parenchyma. In view of the clinical relevance of the minor salivary glands it is mandatory that the functional principles and control mechanisms underlying their secretion be investigated in future studies.

Due to clefts of the lips, jaws and/or palate and velum no normal structures are formed in the orofacial system, and thus all processes of growth and development as well as function are disturbed to an extent varying with the extension of the malformation. Integration of these children in kindergartens or regular schools is impossible unless surgery is performed. Apart from qualified interdisciplinary initial care the acknowledgement of these children as severely handicapped persons in accordance with the law could be of great help and relief for the parents. The German law for securing the integration of severely handicapped persons in work, profession and society (Schwerbehindertengesetz) pays particular attention to severely handicapped children. The basic considerations in writing medical opinions are described.

A reclassification of 272 tumors of the salivary glands of the head resulted in a high proportion of new allocations, particularly among adenocarcinomas, adenoid cystic carcinomas, and pleomorphic adenomas, sometimes even involving a different assessment of the tumors' benign or malignant character. The implications for clinical practice and for prognostic studies are discussed.

Based on 8 case reports, the clinical features, etiology and therapy of unilateral condylo-mandibular hyperplasia are discussed. It is assumed that the underlying cause of this clinical picture is traumatic damage to the articular cartilage. According to our findings a distinction can be made between condylar hyperplasia and condylo-mandibular hyperplasia depending on the type of trauma and whether this damage occurs prior to or after completion of mandibular growth. Resection of the affected condyle is the treatment of choice. Immediate reconstruction of the joint using autogenous material (costal cartilage, iliac crest grafts) is recommended. In those cases of condylo-mandibular hyperplasia where esthetic impairment is only slight and the occlusion is left intact, the indication for surgery must be carefully discussed with the patient.

The ultrastructural phenomena of obstructive palatal sialadenitis were studied in 7 denture wearers versus 3 non-denture wearers as control. Apart from mucositis severe stagnation of salivary flow in the excretory ducts was observed in patients with dentures with short periods of service. In contrast to the control group there were mucous droplets after exocytosis of the acinus cells that remained intact even in the lumina of the distal excretory ducts. Desquamation of the duct and acinus cells results in a change in the organic components of the secretory mucus. The periductal infiltrate consisted mainly of plasma cells and lymphocytes, whereas neutrophils or macrophages were not observed. Ultrastructurally there was no evidence of an ascending microbial infection of the ducts. Probably, infections do not play an important role in the pathogenesis of obstructive palatal sialadenitis.

Colour Doppler ultrasonography shows blood flow in real time and colour by combining the features of real time B mode ultrasound and Doppler. At each point in the image the returning signal is interrogated for both amplitude and frequency information. The resulting image shows all non-moving structures in shades of gray and moving structures in shades of red or blue depending on direction and velocity. The technique of colour Doppler ultrasonography and our experiences in 63 examinations are described. The clinical application of this new simple non-invasive method in maxillo-facial surgery is discussed.

In an animal model using 24 inbred Lewis rats the effect of the simultaneous implantation of in vitro cultivated osteoblasts and a porous hydroxyl apatite ceramic material on bone regenerations was studied. Bone tissue was harvested from 2 inbred rats and a cell line of osteoblasts was established. The osteoblasts were multiplied in cell cultures and after 3 passages inserted along with granular HA into monocortical femur defects in 24 rats of the same inbred line. After various times of observation the femurs were examined radiographically and bone growth was assessed histologically. No significant increase in bone growth rate was observed, although earlier studies in the same model showed a marked qualitative effect of reimplanted in vitro cultured osteoblasts on new bone formation. Considering that pre-incubation largely reduces the toxic effect of HA ceramics, the results of this study indicate that the activity of the implanted osteoblasts in the defect is prevented by the simultaneous implantation of replacement material and cells.