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

182 patients were treated with our method of tension bolt osteosynthesis between 1980 and 1989. Follow-ups of 103 patients with severe displacement and dislocation fractures showed the results to be clearly better than those of conservative functional treatment. Compared with other surgical procedures this method has the advantage that it does not require the joint area to be exposed again for removal of the osteosynthesis material. Slight displacement, diacapitular fractures and fractures in children still require conservative functional treatment.

In a total of 21 patients with squamous cell carcinomas of the oral mucosa 26.9% of the total volume of 57Co-Bleomycin injected into the tumor was found in the blood as early as 10 min following injection. Examinations using a gamma camera demonstrated that 94.6% of the substance have cleared the tumor tissue after just 1 h. This sharp and rapid drop in activity, which was particularly pronounced in carcinomas of the tongue and the floor of the mouth, might be caused by rapid resorption due to the high degree of vascularization of the maxillofacial region. Autoradiography showed deposits of the substance in tumor-free areas of the operation specimens. It seems that the postulated advantages of intratumoral application--increased concentration and depot effect in the tumor tissue--are no longer tenable, thus large-scale clinical trials with intratumoral bleomycin treatment cannot be justified.

Studies on 26 patients confirm the relevance of the factors tumour size and histological subtype for the prognosis of adenoid cystic carcinoma. For high risk tumours (tumour size over 3 cm, solid or tubular subtype) a postoperative adjuvant radiologic therapy is recommendable. The rate of wrong diagnoses found by reclassification is surprisingly high.

A case of aneurysmatic bone cyst of the mandible is described. Following curettage the condition recurred twice and was then successfully treated with cross-section and primary reconstruction of the mandible. The pathogenesis of aneurysmatic bone cysts and the indications for radical surgical treatment are discussed.

11 patients were treated for severe mandibular prognathism or maxillary retrognathism with a one-stage procedure combining Le-Fort I and sagittal-split osteotomy of the ramus. Clinical and radiographic check-ups were done at 3, 6, 12 and 18 months after the operation. The evaluation was based on the measured base angles and distances between the planes passing through skeletal key positions of the visceral cranium and the resulting soft tissue positions. The esthetic and functional rehabilitation obtained was good. In 3 of our patients the skeletal relapse rate was 1.1 mm.

The value of ultra short antimicrobial prophylaxis using azlocillin in preventing postoperative wound infections was studied in a prospective clinical/bacteriological study in 41 orthognathic operations. Preoperatively the oral mucosa and pharyngeal flora of each patient was subjected to bacteriological identification with particular emphasis on anaerobes and sensitivity tests for organisms with established pathogenic potential. The results of a bacteriological examination of the redon drains on day 1 postoperatively indicated a contamination of the surgical wound. Clinically 31 patients showed moderate postoperative edema of the buccal soft tissues and 10 patients had hematomas or hemorrhages. In all patients the operation was followed by primary intraoral wound healing without any signs of an early infection.

The clinical behavior of 51 adenoid cystic carcinomas of the salivary glands demonstrated a protracted and partly insidious course of disease with obstinately recurring tumors and a high tendency for distant metastases. The tumors are mainly localized in the minor salivary glands, invasion and growth along adjoining nerves are characteristic of these tumors. With increasing size of the tumor the prognosis significantly deteriorates. The treatment of choice is radical surgery, possibly combined with irradiation. A treatment of both the primary tumor and the recurrent tumor is of benefit in the presence of distant metastases, because the latter remains clinically symptomless for years. Because of the protraction of the disease the importance of early detection of these tumors is pointed out.

In a clinical statistical evaluation of patients seen in our hospital between 1967 and 1987 a total of 25 cases of facial asymmetry are assessed. The importance of CT scans for diagnosis and treatment planning is emphasized. The histochemical analysis of native cryostat hard bone tissue sections proves the existence of atypical bone remodelling processes in the inner bone surface late in the 3rd decade of life.

In a placebo-controlled double-blind study using 3 x 400 mg ibuprofen during the surgical removal of impacted and dislocated third molars, a pain reduction of 64% (p = 0.05) as against the placebo control group could be demonstrated on the day of surgery and the first postoperative day. In view of the published results of a double-blind study on the reduction of cheek swelling using dexamethasone, the perioperative combination of 3 x 600 mg ibuprofen with 2 x 6 mg dexamethasone seems to be helpful in reliably preventing pain and swelling after dental surgery.

2 cases of maxillary myxoma are reported. These extremely rare tumors of the maxillo-facial region have a high rate of local recurrence. The widely discussed classification into odontogenic and osteogenic myxomas seems questionable and has no therapeutic implications.