Mund-, Kiefer- und Gesichtschirurgie : MKG最新文献

Recently, a chemically modified ultra-hydrophilic sand-blasted, large grit and acid-etched (modSLA) titanium surface has been introduced in order to enhance bone apposition. Indeed, preliminary preclinical and clinical data have indicated that modSLA implants may enhance bone apposition during early stages of wound healing. These positive effects on bone regeneration might be probably mainly due to the hydrophilic surface properties noted for modSLA which ensured a stabilization of the blood clot. The aim of the present review article is to evaluate, based on the currently available evidence, the potential impact of modSLA surfaces for implant dentistry.

Objective: The aim of this study was to evaluate the benefit of image fusion of CT (computertomography) and bone SPECT (single photon emission computed tomography) in diagnosis of head and neck cancer.

Methods and patients: Computer based image fusion has been applied in 39 patients with suspected cancer in the oromaxillofacial region following CT and SPECT without any further hazard for the patients. Afterwards image fusion was set in comparision to simultaneously evaluation of CT and SPECT and histological findings.

Results: In 5 out of 39 patients SPECT/CT image fusion obtained more precise anatomical findings in tumour expansion than simultaneously evaluation of CT and SPECT.

Conclusion: For planning of surgical and radiation therapy of oral and maxillofacial cancer, image fusion of CT/SPECT provides efficient and plastical diagnostic imaging. Particularly in complex anatomical regions like maxilla or base of the skull image fusion could be an additional device, if simultaneous evaluation of CT and SPECT is not clear.

Background: There are several techniques described for the reconstruction of the anterior floor of mouth after tumour surgery. Here, we point out the advantages of the central island tongue flap for this indication.

Patients and methods: We report on 20 patients with medium sized defect in the anterior floor of mouth, which was reconstructed with the central island tongue flap. Besides this surgical technique, we discuss the results of oral rehabilitation after a follow-up period of at least 3 months.

Results: There was now flap necrosis or loss, and the median time for flap formation was less than 45 min. In the follow-up we found successful oral rehabilitation in speech and swallowing.

Medical work is, just like any other profession, not always without error and even when no mistake has been made the patient may suffer health damages, because such are the unavoidable risks. Arbitration procedures of medical liability disputes can in particular cases resolve the individual conflict between physician and patient. The results of these arbitration procedures can point towards the main focus of diagnosis, patient accusations (patient dissatisfaction) and treatment errors. In the space of 6 years from 2000 until 2005 the North-German arbitration office handled 157 arbitration procedures against Maxillofacial surgeons. The decisions were statistically and casuistically analysed with regard to patient accusations, type of treatment error, frequency of treatment error, health damages that were caused and not caused by errors. Liability claims against a physician result only from those errors that have caused health damages to a patient. Not all errors cause damage automatically. Patient claims were found to be justified in 28% of all procedures and a recommendation for regulation was made to the physician's insurance. Maxillofacial surgery, with reference to the 20.4% of cases analysed, clearly represents less than the total average. The main focus of accusations raised by patients and also the main focus of the observed treatment errors are operative errors as a cause of sensitivity defects of the lower lip and the tongue, also of tongue damages and their associated taste defects. Parallel to the 20.4% of cases, which showed iatrogenic health damages caused by errors, 60.9% of cases showed patients had also suffered iatrogenic damages even though no medical errors had caused them.

Background: Fractures of the mandible are a common form of facial injury. The aetiological factors associated with mandibular fractures and the trends in these factors over a 10-year period are reported.

Methods: A retrospective survey was carried out of 724 patients presenting with a fracture of the mandible over the 10-year-period 1994-2003. Patients; records were reviewed and analyzed according to age, sex, cause of injury, anatomic site of fracture, treatment and postoperative complications.

Results: Over the 10-year-period the rate of mandibular fractures remained constant (mean 40,7%). There were no changes in the age group (mean 33,3 years) or in the higher prevalence in male (male-female-ratio 2,3 : 1). The major causes of fractures were assaults (38,6%) and accidental fall (27,3%). The most common fracture site was the condylar region (47,0%) followed by the angle (29,4%). Most fractures were treated by closed reduction until 2002, thereafter surgical treatment increased noticeable. The complication rate was 8,9% and the most common complications were hardware exposure and infection.

Conclusion: Fractures of the mandible are a prevalent form of facial injury. Aetiological factors show no significant change over the 10-year-period. Complication-rate is low and will support the tendency towards surgical treatment.

An 84-year-old gentleman developed an angiosarcoma in the lateral temporal fossa 60 years after a World War II injury. The tumour resection confirmed the close spatial relationship of the tumour and a shell splinter. Analysis of the metallic composition showed no clear carcinogenic potential of the ingredients; an inflammation-related carcinogenesis seems more probable. A review of the literature revealed two similar cases.

Background: Cleidocranial dysplasia (CCD) is a rare dysplasia of bony and dental tissue. Characteristic are typical craniofacial and dental findings including morphological anomalies. CCD is possibly the only general syndrome that can be diagnosed based on the dental findings alone. CCD correlates with mutations in the RUNX2 gene.

Purpose: The present interdisciplinary study correlates phenotypic findings with genetic variations in the corresponding gene.

Patients and methods: The coding sequence of the RUNX2 gene from 31 CCD patients from 20 families was analyzed using molecular genetic methods including polymerase chain reaction and direct sequencing. The craniofacial and dental findings of each patient were evaluated according to a standardized scoring scheme and tested with homogeneity analysis for general phenotypic findings.

Results: Several mutations of the RUNX2 gene were identified. Depending on the mutation type, they showed different distribution patterns within the gene coinciding with the functional domains of the gene product. With homogeneity analysis of the phenotype cardinal (especially dental findings) and minor findings (pneumatization disturbances, Wormian bones) were identified. In combination with the genetic data, the statistical analysis showed that loss-of-function mutations of the RUNX2 gene result in a milder markedness of the CCD phenotype than gain-of-function or decrease-of-function mutations.

Conclusions: We found that type and location of a specific mutation within the RUNX2 gene might have an impact on the expressivity of CCD. Due to the limited sampling size this hypothesis must be verified by investigations in larger patient groups.

Investigation: In most cases it is not sufficient to use photographs and plaster casts to document and analyze the three-dimensional morphology of lip, jaw, and palate clefts. The aim of this study was to evaluate the applicability of surface scanning with a 3-D laser topography scanner in patients with unilateral cleft lip.

Patients and methods: Three-dimensional surface scans of the face were performed pre- and postoperatively in 20 patients (3-35 years of age) with a 3-D laser topography scanner. All patients were suffering from nonoperated, one-sided cleft lip, cleft lip-jaw, or cleft lip-jaw and palate. The digital data sets were metrically analyzed and expressed on the basis of quotients, independent of size factors.

Results: Using this 3-D laser scanner it was possible to acquire good quality three-dimensional data sets. Measurements were in the dimension of millimeters. Based on the data sets it was possible to provide the three-dimensional cleft morphology with reproducible landmarks and analyze the data. The postoperative symmetry of the face was controlled and objectively quantified. It is disadvantageous however that numerous views need to be taken to get the full image of the face and that the scanning process takes about 2 s.

Conclusion: The presented 3-D laser scanner renders a precise 3-D surface analysis of the lip and nose region in cleft patients. For lively infants or uncooperative adults, the system is suitable only to a limited extent due to the time-consuming scanning process.