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

The AOT is a relative rare benign odontogenic tumor. It most often appears in the canine region of the maxilla and mandible in young patients. Radiolucencies in the region of non-erupted or vital teeth may produce diagnostic problems. The histological diagnosis of AOT is characterised by odontogenic epithelium, ductlike structures, amyloid-like material and calcifying areas. Case report A female patient of eleven years and ten months was referred for surgical exposure of the left mandibular canine by an orthodontist. This tooth was retained and root formation was incomplete. Radiologically, a radiolucency was seen, extending distally from the crown of the tooth towards the root. The deciduous tooth 73 was extracted and the retained left mandibular canine was surgically exposed. Healing was without result and the tooth was moved orthodontically. Two years later the tooth was seen in regular position and occlusion. Vitality tests were positive, distally to the tooth a 1.5[Symbol: see text]mm periodontal pocket was disclosed. A large radiolucency around the root of the tooth was seen. Supposing a cystic lesion a surgical intervention was performed without removal of the tooth. Histopathologically, an AOT was revealed. Conclusions In the sequence of surgical interventions it is highly likely that already at the first operation an AOT was present, however, went unnoticed clinically. The histological diagnosis of an AOT was only revealed after a second operation including tumor removal. In spite of surgical removal of the AOT the involved tooth found its position in the dental arch.

Purpose: The development of overall survival of a DOSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region) clinic's overall population comprising a time period of more than 20 years (1983-2004) should be assessed. At a cutoff date (January 1st, 1997), a change from a primarily surgically based to a consequent multi-modality treatment regimen was implemented. The periods of time before and after that change should be compared.

Methods and patients: The data of the DOSAK registry entries on 1038 patients suffering from primary untreated oral and oropharyngeal carcinomas were updated with respect to follow-up and mortality data to achieve a 100% quality of follow-up. The end point (death) was reached in 67% of the overall population. Statistical analysis was carried out by the Trium Analysis Online corporation, Munich.

Results: The portion of female and older tumor patients increased, more than half of all tumor patients were clearly in stage IV of the disease at first referral. The portion of patients operated on persisted approximately (80%), the portion of additional treatment modalities could be increased considerably. The fact of a bony infiltration by the tumor and the operability remained highly significantly relevant for survival in multivariate analysis, despite of multi-modality treatment. The survival rate of the patients remained significantly dependent on the clinical stage of the disease in multivariate analysis but could be improved by 10% in the clinical stages II and III and in the patients who could not be operated on. All in all, the cutoff date was statistically relevant for survival in multivariate analysis, i.[Symbol: see text]e. the change in the treatment regimen had a verifiable positive effect on the survival of a unicentric overall population.

Conclusion: Survival improvement in an overall population via change in treatment strategy is possible in relatively short time; the clinical stages II and III and the non-operable patients have the greatest benefit from a multi-modality treatment.

The clinical follow up of atrophic jaws treated with augmentation procedures and dental implants is demonstrated and evaluated over a period of five years. In total 50 patients (24 male and 26 female) from the department of maxillofacial surgery of the Friedrich Alexander University Erlangen-Nuernberg who received an augmentation procedure were prospectively evaluated. The mean age was 59.1 years on the female and 56.9 years on the male patients. All patients received prior to implant placement an augmentation with autogenous bone or a bone substitute and were reconstructed using a fixed or removable implant borne rehabilitation. Overall 293 implants from five different systems were used, 10 implants on eight patients were lost in the observation period. Three implants were lost during the healing period and seven after prosthetic rehabilitation. This leads to a cumulative survival rate of 96.6%. The success rate, according to the criterions defined by Karoussis et al. [25] was 94.04%. After twelve months in the area of augmentation an overall resorption rate of 26.4 % was found, at five years the rate mounted to 31.67%. Comparing the resorption rates in maxilla and mandible the vertical loss was 35.88%, rsp. 26,05%. Comaring the posterior and anterior augmentation areas the vertical loss was significantly (p: 0.048%) higher in the posterior with 38.72% compared to 28.26% in the anterior region. Measurement of the SFFR (sulcus fluid flow rate) demonstrated a significant (P. 0.03) correlation with bone resorption, meaning that higher SFF rates showed higher rates of vertical resorption. Additionally a high SFF rate correlated with higher pocket depths and reduced keratinized periimplant gingival rates.

Objective: To minimize overall mortality and optimise reconstructive and cosmetic outcome in severely injured patients with maxillofacial injuries the interdisciplinary coordination of several surgical disciplines is required. It is still discussed controversy whether patients with maxillofacial fractures benefit from early fracture repair or if delayed operative management also yields in good results.

Methods: Herein we analysed the data of 1252 severely injured patients between May 1998 through June 2002 in our trauma department regarding fractures of the maxillofacial region, injury severity, length of ICU stay and postoperative complications in patients with either early (within 72 hours) or delayed ( > 3 days) facial fracture repair.

Results: 147 patients had severe facial fractures. Average age was 39.8 years (3-87 years), mean ICU was 25 (+/- 16) and the overall mortality 12% (n = 18). The most common cause for the injuries were traffic accidents in 45%. 78 patients (53%) underwent surgical repair of the maxillofacial fractures; 18 patients had early fracture repair and 60 patients had delayed operative repair. We found 4 complications (22%) in the early repair group and 13 local complications (21%) in the group with delayed surgical repair.

Conclusion: Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.

Background: Based on own retrospective studies a condylar head add-on system for immediate, temporary reconstruction in patients undergoing ablative surgery requiring the removal of the manibular condyle has been developed in cooperation with the Department of Oral and Maxillofacial Surgery of the University of Tennessee, USA, and the Association for the Study of Internal Fixation (AO/ASIF).

Purpose: The design of the new condylar head add-on system and its use in an anatomical dissection study on a human cadaver are introduced and discussed. DESIGN AND FIRST EXPERIENCES: The condylar replacement is made of commercial pure titanium and is conceived as an add-on system. It consists of a reconstruction plate (2.4 Uni-LOCK-System) und an adaptable condylar head that can be fitted on either side. The offset of the condylar head in a medial direction allows anatomically correct positioning of the implant. The slanted oval head shall provide a large contact area while maintaining function of the mandibular joint. The height-adjustable positioning of the condylar head add-on with four different fixations plates facilitates an intraoperative vertical correction of the condylar head without necessary bending of a new reconstruction plate. A condylar head add-on used on both sides and combined with the frequently used 2.4 Uni-LOCK-plate benefits from reduced storekeeping and turns out to be advantageous from an economic point of view.

Perspective: An international, prospective multi-center study evaluating the intraoperative applicability of the new condylar head add-on system and its functional as well as aesthetic results during the first two postoperative years has started in September 2006.

Background: With the new term "keratocystic odontogenic tumour" (KCOT) keratocyts are even in the nomenclature a close differential diagnosis to ameloblastomas (A).

Purpose: Recurrence of KCOT and A were retrospectively compared with regard to treatment and immunohistochemical markers of cell cycle and migration and cell architecture.

Patients and methods: Biopsies harvested over a period of 22 years of 101 patients (86 KCOT, 15 A) were examined. The histopathological slides were stained with H&E and with the immunohistochemical markers: Cyclin D1, Collagen IV, p16, Cox-2-Laminin-5 and Tenascin-C.

Results: Mean age KCOT 47 years (range 14-80 years), A 41 years (range 16-79 years). Gender KCOT: m:f =2:1; A: m:f = 3:2. Region of origin mandible with predilection of the angle and the ramus: KCOT: 76; A: 12. Maxilla: KCOT: 18; A: 3. Multiple lesions were found in 5 KCOT patients. Treatment primary KCOT: cystectomy (46), cystostomy (6), cystectomy and curettage (17), cystectomy and marginal ostectomy (14), resection (11). A: resection (10), enucleation (5). Recurrence rate KCOT: 11,7% after 5,5 years. Recurrence after: cystostomy (4), cystectomy (6), cystectomy and curettage (3), cystectomy and marginal ostectomy (2). A: no recurrences. Immunohistochemistry Cell cycle associated and extracellular matrix proteins did not differ in quantity in KCOT and A, and did also not differ in recurrent and non-recurrent KCOT.

Conclusions: 1. KCOT are in the own cohort more likely recurrent than A. 2. Recurrence rate of KCOT can not be predicted by the used (most common) markers of cell cycle, migration and modulation of architecture. 3. Higher recurrence rate of KCOT in the patients examined is proposed due to less extensive resection.

The aim of the present study was to assess the impact of standardised computer-manipulated changes to images of the orbital region. Judges (n=250) ranked each image for attractiveness on a visual-analogue-scale. The images were thereby classified into different clusters according to their ratings of attractiveness. These clusters were highly significantly different (p<0.001). The degree of negative impact of changes to the orbital region on facial attractiveness increased significantly from lateral to medial and from cranial to caudal. Small asymmetrical or symmetrical lateral variations did not influence attractiveness negatively.

Background: The treatment of infectious oral lesions is an important prophylactic procedure preceding immunsuppressive therapy. The case reported underlines the importance of this treatment by showing severe complications of an infective dental focus in an immunocompetent patient.

Case report: A 65 year old patient was referred to hospital due to neurological disorders including hypaesthesia, movement deficits, nausea and falls. Because of progressive aggravation with hemiplegia a craniotomy and biopsy of a suspicious area in the pons was performed. A brain stem abscess caused by Streptococcus viridans was diagnosed. Brain stem abscesses are very rare events who contribute to only about 0.6%-6% of all intracranial abscesses. The intraoral inspection revealed a periodontally diseased and carious affected dentition with many missing teeth. Other foci were ruled out. Because of persistency of the symptoms another operation with abscess drainage was performed. Afterwards the clinical symptoms improved but hemiplegia was still present.

Conclusions: Even minor dental procedures as well as existence of a carious or periodontal disease may cause bacteremia with severe septical implications. Patients at risk (e.g. dieases of the heart valves or diabetes) should always treated with an antibiotic prophylaxis before treatment according to the guidelines of the DGZMK. All oro-pharyngeal infectious foci have to be treated sufficiently to prevent sceptical complications. Even more important is the prophylactic treatment preceding chemo- or radiation therapy.

When humans observe a face, the eyes, mouth and nose regions are the preferred targets of the centre of gaze, with the outlines of eye position recordings approximating a triangle with vertices located in the centre of the eyes and mouth [31]. We studied the significance of cutaneous asymmetries inside and outside the Yarbus triangle on the basis of the assessment of digitally-manipulated images by 201 independent judges. We show that certain facial variations (such as naevi) are more attractive when asymmetrical than symmetrical (p<0,001). They appear more attractive when located laterally rather than medially, particularly so when located outside the Yarbus triangle as compared to inside it (p<0,001). The significance of facial symmetry increases significantly when approaching the Yarbus triangle or the midline, respectively.