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

DNA ploidy and S-Phase fraction (SPF) of 279 salivary gland tumours were analysed using high-resolution DNA flow cytometry. All 229 benign neoplasms were diploid while 12 of 50 malignant tumours showed cell populations with aneuploid DNA content. The SPF values of diploid malignancies were significantly higher if compared with pleomorphic adenomas but did not differ from that of the zystadenolymphoma (Warthin tumour) group. While aneuploidy represents a distinct indicator of malignancy SPF values are of minor relevance for dignity assessment in salivary gland tumours.

Although parasitel infections in northern Europe are rare, it must be considered as differential diagnosis of malignant tumours of mucous membrane. With increasing tourisms in endemic areas, infections with parasite pathogen are spreading in non-endemic areas as well. In this case a mucous membrane malignancy with clinical feature of ulcer on unusual location was imitated. In this reported case the patient suffers with hepatitis c, causing cirrhosis of the liver and making a liver transplantation necessary. In this patient a history of a leishmaniosis which had been treated successful by the tropical institute is reported, but because of a new actually leishmaniosis-infection a liver transplantation is contraindicated. Under oral therapy with Miltefosin (IMPADIVO) a remission was successful. The leishmaniosis is a classical tropical disease. WHO reported a morbidity of nearly 12 million people in 88 countries around the world especially in tropical areas. Repeatedly infections in northern Europe caused by the phlebotonus-sandflies are described. Therefore leishmaniosis must be considered as differential diagnosis in suspect lesions of mucous membrane.

This article reports on the treatment of jaw cysts using a new bone substitute material. Ostim is a nanocrystalline, phase-pure hydroxylapatite which is manufactured in an aqueous suspension and then concentrated to form a white paste with a 35% content. The material is applied directly into the bone cavity using a syringe and, due to its paste consistency, produces uniform surface contact with the walls of the bone cavity. The material is fully resorbed and ensures rapid bony regeneration of jaw defects with no complications during the healing process. The results of 44 applications were described.

Background: Three different fungal-related clinical pictures have to be differentiated in the paranasal sinuses: allergic fungal sinusitis, fungus ball and invasive sinonasal mycosis.

Purpose: A morphological reevaluation of fungal-related diseases of the paranasal sinuses as well as a retrospective analysis of their clinical parameters was performed.

Patients and methods: 86 patients with patho-histological proven fungal-related disease of the nasal sinuses were enclosed in this study. Reevaluation and correlation of clinical and histological parameters were conducted on routine material (HE, PAS and Grocott) according to the modern morphological definitions.

Results: Invasive sinonasal mycosis was seen in 22 cases, eleven male and eleven female, mean age 57 years (22 to 84 years). It was significantly related (nine out of 22 patients, 41%) to immunocompromising conditions: three patients had diabetes mellitus type II, five had have a radiation therapy due to carcinoma and one patient suffered from bacterial endocarditis. A fungus ball was diagnosed in 60 patients, 26 male, 34 female, mean age 54 years (22-88 years). An immunocompromising condition was seen in nine out of 60 patients (15%). Causes for immune impairment were diabetes mellitus (two patients), radiation therapy due to carcinoma (four patients), myocarditis (one patient) and chronic hepatitis (two patients). Allergic fungal sinusitis was recorded in four patients, three male, one female, mean age 43 years (17-63 years). No immunosuppression was diagnosed.

Conclusions: Despite the fact that allergic fungal sinusitis is the most common fungal disease of the paranasal sinuses, it is not well known among physicians and pathologists and therefore underrepresented within the diagnoses of paranasal infections. The term "aspergilloma" is imprecise and does not represent a clear diagnosis. A further differentiation in "fungus ball" (without invasion) and "invasive sinonasal mycosis" is required. The three groups of fungal-related sinusitis occur at different ages. Allergic fungal sinusitis is common among young adults. An immunocompromising condition is a prerequisite for an invasive sinonasal mycosis.

Purpose: The therapy of patients with oral cancer often requires a combination of surgery and radiotherapy. This leads to trauma of healthy tissue. The impact of this side effect on quality of life was investigated. Additionally the impairment of 19 factors was determined (comprehension of speech for unknown others, comprehension of speech for familiar others, eating/swallowing, mobility of the tongue, opening range of the mouth, mobility of lower jaw, mobility of neck, mobility of arms and shoulders, sense of taste, sense of smell, appearance, strength, appetite, respiration, pain, swelling, xerostomia, halitosis).

Methods: This retrospective multicenter study was conducted under the auspices of DOESAK (a German, Austrian and Swiss cooperative group on tumors of the maxillofacial region). The Bochum Questionnaire on Rehabilitation was used to determine 147 items. 3894 questionnaires where sent to 43 clinics in Germany, Austria and Switzerland. 1761 questionnaires where returned, while 1411 of them included all of the answers necessary for this study.

Results: 686 of 1411 patients where irradiated. Before the beginning of therapy the impairment of the 19 factors was not significantly higher in the group that later received radiotherapy. After therapy there is a significantly higher impairment of the irradiated patients. The factors that are especially worse are xerostomia, swallowing and understanding of speech. The quality of life was not significantly lower.

Conclusions: Although radiotherapy leads to trauma of healthy tissue this method is indicated as it has no significant impact on quality of life. During the rehabilitation physiotherapists should relieve the impairment of speech, eating and swallowing.

The aim of the present study was to histologically evaluate extraction wound healing after socket preservation using a beta-TCP root taper.Ten dogs were used in the study. Immediately following careful extraction of the first premolar of the lower jaw the extraction sockets were filled using a chair-side thermically formed polylactide-linked root taper (RT). To avoid contamination, a further polylactide barrier covered the crestal surface of the taper. Untreated extraction sites of the opposite side served as control. After three and six months of healing, the animals were sacrified and dissected blocks were prepared for histomorphometrical analysis. Following parameters were evaluated: difference between lingual and buccal bone height, lingual and buccal alveolar wall and total bone width 1, 3 and 5mm underneath the top of the respective crest. During the entire study period healing was uneventful for all animals. Histological analysis of three months specimens revealed a definable area of minor mineralized bone within the former extraction sockets in both RT and control group. In the test group small areas of material organized by connective tissue but no remnants of the bone substitute material could be observed. After six months the borderline between new and pre-existing bone had disappeared. Histomorphometric analysis revealed no statistically significant differences between test and control group after three or six months (p>0.05, paired T-test). Within the limits of the present study it was concluded that the application of polylactide-stabilized RT does not improve the dimensional ridge alterations after tooth extraction.

Case report: We report on the case of a 31-year old female presenting a massive bleeding during extraction of left lower wisdom tooth, which could be managed by local compression. In the following transfemoral angiography an extensive arteriovenous malformation (avm) in the pterygomandibular space with osseous infiltration was diagnosed and embolised during the same session. After the acute stage the malformation could be controlled by repeated embolisation, the wound being closed by use of a transposition flap.

Conclusions: Although arteriovenous malformations of the head and neck are rare, they can manifest with dramatic bleeding complications during surgical interventions. A thrill on palpation and auscultation may also refer to the existence of such a vascular lesion. An av-malformation may be stimulated by hormonal changes during puberty or pregnancy as well as by local trauma. Colour coded duplex sonography, magnetic resonance imaging and transfemoral angiography are suitable diagnostic tools. The treatment of choice is superselective embolisation followed by surgical resection of the vascular nidus, which should be performed by under an interdisciplinary approach.