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

Background: Wegener's Granulomatosis is a rare systemic disease characterized by the triad of necrotizing granulomas of blood vessels, upper respiratory tract, and kidneys. Diagnosis depends on clinical symptoms (ACR-criteria), detection of serum circulating antineutrophil cytoplasmic antibodies (c-ANCA) and bioptical histopathology.

Case-report: A 34-year-old patient presented with intraoral ulcerating, necrotizing inflammations of the palate and the gingiva. Chest radiograph (nodules, infiltrates), urin analysis (red blood cell casts) being inconspicuous Wegener's granulomatosis was diagnosed by histopathology of an intraoral incisional biopsy. Conventional therapy with corticosteroids and cyclophosphamide relapsed while the disease was taking a progressive course (pulmonary infiltrates, necrotizing vasculitides all over the common integument). The patient died of cardiac decompensation three months after diagnosis. c-ANCAs were not present at any time of disease.

Conclusions: 1. Symptoms of the head and neck are manifest in up to 95% of Wegener's granulomatosis. So knowledge of the disease is important for dentists and oral and maxillofacial surgeons in spite of its low prevalence. 2. c-ANCA-titers do not reflect disease activity. Negative c-ANCAs do not exclude Wegener's granulomatosis. 3. Wegener's granulomatosis can take a progressive, therapy resistent course.

Introduction: Obstructive sleep apnea (OSA) is a common disorder in adults, however it also occurs in neonates with severe mandibular hypoplasia. The clinical significance of OSA results from hypoxemia and sleep fragmentation due to a collapse of the upper airway. Recently OSA has received much attention due to its potentially serious consequences on cardiac function. Besides daytime sleepiness and fatigue life expectancy is significantly shortened by a higher risk for apoplectic insults and heart failures. This paper reviews common surgical procedures with an emphasis on jaw advancement procedures.

Material and methods: In six adults (mean age 46,9 ys; 2 female, 4 male; BMI averaged 28kg/m(2)) suffering from OSA with a history of a long-lasting unsuccessful continuous positive airway pressure (CPAP) therapy a bimaxillary advancement was performed. The respiratory disturbance was preoperatively evaluated by polysomnography; daytime sleepiness was recorded according to the 'Epworth Sleepiness Scale'. Controls were performed six months after therapy. All patients had a regular intermaxillary relation. Bimaxillary advancement was planned and performed according to the principles of cranio-maxillofacial corrective surgery. To widen the posterior airway space much attention was focused on the advancement of the mandible by 10mm.

Results: The apnea/hypopnea index decreased from preoperatively 37/h to 4/h after treatment. The minimal peripheral oxygen saturation increased from 78% to 89%, whereas the average oxygen saturation raised from 92 to 95%. The arousal index decreased from 24/h to 9/h. Periods of snoring were reduced from 29,5% to 6,9%. According to the 'Epworth Sleepiness Scale' the patients' estimation improved from a level of 11 to 4. Sleep had a recuperating effect. All surgical procedures were uneventful.

Conclusion: Standard treatment of OSA is the CPAP-therapy. In some patients, however, CPAP-therapy cannot be applied, fails or is not well accepted. A great variety of surgical procedures for the treatment of OSA have been described. Bimaxillary advancement in adults and osteodistraction in neonates are safe and successful surgical techniques for an immediate improvement in OSA. Osteodistraction treatment can help to avoid tracheotomy in neonates.

Purpose: The surgical treatment of oral cancer results in functional and aesthetical impairments. Patients' quality of life is considerably impaired by oral symptoms resulting from therapy of oral cancer. In many cases the inevitable resection of the tumor, as well as the adjuvant radiochemotherapy will cause the destruction of physiologically and anatomically important structures. One focus of research was the specific rehabilitation of dental loss by functional dentures. Another was the course of 19 impairments (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: Commissioned by the German, Austrian and Swiss cooperative group on tumors of the maxillofacial region (DOSAK), data were collected in 3.894 questionnaires at 43 hospitals in Germany, Austria and Switzerland. The catalogue comprised 147 items in 9 chapters. At the end of the enquiry, 1.761 anonymous questionnaires were returned by 38 hospitals. 1.652 of these could be evaluated regarding the question.

Results: The sum score of the 19 impairments was highly increased immediately after the operation and recovered over the next 6 months, without, however, reaching the pre-surgery level. Of 1.652 patients, only 35% did not lose any teeth during therapy. 23% lost up to 5, 17% up to 10 teeth. A quarter of the patients lost more than 10 teeth. The more teeth were lost, the greater the decline of quality of life (p < or = 0.001), although this could be allayed by the functionality of the dentures (p < or = 0.001). There is a reciprocal dependence between the functionality of dental prosthetics and impairment by eating/swallowing (p < or = 0.001).

Conclusions: Patients' quality of life after radical surgery of a carcinoma of the oral cavity depends not only on the functionality of dentures and the specificity of rehabilitation, but also from the initial findings, the extent and location of the resection, the chosen therapy, the general circumstances of the patient's life as well as their strategies of coping. These factors, however, unlike those of functionality of dental prosthesis and rehabilitation, are not modifiable.

The minimally invasive sinus floor elevation as first described by Summers is limited in augmentation volume, whereas a more invasive approach is required for the technique of Tatum for larger bone defects. We developed a new technique for the transcrestal elevation of the sinus floor with bone dowels using a press-fit technique (dowel lift). We present the technique with first in vitro results in a fresh, unpreserved, human cadaver.

Oral cytology has aroused new interest caused by introduction of the cytobrush as a sampling device and the use of additional analytical methods. By brushing it is possible to reach deeper layers of the oral mucosa where squamous intraepithelial neoplasia (SIN) begins. The biological potential of the oral epithelial cells obtained can be evaluated by the following additional methods: computer-assisted image analysis (OralCDx), DNA cytometry, immunohistochemistry, monolayer cytology, and molecular biological analysis. All of those methods can increase sensitivity (up to 100%) and specificity (up to 100%) of oral brush biopsy. Nevertheless, there are reports that oral epithelial carcinomas were not identified. No comparative study exists allowing conclusions to be drawn about the value of the single methods. Immunocytochemistry with commercial antibodies against laminin-5 is generally available and methodologically easy. Oral brush biopsy as a non invasive diagnostic method can be useful for the early detection of oral mucosal lesions. Positive findings or progression of the lesion despite negative findings are indications to refer the patient to a specialized clinic where a surgical biopsy should be performed, followed by histopathological analysis. Histopathology remains the gold standard for the definitive diagnosis of oral malignant lesions.