[Stability of the mandible after high sagittal supraforaminal osteotomy. Roentgen cephalometric study]. / Stabilität des Unterkiefers nach hoher sagittaler supraforaminaler Osteotomie. Röntgenkephalometrische Untersuchung.

AIM OF THE STUDY: The aim of this study was to investigate the stability achieved with high sagittal supraforaminal osteotomy (HSSO) for setback and advancement procedures of the mandibular ramus. MATERIAL AND METHODS: Computerized cephalometric X-rays of 102 patients, taken at four different times during treatment, were evaluated. RESULTS: The mean postoperative relapse was 20%, depending on the extent of the surgical correction (correlation coefficient: -0.68). Mandibular setback gave more stability than mandibular advancement. The type of osteosynthesis (positional screw combined with miniplate osteosynthesis or intermaxillary fixation) did not influence the stability. Unimaxillary osteotomies were more stable than bimaxillary procedures (p < 0.001).

Prognosis of facial growth in patients with unilateral complete clefts of the lip, alveolus and palate.

AIM: Unfavourable facial growth in patients with cleft lip, alveolus, and palate may occur during puberty. Usually this development is not predictable in a young patient. The aim of the present study was to find an individual growth prediction at an early age that would allow us to decide whether later orthognathic surgery should be included in the treatment plan. MATERIAL AND METHODS: Lateral cephalograms of 41 patients with unilateral clefts of lip, alveolus and palate (uCLAP) with observation intervals of 4 years were computerized, correlations between the variables of the first and second radiograph were calculated and regression equations were established. RESULTS: The skeletal change of the intermaxillary relationship can be explained purely by the lack of midfacial growth. An individual prediction of the angle SNA over a period of 4 years is possible with a correlation coefficient of 0.95. Additional predictions for SNB, Holdaway angle and the index of anterior facial height proportions are demonstrated. CONCLUSION: The prediction procedure elaborated in this paper facilitates the decision at the age of 12 years already, whether or not orthodontic occlusal treatment has been successfully completed at an early age. The alternative is to limit orthodontic treatment to the simple alignment of the two dental arches independently of their intermaxillary relation, and then to correct the facial skeleton and the dental occlusion simultaneously by combining surgical and orthodontic treatment after the completion of growth.

[Interdisciplinary treatment of a 3 1/2-year-old child with extensive ameloblastic fibro-odontoma. Case report and follow-up documentation over 21 1/2 years]. / Interdisziplinäre Behandlung eines 3 1/2-jährigen Kindes mit ausgedehntem ameloblastischen Fibroodontom. Fallbericht mit Verlaufsdokumentation über 21 1/2 Jahre.

BACKGROUND: This report deals with a 3 1/2 year old patient with an ameloblastic fibro-odontoma of the frontal part and left corpus of the mandible. The tumor had become symptomatic 2 months prior to admittance by a local, painless swelling of the bone and the mobility of teeth. The initial findings and the progress of the disease led to the preliminary diagnosis of a malignant mesenchymal tumor. Its extent and aggressive growth prompted a continuity resection of the mandible and immediate reconstruction with a costal autograft. The definitive histological diagnosis was an ameloblastic fibro-odontoma. The patient was followed up over a period of 21 1/2 years. THERAPY: Further treatment included an iliac crest onlay graft, followed by autotransplantation of three third molars into both transplants. Two of the wisdom teeth had to be replaced by dental implants because of ankylosis and infra-occlusal positioning. The prosthetic rehabilitation was carried out by a bar attachment and a partial cover denture. This report supports the concept of the interdisciplinary treatment of patients with tumors that occur during the growth phase.

[Interdisciplinary treatment of ameloblastic fibro-odontoma in a 3 1/2 year old child : Case report covering a follow-up period of over 21 years]. / Interdisziplinäre Behandlung eines 3 1/2-jährigen Kindes mit ausgedehntem ameloblastischen Fibroodontom : Fallbericht mit Verlaufsdokumentation über 21 1/2 Jahre.

Background. This report deals with a 3 1/2 year old patient with an ameloblastic fibro-odontoma of the frontal part and left corpus of the mandible. The tumor had become symptomatic 2 months prior to admittance by a local, painless swelling of the bone and the mobility of teeth. The initial findings and the progress of the disease led to the preliminary diagnosis of a malignant mesenchymal tumor. Its extent and aggressive growth prompted a continuity resection of the mandible and immediate reconstruction with a costal autograft. The definitive histological diagnosis was an ameloblastic fibro-odontoma. The patient was followed up over a period of 21 1/2 years. Therapy. Further treatment included an iliac crest onlay graft, followed by autotransplantation of three third molars into both transplants. Two of the wisdom teeth had to be replaced by dental implants because of ankylosis and infra-occlusal positioning. The prosthetic rehabilitation was carried out by a bar attachment and a partial cover denture. This report supports the concept of the interdisciplinary treatment of patients with tumors that occur during the growth phase.

[Premolar autotransplantation after front tooth loss in the maxilla]. / Die Prämolaren-Autotransplantation nach Frontzahnverlust im Oberkiefer.

The general rules for autotransplantation of human premolars in cases of traumatic loss of upper incisors are given. The basic conditions for tooth transplantation concerning the donor side as well as the recipient side are presented. Technical details and the principles of indication are outlined. If a correct technique is combined with a precise indication, the long-term results after tooth transplantation are excellent, with a more than 90% rate of success. Thus the concept of premolar transplantation to the front of the upper jaw in cases of traumatic loss of the upper incisors in children will need more attention in the future.

[3D displays for craniofacial surgery]. / 3D-Darstellungen für die Kiefer- und Gesichtschirurgie.

3D visualisation from tomographic image sequences has turned out to be a useful addition to diagnosis and surgical planning in craniofacial surgery. However, its clinical use still suffers from the very large variety of different methods and parameters from which the surgeon may choose. This is true not only of the data acquisition but also for of documentation of the results. Furthermore, there is no standardisation of procedures according to classes of malformations. This paper presents a systematic investigation of these problems. It proposes a standardisation of craniofacial malformations and describes an optimisation of the procedure of 3D visualisation. The procedure described has become a standard tool for craniofacial surgery in our hospital.

[Long-term results after genioplasty]. / Langzeitergebnisse nach Genioplastik.

The serial records of 21 patients were analyzed to study the stability of genioplasty performed in the course of orthognatic surgery and to describe its effect on the soft tissue profile. A pre-operative and a post-operative cephalogram as well as a cephalogram one year after surgery of each patient were available. Sagital correction of the chin from 16.5 mm advancement to 1.1 mm reduction and vertical movements between 4.8 mm lengthening and 9.3 mm shortening remained nearly unchanged during the control period. No post-operative movements of the chin fragment were observed except for minor resorptions that can be attributed to an osseous remodelling and rounding of sharp edges. In cases of a long face syndrome a bone apposition from 1 mm to 5.5 mm appeared at the lower edge of the chin. The average of sagittal soft tissue change in relation to the correction of the bony chin was 71%. The individual values ranged from 4% to 145% and the standard error of the estimate was 3 mm. Therefore the planning of the soft tissue profile is rather unreliable. A genioplasty performed with rigid fixation by compression screws or mini plates, preservation of vascular supply and re-fixation of the soft tissue of the chin results in accurately predictable and stable bony contours. On the other hand, the planning of surgery procedures related to the soft tissue profile is--if at all possible--very insecure.

[Vertical-sagittal "peninsular" osteotomy of the body of the mandible: a concept for forward displacement and anterior rotation of the mandible]. / Die vertikosagittale Halbinselosteotomie des Unterkieferkörpers: ein Konzept zur Vorverlagerung und anterioren Rotation der Mandibula.

A new mandibular osteotomy is presented for special indications of severe mandibular retrognathia combined with a high mandibular plane angle, a dentoalveolar compensation and an open bite. The procedure allows an anterior rotation of the mandible with a maximum skeletal and minimum dental advancement.

[Inferior pedicled gastrocnemius flap in the treatment of soft tissue defects of the distal lower leg (case report)]. / Der inferior gestielte Gastroknemiuslappen zur Behandlung von Weichteildefekten am distalen Unterschenkel (Fallbericht).

The inferiorly based gastrocnemius muscle flap is reported. This is a new method, first described by Bashir in 1983, that allows repair of soft-tissue defects of the most distal part of the calf without arterial or venous anastomosis. The surgical technique is described and advantages and disadvantages compared to other methods.

Midfacial osteotomies in patients with cleft lip, alveolus and palate.

Surgical/orthodontic strategies in patients with hypoplastic midfaces and cleft of lip, alveolus and palates after completion of skeletal growth are guided by cephalometric data, with the soft-tissue profile playing the most important role. The Le Fort I, the extended Le Fort I and, less frequently, the Le Fort II procedure depend on the extent of midfacial hypoplasia. Osteotomy planning should consider that in cleft patient's maxilla, the anterior nasal spine and A-point need to be advanced and caudally rotated to a larger extent than is necessary in non-cleft patients. A slight overcorrection of ANB-angle is necessary to achieve a harmonious and attractive soft-tissue profile since upper lip and nasal soft tissue require more bony support. In severe bimaxillary disturbances the midfacial advancement has to be combined with mandibular osteotomies. Stabilization after midfacial osteotomies should be done by corrosion-resistant Vitallium or titanium miniplates. This technique provides sufficient stability to restore early function immediately after surgery. Intermaxillary fixation following surgery is no longer necessary. Several decisive advantages are provided by this technique over the previously applied wire suspension concepts or wire suturing techniques. The most advantageous points are: No intermaxillary fixation is required immediately postoperatively; Normal soft food intake is resumed after 8-10 days when wound healing is completed; Rigid plate fixation leads to a considerable improvement in bone healing, while 'pumping-effects' induced by micromovements from the masticatory muscles are avoided; Plate fixation allows immediate functional 'antirelapse-treatment' against relapse tendencies, using functional treatment by means of soft intermaxillary elastics.