Congenital infiltrating lipomatosis of the face with associated involvement of the TMJ structures. Case report and review of the literature.

We report a case of congenital infiltrating lipomatosis of the face (CILF) with right TMJ ankylosis causing asymmetry and reduced mouth opening. The management involved soft tissue debulking combined with a right TMJ arthroplasty and is explained in detail. A review of the relevant literature revealed the rarity of this condition. The diagnosis of CILF remains challenging. The currently accepted treatment strategy is less aggressive as facial asymmetry tends to recur. Infiltration of the facial structures from adipose tissue requires several surgical procedures in most cases. Bony hypertrophy on the affected side has been a common finding in reported cases. There have been no previous reports of TMJ ankylosis associated with this condition. CILF is a benign condition with a good long term prognosis. After 2 years of follow up our patient, has maintained full function despite facial asymmetry.

Bone regeneration using a naturally grown HA/TCP carrier loaded with rh BMP-2 is independent of barrier-membrane effects.

The present study investigated whether bone regeneration and biomaterial replacement would be improved by loading of biogenous biphasic biomaterial scaffolds (HA/TCP ratio 30/70) with rhBMP-2, and whether the placement of three barrier membranes differing in structure and porosity (prototyped SLA Ti specimens, GORE RESOLUT Adapt specimens, and titanized TiMESH light specimens) would have a synergistic effect. A rabbit calvarial model was used for the implantation studies. Histological specimens were obtained after 12 weeks and evaluated quantitatively for differences between the various material combinations. Loading of the biomaterials with rhBMP-2 significantly enhanced the amount of regenerated bone and caused a pronounced biomaterial replacement. While BMP-induced bone had formed uniformly over the surgical defects, bone regeneration in the absence of BMP depends on bone promotion from the margins of the defects toward the center. No positive effect on bone regeneration was seen for any of the placed barrier membranes. While the present study had shown that rhBMP-2 loading significantly increases bone regeneration using the investigated biomaterial, barrier-membrane placement may be useful in predetermining the final shape of the regenerative site but provides no additional beneficial impact on the amount and quality of the bone regeneration induced by rhBMP-2.

Fixation of zygomatic fractures with a biodegradable copolymer osteosynthesis system: short- and long-term results.

Biodegradable osteosynthesis devices can be viewed as addition to, not yet replacement for conventional metal osteosynthesis materials. In a series of 65 patients with zygomatic fractures, a short-term complication/sequelae rate of 22.8% and a long-term complication rate of 9.4% were recorded. Lactosorb plates, panels and screws were the only devices used for osteosynthesis. All complications associated with the biodegradable material could be considered minor and were resolved by the use of minor surgical procedures or conservative measures. The results of this study indicate that treatment of zygomatic fractures with biodegradable osteosynthesis material has no major long-term adverse effects beyond the total material resorption time.

Ameloblastomas of the jaws: clinico-pathological review of 11 patients.

AIMS: The ameloblastoma is an uncommon benign odontogenic neoplasm of the maxillofacial region constituting less than 1% of tumours of the oral cavity. The purpose of this paper is to discuss and evaluate the surgical treatment and the outcome from a series of 11 patients with ameloblastomas. METHODS: Between the years 1995 and 2003, 11 patients (eight female and three male) aged 17-86 years (mean 52.7) suffering from ameloblastomas of the jaws were seen in our Department. RESULTS: Ten patients were treated surgically. In eight of those radical surgery was applied. Patients with maxillary tumours were subjected to hemimaxillectomy and local excision. Radical treatment with segmental resection of the mandible was performed in six patients with multilocular (solid) mandibular ameloblastomas, with immediate reconstruction of the defect. Follow-up ranged from 3 months to 7.5 years. CONCLUSION: Multilocular (solid) type of tumours should be approached with radical surgical treatment. Enucleation and rarely marsupialization can be applied selectively to unilocular ameloblastomas.

Pulsatile expansion therapy for orbital enlargement.

Experimental and clinical investigations have documented the modulatory role of the globe in the development of the orbit. In cases of absence or early loss of the globe, severe hypoplasia of the orbit and midface has been reported by several authors. Statical conformers and orbital osteotomies have been used to correct the resulting facial asymmetry. When replacing such conformers by increasingly larger ones, orbital structures are negatively influenced by the repeated trauma of surgical interventions. Simulating the modulatory role of the globe on orbital growth was the objective when developing a pulsatile device for orbital enlargement in cases of anophthalmia and microrbitism. The design, application and preliminary experience with a dynamic, pulsatile expanding system are presented.

Histomorphologic findings on human bone samples six months after bone augmentation of the maxillary sinus with Algipore.

Sinus grafting, a popular and standard treatment for maxillary atrophy, uses a variety of grafting materials. In this study, specimens obtained 6 months after sinus grafting with Algipore were evaluated under light microscopy and showed osseoformation, xenograft degradation, and bone ingrowth into particles. Osteoblastic cells were embedded in the intracorpuscular bone matrix, which indicated that xenograft particles are an osseoconductive scaffold and stimulate matrix deposition. Acute inflammatory responses after insertion of Algipore did not occur. Particles were degraded during physiologic bone remodeling, and newly formed bone gradually replaced resorbed biomaterial.

Colour stereolithography for planning complex maxillofacial tumour surgery.

High-precision anatomical facsimile models of the patients' skulls, individually produced by colour stereolithography, were used in the preoperative planning for seven patients with complex maxillofacial tumours. Selectively coloured models facilitated the management of ablative surgery and reconstructive procedures as well. The indicators for preoperative colour stereolithographic model planning concerning maxillofacial tumour surgery are discussed.