Comparative analysis of nasal and oral mucosa dendritic cells.

BACKGROUND: Mucosal dendritic cells (DC) play a crucial role in tolerance induction as seen in mucosal immunotherapy of atopic diseases. Nevertheless little is known about the phenotypical differences of oral and nasal mucosal DC (nmDC). Recently, we could show that oral mucosal myeloid CD1a(+) DC (omDC) differ from their skin counterparts especially by the expression of high affinity receptor for immunoglobulin E (IgE; FcepsilonRI). However, expression pattern of FcepsilonRI and phenotypical characteristics of CD1a(+) nmDC have not been elucidated in detailed yet. METHODS: We performed detailed phenotypical comparison of nmDC and omDC of atopic and nonatopic individuals. RESULTS: As reported for omDC, FcepsilonRI on nmDC of atopic donors was elevated and mostly occupied by IgE while FcepsilonRI was present only in low amounts on nmDC of nonatopic donors. Nevertheless, the highest FcepsilonRI expression has been observed on omDC. Furthermore, significant amounts of costimulatory molecules CD40, CD80 and CD86 could be detected on nmDC that expressed more CD80 compared with omDC. Moreover, nmDC displayed less major histocompatability complex (MHC) class I and II molecules than omDC. In addition, nmDC expressed more C-type lectins CD205, CD206 as well as myeloid marker CD11b while omDC displayed increased expression of CD207 and lipopolysaccharide (LPS) receptor CD14. CONCLUSION: Together these data imply that nmDC phenotypical differ from omDC which might result in diverse functional properties and might be of relevance for selecting routes for immunotherapy of atopic diseases. Moreover these data provide a basis for further studies investigating immunological mechanisms underlying mucosal immunotherapy.

Diagnosis and management of cervical teratomas.

We present three cases of cervical teratoma, two of which were detected prenatally by ultrasound. The two cases diagnosed prenatally showed rapid early growth, which indicated the aggressive nature of the tumour and assisted the parents' decision to terminate the pregnancy. The third case was undiagnosed prenatally and the child was born after a normal pregnancy and uncomplicated vaginal delivery. She recovered well after excision of the teratoma.

Predictive variables for the biological behaviour of basal cell carcinoma of the face: relevance of morphometry of the nuclei.

We did a morphometric analysis of 130 histological sections of basal cell carcinoma (BCC) of the face to find out whether morphometric variables in the structure of the nuclei of BCC cells could serve as predictors of the biological behaviour. We considered the following variables: maximum and minimum diameters, perimeter, nuclear area and five form factors that characterise and quantify the shape of a structure (axis ratio, shape factor, nuclear contour index, nuclear roundness and circumference ratio). We did a statistical analysis of primary and recurring tumours and four histology-based groups (multifocal superficial BCCs, nodular BCCs, sclerosing BCCs and miscellaneous forms) using a two-sided t test for independent samples. Multifocal superficial BCCs showed significantly smaller values for the directly measured variables (maximum and minimum diameters, perimeter and nuclear area). Morphometry could not distinguish between primary and recurring tumours.

[Possible complications in arthroscopic lavage of the temporomandibular joint]. / Mögliche Komplikationen bei der arthroskopischen Lavage des Kiefergelenks.

COMPLICATIONS: Arthroscopy of the temporomandibular joint is an invasive procedure that can entail potential complications. Based on many years of personal experience and taking data from the literature into account, this article discusses functional, surgical, and anesthesiological complications of arthroscopy of the temporomandibular joint. The majority of these complications can be avoided by heeding specific knowledge of topography, careful manipulation, and corresponding surgical experience. INFORMING THE PATIENT: The information given to the patient prior to the intervention should cover not only hemorrhaging, swelling, and wound infection, but also damage to (branches of) the facial nerve, the risk of perforation of the auditory canal as well as the possibility of temporary occlusal disturbances.

Tissue expansion using osmotically active hydrogel systems for direct closure of the donor defect of the radial forearm flap.

Although widely used, the radial forearm flap has been criticized for the poor quality of its donor site. Attempts to avoid donor-site problems have concentrated on the elaboration of the split-thickness and full-thickness skin graft methods of reconstruction. Skin grafts frequently fail over the flexor carpi radialis tendon, leading to chronic skin breakdown or, at best, tendon adhesion. Tissue expansion appears to be a good alternative that allows the use of local tissues to ultimately improve the forearm donor-site appearance. To avoid the disadvantages of traditional silicone balloon expanders (such as pressure peaks, infection, the valve at a distance from the expander, postoperative fillings), an osmotically active system was used. In an 18-month prospective study, 10 osmotically active hydrogel tissue expanders were placed on the forearms of 10 patients. The radial forearm flap was performed for intraoral reconstruction after surgical resection of oral cavity malignancies. The study showed that, in nine out of 10 patients, the expanded skin achieved was sufficient to cover the donor site after raising the forearm flap. Additionally, the expansion-related swelling pressure was well tolerated by the patients, the cosmetic results were very satisfactory, and the incidence of complications was very low. By using osmotically active hydrogel tissue expanders, there is no postoperative filling and no risk of complications arising from defective balloon expanders, filling valves, or missing ports.

Type A botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles: an alternative treatment.

The treatment of hypertrophy of the masseter and temporal muscles has to date been dominated by conservative and surgical measures. Local therapy with type A botulinum toxin permits an alternative method of treatment. After targeted, sometimes electromyographically controlled, intramuscular injection of the affected muscles, marked inactivity atrophy occurred in the muscles of seven patients over the course of 3 to 8 weeks. This atrophy remained constant over a follow-up period of up to 25 months, and no side effects were observed. Because of its minimal invasiveness, this technique seems to have an advantage over conventional surgical therapy. Consequently, treatment with type A botulinum toxin can be regarded as a sensible alternative to surgery in cases of hypertrophy of the masseter and/or temporal muscles.

Fetal cleft lip and palate: sonographic diagnosis, chromosomal abnormalities, associated anomalies and postnatal outcome in 70 fetuses.

OBJECTIVE: The aim of this study was to determine the relationship between facial clefts, associated malformations and chromosomal abnormalities. STUDY DESIGN: Sonograms of 70 fetuses with cleft lip with or without cleft palate were prospectively and retrospectively evaluated in our tertiary referral center for the nature of the cleft lip or palate and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of the 70 patients (90%). RESULTS: The frequency of additional anomalies and the mortality rate in this selected population varied with the type of cleft. None of the fetuses presenting an isolated cleft lip had additional anomalies and all survived. All fetuses presenting a median facial cleft had concurrent anomalies (particularly of the central nervous system (90%)) and a fatal outcome. Associated defects were more frequent in fetuses with bilateral clefts (72%) than in those with unilateral clefts (48%). Fetuses with a unilateral cleft lip with or without cleft palate had a better survival rate (52%) than those with a bilateral cleft lip with or without cleft palate (35%). The frequency and type of chromosomal abnormalities varied with the type of cleft. The highest rate of chromosomal abnormalities was found in fetuses with median clefts (82%). CONCLUSIONS: Although no conclusions regarding the prevalence of chromosomal or other anomalies in patients with a cleft lip with or without cleft palate in the general population could be drawn, the study revealed a strong relationship between the type of facial cleft, associated malformations, chromosomal abnormalities and fetal outcome.

[Mandibular hypoplasia. Growth induction by osteochondral transplants or callus distraction?]. / Mandibuläre Hypoplasie. Wachstumsinduktion durch osteochondrale Transplantate oder Kallusdistraktion?

In order to restore function and esthetics in mandibular hypoplasia, transplantation of osteochondral grafts and the distraction osteogenesis technique are used alternatively. In a retrospective study the indication, growth and complication rate of osteochondral graft and distraction osteogenesis cases in mandibular hypoplasia were compared. In total, 12 patients (4-14 years old; 7 female, 5 male) with different grades of mandibular hypoplasia received osteochondral grafts (7 costochondral, 5 iliac crest; observation period 4-9 years). In 5 patients (10-12 years old; 1 female, 4 male), distraction osteogenesis was performed (observation period 10 months to 3 1/2 years). In the results, according to the literature, the range of growth after osteochondral grafting varied considerably, approximate normal growth was noticed in only two cases. On the other hand, all patients treated by distraction osteogenesis showed a stable increase of bone length as expected. After osteochondral grafts, adequate growth is to be expected in the minority of cases and it does not seem predictable in individual cases. Therefore, the indication for osteochondral grafts should be restricted to severe hypoplasia, where the local amount of bone does not allow the use of a distraction device, and to cases where support of the mandibula at the skull base is necessary. In all other cases of mandibular hypoplasia in children, distraction osteogenesis should be discussed as the primary option, even if in the long term a second surgical procedure should be necessary.

Frey syndrome: treatment with type A botulinum toxin.

BACKGROUND: Frey syndrome was first described by Baillarger in 1853. Frey provided a detailed analysis and description as "auriculotemporal syndrome" in 1923. According to the literature, even the most recent therapeutic measures described for the treatment of patients with Frey syndrome have little chance of success and a high incidence of side effects. Thus, a type of treatment is desirable that can suppress the symptoms of Frey syndrome and can offer a good success rate, minimum invasiveness, and few side effects. METHODS: The experience of the authors and data from the literature confirmed the efficacy of type A botulinum toxin treatment for patients with Frey syndrome up to a maximum observation period of 3 years. RESULTS: In the current study, seven patients with severe, symptomatic Frey syndrome after parotidectomy were treated successfully with type A botulinum toxin. CONCLUSIONS: The method of local, intracutaneous treatment with type A botulinum toxin for patients with Frey syndrome is effective, virtually side-effect free, and minimally invasive.

[Value of computerized tomography and magnetic resonance tomography in diagnosis of malignancies of the mouth cavity and oropharynx]. / Stellenwert von Computertomographie und Magnetresonanztomographie bei der Diagnostik von Malignomen der Mundhöhle und des Oropharynx.

PROBLEM: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer--some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria. PATIENTS: 165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. RESULTS: The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%. CONCLUSION: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.

Staged operations for basal cell carcinoma of the face.

211 patients (88 female, 123 male, mean age 63 years) presented with 279 basal cell carcinomas (191 primary tumours, 88 recurrent tumours) in the head and neck area that were excised. The resected margins were examined microscopically and the defect repaired at a second operation. The excision margin was 1-2 mm. The recurrence rate was 3%, which is lower than is achieved by other methods, and unaffected structures are optimally conserved.

Tooth-borne distraction to widen the mandible. Technical note.

Based on reported animal studies, the case report presented demonstrates the use of tooth-borne distraction osteogenesis for mandibular widening of 1 cm in order to avoid extraoral distraction devices. Detrimental side effects on healthy anchoring teeth are not likely.

Salivary gland involvement as an initial presentation of Wegener's disease. A case report.

The case is presented of a 47-year-old woman with an 8-week history of persistent right ear discomfort and a 2-week history of unilateral parotid swelling, as well as peripheral paresis of the facial nerve. The case points to the difficulties encountered when Wegener's granulomatosis presents in an unusual and varied way which mimics a malignant tumour of the parotid gland. To our knowledge, the association of parotid gland involvement and facial palsy in Wegener's granulomatosis has not previously been described in the literature.

Tooth-borne distraction of the mandible. An experimental study.

Two mini-pigs and 6 micropigs were fitted with a dentally fixed device for osteodistraction of the mandible. Following bilateral osteotomy and after a latency period of 7 days, the apparatus was activated 1 mm per day. A 9 mm lengthening of the mandible was achieved. After a retention period of 6 weeks, the device was removed followed by a consolidation period of 6 weeks. During the experiment, the callus and bone formation and potential dental and periodontal reactions were radiologically examined. Polychrome sequential labelling was performed by injecting calcein green and xylenol orange for histological assessment of bone. The animals were killed at the 14th postoperative week and the area of distraction and the roots of the adjacent teeth were histologically studied. After 12 weeks, the osteogenesis in the distraction gap was complete, showing lamellar bone. No detrimental effects at the roots or in the periodontium of the adjacent teeth were seen. Thus, lengthening or widening of the mandible using a tooth-borne distraction device seems feasible in selected cases.

3-dimensional analysis of cleft palate casts.

It is the aim of presurgical infant orthopedics (PSIO) to reduce the width of the cleft and to achieve optimal alignment of the cleft palate segments within the first few months of infancy prior to any surgical cleft closure. The question about the amount that PSIO can stimulate and steer the growth of the maxilla using a Hotz and Gnoinski passive appliance has not yet been satisfactorily answered. In this study, a 3-dimensional digital computer-aided procedure was developed to analyze metrically and to visualize the growth of the edentulous maxilla of cleft lip and palate in infants. In a pilot study, a series of digital scans of consecutive plaster casts was carried out. 5 infants with complete unilateral cleft lip and palate (UCLP), who had been treated with passive appliances were evaluated. Impressions were taken at the age of one week and after 3, 6 and 12 months. Following digitizing, the casts were computer-reconstructed and segmented perpendicular to the alveolar crest, the reference points being C1, C1', C2, C2' and I. The volume of the resulting segments was ascertained. Computer superimposition of reconstructed consecutive casts was employed to facilitate a visualization of the extent and direction of morphological changes. Our first results have shown that with our method it is possible to quantify the growth rate of defined segments of the maxilla. The 3-dimensional analysis presented here will be the basis for further studies to objectify PSIO.

[Dental assisted distraction osteogenesis of the mandible. Results of an animal experimental study and initial clinical application]. / Dental gestützte Distraktionsosteogenese des Unterkiefers. Ergebnisse einer tierexperimentellen Studie und erste klinische Anwendung.

In recent years lengthening of the human mandible by distraction osteogenesis has become an accepted treatment for correction of severe mandibular disto-basal discrepancies. Using extra-oral and intra-oral distraction devices the technique of osseous anchorage is usually preferred. To avoid the disadvantages of this method it is the aim of many research groups to develop a tooth-borne distraction. In the present animal study, six minipigs were treated with a new solely dentally fixed orthodontic device for mandibular distraction osteogenesis. Following bilateral osteotomy in the dentigerous area of the mandibular body and a latent period of 2-7 days, a mandibular lengthening of 9 mm was reached within a period of 9 days. This situation was retained using the distraction device for 6 weeks. After the removal of the apparatus, there followed a period of another 6 weeks of consolidation. The callus and bone formation and potential dental, periodontal and nerval reactions were radiologically examined and histological examination was performed at the end of the experiment. At 12 weeks after the mandibular lengthening, the osteogenesis in the distraction areas was complete. No destructive processes were recognizable, either at the roots or at the periodontium of the teeth near the osteotomy gap. The mandibular nerve at the osteotomy site remained intact. The results justified transferring this procedure to humans. The clinical application of the device is presented.

[Postoperative pain after interventions in the area of the mouth-jaw-face]. / Postoperative Schmerzen nach Eingriffen im Mund-Kiefer-Gesichts-Bereich.

In order to establish effective postoperative analgesia we studied the incidence and significance of pain following maxillofacial surgery. The trial included 102 patients undergoing one of six different surgical procedures. Postoperative pain was assessed using a visual analogue scale (VAS) and the short form of the McGill Pain Questionnaire (SF-MPQ) up to the third postoperative day. Postoperative pain intensity was significantly correlated to operating time, the frequency of analgesic demand and the type of surgery (orthognathic surgery > TMJ surgery > osteosynthetic surgery > osteotomy of impacted third molars > tumor resection > removal of osteosynthetic materials). Patient's age, sex and ethnic origin did not significantly affect the severity of postoperative pain.

[High condylectomy for control of pathological growth in condylar hyperplasia]. / Die hohe Kondylektomie zur Ausschaltung überschiessenden Wachstums bei der kondylären Hyperplasie.

With the aim of eliminating pathological growth during the active period of condylar hyperplasia, 17 patients were treated with a high condylectomy with a retroauricular incision. Postoperatively none of the patients showed signs of continuing growth activity neither clinically nor roentgenologically. Thus, the high condylectomy can be recommended as a reliable technique to stop pathological and untimely growth with a low risk of complications, before occlusion and skeletal asymmetry are corrected by orthodontic surgery.