[Comprehensibility of online-based patient education material in ophthalmology]. / Die Lesbarkeit von onlinebasierten Patienteninformationen in der Augenheilkunde.

BACKGROUND: Investigations have shown that the internet as a source of information in medical issues is increasing in importance. For most patients information delivered or supported by hospitals and universities is considered to be the most reliable, however, the comprehensibility of available information is often considered to be wanting. Comprehensibility scores are formulae allowing a quantitative value for the readability of a document to be calculated. OBJECTIVE: The purpose of this study was to assess data by analyzing the comprehensibility of medical information published on the websites of departments for ophthalmology of German university hospitals. We investigated and analyzed medical information dealing with three eye diseases with potentially severe irreversible damage. METHODS: The websites of 32 departments for ophthalmology of German university hospitals were investigated. Information regarding cataracts, glaucoma and retinal detachment (amotio retinae) were identified and analyzed. All information was systematically analyzed regarding comprehensibility by using the analysis program Text-Lab ( http://www.text-lab.de ) by calculation of five readability scores: the Hohenheim comprehensibility index (HVI), the Amstad index, the simple measure of gobbledygook (G-SMOG) index, the Vienna non-fictional text formula (W-STX) and the readability index (LIX). RESULTS: In 59 cases (61.46 %) useful text information from the homepage of the institutions could be detected and analyzed. On average the comprehensibility of the information was identified as being poor (HVI 7.91 ± 3.94, Amstad index 35.45 ± 11.85, Vienna formula 11.19 ± 1.93, G­SMOG 9.77 ± 1.42 and the LIX 54.53 ± 6.67). CONCLUSION: In most of the cases patient information material was written far above the literacy level of the average population. It must be assumed that the presented information is difficult to read for the majority of the patients. A critical evaluation of accessible information material seems to be desirable and available texts should be amended.

[Delayed Infection after Upper Lip Augmentation with Absorbable Hyaluronic Acid Filler]. / Verzögerte Infektion nach Augmentation der Oberlippe mit resorbierbarem Hyaluronsäurefiller.

Since introduction of the first fillers in the 1980s a multitude of substances has been developed and approved for facial contour augmentation and correction of skin defects. Here we present the interesting case of a patient who presented to us with a delayed infection 6 weeks after augmentation of the upper lip with a hyaluronic acid. We observed full convalescence after operative and high-dose antibiotic treatment of the abscesses. Generally speaking, complications after augmentation with resorbable fillers are rare. However, complications might occur even within unexpected time periods and therefore need our special attention.

[Significance of prenatal diagnosis of lip-jaw-palatal clefts]. / Bedeutung der pränatalen Diagnostik von LKG-Spalten.

UNLABELLED: AIMS AND PATIENTS: Visualization of sonographic anatomy of the fetal face has acquired special importance, as conspicuous features in the phenotype facilitate the diagnosis of syndrome-like or chromosomally induced clinical conditions. Between 1990 and 1999, an orofacial cleft was diagnosed sonographically in 70 fetuses at the Clinic for Prenatal Diagnosis and Therapy of Bonn University Hospital. The aim of the study was to investigate whether the type of cleft correlates with the prevalence of associated anomalies or with karyotyping after amniocentesis. The types of associated anomalies and the neonatal outcome of these 70 fetuses were also reexamined. RESULTS: We found a clearly positive correlation with the type of cleft, both for the associated anomalies and for the karyotype. The size of the cleft was much smaller with normal karyotypes than in the case of fetuses with trisomy 18. The trisomy 13 fetuses displayed the most pronounced clefts. None of the fetuses with an isolated lip cleft had an associated anomaly; all were born alive and could be treated surgically. In contrast, all the fetuses with a median cleft had severe associated anomalies that were incompatible with life. Associated anomalies occur more frequently with bilateral cleft lip and palate than with unilateral clefts. The fetuses with a unilateral cleft had a higher survival rate than those with a bilateral cleft. The most common associated anomaly in cleft fetuses is located in the region of the central nervous system. DISCUSSION: Early sonographic information on cleft formation in combination with the karyotype can give rise to differentiated obstetric measures up to the point of termination of pregnancy in the event of an infaust prognosis.

[Risk and prevention of lesions of the lingual nerve in wisdom tooth osteotomy. Analysis of the literature and faculty opinion in maxillofacial surgery in German-speaking countries]. / Risiko und Vermeidung von Läsionen des N. lingualis bei der Weisheitszahnosteotomie. Literaturanalyse und Lehrmeinung in der MKG-Chirurgie in deutschsprachigen Ländern.

BACKGROUND: Disturbance of lingual nerve function is one of the relevant complications after surgical removal of lower third molars. In the literature, however, protective measures against this complication are not unanimously recommended. In order to find out the current opinion in terms of the state of the art in this field, a questionnaire was sent to the heads of 39 University Departments for Oral and Maxillofacial Surgery in Germany, Austria, and Switzerland. All of them responded. TECHNICAL FINDINGS: In 54% of the departments, a periosteal elevator or similar instrument is recommended for the protection of the lingual nerve in every instance, whereas in 8% of the departments this is not recommended. In the remaining departments, the decision about protective measures is made according to the individual anatomical situation. STATISTICS AND DISCUSSION: The literature review revealed insufficient data quality for a sound data-based decision on whether and when to use an instrument to protect the lingual nerve. In any case, the statistical risk of a temporary disturbance of the lingual nerve seems to be higher with use of the lingual split (0.5%-19.8%) than with the lateral osteomtomy technique (0%-1.9%). In contrast to widespread opinion, even in anatomically difficult cases, there seems to be no statistical advantage of the standardized use of a protective instrument either in respect to temporary or permanent nerve damage. Yet, a slight increase of temporary lesions seems to be documented when the instrument is used. According to the current literature data, the subperiosteal insertion of an instrument to protect the lingual nerve cannot be considered an essential standard procedure in each case.

[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.

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.

[Conservative and surgical treatment possibilities in temporomandibular joint diseases]. / Konservative und chirurgische Behandlungsmöglichkeiten bei Kiefergelenkerkrankungen.

For the most frequent TMJ derangements, highly efficient nonsurgical treatment is preferable. Within this concept, the interdependence between the TMJ and the jaw musculature is increasingly focussed. Surgical therapy is only an option under defined circumstances in cases resistant to nonsurgical treatment, or if nonsurgical treatment is meaningless from the beginning. Within surgical concepts, arthroscopy is becoming increasingly important. A close interdisciplinary cooperation between the dentist and oral and maxillofacial surgeon seems to improve the potential outcome in these cases.

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.

[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.

Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity.

In a follow-up of 1107 dentoalveolar operations in the postcanine region, 24 (2.2%) temporary sensitivity disturbances of the inferior alveolar nerve and 16 (1.4%) of the lingual nerve were found. Permanent disturbances were not present. Complete recovery had occurred by 6 months in all cases. The incidence of temporary sensitivity disturbances depended on the different surgical interventions performed. For evaluation and follow-up purposes, a computer-aided pain and thermal sensitivity (PATH) tester was used. By PATH testing, spontaneous recovery can already be ascertained at the third or fourth postoperative month.

Temporomandibular joint surgery.

Rapid progress has been made in the field of temporomandibular joint (TMJ) surgery during the past decade. These developments are predominantly due to the ongoing refinement of imaging and operative techniques. Parallel to these changes, the new techniques of arthroscopic surgery have been introduced into standard therapy for internal derangement and osteoarthrosis, to some extent. Several earlier studies have shown that open and arthroscopic surgery have similar success rates. Therefore, the surgeon has to decide which method would combine the smallest risk of postoperative morbidity with the least operative effort. In this regard, arthrocentesis is inaugurated as a new operative method for treatment of the closed lock. However, the basic concepts of arthroscopic surgery seem to be contradictory to the concepts of open surgery, which have also been proven successfully. Thus, the success of arthroscopic methods challenges our understanding of the pathogenesis and pathophysiology of internal derangements and osteoarthrosis of the TMJ. Today, morphologic findings from either arthroscopy, magnetic resonance imaging and new findings in the field of joint physiology lead to plausible explanations for the etiology and symptomatology of internal derangements. This is discussed in several papers. Additionally, arthroscopy may very well be an appropriate method of investigating intra-articular changes in the TMJ caused by trauma. So far, our knowledge about these effects still seems to be insufficient. For several years, the literature has reflected an increasing discussion about alloplastic materials used for interpositioning in the TMJ. A more rational approach in estimating the potential risks of these materials seems to be highly necessary.(ABSTRACT TRUNCATED AT 250 WORDS)