Morphological changes elicited in skeletal muscle by a Nd:YAG laser scalpel and electrocautery during surgical reduction of the human tongue.

A Nd:YAG laser scalpel was used for the surgical reduction of a human hyperplastic tongue. This instrument combines a fine cutting precision with haemostatic properties, whereby loss of blood is minimized and the surgeon's field of view unimpeded by flooding from the damaged capillary bed. The coagulative properties of Nd:YAG laser light are, however, insufficient to effect blood flow stasis in larger calibre vessels (arteries > 2 mm; veins > 3-5 mm), such as those located at the base of the tongue. For this purpose, bipolar diathermy (electrocautery) was employed. The ultrastructural changes incurred by skeletal muscle fibres using these two "heat" sources were compared. The damage profile elicited using each modality was similar: coagulation of myofilamentous proteins leads to destruction of fibrillar architecture with concomitant loss of periodic banding; on moving away from the wound margin, characteristic features are gradually restored. As the severity of these heat-induced effects decreases, there is a corresponding increase in superimposed dislocation and tearing phenomena induced by post-treatment swelling.

[Functional long-term result after mandibular reconstruction with vascularized iliac bone graft. A case report]. / Funktionelles Langzeitergebnis nach Unterkieferrekonstruktion mit vaskularisiertem Beckenspan. Eine Fallbesprechung.

In an eleven-year-old boy with a large sarcoma of the left mandible, a hemimandibulectomy with en bloc soft tissue resection was performed. Preoperatively a chemo-and radiotherapy was administered and after resection of the sarcoma stabilization of the remaining mandible was achieved by temporary reconstruction plate articulating in the temporomandibular fossa. Postoperative cytostatic therapy was then given and further development of the remaining mandible awaited. In the ensuing years no loco-regional or systemic manifestations of the sarcoma could be detected, therefore definitive reconstruction of the mandible was undertaken at the age of 16 years. A free osseo-musculo-cutaneous composite graft was taken from the left iliac crest and revascularisation established microsurgically. In a short time, primary healing and remodelling of the new hemimandible could be seen, hence osseointegrated dental implants were inserted in order to allow normal mastication. The process of remodelling of the reconstructed hemimandible was examined ten years later comparing X-ray findings during different periods of growth.

Influence of surgical tongue reduction on pressure from the tongue on the teeth.

Pressures from the tongue on the teeth were recorded in 21 children and adolescents before and after surgical reduction of the tongue. The recordings were made before surgery, and 6 and 12 months after the operation. Simultaneous measurements were made at the lingual surfaces of the maxillary and mandibular central incisors and at the left first molar, in the rest position and during chewing and swallowing. The method had been used in a previous study of normal cases, which served as a reference. Presurgical pressures recorded in the rest position at the maxillary incisors agreed with measurements recorded in the same location in the reference sample. Measurements recorded during rest in the other locations were somewhat higher than those of the reference group. Pressures recorded before the surgery during chewing and swallowing varied from similar measurements made in the reference group. At the recording 6 months after surgery, resting pressures at the molars were lower than they had been presurgically. No significant differences were found for pressures during chewing. A lower pressure was recorded in one location during swallowing. At the recordings made 12 months after surgery none of the pressures differed significantly from the presurgical values. Resting pressures were, however, lower than they had been before surgery and were closer to those of the reference sample.

Effect of surgical reduction of the tongue on oral stereognosis, oral motor ability, and the rest position of the tongue and mandible.

The oral ability to recognize forms and oral motor ability were studied by means of two specific tests in 27 subjects, 10 to 23 years of age, before and after tongue reduction because of macroglossia. Recordings were made before and 6 and 12 months after the operation. At the same time the natural position of the head and of the cervical column, the craniocervical relation, the position of the tongue and the hyoid bone, and the rest position of the mandible were studied with profile roentgen-cephalometry. The surgical reduction of the tongue had a minor influence on the subject's performance in the test of oral ability to recognize forms, where the number of false identifications increased somewhat. The oral motor ability and the positions of the head, the cervical column, and the hyoid bone were unaffected. After the operation, the tongue did not fill out the oral cavity as much as before and the freeway space decreased.

[Mandibular reconstruction. An historical overview]. / Die Unterkieferrekonstruktion. Ein geschichtlicher Uberblick.

In a historical review the most important technologies and auxiliary materials for lower jaw reconstruction are demonstrated and discussed. Personally developed implants for anatomical and functional reconstruction of the continuity and rigidity based on the latest experiences of bone surgery, are presented. The results of this development are demonstrated by several steps of mandibular reconstruction in a special clinical case. The discussion deals with the conclusions drawn from the historical review in comparison to our own clinical results.

[Reconstruction of the lingual nerve following iatrogenic lesion]. / Rekonstruktion des Nervus lingualis nach iatrogener Läsion.

Because of its topographic location, the lingual nerve is exposed to injury during intraoral surgery. An iatrogenic lesion is indeed an infrequent, but an unpleasant complication for both the patient and the doctor. Experience in peripheral nerve surgery increased the success rate of a reconstruction of the lingual nerve.

Mandibular reconstruction using a special plate. Animal experiments and clinical application.

The use of a variety of procedures and techniques for mandibular reconstruction suggest that no satisfactory solutions have been found with regard to restoration of functional stability, joint function and masticatory function. In view of the varied clinical problems involving restoration of mandibular function, we developed our own reconstruction plate, a condylar prosthesis, and a reconstruction plate with a condylar head. The U-shaped notches of the reconstruction plate permitted universal adaptation of the plates by means of special pliers. The most important result of the animal experiments was the achievement of stability under functional stress. This made intermaxillary fixation unnecessary. The preliminary experience in our clinical cases with the reconstruction plate showed a reduction of masticatory disability. The clinical results corresponded well with those of the animal experiments, and thus confirmed the value of the experimental model chosen.