[Therapy-resistant aggressive cystic lesion of the mandible]. / Therapieresistente aggressive zystische Läsion des Unterkiefers.

Several extensive surgical interventions of a cystic lesion in the left mandible were followed by recurrences. The lesion extended from the primary mandibular region into the area of pterygopalatine fossa finally infiltrating the orbital region and the skull base. Histological results could never demonstrate a malignancy with certainty. Due to the patient's poor general condition, the refusal for further surgical inventions and due to the malignoma-like growth pattern radiation treatment was performed. However, this had no effect on tumor progression.

Detection of therapeutically relevant diagnoses made by sonography of the upper abdomen: portable versus high-end sonographic units -- a prospective study.

AIM: To compare the efficiency of a portable sonographic unit with a high-end unit used for sonographic examinations of the upper abdomen to detect therapeutically relevant diagnoses and to answer clinical questions. METHODS: Over a period of five years, 575 patients were examined by four examiners as part of the daily routine work. Patients without known diagnoses were examined first with the portable SonoSite 180 system, with documentation of the findings and diagnoses, and immediately thereafter with the high-end Philips HDI 5000 system. Subsequently, any discrepant findings and diagnoses were recorded. The assessment was confined to therapy-demanding diagnoses and to the resolution of the clinical question (major findings) as well as to other therapeutically relevant findings (minor findings). RESULTS: Of the 575 data sets (duplicated examinations), 574 could be evaluated. The major findings coincided in 447 (78 %) of 574 cases and were discrepant in 121 (22 %) cases in which the major findings were solely detected with the high-end Philips HDI 5000 system and missed with the portable SonoSite 180 system. Findings of the upper abdomen coincided in 252 (85 %) of 297 cases and were undetectable with the portable unit in 44 (15 %) cases. For 166 intestinal examinations, the proportion of coinciding major findings was 58 % (96 of 166 cases), with 42 % (71 of 166 cases) overlooked with the portable unit. For examinations of the pleura, the findings coincided in 99 (89 %) of 111 cases. The findings of emergency examinations coincided in 138 (75 %) of 185 cases, with 47 (25 %) findings exclusively detected with the HDI 5000 system. In emergencies without intestinal involvement, the findings coincided in 105 (89 %) of 118 cases. CONCLUSION: As expected, the high-end unit is markedly superior to the portable sonographic unit, especially for clinical questions requiring a high physical resolution, as needed for gastrointestinal structures, biliary system and pancreas. The portable unit provided its best results for examinations of the pleura and for emergency examinations as long as the gastrointestinal tract is excluded. For the routine use of portable sonographic units, it is important to know the limitation of the particular unit.

Endoscopy: a minimally invasive procedure for diagnosis and treatment of diseases of the salivary glands. Six years of practical experience.

During a 6-year period we did a total of 72 videoendoscopies of the salivary glands and their associated ductal systems. This minimally invasive procedure is associated with little morbidity and discomfort. The main indication was sialolithiasis of the submandibular and parotid glands. Sialoendoscopy was used not only for diagnosis of radiolucent calculi but also for simultaneous removal of calculi. Sialoendoscopy was also of benefit in the diagnosis and treatment of other diseases of the salivary glands. Even patients with chronic sialadenitis could be helped with endoscopic dilatation of the causative sialostenosis, thereby enabling us to conserve the gland.

Clinical indications for digital volume tomography in oral and maxillofacial surgery.

Digital volume tomography (DVT, NewTom, NewTom AG, Marburg, Germany) is a novel technique for maxillofacial imaging at a lower radiation dose and lower cost than CT. We describe four clinical cases to illustrate its potential advantages.

[Orbital floor reconstruction. Comparison of a new perforated 0.15 mm thick PDS layer with established titanium dynamic mesh]. / Orbitabodenrekonstruktion. Vergleich einer neuen perforierten 0,15 mm dicken PDS-Folie mit etabliertem Titanium-Dynamic-Mesh.

INTRODUCTION: For surgical reconstruction of the orbital floor after blow-out fractures, a new perforated PDS (poly-p-dioxanon) foil (0.15 mm thickness) has recently become available. The main target of this prospective and randomized interdisciplinary clinical study was to compare this new PDS foil with the proven titanium dynamic mesh (0.3 mm thickness). PATIENTS/METHODS: Aside from the common diagnostic procedures, an extensive ophthalmologic examination was performed and documented preoperatively (U1), 4 days (U3), 1 month (U4), and 6 months (U5) postoperatively. RESULTS: In both groups the surgical procedure was tolerated well. The new perforated PDS foil turned out to be easier to handle intraoperatively because of smooth and clean cutting edges. The surgical treatment was well tolerated in all randomized groups. In contrast to the control group, the PDS and TD groups showed postoperatively a slight increase of the preoperative exophthalmos (mean 0.5 mm). CONCLUSION: The new perforated PDS foil is comparable concerning cosmetic and functional aspects. Especially with regard to stability after blow-out fractures, the new perforated PDS foil is equal to titanium dynamic mesh up to 20 mm in diameter. PDS foil is felt to be superior regarding bioresorption and due to the more convenient handling.

Prototype of a novel autonomous perfusion chamber for long-term culturing and in situ investigation of various cell types.

In the context of a neurobionic approach to chemical analysis and sensorics, this article depicts the development of a miniaturized autonomous perfusion chamber setup for the growth and the electrical as well as optical investigation of (neural) cell cultures in vitro. We suggest an autonomous, modular, temperature-controlled, transparent, and sealed perfusion cell culture housing adaptable to various mounts, sizes and different needs. The design includes the electronics of a temperature and medium supply control unit. The setup combines the possibility of uninterrupted cell culturing with simultaneous microscopic and analytical investigation of variable amounts of cells or organs of human, animal, or plant origin under sterile conditions on different substrates without the need of an external incubator or a sterile working environment. Its use is demonstrated exemplarily with neuronal cultures from embryonic chicken that were cultured in a prototype system for 3 weeks. It turned out that cell survival in such a chamber was prolonged with timed medium flow rather than continuous perfusion.

Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.

INTRODUCTION: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. PATIENTS AND METHODS: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. RESULTS: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly + /- 1 mm) were not considered as relevant by the patients. CONCLUSION: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle.

[Video-endoscopy of the major salivary glands]. / Videoendoskopie der grossen Kopfspeicheldrüsen.

Videoendoscopy is a minimally invasive procedure for the diagnosis and therapy of sialopathies of the major salivary glands. The main indication is sialolithiasis of the submandibular and parotid glands. Sialoendoscopy offers, on the one hand, a diagnostic method for radiolucent calculi in particular and, on the other, can be used to simultaneously remove calculi. Furthermore, endoscopy is of high value for the diagnosis and treatment of other salivary gland diseases in which there are pathological changes of the ductal system. For example, regeneration of the gland is now possible in cases of chronic sialadenitis, due to the removal of a sialostenosis. Sialadenectomy can thereby be avoided.

[Odontogenic focus as the etiology of cerebral ischemia]. / Odontogener Fokus als Ursache zerebraler Ischämien.

Recent studies have shown that acute infections, especially of the respiratory tract, are an important risk factor for cerebral ischemia. Additionally we know that chronic dental infections may be a risk for myocardial infarction and artherosclerosis. However, the connection between stroke and dental infections has hardly been examined so far. Therefore we performed a case-control study using a standardized questionaire and examination. We investigated 66 patients consecutive to a acute cerebral ischemia/stroke and 60 age- and sex-matched nonstroke neurological patients as a control group. Dental status was determined by a so called total dental index (TDI) which reflects primarily caries, periodontitis, periapical lesions, devital and missing teeth as well as by a panoramic index (PI). Specifically, older patients with cerebrovascular ischemia tended to have a significantly worse dental status and had more severe periodontitis and periapical lesions than control subjects. A predefined poor dental status was associated with cerebrovascular ischemia independent from other vascular risk factors and social status. In conclusion, poor dental health, mainly resulting from chronic dental infections, may be associated with an increased risk for cerebrovascular ischemia. The results must now be verified in larger studies. As chronic dental infections are a common and also easily treatable factor, their identification as a risk factor for stroke would be quite important in the field of preventive medicine.

[Multi-local angiosarcoma of the oral mucosa]. / Multilokuläres Angiosarkom der Mundschleimhaut.

A 64-year-old man presented with a bluish, livid swelling in the region of the lateral alveolar processes of all four quadrants. Evaluation and histopathological findings resulted in the diagnosis of an angiosarcoma at multiple sites. A survey of the literature and an epidemiologic review of our own patients prove this to be an extremely rare occurrence. A partial resection of the maxilla and the mandible on both sides was performed in sano. After discharge, however, a sarcoma was detected in the region of the right scapula 5 months after surgery. Therefore radiation treatment was initiated. The patient died 4 weeks later. The course confirms the poor prognosis of this tumor.