Camouflage in head and neck region--a non-invasive option for skin lesions.

The technique of camouflage, a non-invasive procedure to correct flaws in the texture and colour of the facial skin, is presented. The acceptance and use of camouflaging by 52 patients with different diagnoses are presented. The advantages of camouflaging are discussed in comparison to medical tattooing.

Custom-made cast titanium implants produced with CAD/CAM for the reconstruction of cranium defects.

Titanium implants for the reconstruction of bony skull defects, using data from three-dimensional spiral computer tomography, have been described by other authors. Instead of milling the implants from a titanium block, an advanced method of rapid prototyping for a fine casting process is presented. Casting vs milling offers several advantages. It is possible to form very thinly tapered structures and to obtain more complex geometrical structures with smaller diameters. Many geometrical forms, which cannot be milled for technical reasons, can be produced using this technique.

A method for the bony and dental reconstruction of the maxilla in dentate patients.

Reconstruction was carried out on eleven patients using a vascularized full thickness calvarial bone flap following partial maxillectomy. The donor site was covered with a split calvarial bone graft. Intraorally a mucosal transposition flap was used to cover the graft. Six months later implants were inserted and were allowed to heal for three months before dental rehabilitation began. No serious complications were encountered.

The infrahyoid flap. A technique for defect closure in the floor of the mouth, the tongue, the buccal mucosa, and the lateral pharyngeal wall.

The surgical technique, indications, and results of the infrahyoid muscle flap are presented. This flap is fed by the superior thyroid vessels and innervated by the ansa cervicalis. The flap is indicated in case of medium-sized defects in the floor of the mouth, the tongue, the buccal mucosa, and the lateral pharyngeal wall. The advantages of the technique presented include the rapid flap elevation close to the original operating field, the ability to use the motor capability of the flap, and the ability to combine it with other local flaps--for example, the platysma flap. This technique appeared to render excellent function for swallowing and speech. Safe flap grafting is possible only if the internal jugular vein is preserved.

Otoplasty: a combined approach to different structures of the auricle.

A technique for otoplasty is presented, which combines the advantages of different methods. The procedure includes a dorsal skin excision, a cartilage incision at the border between the concha and scapha, scoring of the crus superior on the anterior side, and if necessary a reduction of the conchal height and modification of the position of the cauda helicis by cartilage excision. The results of the treatment of 526 ears in 312 patients are retrospectively analysed by a patient questionnaire and a chart review.

Immunocytologic detection of isolated tumor cells in bone marrow of patients with squamous cell carcinomas of the head and neck region.

The well-documented specificity of anticytokeratin monoclonal antibodies for detection of epithelial micrometastatic cancer cells in bone marrow as a prognostic indicator inspired us to apply this approach to patients with squamous cell carcinomas (SSC) of the head and neck region. The sensitivity of the broad-spectrum anticytokeratin monoclonal antibody (mAb) A45-B/B3 used for tumor cell detection was demonstrated by immunostaining of cryostat sections from the respective primary tumors. Analysis of 31 patients with SSC revealed A45-B/B3-positive cells in 10 cases (32.3%) at frequencies of 1-207 per 1 x 10(6) mononuclear cells. Most specimens displayed isolated tumor cells, while cell clusters were found in only two cases (6.5%). The present data suggest that hematogenous dissemination of cancer cells is more frequent than expected from clinicopathologic staging of patients with SSC of the head and neck region.

Silver concentrations in human tissues. their dependence on dental amalgam and other factors.

Human tissue samples (liver, kidney cortex, 5 brain regions: grey matter of cerebrum, white matter of cerebrum, nucleus lentiformis, cerebellum, brain stem) from 173 decreased persons were analysed for silver (Ag) by GF-AAS (Graphite Furnace Atomic Absorption Spectrometry) and the results compared with the number of teeth with amalgam fillings and the concentration of inorganic mercury (Hg), which had been determined in the same tissue samples in a previous study. It was found that the mean Ag concentrations in liver and brain of adult females are approximately twice that of males. Moreover, the Ag concentrations, especially in the brain, depend possibly on age. To exclude these confounding factors as far as possible, the influence of dental amalgam and the correlation of Ag and Hg were evaluated only in a sub-group of 93 males, aged 11-50 years. In this sub-group statistically significant correlations were found between the number of teeth with dental amalgam and the Ag concentrations in the cerebral cortex and the liver. No such correlation was found for the kidney. Ag and inorg. Hg correlate well in this sub-group in the liver, but not in the cerebral cortex or the kidney. Individuals from this sub-group with (i) 0-2 and with (ii) more than 9 teeth with amalgam fillings show mean Ag concentrations (micrograms/kg in tissue wet weight, geom. mean) of 1.59 and 5.41 in the grey matter of cerebrum, 1.42 and 4.25 in the white matter of cerebrum, 1.53 and 4.89 in the nucleus lentiformis, 1.95 and 5.02 in the cerebellum, 1.05 and 3.27 in the brain stem, 3.40 and 8.15 in the liver and 0.42 and 0.44 in the kidney cortex. In contrast, comparing all individuals under investigation with only 0-2 teeth with amalgam no correlation between Ag and inorg. Hg could be found in liver, kidney cortex or cerebral cortex. These results show that amalgam fillings release Ag as well. Considering the different toxicokinetics of Ag and Hg it can be concluded that Ag is a reliable marker for the fact that the elevated concentrations of inorg. Hg found in tissues of individuals with amalgam fillings derive mainly from these fillings and not from other theoretically possible sources.

[Prospective comparative randomized study of tooth apex resection and orthograde root filling with Guttapercha and titanium pins]. / Prospektive randomisierte Studie zur Wurzelspitzenresektion und orthograden Wurzelfüllung mit Guttapercha- und Titanstiften im Vergleich.

The prospective randomised study on the root apex resections with orthograde root filling comparing Guttapercha with Titan pins encompasses 500 patients with 633 operations on all front teeth and premolars. The patients were divided into three preoperative stages so that for this broadly defined diagnoses comparable collectives could be built. After an average postoperative interval of 21 months, 258 patients with 298 resected teeth could be evaluated. From these, 188 root apex resections had been treated with Guttapercha and 110 with Titan pins. 73.5% of the root apex resections were successful, whereby the group treated with Guttapercha was more successful by 7%. The comparatively high failure rate of 26.5% is attributable to the broadly defined diagnosis and the long follow-up period.

Venous graft as temporary arteriovenous shunt in free tissue transfer.

A new method of interpositional venous graft in microvascular tissue transfer is described. The interpositional vein is transferred to the vessels of the recipient site primarily, forming an arteriovenous shunt. Later, when the microanastomosis to the flap is created, the shunt is divided into an arterial branch and a venous branch. This method reduces the ischemic time of the free flap and allows the use of interpositional grafts of optimal length.

Radioimmunoscintigraphy of squamous cell carcinoma in the head and neck region.

Radioimmunoscintigraphy (RIS) with a monoclonal antibody (SQ 174, Biomira, Inc, Canada) is introduced as a new diagnostic method for detection of squamous cell carcinoma in the head and neck region. RIS could detect eight of the 10 primary tumors. One patient had histopathologically proven nodal disease. This lymph node was seen in RIS. No false positive results were seen in RIS, whereas sonography, computed tomography, and magnetic resonance imaging showed several false positive results.

Microsurgical and prosthetic reconstruction of patient with recurrent ameloblastoma extending into the skull base.

A patient with recurrent ameloblastoma extending into the skull base is presented. An interdisciplinary treatment strategy is described, which included proper diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) scans and radical resection of the tumor in cooperation with the neurosurgeon, followed by reconstruction with microsurgical methods, and prosthetic rehabilitation based on an implant-supported epithesis.

Value of magnetic resonance imaging in staging carcinomas of the oral cavity and oropharynx.

The value of magnetic resonance imaging (MRI) in preoperative tumor (T) staging was assessed prospectively in 46 patients with malignant carcinomas of the oropharynx and oral cavity. In each case, the MRI findings were compared with the preoperative clinical and postoperative histopathologic findings. MRI showed an accuracy of 89% in identifying the T stage, as compared with the histopathologic result. The accuracy of the clinical examination was 78%. Compared with the clinical examination, MRI is particularly suited for differentiating T3/T4 and the larger T2 tumors. MRI tends to overinterpret the T stage when the neighboring tissues are inflamed or edematous, as it allows no demarcation between inflamed or edematous tissue and tumor. Moreover, normal oropharyngeal mucous membrane and intrinsic tongue muscle both absorb contrast medium. In the clinical examination, the T stage is often underestimated, as the depth of infiltration and bone involvement cannot always be determined with certainty. The ability of MRI to give an axial, coronal, and sagittal image allows an exact preoperative view of tumor spread and assessment of infiltration into adjacent structures.

The sperm acrosome: functional and clinical aspects.

The acrosome of mammalian spermatozoa contains high amounts of acrosin, which is believed to be essential for gamete fusion, particularly for binding to, and penetration of, the zona pellucida. In addition, its activation from proacrosin seems to be associated with the capacitation process. Furthermore, it might facilitate cervical mucus penetration and intrauterine sperm migration by releasing kinins from kininogen, as well as participating in the acrosome reaction and in chromatin decondensation in the oocyte. Considering these functions of the acrosome during the process of fertilization, the morphology and functional integrity of the acrosome in ejaculated human spermatozoa are of fundamental importance in attachment, species-specific binding and zona penetration preceding gamete fusion. It is therefore mandatory to focus on acrosomal membrane functions and consider particularly the occurrence of acrosomal disturbances in spermatozoa from men of barren marriages. For this purpose, biochemical and immunocytochemical methods have been used to investigate acrosin activity and possible alterations of the acrosomal membrane system in different groups of sub- and infertile patients. Of particular interest is the ability of spermatozoa to undergo the acrosome reaction, which can be studied using the triple-stain technique. Of all the spermatological groups investigated (normo-, astheno-, oligo-, terato- and polyzoospermia), polyzoospermic semen samples showed severe acrosomal disturbances indicating functionally defective acrosomes which might hinder fertilization. The data indicate the need for the introduction of acrosomal markers in clinical andrology for proper diagnosis of acrosomal sperm defects.

Absence of acrosome reaction in polyzoospermia.

Using the recently described triple-stain technique the time course of the acrosome reaction in a group of patients with polyzoospermia was evaluated and was compared to that of a group of normozoospermic men and a group of men with proven fertility. Polyzoospermia (greater than 250 Mill. spermatozoa/ml) has been repeatedly associated with subfertility. This investigation shows that most of the spermatozoa of polyzoospermic men do not undergo the acrosome reaction in vitro. This renders the spermatozoa incapable to penetrate the outer investments of the oocyte which might be one of the reasons for the reduced fertility observed in this patient group.

The kinetic of acrosome reaction--an additional sperm parameter?

Spermatozoa of six men with normozoospermia, oligozoospermia and teratozoospermia were capacitated in vitro in modified Tyrode's medium und evaluated for acrosome reaction using the recently described triple-stain technique. The resulting kinetics illustrate the different capacitation behaviour and ability of spermatozoa to undergo acrosome reaction. The data were completed by the movement characteristics of spermatozoa during the incubation period. The kinetic of acrosome reaction seems to be an important functional sperm parameter that may be useful to discriminate between fertile and infertile spermatozoa.