[Quality of life of patients with squamous cell carcinoma of the oral cavity]. / Die Veränderung der Lebensqualität während und nach der Behandlung von Mundhöhlenkarzinomen.

OBJECTIVE: The aim of this study was to assess the changes in quality of life during and after treatment in patients with cancer of the oral cavity. PATIENTS AND METHODS: In the period between October 1999 and September 2000, 57 patients of the Department of Craniomaxillofacial Surgery, University of Cologne, underwent surgery, radiation therapy or the combination of both for the treatment of cancer of the oral cavity. Before, during and after the therapy their quality of life was measured with two psychometric scales. RESULTS: The average loss of quality of life in the female group was less than in the male group. Younger patients suffered more than older ones did. All patients had a loss of quality of life 3 months after the beginning of the therapy. The biggest decrease was in the group of patients treated with combined therapy, and the lowest loss in the radiated group. During the assessment period of 9 months, there were significant differences between all three groups. The size of the tumor did not show any influence on the reduction of quality of life. Patients with cancer of the tongue or maxilla showed more loss of quality of life than patients with tumors located in other regions of the oral cavity. CONCLUSION: Location of the tumor, age, gender of the patient, and type of therapy influenced the quality of life, while the size of the tumor did not.

Callusmassage. A new treatment modality for non-unions of the irradiated mandible.

Recent reports on orthopaedic surgery focus on mechanical stimulation of the regenerate during distraction therapy of non-unions in long-bone-surgery. In the field of maxillofacial surgery, callus stimulating techniques are rarely reported. The case of a 65-year-old man with a radiogenic mandibular non-union after ablative tumour therapy and pre-operative radiation therapy presented with a non-union. Vertical distraction in combination with subsequent repeated, stepwise compression and distraction (=massage) had a positive effect on the consolidation of the regenerate.

Use of an image-guided navigation system in dental implant surgery in anatomically complex operation sites.

INTRODUCTION: Recent developments in computer assisted surgery have brought major improvements to maxillofacial surgery. Computer systems for intra-operative navigation have been introduced enabling the surgeon to locate the continually updated position of the instruments and the operation site on the patient's three-dimensional reconstructed image data set displayed on a monitor in the operating room. Complex surgical procedures can be performed according to the preoperative plan based on CT and/or MRI data minimizing surgical risks and optimizing clinical results. Nowadays computer-assisted-surgery has also proved effective in dental implantology. AIM: The objective of this study was to compare the accuracy of conventional and computer-assisted dental implantation planning and surgery. Analyzing our early experiences, we aimed to evaluate the benefit from utilising computer assisted surgery (CAS). PATIENTS: Five patients were treated with the aid of CAS, a total of 18 dental implants being placed. Only difficult operation sites, e.g. following bone augmentation or anatomically malformed jaws were included in this study. METHOD: An infra-red light based navigation system (Vector Vision 2, BrainLAB, Munich, Germany) including a three-dimensional planning approach for maxillofacial surgery was used. Placement of dental implants in the maxilla included direct visualization when drilling the implant socket according to the axis previously planned on radiographs and CT scans. RESULTS: In two cases the conventionally planned implant location had to be changed due to insufficient bone being available. With four implants, it proved possible to insert longer fixtures after the CAS system had evaluated all parameters of the surgical region. In one case a shorter implant was installed due to insufficient bone at the designated location. CONCLUSION: The use of an image-guided navigation system provides a valuable tool in implant dentistry and proved superior to conventional implant surgery especially in difficult anatomical regions.

[Expression of lectin binding sites as a prognostic parameter in mouth mucosa carcinomas]. / Expression von Lektinbindungsstellen als prognostischer Parameter bei Mundschleimhautkarzinomen.

BACKGROUND: Normal oral mucosa and invasive squamous cell carcinoma of the oral mucosa and the lips were examined immunoenzymatically for different lectin-binding sites and evaluated semiquantitatively. In 110 patients suffering from invasive squamous cell carcinoma of the oral mucosa or the lips, the course of the disease was examined retrospectively with regard to metastases, recurrence and survival time over a minimum of 60 months and was correlated with cell surface binding to lectins (PNA, WGA, UEA I) of the primary tumor. Normal oral mucosa shows intensive cell surface binding to the lectins PNA, WGA and UEA I, but in more than half of the cases the PNA-defined epitopes are blocked by sialic acid. RESULTS: The comparison of the cumulated survival rates showed a much better prognosis for primary tumors with lectin-binding sites than for those without. Strong and medium WGA-binding pT2 tumors showed significantly better survival rates than those pT2 tumors with poor WGA-binding sites. Carcinomas without lectin binding showed the highest recurrence risk in the course of the disease. In squamous cell carcinomas without WGA and UEA I bindings, the period of time before a relapse occurred was significantly shortened. Carcinomas expressing UEA I-binding sites showed a considerably lower metastasis rate than UEA I-negative tumors. Squamous cell carcinomas with complete sialic acid-blocked PNA-binding sites had the same lymph node metastasis rate as those without expression of PNA-specific disaccharides. A significantly lower metastasis rate than both these groups was exhibited by tumors without or with only partially blocked PNA-binding sites. DISCUSSION: In addition to aiding routine grading, the study of PNA-, WGA- and UEA I-binding patterns can therefore provide further information in cases of oral squamous cell carcinoma regarding the potential for metastasis and tumor prognosis.

Image guided surgical navigation for removal of foreign bodies in the head and neck.

INTRODUCTION: The removal of foreign bodies in the head and neck area is often a surgical challenge due to a combination of difficult access and a close anatomical relationship of the foreign body to vital structures. Recent developments in computer-assisted surgery (CAS) have brought major improvements to the operating rooms for maxillofacial surgeons. The purpose of this paper is to report our experience in computer assisted removal of foreign bodies from the head and neck area, based on various clinical cases. PATIENTS: Computer assisted removal of foreign bodies from the head and neck area was performed in 11 patients. Three patients sustained gun shot wounds with remaining projectiles or fragments in the soft tissue. In six cases, objects related to a preceding surgical intervention were removed. Two patients presented with dislocated teeth in the facial or cervical soft tissues after 3rd molar surgery. METHOD: For surgical planning and intra-operative navigation, a computer based image guided surgery system (VectorVision(2), BrainLab) was used. RESULTS: In 10 of 11 cases the foreign bodies could be removed without major complications by a minimal invasive manner. More than 40 % of surgery time could be saved compared to similar interventions operated upon using conventional methods. CONCLUSION: In our opinion, the use of a computer based image guided surgical system is of great benefit when removing foreign bodies from the head and neck area. The minimally invasive access helps to prevent major complications such as injury to vital structures and allows a quicker operation.

Comparisons of bone volumes and densities relating to osseointegrated implants in microvascularly reconstructed mandibles: a study of cadaveric radius and fibula bones.

The study was designed to compare the dimensions and densities of two frequently used bone donor sites with regard to placement of endosseous dental implants in microvascularly reconstructed mandibles. A total of 40 radii and of 40 fibulae were investigated. Fifty two percent of the fibulae had adequate bone volume for the positioning of four 10 mm implants, while this figure was 55% for the radii. After using the 'double barrel' technique the placement of four 10 mm implants succeeded in 87% of all the fibulae. Due to the lack of bone length required, this special technique was not possible in the radii investigated. Cortical thickness and density of bone were higher in the radii when compared with the fibulae. In each bone the central and distal parts presented the highest values of cortical thickness and density. Although the radius offers enough substantial bone for implant placement in some cases this cannot be used for clinical purpose, as only hemicortical grafts can be obtained. Otherwise the resulting donor site morbidity would be intolerable. In conclusion, our results support the clinical experience that the fibula is today's 'work horse' donor site for reconstruction of the mandible.

Neurinoma of the facial nerve mimicking a parotid tumour. A case report.

A case of a facial neurinoma localized in the right parotid gland is presented. Neurinomas derived from the facial nerve are very rare especially when extracranially located. Despite imaging and other investigations, extirpation of the tumour and histopathological examination are the only way to establish the diagnosis. Neurinomas are encapsulated and can be dissected without interruption of nerve branches.

Comparative densitometric study of iliac crest and scapula bone in relation to osseous integrated dental implants in microvascular mandibular reconstruction.

The study was designed to compare dimension and density of four frequently used bone donor regions (the iliac crest, the lateral border of the scapula, the radius and the fibula) with regard to placement of endosseous dental implants in microvascular mandibular reconstruction. The first part of the study reports on the results of bone dimension and density findings for iliac crest and scapula bone. Nearly all of the iliac crests had adequate dimensions for the positioning of four 10 mm implants. In 63% of the scapulae, it was possible to place four 10 mm implants. In the case of the scapula, half of the female subjects lacked enough available bone for the insertion of four 10 mm implants because of their inadequate width. Bone density and cortical thickness was found to be similar in the iliac crest and scapula. Age and side do not have an important influence on cortical bone dimensions and density. In contrast to the iliac crest, the lateral margin of the scapula astonishingly showed increasing values for bone density and increasing thickness of the cortex. Analogical advanced biological age works in conformity with the scapula flap. The results could, together with other clinical criteria, contribute to the choice of the best individual alternative in mandibular reconstruction.

[Osteomyelitis of the facial skull in Albers-Schönberg osteopetrosis]. / Osteomyelitis des Gesichtsschädels bei Osteopetrosis Albers-Schönberg.

Albers-Schönberg osteopetrosis, a rare heritable bone disease with autosomal dominant or recessive transmission, is generally characterised by diffuse sclerosis of the whole skeleton accompanied by pathological bone fragility and delayed physical development, profound intractable myelophthisic anaemia, neurological deficits, and osteomyelitis, especially of the jaws and the skull. The precise aetiology of the osteopetrosis is not clear. Therefore therapy is restricted to alleviation of symptoms. In this study the case of a patient suffering from the benign form of osteopetrosis is presented. Osteomyelitis of the skull was treated successfully 2 years after the removal of lower and upper jaw teeth by a combined multistage surgical and antibiotic approach.

Cutaneous manifestation of sarcoidosis (Boeck) with severe osseous destruction of the midface. A case report.

A 16-year-old Caucasian girl presented with brownish red plaques and papules beneath the right eye, and a right side open bite. The cutaneous changes had occurred more than 13 years previously. Radiological evaluation of the chest demonstrated bilateral hilar lymphadenopathy. Kveim-Siltzbach test of the skin was positive. Histological examination of several biopsy specimens taken from skin, oral mucosa and anterior wall of the right paranasal sinus revealed the diagnosis of sarcoidosis (Boeck). Therefore steroid therapy was initiated and the patient was placed on 40 mg prednisone daily. Under this treatment the sarcoidosis manifestations improved generally, and the prednisone dose was subsequently reduced.

[Ontogeny of the human temporomandibular joint]. / Zur Ontogenese des menschlichen Kiefergelenkes.

An analysis of the human temporomandibular joint is done regarding to the appearance of secondary cartilage formations during the prenatal development of condylus and temporal joint elements. Sagittal sections of nine human fetuses (49 mm CRL to 315 mm CRL) show a closed relationship between the development of the bony and soft tissues of the joint. The temporary appearance of secondary cartilage in the temporal joint area is induced by the functional loading of the capitulum. This process requires the genesis of the two free articular cavities on the one side and the functional attachment of the lateral pterygoid muscle to the discus and the collum mandibulae on the other. Pointing out the clear relationship of the articulating joint surfaces and the in between discuss, a left temporomandibular joint of a fetus (125 mm CRL) is reconstructed in a medioventral view with the help of a three dimensional drawing. The location of the temporal secondary cartilage formation within the centre of the temporal loading area of the condyle assures its functional genesis during the embryological development of the human temporomandibular joint.

[Microsurgical arterial prostheses in tissue pretreated with Cisplatin]. / Mikrochirurgischer Gefässersatz im zytostatisch (Cisplatin) vorbehandelten Gewebe.

Female WAG-Rij rats (160-180 g b.w.) were treated with Cisplatin (12.6 mg/kg b.w.) over 3 weeks. After chemotherapy a homologous freeze-dried carotid segment of 4 mm length was grafted in the right carotid artery. The evolution of the new prosthesis endothelium was observed by SEM. 4 weeks after the microsurgical treatment, the healing process and reendothelialization of the prosthesis was concluded in the control group. In the cisplatin group endothelial damages and irregularities of the pseudointima of the freeze-dried graft were found up to the sixth week after surgery. This may be the reason for thrombosis and a lower patency rate after chemotherapy.

A new method for multiple applications of cytostatic drugs in rats.

The implantation of a small silicon catheter for repeated intravenous applications of drugs in laboratory animals (rats) is described. Under an operation-microscope, the catheter is inserted into the external jugular vein and remains in situ in a skin pocket during the treatment. By dissecting the wound, multiple fractions of drugs can be administered via the catheter at intervals of days or weeks. The method has the advantage that in long-term studies with rats, intravenous injections or infusions of cytostatic drugs are possible with high accuracy.

[Functional aspects of embryonic secondary cartilage development in the human TMJ]. / Funktionelle Aspekte bei der embryonalen Sekundärknorpelbildung des menschlichen Kiefergelenkes.

The development of the temporomandibular joint was studied histologically in sagittal sections of four human fetuses with a crown-to-rump length of 49 mm to 315 mm. Special attention was paid to the appearance of secondary cartilage in the condylar and glenoidal joint elements. There was a close relationship between the development of both the soft tissue and bony elements. It is the purpose of this paper to report histologic observations made in humans regarding the functional genesis of the temporal secondary cartilage.

[Densitometry of the bony structures of the human TMJ]. / Densitometrische Untersuchungen der knöchernen Strukturen des menschlichen Kiefergelenkes.

Four millimeter sagittal section of 65 formalin-fixed human TMJs were prepared. The X-rays of these specimen were evaluated numerically in a densitometer. The distribution of bone material and densities in condyle and fossa led to a classification of condylar and fossa types. In 48 specimen a combination of increased density of the condyle on the facial aspect with a thin bony lamella in the roof of the fossa, which either shows high density or very little material of low density, a so-called parchment fossa, was observed. The varying degrees of density as a function of mechanical stresses are discussed. The transfer of forces in the human TMJ during mastication exposes the superio-anterior or superio-facial segments of the condyle and the posterior slope of the articular tubercle to loading forces, while at the same time the roof of the fossa remains free of load.