Limitations of B-scan ultrasound for diagnosing fractures of the mandibular condyle and ramus.

The aim of this study was to analyse the applications and limitations of B-scan ultrasonography for diagnosing fractures of the mandibular condyle and ramus. Thirty-two patients with 39 radiologically proven fractures of the mandibular condyle and ramus were included in the study. The patients were examined with a 7.5 MHz small-part applicator. Five patients without fractures of the facial skeleton acted as controls. Normal sonoanatomical findings had been obtained for patients without mandibular fractures. B-scan ultrasonography enabled the experienced examiner to identify dislocated fractures of the mandibular ramus and the articular process in 67% of the fractures. The main disadvantage of ultrasonography was the inability of this technique to identify non-dislocated fractures. Because of its low sensitivity and specificity, B-scan ultrasonography does not provide an alternative to X-ray diagnosis of mandibular condyle and ramus fractures.

The presence of collagen III and IV in experimental microsurgical anastomoses of arteries.

PURPOSE: This study investigated the distribution of collagen III and IV in experimental microvascular anastomoses and correlated the findings with the quality of the healing process. MATERIALS AND METHODS: A previously excised and reanastomosed section of the left common carotid artery of 21 female Wistar rats were explanted 4 weeks after surgery. Collagens III and IV were identified in perfusion-fixed specimens by immunohistochemistry. RESULTS: The identification and distribution of collagens reflected the quality of each suturing procedure. A myointimal hyperplasia was present, extending into the vascular lumen, and was closely related to the ends of the vessel segments. The extent of myointimal hyperplasia was dependent on the length and the vitality of the vessel segments. The media was the weakest part of the tissue layers with regard to regenerative potential in the axial direction. The marked cuff of the adventitia around the anastomosis was rich in collagen III-positive vasa vasorum. Collagen IV was distributed in net-like patterns in the media. The distribution pattern in the media was not observed in anastomoses with incomplete approximation and necrotic segment ends. The collagen IV-positive subendothelial basal membrane was incomplete in the aneurysms because of partial necrosis. CONCLUSIONS: The experimental findings support the need for atraumatic suturing in microvascular surgery. Immunohistochemical detection of collagens can be a valuable tool for studying the basic processes of wound healing and the integration of microvascular flaps into their recipient sites.

TNM staging, histopathological grading, and tumor-associated antigens in patients with a history of mucoepidermoid carcinoma of the salivary glands.

BACKGROUND: The aim of this study was to evaluate the TNM categories and histopathological grading as prognostic factors in mucoepidermoid carcinoma (MEC). In addition, the study was designed to provide baseline data on levels of tumor-associated antigens (TAA) in sera of MEC patients. MATERIALS AND METHODS: Fifty-nine patients with MEC of the salivary glands were evaluated. RESULTS: Reclassified TNM stage, at the time of initial diagnosis, varied considerably. In disease-free patients, none of the tested sera were TAA elevated above the cut-off levels. Our patients who died of tumor metastasis had all been classified as stage III or IV at the time of initial diagnosis. Distant metastases are rarely found even decades after surgical therapy. CONCLUSIONS: Long-term follow-up is recommended for patients with MEC of the salivary glands. TAA are not elevated in disease-free patients. The value of TAA in the monitoring of MEC patients remains to be evaluated in further studies.

[Detection of extracellular matrix protein (laminin) in experimental arterial anastomoses]. / Nachweis von extrazellulärem Matrixprotein (Laminin) in experimentellen arteriellen Anastomosen.

AIM: To investigate the distribution of Laminin in experimental microvascular surgery. MATERIAL AND METHODS: Autografts (4 mm) of the left common carotid artery in 20 Wistar rats were harvested after 4 weeks. The specimens were investigated immunohistochemically for the demonstration and distribution of Laminin. RESULTS: The demonstration and distribution pattern of Laminin was a function of the accuracy of each single suture. In the intima, the organisation and amount of Laminin was directed to the lumen and dependent from the distance and vitality of the vessel segments' cells. The media had in its axis direction the lowest reparative potency to regenerate the continuity break. The adventitia formed a thick cuff around the anastomosis, which was circularly grown through with Laminin-positive vasa vasorum. The marked myointimal hyperplasia in the area around the anastomosis and in the entire autograft was constituted of Laminin-positive extracellular matrix. CONCLUSIONS: Our results support the demand for a careful and atraumatic suture technique in microvascular surgery.

[Ultrasound of segment distraction and callus formation in reconstruction of the mandible. Value of surgical ultrasound of callus distraction of vascularized ilial crest transplants and mandibular segments in a previously irradiated area]. / Sonographie der Segmentdistraktion und Kallusbildung des rekonstruierten Unterkiefers. Stellenwert der chirurgischen Sonographie der Kallusdistraktion vaskularisierter Beckenkammtransplantate und Underkiefersegmente in einer perkutan strahlenvorbelasteten Region.

PURPOSE: B-scan ultrasonography (US) was applied in patients subjected to callus distraction for bone formation at the interface of mandibular segments and vascularised bone grafts. METHODS: This study consisted of 7 patients requiring further surgical augmentation to allow for prosthetic treatment. All patients had been preoperatively irradiated percutaneously in the region of the primary oral squamous cell carcinoma up to an isodose of 60-75.5 Gy. Ablative surgery was then performed, including discontinuity resection of the mandible. Vascularised iliac crest grafts had been chosen due to poor healing conditions in the irradiated recipient site. For callus distraction, a distraction device was inserted in both the mandibular segment and the bone graft. Subsequently, osteotomy was performed, and distracting forces were applied to the segments. For US, a small-part applicator was used (7.5 MHz). RESULTS: US gives a true estimation of the distraction length, actually achieved at the time of investigation. The applicator can be easily adjusted to the area of interest. Application is safe and easy, the results are reliable, and the procedure can be carried out without affecting the hygiene of the wound after surgical intervention. In addition, US enables the supervising surgeon to detect zones of calcification in the area of callus distraction at an earlier point than can be detected by standard x-ray documentation, thus facilitating control of the therapy. CONCLUSION: US is highly recommended for routine application in callus distraction of the mandible. X-ray documentation is a "must".

P53 auto-antibodies in the sera of patients with oral squamous cell carcinoma.

AIM: To investigate the sera of patients with oral squamous cell carcinoma (OSCC) for the existence of p53 auto-antibodies. MATERIAL AND METHODS: The sera of thirty-nine OSCC-patients were investigated. All samples were from untreated patients with no history of another neoplastic disease. The sera of nine healthy subjects served as controls. RESULTS: P53 auto-antibodies were not detected both in all healthy subjects and in 20.6% OSCC-patients with their disease at an advanced stage. We prove that the extinction rates for p53 auto-antibodies in OSCC are very weak in the majority of investigated sera (50%) and are not related to tumour stage. CONCLUSION: It is unlikely that p53 auto-antibodies can serve as a prognostic marker of OSCC.

[Insertion of autografts after acute damage of the common carotid artery. Experimental microvascular anastomoses after balloon dilatation]. / Einsatz von Autointerponaten nach akuter Schädigung der Arteria carotis communis. Experimentelle mikrovaskuläre Anastomosen nach Ballondilatation.

The objective of our investigation was to study the patency rates of anastomoses in arteries, damaged by a balloon dilatation, in a training model of microvascular surgery. In general anaesthesia, a balloon dilatation was repeated 5 times in 31 left common carotid arteries of female Wistar rats (body weight: 250 to 350 g). A common carotid artery autograft of 4 mm was harvested 1 minute after reflow, turned 180 degrees, and reinserted into the artery. The reflow of the vessels was investigated by micro-Doppler ultrasound equipment. Autografts without balloon dilatation or any other intended damage were performed in further 26 common carotid arteries. In addition, in further 14 common carotid arteries the balloon dilatation was the sole damage. The vessels were harvested and investigated postoperatively after perfusion with 3% glutaraldehyde at 1 day, 7 days, and 1 month. The balloon dilatation in no instance caused an occlusion of the vessel as judged by the micro-Doppler ultrasound. One vessel was found to be occluded after reflow was allowed following insertion of the autograft in the group without balloon dilatation. However, this vessel proved to be patent after explantation (patency rate: 100%). In the group with balloon dilatation preceding the autograft insertion, by micro-Doppler ultrasound, 16 vessels were occluded and 14 were patent. At different times of follow-up, in this group the summarized patency rates were 50%. The patency differences in both groups with autografts proved to be significant, both after micro-Doppler imaging and by histological evaluation (p < 0.001). For clinical use the balloon dilatation is recommended to remove a thrombus or to dilate a spastic vessel segment in anastomized vessels threatening the success of microvascular flaps. In this training model of microvascular surgery we demonstrated the thrombogenic effect of balloon dilatation.

[Salvage therapy of advanced squamous cell carcinoma of the mouth cavity and oropharynx. Results of interstitial high-dose-rate brachytherapy combined with ablative tumor surgery]. / Salvagebehandlung fortgeschrittener Plattenepithel-karzinome der Mundhöhle und des Oropharynx. Ergebnisse der interstitiellen HDR-Brachytherapie in Kombination mit ablativer Tumorchirurgie.

PURPOSE: The clinical effect of high-dose-rate (HDR) interstitial brachytherapy combined with tumor resection was investigated in this retrospective study on patients with recurrent oral and oropharyngeal squamous cell carcinoma. PATIENTS AND METHODS: Oral and oropharyngeal squamous cell carcinoma in 38 patients were treated over a period of 7 years (1988-1994) by HDR interstitial brachytherapy using Gammamed 12i equipment. Pretreatment of patients in terms of irradiation and surgery differed (33 irradiated with a total dose between 60.0 and 75.6 Gy, including 8 patients with additional surgery; 1 patient with surgery alone, and 4 patients without any pretreatment). Indications for interstitial brachytherapy differed according to individual responses to treatment and medical histories. RESULTS: Interstitial brachytherapy was successful in the majority of patients, i.e. complete remission: 12, partial remission: 19, no change: 2, progression: 5. Local control and overall survival including patients with surgical treatment was 59% and 81% at 6 months and 47% and 49% after 12 months, respectively. CONCLUSION: Interstitial HDR brachytherapy with Iridium 192 is recommended in patients with local recurrences or second primary carcinomas after previous external radiotherapy in the head and neck region. Combination of interstitial brachytherapy and surgery is preferable for these patients.

Mucoepidermoid carcinoma of salivary gland origin: classification, clinical-pathological correlation, treatment results and long-term follow-up in 55 patients.

Over a period of 30 years, 55 patients with mucoepidermoid carcinomas (MEC) of the salivary glands underwent surgical treatment. Reclassified TNM-stage (Hermanek et al., 1992) at the time of initial diagnosis varied (T0: 0, T1: 26, T2: 20, T3: 2, T4: 7; N0: 49, N1: 4, N2: 2; M0: 53, M1: 2). In 46% (n = 24), the history of symptoms ranged from 6 months to 2 years without any specificity of features. The therapy of choice is a radical ablative surgery of the primary tumour. The resection of the related lymphatic system has to be included in the therapeutic concept in patients suspected of having metastases of the regional lymph nodes. The prognosis is excellent in patients with a localized manifestation of the disease only. Our patients who died for reasons of tumour metastasis had all been classified as stage III or IV at the time initial diagnosis (n = 5). Distant metastases are rarely found even decades after surgical therapy (n = 1). This is why a long-term follow-up is recommended for patients with MEC of the salivary glands.

Mucoepidermoid carcinoma of the salivary glands, Clinical data and follow-up of 52 cases.

Between 1965 and 1993, a total of 52 patients with mucoepidermoid carcinomas underwent surgical treatment. Their TNM stage at the time of initial diagnosis varied (T0:0, T1:24, T2: 19, T3: 2, T4: 7; NO: 46, N1: 4,N2: 2; MO:50, M1: 2). In the majority of patients (n=24) the history of symptoms ranged from more that 0.5 to 2 years without any specificity of features. Radical ablative surgery of the primary tumour is the therapy of choice. In patients suspected of having metastases of the regional lymph nodes, resection of the related lymphatic system has to be included in the therapeutic approach. The prognosis is excellent in patients with a localized manifestation. The patients who died for reasons of tumour metastasis had all been classified as having stage Iii to IV disease at the time of initial diagnosis. Distant metastases are rarely found even decades after surgical therapy. Long-term follow- up is recommended for patients with mucoepidermoid carcinomas.

Interstitial high-dose rate brachytherapy with iridium-192 in patients with oral squamous cell carcinoma.

Thirty-four patients with recurrent oral and oropharyngeal carcinomas were treated over a period of 4 years, by interstitial high-dose rate (HDR) brachytherapy (BT) using an iridium-192 source (Gammamed 2i and 12i equipment, Sauerwein, Germany) and fractionated application (1 up to 3 times, weekly recovery phases, single maximum dose 10 Gy). Pretreatment characteristics of patients in terms of irradiation (RT) and surgery differed (22 had external RT alone, with a total dose between 60.0 and 75.6 Gy; RT and surgery: 7; surgery alone: 1). The initial TNM-stages (UICC, Hermanek et al., 1987) of patients were: I = 2, II =3, III = 7, IV = 22. In the majority of cases, clinical indications for HDR-BT included tumour recurrence or progression following external RT, and second primary tumours of the oral cavity. Therapy was successful in most cases, i.e. complete remission: 11, partial remission: 16, no change: 2, progression: 5. Local control and overall survival rates, including patients surgically treated after BT, were at 6 months 58% and 62%, and 44% and 53% at 12 months, respectively. This type of treatment is recommended in patients with local recurrence or second primary tumours after previous external RT in the head and neck region. However, the benefit of interstitial HDR-BT remains questionable, particularly in patients with large tumours and lymph node metastases.

[Long-term after care in chronic skin diseases exemplified by idiopathic hyperlipidemic xanthomatosis]. / Beitrag zur langfristigen Nachsorge bei chronischen Hauterkrankungen am Beispiel der idiopathischen hyperlipidämischen Xanthomatose.

Based on two detailed case reports of idiopathic hyperlipemic xanthomatosis, we discuss the problems concerning xanthomatosis. The important role of a long-term follow-up of these patients as, in our cases, over 16 and 27 years, resp., by the same doctor is pointed out.