One- or two-plate fixation of mandibular angle fractures?

Standard treatment of mandibular angle fractures with miniplates, according to the recommendations of Champy et al. (1976), consists of fixation with one plate at the superior border of the mandible ventral to the external oblique line. In certain constellations, a second miniplate at the lower mandibular margin may provide additional stability. In contrast, extremely high complication rates following two-plate fixation of mandibular angle fractures were reported by Ellis and Walker (1994). In a prospective randomized study, 31 consecutive patients were treated with 2.0 mm (mini) plates (Synthes Co., Switzerland). One group was treated with one plate, the other one with two plates. In none of the patients was intermaxillary immobilization used. Follow-up was performed 6 months postoperatively, consisting of clinical and radiographic examination. No significant differences (P = 0.74 for infection, and P = 1.0 for occlusal and postoperative sensory disturbance) in postoperative short- or long-term complications were found between the two groups. The results are compared with our experimental investigations presented at the annual congress of the Germany Society of Oral and Maxillofacial Surgery, 1995. Two-plate fixation may not offer advantages over single-plate fixation in general. However, individual fracture constellations may benefit from variation in plate(s) localization. Factors contributing to complications in mandibular angle fractures are discussed.

Evaluation of the incorporation of bone grafts used in maxillofacial surgery with [18F]fluoride ion and dynamic positron emission tomography.

This study investigates the incorporation of bone grafts used in maxillofacial surgery by means of [18F]fluoride ion and positron emission tomography (PET). It considers patients who received pedicle grafts for mandibular reconstruction or onlay grafts for alveolar ridge augmentation. Dynamic PET images and arterialized venous blood samples were obtained within a 1-h period after i.v. injection of [18F]fluoride. Assuming a three-compartment model and applying multilinear least squares fitting, bone blood flow (K1) and fluoride influx (Kmlf) were determined. Additionally Patlak plot analysis was used to calculate fluoride influx (Kpat). In cervical vertebral bodies as the reference region, mean values for flow of K1 = 0.1162 +/- 0.0396 ml/min/ml and influx of Kmlf = 0.0508 +/- 0.0193 and Kpat = 0.0385 +/- 0.0102 ml/min/ml were found. Essentially these figures are comparable with physiological values in animal and man reported in the literature. Early after surgery a significant increase in flow and influx compared to vertebral bodies was observed in the regions of osteosyntheses between grafts used for reconstruction and recipient bone (K1 = 0.2181, Kmlf = 0.1000 and Kpat = 0.0666 ml/min/ml) and in onlay grafts (K1 = 0.2842, Kmlf = 0.1637 and Kpat = 0.0827 ml/min/ml). At the same time pedicle grafts showed a significant increase in flow but not in influx (K1 = 0.2042, Kmlf = 0.0774 and Kpat = 0.0529 ml/min/ml). Furthermore Kpat was significantly lower in pedicle grafts than in onlay grafts. In follow-up studies a significant decrease in flow occurred in pedicle grafts and the regions of osteosyntheses. Moreover the latter showed a significant decrease in Kmlf as well. It is concluded that [18F(-)] PET depicted increased blood flow and osteoblastic activity in onlay grafts and regions of osteosyntheses, indicating bone repair in the graft and adjacent host bone early after surgery. For the regions of osteosyntheses the decrease in both parameters corresponded to uncomplicated healing. The lack of increased influx, although flow was increased in pedicle grafts, most likely indicates that some necrosis occurred in these grafts despite patency of anastomoses. It may be concluded that [18F(-)] PET provides further insight into the biology of graft incorporation.

Palliative intra-arterial (i.a.) chemotherapy with carboplatin (CBDCA) and 5-FU in unresectable advanced (stage III and IV) head and neck cancer using implantable port-systems.

Intra-arterial drug therapy for head and neck cancer has been used for over 30 years. Owing to catheter-related complications occurring quite frequently this method was abandoned in many institutions. However, the development of subcutaneously implantable injection ports has renewed interest in regional drug delivery. A total of 19 injection ports have been implanted in 17 patients suffering from advanced or recurrent head and neck cancer. Regional chemotherapy was well tolerated; the predominant side effects were hemialopecia and mild unilateral mucositis. Therefore, regional, intra-arterial chemotherapy using implantable injection ports should be considered for palliative treatment of advanced head and neck cancer.

Immunochemical demonstration of plasminogen phenotypes using electroblotting.

The polymorphism of plasminogen (PLG) was analysed by isoelectric focusing on polyacrylamide gels, followed by electroblotting. For analysis, neuraminidase-pretreated sera were used. In a random sample of 500 unrelated individuals from east Westphalia 8 phenotypes were observed. The allele frequencies were: PLG*1 (A), 0.708; PLG*2 (B), 0.274; PLG*3 (A3), 0.013; PLG*V, 0.005. The family data (300 mother-child pairs) confirmed the hypothesis of autosomal codominant inheritance. PLG phenotypes could be determined in 1-year-old bloodstains (cotton and glass) that had been stored at +4 degrees C and -20 degrees C. The PLG phenotypes could clearly be demonstrated in sera diluted 1:4. The phenotype 1 (A) could still be detected in dilutions of 1:6. The theoretical exclusion rate was calculated to be 22.6%.

[Forensic application of the polymorphism of coagulation factor XIIIB]. / Zur forensischen Anwendung des Polymorphismus des Gerinnungsfaktors XIII B.

Gene frequencies of coagulation factor XIIIB polymorphism were determined in a random population sample of east Westphalia (n = 417). Furthermore, mendelian inheritance of alleles was examined in 60 families. Determinations were made after treatment of serum samples with neuraminidase by immunofixation on agarose gels. All six phenotypes were observed in our population sample. The gene frequencies were: FXIIIB1 = 0.71, FXIIIB2 = 0.11, FXIIIB3 = 0.18. The family data confirm the hypothesis of autosomal inheritance of three common alleles and disprove the two-allele model of Kera et al. [5].