[Results of various reconstructive procedures in defects of the fronto-facial area]. / Ergebnisse unterschiedlicher Rekonstruktionsverfahren bei Defekten im fronto-fazialen Bereich.

Small calvarial defects may be recontoured by Gore-Tex membranes or by micro burr hole covering plates in combination with bone dust. In extended defects the best primary and secondary results are obtained with splitted calvarium grafts due to their stabilizing and esthetic features. Micromeshes prevent contour disturbances in the contact zone of the transplants.

[Fracture healing of the ethmoid bone--a contribution to rhinologic management of naso-ethmoid injuries]. / Untersuchungen zur Frakturheilung im Siebbein--Ein Beitrag zur rhinologischen Versorgung nasoethmoidaler Verletzungen.

Severe maxillofacial trauma accompanied by a dislocated ethmoidal bone fracture was confirmed by CT imaging in 15 adult patients. Routine surgical management included reduction of fractures, miniplate fixation and/or intermaxillary fixation with interosseous wiring. The fractured ethmoidal cell system was left to heal spontaneously. A follow-up examination including endoscopy of the nasal cavity as well as active anterior rhinomanometry and computed tomography was carried out approximately 24 months after surgery. The fractured ethmoidal cell system showed a clear tendency to spontaneously reventilate and drain. However, in 8 of 30 sides a traumatic obstruction of the anterior ethmoid led to secondary frontal sinus mucositis. 12 out of 30 maxillary sinuses ranged from marked mucosal swelling to the development of a traumatic mucocele. Altogether, 9 of the 15 patients suffered from paranasal sinusitis. Routine debridement of every fractured ethmoidal cell system does not appear to be necessary. In case of fractures of the anterior ethmoid with probable obstruction of the nasofrontal duct and/or maxillary sinus ostium, endonasal endoscopic surgery is recommended for minimally invasive reconstruction of the ventilation and drainage of the frontal and maxillary sinus during primary surgical management. Furthermore, patients with severe naso-orbito-ethmoidal fractures should undergo rhinological follow-up examination including CT-imaging approximately 3 months after surgery.

The treatment of mandibular fractures in children.

92 children with mandibular fracture were treated at our hospital between 1980 and 1989. Distribution and treatment of the fractures focus on a new classification based upon the stage of the dentition, site of the fracture and displacement of the tooth-bearing part of the mandible. The treatment rationale includes intermaxillary fixation by specially designed mini-arch bars with acrylic resin stiffening in cases with undisplaced fractures in the early stages of the dentition. With the help of this technique, invasive procedures for fracture immobilization become less common. The indication for miniplate osteosynthesis is limited to displaced or multiple fractures of the tooth-bearing part of the mandible. The combination of miniplates and monomaxillary splinting with mini-arch bars allows a shorter duration of intermaxillary fixation and hence early functional treatment of additional condylar fractures. Correctly applied miniplates neither injure the tooth germs nor lead to growth disturbances of the mandible. The classification and treatment of mandibular fractures in children are discussed.