Septic arthritis of the temporomandibular joint leading to an epidural abscess.

Septic arthritis of the temporomandibular joint (TMJ) is rare, but patients with this diagnosis are at high risk for significant morbidity. We present a case of a 15-year-old man who presented with increasing trismus for 3 days. He had only minimal discomfort and swelling of the right cheek and temporal region, and pericoronitis of an impacted wisdom tooth was suspected. Under intravenous antibiotics, pain subsided, but trismus and a slight swelling remained. CT scan showed septic arthritis of the TMJ with an abscess formation penetrating into the epidural space. Immediate drainage and craniotomy were performed. Under intravenous antibiotics, the patient made a full recovery. The source of infection remained undetermined. To our knowledge, this is the first reported case of septic arthritis of the TMJ spreading into the epidural space.

Microvascular medial femoral condylar flaps in 107 consecutive reconstructions in the head and neck.

We have assessed the role of the medial femoral condylar flap in 107 patients who had reconstructions of the head and neck. We retrospectively reviewed their medical records for indications, complications, and outcomes. The flap was primarily used for coverage of alveolar ridge defects (n=67), secondly for defects of the facial bone, calvaria, or skull base (n=35), and thirdly for partial laryngeal defects (n=5). Two flaps were lost. One patient fractured a femur 5 weeks postoperatively. The duration of follow up ranged from 6 months to 12 years. The medial femoral condylar flap is well-suited to individual reconstructions of the alveolar ridge, midface, calvaria, skull base, and part of the larynx with poor recipient sites. The flap does not replace other wellknown flaps, but offers new solutions for solving special problems in head and neck surgery.

The intraoral anastomosing technique in reconstructive surgery of the face - A consecutive case series of 70 patients.

INTRODUCTION: New techniques in microvascular flap transfer result in new indications for reconstructive treatment of facial defects. In this study, the indications and success rate of an intraoral anastomosing technique in facial reconstruction were examined. METHODS: Seventy patients with intraoral defects or central midface defects were reconstructed with the use of microvascular flaps. Anastomoses were performed by an intraoral anastomosing technique. Indications for the use of this technique, types of flaps, complications and problems were evaluated. RESULTS: Except for 5 reconstructions, all were performed to correct bone defect coverage of the jaws. All anatomising procedures worked without severe intraoperative problems. There was one total flap loss caused by venous congestion, and two partial losses not associated with the anastomosing technique. There were no other complications or problems. CONCLUSIONS: The main indications for the use of intraoral anastomosing techniques are alveolar ridge reconstruction in patients with defects not caused by a malignant tumour and central midface reconstruction in the case of short flap pedicle. The success rate of the intraoral anastomosing technique is similar to that of extraoral techniques reported in the literature.

Long-term skeletal and dental stability after orthognathic surgery of the maxillo-mandibular complex in Class II patients with transverse discrepancies.

INTRODUCTION: Two-jaw surgery has become the standard procedure for correcting skeletal maxillo-mandibular discrepancies in adults. However, only a few studies have reported on the long-term stability of bimaxillary orthognathic surgery in patients with Class II malocclusion and transverse discrepancies. In this study, the long-term outcome of two-piece maxillary treatment during bimaxillary surgery in patients with skeletal Class II malocclusion was examined and the results are discussed. MATERIAL AND METHODS: Dental plaster casts and lateral cephalograms of 47 patients were collected in five phases of treatment: baseline (t1), preoperatively (t2), postoperatively (t3), at the end of orthodontic treatment (t4), and at the time of long-term follow-up (t5), and were retrospectively analyzed. RESULTS: At follow-up all patients showed a Class I occlusion. The maxillary width was, on average, enlarged by 2.7 mm surgically. During the following 8.8 years after treatment, 1.7 mm were lost. The cephalometric analyses showed no severe changes in the sagittal maxillary position for the duration of follow-up. The sagittal mandibular position (SNB) was changed significantly by the mandibular advancement from 75.4° to 77.8° and remained stable for 8.8 years postoperatively. CONCLUSION: Bimaxillary surgery with two-piece maxillary treatment in patients with Class II malocclusion leads to stable long-term occlusal results in the sagittal plane. The transverse enlargement achieved by intraoperative widening does not remain stable over the years. A relapse of about 60% of the surgically expanded transverse width is seen. In Class II deformities without an open bite, where extended transverse enlargement is necessary, a two-step procedure with primary surgically-assisted rapid palatal expansion followed by one-piece surgery should be planned.

The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures.

The role of the titanium functionally dynamic bridging plate (TFDBP) in the fracture treatment of the severely atrophic mandible was assessed retrospectively. In 28 consecutive patients with fractures of a severely atrophic mandible fixation was carried out with TFDBPs. Twenty-one patients with 27 fractures were included in the study and then followed up for complications and the progress of fracture healing for 17 months postoperatively on average. There was only one case that required plate removal. All patients showed bone healing 3 months after surgery. The mental nerve sensation improved in 12 out of 23 fractures that had presented with nerve function disturbance. Every patient who had dentures prior to sustaining the fracture was able to return to denture wearing 3 weeks after surgery. No major complications occurred. A high proportion of bone healing with a low complication rate was observed with the use of TFDBPs in the treatment of severely atrophic mandible fractures. The TFDBP is an excellent alternative to conventional plating of the severely atrophic mandible.

The microvascular thenar flap as a new possibility for super-thin soft tissue reconstruction in the oral cavity--initial clinical results.

We report the first clinical use of a free microvascular thenar flap for reconstruction of intraoral soft tissues. In 9 patients with a recurrent oral squamous cell carcinoma (SCC), a new primary oral SCC, or a defect of the hard palate after radiotherapy, we covered the soft tissue defect, after resection of the tumour or local preparation, with a microvascular thenar flap. All patients had had combined resection and irradiation for treatment of the initial tumour. In every case the thenar flap was harvested from the left forearm. Arteries were anastomosed to cervical arteries on either side. The veins were anastomosed to the deep jugular or subclavian vein. Patients were followed up clinically after 3, 6, and 12 months and radiologically every 6 months. The mean length of the pedicle was 21 cm. The mean width of the flap was 27 mm (range 24-30) and the mean length 37 mm (range 26-49). All anastomoses worked well. All flaps healed without major complications. A thin but stable layer of soft tissue resulted in every case. All patients were able to wear their prostheses. Good functional and aesthetic results were seen at each follow-up visit, and there were no signs of relapse. The microvascular thenar flap is well-suited for reconstruction of thin layers of soft tissue in the oral cavity. The long pedicle and hairlessness are also ideal for covering intraoral defects after previous operations and in necks with few if any vessels. Primary wound closure is possible in many cases.

[Dental alterations in junctional epidermolysis bullosa--report of a patient with a mutation in the LAMB3-gene]. / Zahnveränderungen bei junktionaler Epidermolysis bullosa-- Bericht über eine Patientin mit einer Mutation im LAMB3-Gen.

During early odontogenesis the basement membrane is known to be important in epithelio-mesenchymal interactions. Mutations in the gene of one of the major structural proteins of the basement membrane such as laminin 5 might therefore be expected either to seriously compromise ameloblast differentiation and/ or interfere with normal basement-membrane formation and degradation and thus the binding of the ameloblasts to their underlying matrix. Teeth of patients suffering from junctional epidermolysis bullosa (JEB) can be severely affected by abnormal dental development and generalized or focal enamel hypoplasia. Those changes are found in 100% of individuals with JEB but the expression is variable. Beside the quantitative alterations, changes in the prismatic structure and orientation of enamel crystals are described. In addition JEB is associated with an increased risk for dental caries, caused by developmentally compromised enamel and external factors such as difficulties in maintaining oral hygiene because of oral lesions or a softer and more refined high caloric diet. Dental care includes three main strategies: Prevention by consequent oral hygiene and reduction of cariogenic nutrition is of paramount importance to minimize caries development; the restoration of enamel and dentin defects with fillings and stainless steel crowns to guarantee structure and function of teeth; and extractions of most severely affected teeth with osteolytic foci to remove continuous sources of oral infections.