[Wrinkle fillers in cosmetic facial procedures]. / Rimpelvullers in de cosmetische aangezichtschirurgie.

During the last decade cosmeticfacial procedures have become part of the professional work of both dentists and maxillofacial surgeons. A shift has taken place from invasive surgical treatment towards minimally invasive treatments. Besides the use ofbotulinum toxin type A, non-permanent wrinkle fillers can be an alternative to invasive surgical treatment. Since botulism was first described in the 18th century, the neurotoxin has continued to develop, as a result of which Botox, now available in synthetically produced form, can safely be employed in healthcare. The frequency with which patients visit dentists and maxillofacial surgeons offers the professional group the possibility to inform patients about cosmetic facial treatments and to carry them out according to diagnosis.

[Facial ageing and cosmetic facial surgery]. / Verouderingsverschijnselen in het aangezicht en cosmetische aangezichtschirurgie.

The aim of cosmetic facial surgery is to enhance facial beauty by reducing the effects of ageing or by beautifying certain aspects of the face. The face can be subdivided anatomically into the skin, the fat compartments, the ligaments (the links between the skin and the underlying facial skeleton), the superficial musculoaponeurotic system and the masticatory and mimic musculature. As a result of the influence of gravity and ageing, changes which progress according to a fixed pattern take place at all levels of the soft tissue of the face. The supporting facial skeleton also reduces in volume in a characteristic manner. A thorough knowledge of the facial anatomy and the ageing process is essential for safe, effective and predicable facial rejuvenating surgery. The dentist generally has a long-lasting relationship with his patients and therefore may play an important role in advising patients with respect to the (im)possibilities of cosmetic facial surgery.

[Insufficient diagnostics in a patient with a fracture of the mandibular collum]. / Ontoereikende diagnostiek bij een fractuur van het collum mandibulae.

A 13-year-old boy was presented to oral and maxillofacial surgeon with chin and preauricular pain after afallfrom his skateboard. A panoramic radiograph did not show any indication of a fracture of the mandibular collum. Two weeks later, the boy was referred by his orthodontist to the department of Oral and Maxillofacial Surgery of a medical centre in connection with a relapse ofa class III malocclusion despite a recently completed treatment of that problem. A computertomogram displayed a fracture of the mandibular collum. In case afracture of the mandibular collum is suspected, imaging from 2 directions is always required.

Long-term results of maxillomandibular advancement surgery in patients with obstructive sleep apnoea syndrome.

This article describes the eight-year follow-up results of maxillomandibular advancement (MMA) in a cohort of patients with obstructive sleep apnea syndrome (OSAS). Results are promising by means of Apnoea Hypopnoea Index (AHI) and Epworth Sleepiness Scale (ESS).

[Cosmetic facial surgery. The application of botulinum neurotoxin type A]. / Cosmetische aangezichtschirurgie. De toepassing van botulineneurotoxine type A.

During the past decade, cosmetic facial treatments have become a standard element of the work of both dentists and oral and maxillofacial surgeons. A shift has taken place from invasive surgical treatments in the direction of minimally invasive treatments. One of the most frequently carried out minimally invasive treatments is the treatment with botulinum neurotoxin type A. Since botulism was first described in the 18th century, this neurotoxin has undergone a slow development to botox which is now manufactured. Botox attaches itself to the nerve endings and is subsequently taken up in the vesicles which contain acetylcholine. Botox blocks, there, the protein which is responsible for the production of acetylcholine. Botox reduces wrinkles in the skin at the muscles offacial expression and is therefore employed in areas with dynamic wrinkles. Appropriate areas include frown lines in the glabella, lines in the forehead, lateral periorbital lines, hyperactivity in the muscles of the upper lip, hypertrophy of the musculus masseter.

Strategies for patients with newly diagnosed oral squamous cell carcinoma and a positive chest CT. A cohort study on the effects on treatment planning and incidence.

The purpose of this study was to establish how often routine CT scan of the chest yields positive findings in patients suffering from oral SCC and how it influences the treatment in terms of extra diagnostic procedures, treatment planning and treatment delay. Costs of this additional diagnostic approach for pulmonary tumors in a selected group were also calculated. A retrospective study was conducted of a group of 196 patients who were newly diagnosed with a squamous cell carcinoma of the oral cavity between January 2004 and July 2006; 142 hospital files were eligible for reviewing. In 20 (13%) patients chest abnormalities were observed on CT scan of the chest and in 6 (4%) patients malignancy was pathologically confirmed. Both pulmonary second primary tumors and pulmonary metastases were independent of stage of oral malignancy. We found that additional diagnostic procedures did not significantly lengthen the time interval between first consult and start of treatment. The cost of the screening for pulmonary malignancies in the group was € 8.214 per observed pulmonary malignancy. We advocate that CT imaging of the chest should be routinely performed in the diagnostic work up of all patients with a newly discovered SCC of the oral cavity, irrespective of the tumor stage of the oral malignancy.

The use of botulinum toxin type A in cosmetic facial procedures.

Over the past decade, facial cosmetic procedures have become more commonplace in dentistry and oral and maxillofacial surgery. An increasing number of patients seek minimal invasive procedures. One of the most requested procedures is treatment with botulinum toxin type A (BoNTA). Treatment of dynamic rhytids and lines with BoNTA is effective and produces high rates of improvement with rapid onset and long duration of action (longer than 4 months for some patients) compared with placebo. This paper considers the history and pharmacology of this neurotoxin, and focusses on the literature concerning the treatment of different facial areas with BoNTA. It also presents clinical guidelines on the treatment of glabellar lines, the frontalis muscle, peri-orbital lines, gummy smile and masseter muscle hypertrophy. Knowledge about the mechanisms of action and the ability to use BoNTA as an adjunctive treatment are mandatory for those working in the field of cosmetic facial surgery.

[A woman with ankylosis of the temporomandibular joint]. / Een vrouw met ankylose van het temporomandibulaire gewricht.

A 56-year-old woman was referred to an oral and maxillofacial surgeon because of facial stiffness and restricted mouth opening, 13 years after receiving multiple mandible fractures in a car accident. After clinical investigation and computer tomography, ankylosis of the right temporomandibular joint was diagnosed. The patient was treated by means of gap-arthroplasty, in which a myofascial flap of the temporalis muscle was used as an interposition transplant. After a period of physiotherapy, an acceptable recovery of the mouth opening was achieved. Traumatic injury is by far the most prevalent etiology of temporomandibular joint ankylosis, followed by an infection of the temporomandibular joint. Treatment consists basically of a gap-arthroplasty, with or without interposing a transplant between the ramus mandibulae and the joint socket or resection of the ankylotic tissues followed by reconstruction of the mandibular caput with an autologue transplant or an alloplastic material.

[Oral pemphigus]. / Pemfigus oris.

A 33-year-old man suffered from spontaneously developing blisters at the oral mucosa. Firstly, the bullous lesions were observed in the third molar region, but they spread progressively over the buccal and palatal mucosa. The bullous lesions ruptured spontaneously, resulting in erosive lesions and pain. Before being referred to an oral and maxillofacial surgeon, the patient consulted his family doctor, his family dentist, as well as an ear-nose-throat-specialist. The oral and maxillofacial surgeon took a biopsy in order to confirm the clinical diagnosis pemphigus vulgaris. The patient was referred to a dermatologist for treatment with systemic corticosteroids and a non-steroid immunosuppressive drug. Subsequently, the mucosal lesions healed.

[Trigeminal neuralgia by an acoustic neuroma. The need of imaging]. / Trigeminusneuralgie door een neurinoom van de nervus acusticus. De noodzaak van beeldvormend onderzoek.

In a 43-year old female with neuralgia of the second and third branch of the trigeminal nerve, the diagnosis was made on the basis of clinical findings. After the patient was treated with 2 x 200 mg of carbamazepine, all initial symptoms resolved, which confirmed the diagnosis. To distinguish between idiopathic and secondary trigeminal neuralgia, magnetic resonance imaging was scheduled. This investigation showed an acoustic neuroma in the cerebellopontine angle. Without magnetic resonance imaging this benign tumour would be diagnosed in a much later stage and the patient would have suffered unnecessary co-morbidity. Due to the relatively high incidence of secondary trigeminal neuralgia, routine magnetic resonance imaging in patients with a trigeminal neuralgia is justifiable.