Ex corpore linguae: A cohort analysis after a unique surgical technique in oral cancer resection.

OBJECTIVE: Resection of posteriorly located oral squamous cell carcinomas (OSCCs) remains challenging for head and neck surgeons. However, several surgical techniques, such as lip and mandibular splitting, as well as submental "visor drop-down" of intraoral soft tissues, have been proposed for this purpose. Merrick et al. suggested that a pedicled genial drop-down surgical approach should be used to resect dorsally located OSCCs. Our study investigated patient outcomes following this surgical procedure, as no previous study has analyzed long-term follow-up data. MATERIAL AND METHODS: All patients who underwent surgery using the pedicled genial "visor drop-down" approach at the Maxillofacial Department of the University Hospital Giessen in Germany between 1995 and 2010 were included in this study. In addition, our study required that patients diagnosed with OSCC had no history of other intraoral malignancy or any other form of malignancy. A preliminary questionnaire was completed for each patient based on retrospective analysis of available data from medical reports. RESULTS: A total of 51 patients fulfilled all inclusion and exclusion criteria and were evaluated retrospectively. In total, 32 patients were excluded from the study due to OSCC recurrence or acquisition of a different type of malignancy. The male to female distribution of patients in our study was 30 to 21 (58.8%-41.2%), and the mean ages of female and male patients were 57.7 (SD 14.3) and 55.7 (SD 14.4) years, respectively. Approximately 76.5% of tumors were located along the dorsal aspect of the tongue, 17.6% were along the floor of the mouth, 3.9% were in the dorsal mandibular region, and 1.9% were in the dorsal palatal region. The mean overall operation time was 6.25 h, and 28 patients received microvascular flaps for reconstruction. Results of final histopathological examination suggested primary in-sano resection of the tumor in 84.3% of patients. Overall, the 5-year postoperative survival rate was 52.9%; 31.3% of the patient cohort was not followed up for the full 5-year period. In addition, 15.7% of the patients included in our study died during the study period. Unimpaired functional outcomes in terms of swallowing and speech were observed in 86.3% of patients. CONCLUSION: The pedicled genial "visor drop-down" approach, also known as the ex corpore linguae, is a suitable method for the radical resection of dorsally located OSCCs, with a promising 5-year survival rate and satisfactory postoperative oral function.

Comparison between flat-panel volume computed tomography and histologic assessments of bone invasion of maxillofacial tumors: utility of an instantaneous radiologic diagnostic tool.

OBJECTIVE: The aim of this study was to compare the accuracy of flat-panel volume computed tomography (fpVCT) to histopathologic evaluation of excised tumors of the jaws in the detection of the degree of tumor infiltration, the presence of tumor at the resection margins, and the sizes of lesions. STUDY DESIGN: This preliminary study included 47 patients undergoing jaw resection for tumor invasion of bone. The specimens were examined by histology and 3-dimensional fpVCT, and the parameters of bone infiltration, resection margins, and tumor size were determined. RESULTS: In 95.7% of cases, the fpVCT results of tumorous bone infiltration were in accordance with the histologic findings. An examination of the resection margins showed 100% concordance between the 2 methods, and all resection margins were found to be clear in both fpVCT and the histologic examination. Identical pathologic and nonpathologic results were seen with the use of both diagnostic methods. Radiologic estimates of tumor size were larger than histologic measurements in the case of small tumors but the true sizes of the larger lesions were underestimated. CONCLUSIONS: The intraoperative diagnostic gap can be closed by using fpVCT to investigate bone destruction, allowing one-step resections and reconstructions to become more reliable.

Replantation of a displaced incisor in a boy with a cleft lip and alveolus: a case report.

BACKGROUND: Tooth replantation after traumatic avulsion or transplantation is a challenge in oral surgery. A special method named auto-alloplastic replantation, in which a titanium post is used after extraoral endodontic treatment, combines several advantages. The treatment is performed in one step with no further endodontic intervention, no wide root canal instrumentation, no recontamination, and reduced endodontic infection. This is the first report on replantation of an ectopic tooth in a patient with a cleft lip and alveolus using this method. CASE PRESENTATION: This case report presents the treatment of a 13-year-old white boy with a cleft lip and alveolus who had an ectopic incisor in the cleft region. His rehabilitation was performed by a tooth transposition using the auto-alloplastic replantation technique. After preparation of the displaced incisor from the vestibule, extraoral endodontic treatment followed using a titanium post prior to replantation in a newly formed socket. In the follow-up, the tooth is still in place and functioning after 2 years. CONCLUSIONS: This method can be used to bridge the years while a patient is young and jaw growth is incomplete until bone augmentation and implantation can be performed. The tooth will preserve the remaining alveolar ridge and help the adolescent psychologically.

Complications in helmet therapy.

OBJECTIVE: Helmet therapy is an established method to correct positional head deformity in early infancy. Side effects such as skin erythema or pressure sores are well known for helmet therapy, but not yet adequately discussed in current literature. PATIENTS AND METHODS: Retrospectively, all patient-sheets of infants treated by individual orthotic therapy in the years 2007 and 2008 were sighted and complications were noted. Complications were classified and sorted by their frequency and descriptive statistics was performed. The treatment to cure complications was recorded and success in complication control was analysed. RESULTS: Altogether, 410 patients fit the inclusion criteria for this investigation. Complications were apportioned into pressure sores, local ethanol erythema, unsatisfying fit of the helmet or loss of the helmet, skin infection, failed correction of head deformity, and subcutaneous abscess in one case. Non-compliance is to be noticed in a high number, but mainly occurred towards the end of the treatment period. CONCLUSION: Helmet therapy represents a safe therapeutic tool for the correction of positional cranial deformity. Complications have to be clear in number and severity for parental elucidation. Most complications can easily be avoided or eliminated by proper instruction of the parents.

Comparison of miniplate versus lag-screw osteosynthesis for fractures of the mandibular angle.

OBJECTIVES: Treating mandibular angle fractures is common in maxillofacial surgery. The aim of this study was to compare lag screw fixation and miniplates. STUDY DESIGN: This retrospective investigation compared patients treated with miniplates (n = 24) and with lag screws (n = 21). Inclusion criteria were a solitary angle fracture without comminution or other reasons for load-bearing osteosynthesis. The main parameters for the outcome analysis were fracture gaps at 4 defined measuring points on postoperative radiography. Postsurgical complications were recorded. RESULTS: Fracture gaps measured in panoramic radiographs differed significantly between the lag-screw (average 0.56 mm) group and the group using 1 miniplate (average 0.85 mm) and 2 miniplates (1.40 mm). Miniplate fixation resulted in a wider fracture gap, especially in the region of the lower margin of the mandible. CONCLUSION: Lag-screw fixation demonstrated smaller fracture gaps compared with miniplate fixation.

Microsurgical reconstruction of the head and neck--current practice of maxillofacial units in Germany, Austria, and Switzerland.

Refinement in microvascular reconstructive techniques over the last 30 years has enabled an increasing number of patients to be rehabilitated for both functional and aesthetic reasons. The purpose of this study was to evaluate different microsurgical practice, including perioperative management, in Germany, Austria, and Switzerland. The DÖSAK collaborative group for Microsurgical Reconstruction developed a detailed questionnaire which was circulated to units in the three countries. The current practice of the departments was evaluated. Thirty-eight questionnaires were completed resulting in a 47.5% response rate. A considerable variation in the number of microsurgical reconstructions per year was noted. In relation to the timing of bony reconstruction, 10 hospitals did reconstructions primarily (26.3%), 19 secondarily (50%) and 9 (23.7%) hospitals used both concepts. In the postoperative course, 15.8% of hospitals use inhibitors of platelet aggregation, most hospitals use low molecular heparin (52.6%) or other heparin products (44.7%). This survey shows variation in the performance, management, and care of microsurgical reconstructions of patients. This is due in part to the microvascular surgeons available in the unit but it is also due to different types of hospitals where various types of care can be performed in these patients needing special perioperative care.