Osteosclerotic bone dysplasia (melorheostosis) of the mandible.

Melorheostosis is a linear bone dysplasia of unknown origin that may be associated with soft-tissue alterations. Although any part of the skeleton can be affected, this condition is rarely observed in the craniofacial region. Only seven cases of melorheostosis with craniofacial involvement have been reported and cranial manifestation only is even rarer. To the authors' knowledge, manifestation in the mandible only has not yet been documented. A patient with isolated melorheostosis of the mandible with characteristic symptomatic bone pain is presented. The clinical, radiological and histological findings are described and possible therapeutic options are discussed.

[Long-term results following reconstruction of maxillary sinus wall defects with titanium micro-mesh: a CT-based study]. / CT-kontrollierte Spätergebnisse nach Defektdeckung im Kieferhöhlenbereich mit dem Mikrotitangitter.

BACKGROUND: Extensive bony defects of maxillary sinus walls have to be reconstructed to prevent long-term complications. Different autogenous, allogeneic, and alloplastic materials, e.g., titanium mesh, are used for reconstruction. MATERIAL AND METHODS: In 26 patients large defects of the facial and laterodorsal walls of the maxillary sinus were reconstructed using titanium micro-mesh. The mean follow-up period was 49 months (5 months-10 years). All patients were examined with computed tomography applying multiplanar reconstruction techniques and three-dimensional volume rendering. RESULTS: In the CT scans stable scars of 3-6 mm thickness could be found on the antral surfaces of all titanium meshes bridging the defects. In 70% of the patients the volume of the reconstructed maxillary sinus reached 80-100% of the contralateral side. Volume losses were not due to poor adaptation of the titanium mesh but were caused by thickening of maxillary sinus walls or traumatic malpositions. In 77% of the patients ventilation of the maxillary sinus was undisturbed. After mesh removal neither facial contour disturbances nor changes of sinus volume were noted. Soft tissue invasion into the sinus was prevented by a stable scar which had formed underneath the mesh. Three-dimensional reconstruction confirmed symmetrical facial contours in all patients. CONCLUSIONS: The titanium micro-mesh offers a simple and effective alternative to autogenous tissue with stable long-term results for reconstruction of large maxillary sinus wall defects.

Diagnosis and initial management of laryngotracheal injuries associated with facial fractures.

INTRODUCTION: Laryngotracheal injuries are uncommon with an estimated incidence of 1 per thousand (1-6 patients per 15000-42500 trauma victims). They may be associated with fractures of the facial skeleton. Their symptoms are variable ranging from obvious airway obstruction to minor or almost missing symptoms. Early diagnosis and proper initial management may sometimes be difficult or delayed. PATIENTS: Three patients with maxillofacial fractures and concomitant laryngotracheal injuries are presented. The diagnostic procedures used and the management of these injuries are reported. DISCUSSION AND CONCLUSION: Due to their low incidence and their hidden nature laryngotracheal injuries may pose diagnostic problems, especially in polytraumatized or intubated patients. Subcutaneous emphysema is the chief clinical sign. Fibreoptic endoscopy is the most important and informative diagnostic examination. Radiographic evaluation by CT scan provides additional information about the extent of the injury and the indication for surgery. A coordinated team approach is necessary for proper management of these injuries.

Long-term results following miniplate eminoplasty for the treatment of recurrent dislocation and habitual luxation of the temporomandibular joint.

Twenty patients with recurrent mandibular dislocation or habitual luxation of the temporomandibular joint who underwent miniplate eminoplasty between 1994 and 1999 are presented. The follow-up period ranged from 2 to 7 years. Clinical examination showed no evidence of recurrent dislocation. No significant reduction of normal mouth opening was found one year postoperatively. The pain level, self-estimated by the patients on a scale from 0 to 10, decreased significantly from 4.1 preoperatively to 1.2 one year postoperatively. In seven patients fractures of the miniplates occurred 3 to 7 years after eminioplasty (two bilateral fractures, five unilateral fractures). Due to the high incidence of plate fractures miniplate eminoplasty cannot be recommended as the surgical treatment of choice for recurrent dislocation or habitual luxation of the mandible, although the recurrence rate is low and pain is reduced considerably.

Long-term results following reconstruction of craniofacial defects with titanium micro-mesh systems.

INTRODUCTION: Reconstruction of craniofacial defects can be carried out with autogenous tissue (calvarium, rib, iliac crest), allogeneic implants (AAA-bone, lyophilized cartilage) or alloplastic material (methacrylate, hydroxyapatite, titanium implants and mesh systems). Selection of the implant material used for reconstruction is still controversial. MATERIAL AND METHODS: At the Department of Oral and Maxillofacial Surgery, Kantonsspital Luzern, 20 patients with defects in the craniofacial and/or orbito-ethmoidal region have been treated using titanium micro-mesh between 1991 and 1998. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh, have been used for bony reconstruction in non load-bearing areas. The defects were caused by acute trauma, osteomyelitis of the frontal bone and previous operations. The titanium micro-mesh was used with the following indications: (1) immediate reconstruction in the primary treatment of comminuted fractures with bone loss in non load-bearing areas, (2) treatment of contour irregularities (possibly in combination with bone or cartilage grafts). All patients were followed up clinically and radiographically at quarterly intervals for a year. RESULTS: No wound infections, exposures or loss of the mesh have been observed. Long-term stability of the reconstructions was excellent. When walls of the paranasal sinuses were reconstructed complete repneumatisation took place. CONCLUSIONS: Advantages of this reconstructive technique are: (1) universal applicability (craniofacial, orbital, sinus defects, comminuted fractures); (2) stable 3-D reconstruction of complex anatomic structures were easily performed; (3) immediate availability with no donor site morbidity as bone or cartilage grafts were not necessary; (4) combination with bone or cartilage grafts is possible; and (5) very low susceptibility to infection.

Results of a modified staircase technique for reconstruction of the lower lip.

Our experience with a modified staircase technique for closure of lower lip defects is reported. The procedure is based on the original technique of Johanson et al. (1974). However, the integrity of the orbicularis oris muscle is respected when advancing lower lip flaps. Twenty patients with squamous cell carcinoma of the lower lip were treated using this modified reconstruction technique. The size of the defects ranged from 30-60% of lower lip width. No recurrences were observed during a 3-year to 5-year follow-up. All patients showed symmetrical lip movement, an adequate buccal sulcus and intact labial commissures. No symptomatic microstomia was seen and the aesthetic results were excellent. The surgical technique is explained in detail. Four types of flap are presented according to the size and location of lip defects. Lower lip defects up to 60% of the lip width can be closed easily, with good aesthetic results. The technique is also applicable to upper lip reconstruction.

A new therapeutic concept for the treatment of cystic hygroma.

A new therapeutic concept for the treatment of cystic lymphangioma (cystic hygroma) is presented. It consists of intralesional injection of triamcinolone (10 mg/kg) and surgical excision at a second stage if necessary. Four cases are presented to demonstrate the clinical application of this new therapeutic modality. Only in one case it was necessary to perform surgical excision as a second stage procedure, whereas three cases were successfully managed by intralesional injection of triamcinolone alone.

Recurrence of a solitary bone cyst of the mandibular condyle in a bone graft. A case report.

The recurrence of a solitary bone cyst of the mandibular condyle in a costochondral bone graft is reported. A solitary bone cyst of the right condylar head and neck of a 10-year-old boy was treated by total resection and immediate reconstruction with a costochondral bone graft. Two years after the first operation, a recurrence of the solitary bone cyst within the bone graft was noted. An open treatment was performed. A review of the literature on solitary bone cysts and recurrences of solitary bone cysts shows that the case reported is unique. Possible reasons for the recurrence are discussed.