[10 years of outpatient dental surgery using endotracheal anesthesia. Research report from dental practice]. / 10 Jahre ambulante zahnärztliche Chirurgie in Intubationsnarkose. Ein Erfahrungsbericht aus der Praxis.

For certain groups of patients, e.g. handicapped people, children or extremely anxious adults, dental surgery with local anesthesia is not possible and hospitalisation is not desirable. In order to provide outpatient treatment using endotracheal anesthesia, a successful practice-oriented concept is presented, involving cooperation between the dental surgeon and an anesthetist in private practices. In the past 10 years, 4205 patients have received outpatient treatment according to this concept.

Sagittal ramus osteotomy with tandem screw fixation. Technique and results.

Spiessl's traction screw osteosynthesis with compression of the cut surfaces can lead to dislocation of the condyles and crushing of the mandibular nerve in cases of sagittal ramus osteotomy. Such disadvantages can be minimized by joining the bony segments with tandem screws with threads in both parts of the bone. This technique avoids compression at the cut surfaces and permits contact and distance fixing by screws which are adapted to the course of the split. Since 1981, 132 mandibular osteotomies have been performed; they have proved to be adequately stable. The operative technique, the instruments used and the results of the follow-up are described. In order to evaluate the results, an index, namely the joint, relapse and sensation index is proposed for classification. This index can readily be used in practice.

A contribution on revisional and drainage of the frontal sinus by osteoplastic operation.

Osteoplasty of the frontal sinus (bone lid operation) consists of the excision of a piece of bone from the anterior surface of the frontal sinus. A circular saw with an extremely fine saw blade is used. The ensuing cut is thus extremely narrow and the excised bone lid can be reimplanted exactly, flush with the neighbouring bone from which it was excised. Primary healing takes place without the development of intermediary connective or cartilagenous tissue. Only circumscribed pathological lesions of the diseased mucous membrane are removed. Otherwise, healing is promoted by improved drainage and ventilation. For this purpose a channel leading to the nose is created. In order to ensure that this channel stays open it is lined by dura or mucous membrane. The latter is put into place and fixed by an inflatable balloon acting as a tampon. The balloon is traversed by a tube which guarantees adequate drainage and ventilation during healing of the lining material in the channel.

[Surgery of the odontogenic-diseased maxillary sinus. Technic and experiences with the bone cover method]. / Chirurgie der odontogen erkrankten Kieferhöhle. Technik und Erfahrungen mit der Knochendeckel-Methode.

In the well known extranasal surgical methods described by Caldwell-Luc and Denker, the opening of the bone of the facial wall created during surgery remains open. Scar tissue contract around the infraorbital nerve, fistulae, invasion of soft cheek tissue through the bone defect, and closure of the drainage window may result. The "Bone Lid" method avoids these disadvantages. During osteoplastic surgery of the maxillary sinus routinely performed by the author in more than 700 cases since 1973 a piece of bone (the "Bone Lid") including the attached mucosa is cut out of the anterior wall of the maxillary sinus in such a fashion that it serves perfectly to close the opening again as a free graft at the end of the operation. This procedure simplifies treatment of circumscribed changes in the mucosa, and facilitates precise creation of a drainage window essential for the healing of inflamed mucosa of the maxillary sinus. Coverage of the basal bony lesion initially present at the site of this window by a flap of muco-periosteum is simplified and secured by packing using an inflatable balloon. This stops bleeding reliably in the area of the inferior turbinate and around the window and simultaneously assures ventilation and drainage of the maxillary sinus during the healing period. The techniques used and the experience gained with this method are reported in detail.

Osteoplastic surgery of the sinus maxillaris--the "bone lid"-method.

During osteoplastic surgery of the maxillary sinus the surgical defect in the lateral wall of the maxillary sinus is re-closed by means of free reimplantation of the "bone lid", which had been temporarily removed together with the integral mucosa, during creation of the access. This "bone lid"-method has so far been employed successfully in approx. 600 cases. For covering the basal area of the bone lesion of the drainage window to the lower nasal passage, created during surgery by means of a flap of mucosa and periosteum, a novel type of tamponade using an inflatable balloon was tested. The following pages report on the surgical techniques employed and on systematic follow-up investigations.

Investigation of the vascular effect of newer local anesthetics and vasoconstrictors.

Changes in blood flow can be measured with the aid of infrared thermography and make possible a comparative assessment of the vascular effect of vasoconstrictors and local anesthetics. With Adrenalin, vasoconstriction sets in immediately following infiltration; with POR-8, a sufficient vasoconstriction is observed only after 10 to 15 minutes. In both products, ischemia subsides after 60 minutes. Adrenalin then reverses the reaction in reactive hyperemia after 150 minutes, while the tissue infiltrated with POR-8 returns to normal ater 120 minutes. When combining a local anesthetic with a vasoconstrictor, the intrinsic vascular effect has to be considered. We experimentally proved that Novocain (procaine), Hostacain (butanilicaine), and on a lower scale Xylocaine (lignocaine) have a vasodilator effect. Citanest (prilocaine) demonstrates no vasodilatory effect. Carbocaine (mepivacaine) produces a mild vasoconstriction.

[Postoperative complications after Caldwell-Luc radical surgery and possibilities of surgical therapy]. / Postoperative Beschwerden nach Caldwell-Luc-Radikaloperation und Möglichkeiten der chirurgischen Therapie.

The causes for and the avoidance of postoperative complaints following operations on the maxillary sinus were discussed. Additional surgery following the Caldwell-Luc operation is meaningful only in connection with the secondary coverage of defects of the facial wall of the maxillary sinus. Dura is used for coverage. Mucosa from the palate, which is positioned with a new balloon tamponade, is used for larger defects.