[Abnormalities of the maxillary sinus in type 1 neurofibromatosis]. / Fehlbildungen der Kieferhöhle bei Neurofibromatose Typ 1.

AIM: The aim of this study was to determine the malformations of the maxillary sinus in neurofibromatosis type 1 patients (NF1). MATERIAL AND METHODS: Twenty-two patients with NF1 were investigated clinically and radiologically: 11 had an unilateral trigeminal plexiform neurofibroma and 11 had multiple cutaneous neurofibromas. The histological type of NF was ascertained in all cases following tumor resections. The malformation of the maxillary sinus was assessed on plain radiographs and computed or magnetic resonance tomograms. Intraindividual side comparison was used to judge the size of the sinus and its position in the midface. RESULTS: In patients with cutaneous neurofibromas the maxillary sinus appeared symmetrical in size and position. The pneumatization of the sinus had no abnormalities on the radiographs. Malformations of the maxillary sinus were restricted to plexiform neurofibromas. On the side affected by a plexiform NF, the sinus appeared hypoplastic and caudally displaced due to an enlarged ipsilateral orbit. The expansion of the sinus to the lateral side was impaired, obviously due to tumor masses. Consecutively, the alveolar process of the affected side was also displaced leading to a complex malocclusion. DISCUSSION: Malformations of the face are frequently presented as case reports in the literature. Emphasis is given to the elephantiasis-like tumor growth of the face in certain patients with NF1. The underlying pathology has not yet been fully understood. This report provides evidence that in the midfacial region the overgrowth is predominantly caused by the plexiform neurofibroma itself and that the bones can even be hypoplastic and show scoliosis-like malformation compared to the nonaffected side. These findings are relevant when debulking procedures of the face are planned for NF1 patients.

[Stability of the mandible after high sagittal supraforaminal osteotomy. Roentgen cephalometric study]. / Stabilität des Unterkiefers nach hoher sagittaler supraforaminaler Osteotomie. Röntgenkephalometrische Untersuchung.

AIM OF THE STUDY: The aim of this study was to investigate the stability achieved with high sagittal supraforaminal osteotomy (HSSO) for setback and advancement procedures of the mandibular ramus. MATERIAL AND METHODS: Computerized cephalometric X-rays of 102 patients, taken at four different times during treatment, were evaluated. RESULTS: The mean postoperative relapse was 20%, depending on the extent of the surgical correction (correlation coefficient: -0.68). Mandibular setback gave more stability than mandibular advancement. The type of osteosynthesis (positional screw combined with miniplate osteosynthesis or intermaxillary fixation) did not influence the stability. Unimaxillary osteotomies were more stable than bimaxillary procedures (p < 0.001).

Prognosis of facial growth in patients with unilateral complete clefts of the lip, alveolus and palate.

AIM: Unfavourable facial growth in patients with cleft lip, alveolus, and palate may occur during puberty. Usually this development is not predictable in a young patient. The aim of the present study was to find an individual growth prediction at an early age that would allow us to decide whether later orthognathic surgery should be included in the treatment plan. MATERIAL AND METHODS: Lateral cephalograms of 41 patients with unilateral clefts of lip, alveolus and palate (uCLAP) with observation intervals of 4 years were computerized, correlations between the variables of the first and second radiograph were calculated and regression equations were established. RESULTS: The skeletal change of the intermaxillary relationship can be explained purely by the lack of midfacial growth. An individual prediction of the angle SNA over a period of 4 years is possible with a correlation coefficient of 0.95. Additional predictions for SNB, Holdaway angle and the index of anterior facial height proportions are demonstrated. CONCLUSION: The prediction procedure elaborated in this paper facilitates the decision at the age of 12 years already, whether or not orthodontic occlusal treatment has been successfully completed at an early age. The alternative is to limit orthodontic treatment to the simple alignment of the two dental arches independently of their intermaxillary relation, and then to correct the facial skeleton and the dental occlusion simultaneously by combining surgical and orthodontic treatment after the completion of growth.

[Interdisciplinary treatment of a 3 1/2-year-old child with extensive ameloblastic fibro-odontoma. Case report and follow-up documentation over 21 1/2 years]. / Interdisziplinäre Behandlung eines 3 1/2-jährigen Kindes mit ausgedehntem ameloblastischen Fibroodontom. Fallbericht mit Verlaufsdokumentation über 21 1/2 Jahre.

BACKGROUND: This report deals with a 3 1/2 year old patient with an ameloblastic fibro-odontoma of the frontal part and left corpus of the mandible. The tumor had become symptomatic 2 months prior to admittance by a local, painless swelling of the bone and the mobility of teeth. The initial findings and the progress of the disease led to the preliminary diagnosis of a malignant mesenchymal tumor. Its extent and aggressive growth prompted a continuity resection of the mandible and immediate reconstruction with a costal autograft. The definitive histological diagnosis was an ameloblastic fibro-odontoma. The patient was followed up over a period of 21 1/2 years. THERAPY: Further treatment included an iliac crest onlay graft, followed by autotransplantation of three third molars into both transplants. Two of the wisdom teeth had to be replaced by dental implants because of ankylosis and infra-occlusal positioning. The prosthetic rehabilitation was carried out by a bar attachment and a partial cover denture. This report supports the concept of the interdisciplinary treatment of patients with tumors that occur during the growth phase.

[Vertical-sagittal "peninsular" osteotomy of the body of the mandible: a concept for forward displacement and anterior rotation of the mandible]. / Die vertikosagittale Halbinselosteotomie des Unterkieferkörpers: ein Konzept zur Vorverlagerung und anterioren Rotation der Mandibula.

A new mandibular osteotomy is presented for special indications of severe mandibular retrognathia combined with a high mandibular plane angle, a dentoalveolar compensation and an open bite. The procedure allows an anterior rotation of the mandible with a maximum skeletal and minimum dental advancement.