[Components of antibacterial and fibrinolytic activity of human saliva in normal and disordered wound healing]. / Komponenten der antibakteriellen und der fibrinolytischen Aktivität des menschlichen Gesamtspeichels bei normaler und gestörter Wundheilung.

Following oral surgery, there are sometimes disturbances in wound healing. It was the aim of this investigation to look for relationships between the composition of saliva and disturbed wound healing. Resting as well as stimulated fasting whole saliva was collected from 96 patients (19 to 53 years of age) prior to oral surgery. Flow rate, pH, standard bicarbonate, total buffer bases, peroxidase, lysozyme, thiocyanate, secretory immunoglobulin A, lactoferrin, total protein, tissue type plasminogen activator, and plasminogen activator inhibitor were determined. The salivary data of eight patients who suffered from disturbed wound healing were compared to the data of 20 randomly selected patients with normal wound healing. Patients with disturbed wound healing revealed increased activities and secretion rates for peroxidase in resting saliva. In stimulated saliva, decreased secretion rates for thiocyanate and total protein were found. Not a single salivary factor was able to discriminate both groups of patients with sufficient accuracy, but with a combination of tissue type plasminogen activator, peroxidase, plus secretory immunoglobulin A measurements from resting whole saliva a clearly improved and acceptable discrimination of the two patient groups was possible. A discriminant function including six salivary factors could be used to completely separate both groups.

Development and clinical application of the total temporomandibular joint (T.M.J.) endoprosthesis.

In the course of designing a T.M.J. endoprosthesis we performed biomechanical analysis for testing the stress relationships of the condyle. The photoelastic stress analysis showed that the compressive force in the glenoid fossa varied from 90 to 270 N. The experiments showed also that the selected shape of the prosthetic condyle absorbs the forces of the mandible in a way similar to the natural condylar process. Therefore, we developed a total T.M.J. endoprosthesis. The condyle is made of a Titanium--alloy, the socket of high density polyethylene. From 1978 to 1987 we implanted 25 endoprostheses in 18 patients. The mean age of the patients at the time of the operations was 33 years. Indications for the implantation of total T.M.J. endoprostheses in adults are ankylosis, tumours, multiple fractures and, after all possibilities of conservative treatment have been exhausted, severe deforming arthropathy.

[Experimental animal studies on the possibilities of bone reconstruction using preserved allogenic material]. / Tierexperimentelle Untersuchungen zu Möglichkeiten der Knochenrekonstruktion durch allogenes konserviertes Material.

Preserved allogeneic bone is possibly to repair the permanent shortness in autogeneic bone tissue in clinical practice. Complications as to the incorporation were observed after using lyophilised allogeneic implants. These were attributes to immunologic defense reaction. Demineralised bone caused a more intensive bone regeneration histologically than lyophilised bone. The clinical test of a superficial demineralised lyophilised preserved bone with osteoinductive potency and structural stability is recommended.

[Nerve dysfunctions following mandibular surgery on an outpatient basis]. / Funktionsstörungen von Nerven nach ambulanten operativen Eingriffen am Unterkiefer.

The extent and reversibility of any functional impairment of the inferior alveolar and lingual nerves are important criteria for establishing the indication for microsurgical reconstruction. Postoperative dysfunctions were observed by 31.4% of 384 patients operated in the posterior segment of the lower jaw. In more than half of these cases the dysfunctions disappeared after 8 weeks. After 6 months the remission tendency was very slight. After a mean 4 years following operation 6% of the patients reported subjective disorders. Impaired functions were demonstrated objectively in 11.4% of the cases. The phenomenon of adaptation seems to play an important part. Only 2 patients would have desired further surgical treatment.

Total condylar prosthesis for alloplastic jaw articulation replacement.

Increasing attention has been paid to the development and testing of endoprostheses for the mandibular joint during the past few years. Theoretical considerations and knowledge of the compressive forces acting on this joint during rotational movements of the jaw induced us to concentrate our efforts on complete artificial joints right from the start. The clinical results obtained with individually-produced total endoprostheses made of Wisil for the mandibular joint are described. So far, 9 such artificial joints have been implanted in 6 patients. The post-operative assessment of jaw function by the patients, the clinical findings, tooth load measurements and jaw tracing were used to estimate the success of treatment. A total mandibular joint prosthesis which is completely different in regard both to material and shape of the artificial condyle, based on the experience gained so far, is presented.

[Pressure load of the temporomandibular joint--an experimental study]. / Zur Druckbelastung des Kiefergelenks--eine experimentelle Studie.

In the connection with the pathogenesis and therapy of the diseases of the temporo- mandibulare joint it is of interest, if and in what kind of extent the joint is pressure burden. For examining this problem photoelastic investigations on a lower jaw model were performed. According to the opening angle, burden height and attack point of the burden, pressure strengths of 90-270 N were ascertained on the proc. condylaris , when a pure rotation-movement was performed.

Reconstructive surgery of the mandible by means of metal plates.

Reconstructive operations for defects of the mandible arising as a consequence of tumour operations and after trauma, add considerably to the improvement of aesthetics and masticatory function. Here, we have found methods of stable osteosynthesis for transplant fixation to be very useful. The most favourable results were achieved by the application of special mandibular plates. Only homologous spongy bone of the crest of filium was used as the transplant material. The primary temporary bridging of the defect by alloplastic material after mandibular resection in cancer therapy proved very advantageous. The results of treatment permit practical conclusions.

[The eosinophilic granuloma in the jaw region]. / Das eosinophile Granulom im Kieferbereich.

The eosinophilic granuloma is nowadays generally considered as a reticulosis associated with secondary lipoid storage. It occurs very rarely in the jaws. During a period of 10 years, we had but 5 inpatients with a central, monostotic, eosinophilic granuloma. Diagnostic difficulties result from atypical clinical, radiological and paraclinical findings. The diagnosis can be confirmed solely by histologic methods. In agreement with most of the other authors we are of the opinion that the radiological treatment (if necessary, in combination with surgical measures) is optimal.

[Maxillofacial fractures in children]. / Gesichtsschädelfrakturen im Kindesalter

With regard to aetiology, location and therapy, fractures of the facial skeleton in childhood occupy a special position due to the anatomico-morphologic pecularities of the infantile skull. To verify this statement, the author analysed the medical records of 58 patients with fractures of the facial skeleton, having an age range from 1 to 14 years. The fracture incidence was 9.3% as related to the total number of fractures of the facial skeleton. Traffic accidents (41%) were the main cause of these injuries. Clinical and radiographic follow-up examinations of 37 patients (after an average period of 5 years) revealed: jaw or tooth anomalies in 56.7%, anomalous radiographic findings concerning the condyloid process in 14.7%, and anomalous radiographic findings concerning the teeth in the former fracture line in 27%. Conclusions are drawn from these results as to therapeutical management.

[Results in the treatment of lateral middle face fractures]. / Behandlungsergebnisse lateraler Mittelgesichtsfrakturen

During 1960-1973, 90 patients with lateral midface fractures were treated at the Rostock University Clinic and Policlinic of Stomatology. 68 patients underwent a clinical and radiographic follow-up examination. The intra-antral operation methods had yielded better results than the extra-oral treatments. To reduce late sequelae which are observed also in patients for whom a surgical approach had not been indicated, the authors recommend an exact diagnostic evaluation of the lateral midface fractures and a close interdisciplinary co-operation of the oral surgeon and the ophthalmologist.