New and innovative biomaterials, techniques and therapy concepts: Biologization in maxillofacial surgery, oral surgery and dentistry is in full swing. PRF, PRGF, PRP, blood plasma-stabilized augmentations, supplementation of micronutrients and vitamins - what opportunities do such "biological" approaches actually offer? We introduce them here.

Biomaterials of natural origin have recently gained increasing attention in the field of dental implantology. The requirements for such materials, however, are very high. In addition to high clinical efficiency in tissue regeneration, wound healing should be demonstrably positively influenced. The translational division for regenerative orofacial medicine of the Clinic and Polyclinic for Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf (UKE) is examining this research topic by investigating which innovative treatment methods for the reconstruction of bone defects or for augmentative procedures can be applied in the future or are already being applied in the field of oral and maxillofacial surgery.

Regenerative treatment of peri-implantitis bone defects with a combination of autologous bone and a demineralized xenogenic bone graft: a series of 36 defects.

AIM: As the treatment of peri-implantitis-induced bone loss is still a problem, we studied the regenerative treatment of these defects with a mix of autologous bone and a new type of bone graft substitute (demineralized xenogenic bone graft) including growth factors. MATERIAL AND METHODS: In a prospective manner, 36 cases of peri-implantitis-induced bone loss (depth >4 mm) in 22 patients were followed for 1 year. After resolving the acute infection by local rinsing, granulation tissue was removed. The implants were decontaminated with etching gel and the defects were filled with autologous bone mixed 1:1 with a xenogenic bone graft. The prosthetic reconstructions did not have to be removed. Values of probing depths as well as bone defects were analyzed. RESULTS: The radiologic evaluation of the bone defects after regenerative treatment revealed a mean reduction of 3.5 mm comparing the values from 5.1 mm prior to surgery to 1.6 mm 1 year after treatment. Average reduction of the probing depth was 4 mm. The remaining bone defects were larger than 3 mm in 4 out of 36 implants 1 year after treatment. Probing depths of more than 4 mm were present in seven implants. CONCLUSION: Within the limits of the study, we conclude that for bone defects larger than 4 mm in case of peri-implantitis, this single surgical intervention provided a reliable method to reduce bone defects.

Nasal shape and gender of the observer: implications for rhinoplasty.

BACKGROUND: In a previous study we focused on gender specific nasal shapes. The aim of this study was to evaluate if preferences in nasal shape are also dependent on the gender of the observer. METHODS: Stratified on the basis of each photographed subject's (n=311) own evaluation, female and male composite pictures of "average" (n=128, each), "optimal" (n=16, each) and "most unpleasant" (n=8, each) noses were created in a previous study. These composites were assessed by 308 independent female and male judges using a visual analogue scale. RESULTS: On average, female judges were found to accord significantly higher ratings of attractiveness as compared to male judges for the composite images independent of the gender of the person shown (p=0.020). The difference was greatest when assessing most unpleasant male composites (p<0.003) but was not apparent when assessing "optimal" female and "optimal" male noses. Despite this, women displayed the same preferences for "optimal" and "average" noses as compared to the "most unpleasant" noses. In assessing their own noses, women were significantly less satisfied with their appearance in general (p=0.001) as compared to men. CONCLUSIONS: In comparison to men, women are more critical in assessing the appearance of their own nose as opposed to the noses of other people. The implications of this for rhinoplasty, so far as considering the degree of influence of the gender of a person assessing a prospective patient's nose remains a matter of conjecture.

Gender and nasal shape: measures for rhinoplasty.

BACKGROUND: Gender-specific nasal shapes are recommended for rhinoplasty. This study was conducted to clarify whether there truly are gender-related differences and to determine optimal nasal shapes in a Caucasian population. METHODS: The authors created female and male composite photographs of "average" (n = 128 each), "optimal" (n = 16 each), and "most unpleasant" (n = 8 each) noses stratified on the basis of each photographed subject's (n = 311) own evaluation of the attractiveness of her or his nose, using a visual analogue scale. These composites were also assessed by 308 independent judges. RESULTS: Optimal female noses showed a horizontally and vertically lower nasion and were concave to straight in profile as compared with optimal male noses, which had a vertically and horizontally higher nasion and a straight profile. A supratip break was not found in any of the composites. At least half of the judges rated average and optimal male composite noses as female. A significant majority mistook the composite of the most unpleasant female noses as male (frontal view, 62.0 percent; lateral view, 72.4 percent; p < 0.001). Optimal and average female and male noses were found to be independently significantly more attractive than the most unpleasant ones (p < 0.001, n = 308 judges). Women and men with a straight or concave profile were significantly (p = 0.017 and p = 0.006, respectively) more satisfied with the appearance of their nose than those with nasal humps. CONCLUSIONS: Gender-related differences in nasal shape appear to be subtle, with nasion position being one of the main factors. A nasal hump and a supratip break are not desirable.

Facial attractiveness: visual impact of symmetry increases significantly towards the midline.

Symmetry is thought to be a major prerequisite for an attractive face. Many faces are not symmetric, yet are still regarded as beautiful. What role, then, does asymmetry play in the perception of beauty? We studied the assessment of computer-manipulated images by independent judges (n = 200-250): part A: nevi located at different positions; part B: standardized changes of the orbital region. The results showed that slight lateral orbital and facial asymmetry does not impair attractiveness at all and that asymmetries close to the midline are significantly less attractive than those affecting the lateral aspect of the face (P < 0.001). A single nevus which is located laterally on the face is significantly more attractive than a nevus close to the midline (P < 0.001). Faces with a completely symmetric bilateral pair of nevi in the same lateral positions (perceived as attractive when alone), received the worst ratings (P < 0.001). Symmetry is a characteristic of the attractive face, but there are exceptions to the rule. Under certain conditions symmetry can be completely unattractive. The visual impact of symmetry on the perception of beauty increases significantly when approaching the midline.

Long-term recurrence rate of pleomorphic adenoma and postoperative facial nerve paresis (in parotid surgery).

BACKGROUND: The purpose of this study was to evaluate recurrence rates and comorbidity in patients with pleomorphic adenomas of patients after superficial and total conservative parotidectomy. PATIENTS AND METHODS: Localization of pleomorphic adenomas, age, sex distribution and facial nerve function of 73 patients were examined in this retrospective study. The recurrence rate could be determined in 43 of these patients. The interval between surgery and last recall varied between 2 and 20 years (median: 8.1 years). RESULTS: Most of the patients were female (67%) with a parotid pleomorphic adenoma. No recurrence was found regard less of whether a superficial or total conservative parotidectomy had been performed. Our data did show that the total conservative parotidectomy is associated with a higher incidence of temporary impaired facial nerve function, which was seen in 42% of this group. Temporary decreased nerve function after superficial parotidectomy was rare being apparent in only 16% of this group. CONCLUSION: A more radical procedure does not significantly lower the recurrence rate. We suggest that the indication for a total conservative parotidectomy in cases of superficial adenomas should be considered carefully.

[Facial aesthetics Part II - effect of symmetric and asymmetric modulations of the orbital region]. / Gesichtsästhetik Teil 2: Auswirkung symmetrischer und asymmetrischer Veränderungen der Orbitaregion.

The aim of the present study was to assess the impact of standardised computer-manipulated changes to images of the orbital region. Judges (n=250) ranked each image for attractiveness on a visual-analogue-scale. The images were thereby classified into different clusters according to their ratings of attractiveness. These clusters were highly significantly different (p<0.001). The degree of negative impact of changes to the orbital region on facial attractiveness increased significantly from lateral to medial and from cranial to caudal. Small asymmetrical or symmetrical lateral variations did not influence attractiveness negatively.

[Facial aesthetics part I - the significance of the triangle of yarbus]. / Gesichtsästhetik Teil 1: Die Bedeutung der Symmetrieebene des Gesichts.

When humans observe a face, the eyes, mouth and nose regions are the preferred targets of the centre of gaze, with the outlines of eye position recordings approximating a triangle with vertices located in the centre of the eyes and mouth [31]. We studied the significance of cutaneous asymmetries inside and outside the Yarbus triangle on the basis of the assessment of digitally-manipulated images by 201 independent judges. We show that certain facial variations (such as naevi) are more attractive when asymmetrical than symmetrical (p<0,001). They appear more attractive when located laterally rather than medially, particularly so when located outside the Yarbus triangle as compared to inside it (p<0,001). The significance of facial symmetry increases significantly when approaching the Yarbus triangle or the midline, respectively.

A prospective study of kitesurfing injuries.

BACKGROUND: To date, the pattern and rate of kitesurfing injuries are largely unclear. HYPOTHESIS: The pattern and rate of kitesurfing injuries are comparable to that of contact sports such as football and soccer. STUDY DESIGN: Prospective study. METHODS: The study was conducted over a 6-month period of 1 season and included 235 kitesurfers. RESULTS: The number of self-reported injuries was 124, for an overall self-reported injury rate of 7 per 1000 hours of practice. One fatal accident (polytrauma) and 11 severe injuries occurred during the study period (2 knee ligament injuries and 9 fractures at various sites). The most commonly injured sites were the foot and ankle (28%), skull (14%), chest (13%), and knee (13%). Fifty-six percent of the injuries were attributed to the inability to detach the kite from the harness in a situation involving loss of control over the kite. There was a tendency for athletes using a quick-release system to sustain fewer injuries than athletes without such a release system. CONCLUSION: Kitesurfing can be considered a high-risk sport. CLINICAL RELEVANCE: The use of a quick-release system that enables the surfers to detach the kite in case of an accident might aid in the prevention of injuries.

Significance of the expression of the growth factor pleiotrophin in pancreatic cancer patients.

PURPOSE: Recently, we found that pleiotrophin (PTN) acts as a rate-limiting autocrine growth factor in pancreatic cancer cells. The aim of this study was to determine the expression pattern of PTN in pancreatic cancer and to analyze the clinical significance of PTN in pancreatic cancer patients. EXPERIMENTAL DESIGN: We compared PTN expression in malignant (n = 24), inflammatory (n = 13), and normal (n = 14) pancreatic tissues using immunohistochemistry and in situ hybridization and determined PTN serum levels in pancreatic cancer patients (n = 77), in patients suffering from chronic pancreatitis (n = 21), and in healthy volunteers (n = 28). Two-year survival rates were determined for pancreatic cancer patients in relation to serum levels of PTN. RESULTS: The frequency of PTN expression increased from normal tissue (7%) to inflammatory (34%) and pancreatic cancer tissues (67%; P < 0.05). Compared with a healthy control group, we found elevated PTN serum levels in 30% of patients with chronic pancreatitis (mean, 143 +/- 55 pg/ml) and in 53% of pancreatic cancer patients (mean, 200 +/- 29 pg/ml; P < 0.05). Elevated serum levels of PTN dropped in patients after successful tumor resection but were unaffected when only palliative surgery was performed (P < 0.0001). High preoperative serum PTN levels correlated with a worse 2-year survival (P < 0.05). CONCLUSIONS: This study supports the clinical significance of PTN for the malignant progression of pancreatic cancer.