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.

["Esthetic plus"-ITI-implants (TPS): a prospective clinical study]. / "Esthetic plus"-ITI-Implantate (TPS): eine prospektive klinische Studie.

The purpose of this prospective study was to examine the influence of a 1 mm lengthening of the rough surface (TPS) of "esthetic plus"-ITI-implants on the periimplant soft and hard tissues. Twenty-one "esthetic plus" ITI-implants were inserted into the maxilla in an esthetically critical zone of 12 patients with sufficient alveolar bone. Clinical and radiographic examinations were performed after ten and 32 months. The mean DIB-score (DIB = distance between implant shoulder and first implant-bone contact) was 2.19 mm after 32 month. The average DIB-score of implant sites adjacent to natural teeth was 1.90 mm, there only 0.1 mm of the rough surface did not have bone contact. However, the average DIB-scores of implant sites adjacent to other implants (2.63 mm) or distal extension situations (2.79 mm) were much higher. This means that the coronal part of the rough surface had no radiographic bone contact with 0.83 mm (to other implants) and with 0.99 mm (to distal extension situations), what should be taken into consideration when using an "esthetic plus"-ITI-implant. As a consequence a standard ITI-implant with a smooth neck of 2.8 mm would be indicated. The results of the present study indicate, that not only the shortening of the smooth implant neck to 1.8 mm but also the adjacent structures influence the periimplant soft and hard tissues.

[Lesions of the mouth mucosa. An anamnestic and clinical study of 100 consecutive patients with mucosal lesions]. / Veränderungen der Mundschleimhaut. Eine anamnestische und klinische Untersuchung von 100 konsekutiv zugeviesenen Patienten mit Mukosaläsionen.

The present study evaluates and analyzes anamnestic and clinical findings of 100 consecutively referred patients with oral mucosal lesions. The mean age of the cohort was 50.5 years (range 8-91 years) with a female rate of 60 percent. A total of 9 malignant neoplasia were found among the 100 mucosal lesions, including 7 squamous cell carcinomas and 2 mucoepidermoid carcinomas. In addition, 11 cases presented with leukoplakia and 4 cases with lichen planus, both recognized as possible precancerous conditions. These figures support the essential role of the dentist with respect to initial diagnosis and prevention of oral cancer. In addition, stomatologic follow-up examinations are recommended to be performed by each and every general practitioner. In the near future, the dentist will assess oral mucosal lesions more frequently due to the increasing number of elderly patients and to the fact that elderly people present with more lesions compared to younger patients. consistent to literature data, patients with leukoplasia and squamous cell carcinoma had the highest rates of tobacco and alcohol consumption. Therefore, the dentist may also become active in giving preventive information to the patient. the results of the present study showed, that--by employing a standardized examination--a correct clinical diagnosis was identical to the final diagnosis established by laboratory techniques.

[Bone collected with a bone collector during dental implant surgery]. / Mit Knochenkollektor bei dentaler Implantation gewonnenes Knochenmaterial. Mikrobiologische Analyse.

BACKGROUND: Simultaneous implantation and augmentation using autogenous bone collected during implant surgery is a well-established procedure in oral implantology. The aims of this study were (1) to identify any bacterial contamination of bone obtained with a bone collector, and (2) to verify the antimicrobial effect of rinsing the bone collector with a 0.1% chlorhexidine solution prior to augmentation. MATERIAL AND METHODS: A total of 39 patients undergoing a simultaneous implantation and augmentation procedure were examined. All patients rinsed their mouths with a 0.1% chlorhexidine solution for 2 min prior to surgery. Bone was collected with the Osseous Coagulum Trap, while saliva was collected with a separate suction tip. Once bone collection was complete a microbiological swab was taken from the bone collector (sample 1); before the bone was taken from it 200 ml of a 0.1% chlorhexidine solution was aspirated into the collector, after which the bone was removed and the collector sieve was (sample 2) sent for microbiological analysis which included aerobic and anaerobic cultivation of microorganisms and their identification and semiquantitative assessment of microbial growth. RESULTS: Before the collector was rinsed with chlorhexidine microbial contamination was found in 34 (82.7%) of the 39 samples, and 37 different microbial species were identified in cultures. When the collector had been rinsed with 200 ml 0.1% chlorhexidine a significantly lower rate of microbial contamination was found: 66.7% of the samples were sterile. CONCLUSIONS: Despite separate suction techniques for bone dust and saliva and preoperative use of a chlorhexidine mouthwash, bacterial contamination of bone obtained from the mouth with a bone collector has to be anticipated. Not only the physiological bacteria of the oral flora, but also the microorganisms frequently associated with implant failure can be found. Rinsing the bone collector with 200 ml of a 0.1% chlorhexidine solution significantly reduces microbial contamination. The effects on bone vitality must be studied before routine rinsing with chlorhexidine can be recommended.

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. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.