Reconstruction of orbital defects with autogenous bone from mandibular symphysis.

Autotransplant bone is superior to other bone, cartilage, or alloplastic materials for the reconstruction of orbital floor defects. The bone used for filling orbital floor defects is taken from the symphysis of the lower jaw. The piece of bone, up to 3.5 X 1.5 cm in diameter is strong enough to support the orbital contents, while at the same time it is easily modelled and positioned. This method is indicated for reconstruction of the orbital floor, with or without rim defects. Taking of the transplant, while retaining the lower margin of the mandibular symphysis, preserves the contour of the chin.

Mucosal island flaps on submucous pedicles.

For intraoral reconstruction the author uses island flaps of labial or buccal mucosa vascularized through a randomly-chosen submucous pedicle. The procedure for obtaining this flap is simple; the flaps are safe and they successfully close oronasal communications and defects of the buccal mucosa.

Perineural invasion by carcinoma of the lower lip.

Extension of lip cancer to the mental nerve and perineural spread was found in four patients. The main complaint in all cases was sensory disturbance which preceded the diagnosis of recurrence by perineural spread as well as widening of the mandibular canal. In one patient, two cranial nerves, the trigeminal and the facial were involved and one patient had bilateral neural involvement. Three patients died within 1 year of the diagnosis of perineural spread. Prevention includes the separate examination of specimens at the resection line near the mental nerve, and follow-up by examination of the lower vestible, X-ray of the mandible and monitoring of sensory disturbance.

Tongue flaps in repair of large palatal defects.

Anteriorly based dorsal tongue flaps were used in 19 cleft patients for closing large palatal defects. The procedure was successful in 17 patients. One patient had partial marginal necrosis after division of the pedicle, while another had complete necrosis of the distal part of the flap. Our results support the view that for success of the procedure, adequate length, width and thickness of the flap are important, while the height of the palate also plays a role.

Pierre Robin syndrome: characteristics of hearing loss, effect of age on hearing level and possibilities in therapy planning.

Hearing loss was studied in 22 patients with Pierre Robin syndrome (PRS) aged three to 12 years (median 5.0 years). The results were compared to those obtained in 62 patients with isolated cleft palate (ICP) aged one to 27 years (median 5.5 years). Hearing loss was more frequently found in PRS (73.3 per cent) than in ICP (58.1 per cent) patients (p = 0.02). PRS patients had more ears with moderate (21-40 dB) and severe (> 40 dB) hearing loss, disturbing their social contact, with no tendency to normalization with age (Spearman r = 0.065). In contrast to PRS, ICP patients showed a significant tendency to hearing level normalization with ageing (Spearman r = -0.453; p = 0.001). Planigraphs of temporal bones showed inadequately developed pneumatization of the mastoid bone in all PRS patients and in most ICP patients. No malformation of the inner or middle ear was found in either group. PRS patients have a significantly higher risk of conductive hearing loss than those with ICP. Use of tympanostomy (ventilation) tubes is therapy of choice in patients with Pierre Robin syndrome, and it should be introduced as early as possible, even at the same time as palatoplasty.

Maxillofacial war injuries in civilians and servicemen during the aggression against Croatia.

Although civilian populations have been heavily involved in most of the recent wars and conflicts throughout the world, most reports analyzed casualty data of military personnel, often leaving civilian casualties excluded or underestimated. A comparison of epidemiologic and medical data for maxillofacial injuries between civilians and servicemen (policemen, soldiers, and United Nations Protection Forces) during the aggression against Croatia is attempted. Of the 220 casualties admitted to the Department of Maxillofacial Surgery in Zagreb between August 1991 and December 1992, almost one-fourth were civilians. A significant difference between civilians and servicemen was noted in age and sex distribution. The incidence and severity of maxillofacial and associated injuries is almost equal, and the pattern of injuries is of the same type for civilian and military personnel.

Congenital epulis: a case report.

An unusual case of a double congenital epulis involving the alveolar mucosa of both the maxilla and mandible is reported. The authors discuss the clinical picture, histological findings, etiology and treatment of this rare lesion.

Primary hyperparathyroidism: evaluation of different treatments of jaw lesions based on case reports.

On the basis of three case reports, different treatment modalities of primary hyperparathyroidism of the jaws are presented. Surgical intervention made as the result of misdiagnosis in the first case caused an unnecessary bone defect and delayed bone regeneration for several months. Two other cases showed spontaneous regeneration of bone after parathyroidectomy. The second case disproved the earlier opinion that regeneration of the bone lesions could last for several years, and that the normal morphology could be restored. Complete resolution of the central giant-cell lesion was found 6 months after removal of the parathyroid adenoma.

Submucous cleft palate.

An examination of 9720 Zagreb school children, 6-13 years of age, revealed submucous cleft palate (SMCP) in 5 and cleft uvula in 232. The prevalence of SMCP among Zagreb school children was 0.05% or 1:1944. Two out of 102 relatives of CP patients examined had submucous cleft palate. The findings of five SMCP in children and two in parents of CP patients, undiagnosed before the screening, confirms the difficulties of recognition that complicate the obtaining of correct data about their incidence.

Maxillary arch analysis: utilizing a computer-based method.

Objective, computerized analysis of the maxillary arch was used for morphologic studies of cleft palate characteristics. A method for maxillary arch analysis was developed and used in 10 randomly selected, cleft palate patients. The computerized analysis procedure is described in detail.

[Quantitative descriptive analysis of maxillary arch in unilateral cleft]. / Kvantitativna deskriptivna analiza maksilarnog luka kod jednostranih rascjepa.

The need for a simple, routinely applicable method for morphologic analysis of maxillary arch in cleft patients resulted in development of a new original, objective and computerized method. The authors present the rationale and procedure of this method which is extremely suitable for clinical documentation, follow up and clinical investigation of cleft patients. The descriptive factors are expressed in relative numbers--rations of asymmetry and segment displacement. The relative numbers enable comparative analysis between arches of different size.

[Diffuse sclerosing osteomyelitis--a review and case]. / Difuzni sklerozirajuci osteomijelitis gornje celjusti: pregled literature i prikaz slucaja.

The bone responds to stimulation with new bone formation, resorption or the combination of both. Exclussive bone formation i.e. sclerosation is defined as an increase in the bony mass which is a result of either decreased resorption or excessive bone production. The authors describe the following inflammatory sclerosing jaw lesions: sclerosing osteitis, sclerosing periostitis of Garre and diffuse sclerosing osteomyelitis. The etiopathogenesis, clinical features, histologic findings, diagnostic procedures, therapy and prognosis are presented for each pathologic entity. Further a case of rare localisation of diffuse sclerosing osteomyelitis in maxilla is reported. In conclusion, the authors point out that all persistent complication following tooth extraction must arise suspection of among other problems, of diffuse sclerosing osteomyelitis, bearing in mind. Despite therapy the disease frequently recures.

[Central odontogenic fibroma of the mandible]. / Centralni odontogeni fibrom mandibule.

Central odontogenic fibroma of the jaw is not a clearly defined lesion. It is rare, asymptomatic, usually found in the mandible and equally involving both sexes. The characteristic feature of the lesion is a high histomorphologic variability, while clinical, x-ray and histologic behavior of the tumor is not specific. All this contributes to the difficulty in diagnosis. Conservative enucleation of the benign tumor is the treatment of choice. The recurrence is rare, but, those with more epithelial elements are more prone to recur.

Hearing levels in Pierre Robin syndrome.

Hearing was tested in 18 patients with Pierre Robin syndrome (PRS). These results were compared with those obtained for 243 patients with either cleft lip or cleft palate, or both. None of the PRS group patients had middle ear or inner ear malformations, or sensorineural hearing loss in speech frequencies. Hearing loss in PRS is usually conductive, bilateral, and more frequent in PRS patients (30 ears or 83.33%) than in patients who do not have PRS (290 ears or 59.67%). A significantly higher (p < .01) mean of hearing loss for air conduction in speech frequencies (MHLSF = 24.5 dB) was found in PRS patients than in patients without PRS (MHLSF = 17.8 dB). The ears of the PRS patients with hearing loss were examined, revealing middle ear effusion. In all cases, hearing was restored to a normal level through suction and the use of ventilation tubes.

[Hearing disorders in patients with cleft lip and palate]. / Ostecenje sluha u bolesnika s rascjepom usne i nepca.

Hearing threshold in cleft lip/or palate was assessed in 316 ears by pure tone audiometry. Normal hearing threshold was found in almost a half (164/51,9%) of the ears examined. Hearing defects were most frequently observed in cases of complete unilateral cleft palate (48/60%), whereas they were least frequently recorded in cases of cleft lip (15/19,2%). Complete bilateral cleft lip and palate was associated with conduction deafness in 29 (42,9%) ears examined, thus occupying the last but one place according to the frequency of association between deafness and cleft defects. A hearing conduction gap or more than 40 dB was most frequently present in complete cleft lip and palate (7/5,6%), followed by cleft palate (4/5%). Submucous cleft palate was observed to be less frequently accompanied by conduction deafness (9/56,2%) as compared to complete cleft palate, despite a common feature of bone and muscle support discontinuity. Cleft lip was least frequently accompanied by conduction deafness, but it was still present to a relatively high percentage when compared to the cleft-free population.

Kink instability in applied-field magneto-plasma-dynamic thrusters.

Measurements of magnetic and electrostatic fluctuations in an applied field magneto-plasma-dynamic thruster have shown that a m/n=1/1 kink mode becomes unstable whenever the Kruskal-Shafranov limit is violated. A positive correlation is established between the kink and performance degradation at high current, which has until now prevented the use of this kind of thruster in space missions.