Oral manifestations of Wegener's granulomatosis. Review of the literature and report of a case.

Wegener's granulomatosis (WG) is a rare granulomatous vasculitis which used to run a fatal course. At present, it is possible to control or sometimes even cure the disease with immunosuppressives. Successful treatment depends largely on early diagnosis. Based on a review of the literature, the diagnostic relevance of hyperplastic gingivitis (HG) is discussed. HG should be considered an early sign of WG in contrast to oral ulcers.

Current diagnosis and therapy of parotid tumours.

After reviewing a group of more than 400 patients with parotid tumours, we feel that clinical examination, screening ultrasound scanning and pre-operative CT-scan are our most important diagnostic tools. Our treatment concept is based on direct posterior dissection of the main trunk of the facial nerve, total conservative parotidectomy with ablation of all glandular tissue especially in pleomorphic adenomas so that recurrency can be avoided, intra- and postoperative histological examination and filling in the post-operative soft tissue depression in all cases where intra-operative histological examination excludes malignancy. Primary post-parotidectomy defect substitution techniques using the platysma (Roscic) and the sternocleidomastoid muscle (Rausch) as well as a SMAS- and temporoparietal fascia- or galea-flap are illustrated. We currently use the combination of the Rauch- and Roscic- techniques in a way that a sternocleidomastoideus muscle rotation-flap together with a platysma-SMAS-fat-flap entirely cover the defect. We believe that the substitution-plasty, primarily performed for aesthetic reasons, acts as a mechanical barrier for the misdirected regeneration of the nervs to the skin and the sweat glands, and thus tends to avoid Frey's Syndrome. Using our technique concept, we feel that any disadvantage is counter-balanced by the absence of recurrences, no permanent facial paralysis, relatively good aesthetic results and lower incidence of Frey's Syndrome.

[Differential indications for the surgical management of fractures of the mandibular condyle]. / Differentiaal-indicatie voor operatieve verzorging van collum mandibulae-fracturen.

The frequency and importance of collum mandibulae fractures is indicated, especially in connection with the sequels of conservative-functional therapy, and the different classifications and types of fractures are described. The non-surgical approach is evaluated as a treatment. Its inconvenient and sometimes unsatisfactory results necessitate the surgical treatment of certain types of collum mandibulae fractures. Absolute en relative indications for osteosynthetic treatment of condylar fractures are noted, the proposed surgical technique is discussed. The importance of a universal preauricular incision continued in an incision for parotidectomy and resulting in a standard incision or a combined preauricular-submandibular incision, is pointed out. Surgical technique for intra and extra capsular collum fractures is illustrated. Our preference goes to functional stable osteosynthesis using titanium mini-plates and the often obligatory dissection of the facial nerve. The so called "condylar shave" or remodelling condylotomy in analogy with the DAUTREY-operation is a therapeutic contingency in case of bilateral collum mandibulae fractures with unilateral low condylar fracture where classical mini-plate osteosynthesis is done, and intracapsular multi-fractured condylar head on the other side where the condylar shave or rubble clearing is performed The attitude towards children is discussed. The result of this surgical technique is illustrated through the follow-up of 73 surgical treatments of collum fractures in 59 patients. We conclude that surgical osteosynthetic treatment of collum mandibulae fractures with a strict indication in case of dislocated and luxated fractures should be included in the therapeutic range of modern maxillo-facial traumatology.

Granular cells in odontogenic and non-odontogenic tumours.

Granular cells can occur in various odontogenic and non-odontogenic tumours. 5 granular cell lesions, one granular cell ameloblastoma, one so-called granular cell ameloblastic fibroma and three granular cell tumours were examined immunohistochemically for the intermediate filaments cytokeratin, vimentin, desmin, neurofilaments and the neural markers NSE and S-100 protein. The granular cell tumors (granular cell myoblastoma) showed positive staining for vimentin and S-100 protein. Only vimentin could be demonstrated in the granular cells of the so-called granular cell ameloblastic fibroma, whereas the granular cell ameloblastoma showed positive staining only for cytokeratin. A positive reaction with S-100 protein was not found in any of the odontogenic tumours. In our opinion the mesenchymal odontogenic granular cell is a fibroblast, whereas the epithelial granular cell is derived from enamel epithelium. The term "granular cell ameloblastic fibroma" is a misnomer, as a number of these tumours are probably central odontogenic fibromas exhibiting granular cell transformation.