[Long-term outcome of dentoalveolar trauma in relation to post-traumatic instability]. / Langzeitergebnisse dentoalveolärer Verletzungen in Abhängigkeit von der posttraumatischen Beweglichkeit.

PURPOSE: The aim of this retrospective study was to investigate the long-term outcomes of dental injuries. Subluxated and laterally luxated teeth were evaluated according to the findings of CO2 sensitivity, obliteration, pulpal sclerosis, and the duration of post-traumatic fixation of the injured teeth. MATERIAL AND METHODS: The data of 725 patients were analyzed retrospectively over a period of 14 years. Of these, 108 patients could be investigated for a long-term follow-up. Dental trauma was classified according to the degree of luxation (I-III). RESULTS: There was a significant correlation between the degree of luxation and the post-traumatic findings of CO2 sensitivity. There was no significant correlation between the degree of luxation and the post-traumatic findings of apical inflammation, pulpal sclerosis, and/or obliteration. Long-term fixation of injured teeth had no effect on the short- and long-term occurrence of pathologic processes at the root such as root resorption. CONCLUSION: The post-traumatic finding of CO2 sensitivity was related to the degree of luxation of the injured teeth. Apical inflammation, pulpal sclerosis, and obliteration were not related to the degree of luxation. The results suggest that long-term fixation of injured teeth has no negative effects on the long-term outcomes of subluxated and laterally luxated teeth.

[Management of mid-facial fractures]. / Versorgung von Mittelgesichtsfrakturen.

In the past, treatment of maxillofacial fractures was characterized by low incidences of midface fractures, while severe cases were associated with a high death rate. Over the last decades the application of new techniques has provided a successful outcome in the management of these more frequently observed injuries. With the introduction of antibiotics and the principles of modern anesthesiology, conservative methods of fracture treatment such as intermaxillary fixation and the application of extension devices were increasingly replaced by surgical techniques. The development of different osteosynthesis plate and screw systems in the early 1970s has made three-dimensional reconstruction a standard of care in the surgical treatment of midface fractures. With the recent introduction of commercially available bioresorbable systems, removal of osteosynthesis material has become an unnecessary procedure. Further research in innovative techniques of maxillofacial surgery and imaging, such as image-guided surgery by computer navigation, may be warranted to minimize surgical approaches and decrease incidences of perioperative morbidity.

Differential profile of facial injuries among mountainbikers compared with bicyclists.

BACKGROUND: Bicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists. METHODS: The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries. RESULTS: Five hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers. CONCLUSION: Appropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.

Mountainbiking--a dangerous sport: comparison with bicycling on oral and maxillofacial trauma.

The popularity of bicycling is reflected in the number of cycling-related oral and maxillofacial injuries. Five hundred and sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, between 1991 and 1996, accounting for 31% of all sports-related accidents and 48.4% of all traffic accidents. A review of the patient records revealed more severe injury profiles in sixty mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma and 23% soft tissue injuries, compared to 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures and 14% soft tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% LeFort I, II and III fractures. Condyle fractures were more common in bicyclists, with 18.8% compared to 10.8% in mountainbikers. Reduction of facial injuries due to cycling-related accidents needs appropriate design of helmets with faceguards and compulsory helmet use for all cyclists, and particularly mountainbikers.

Neopterin as a prognostic parameter in patients with squamous-cell carcinomas of the oral cavity.

Concentrations of neopterin, which is produced by human monocytes/macrophages upon stimulation by interferon-gamma, were measured in urine specimens in 23 patients with squamous-cell carcinoma of the oral cavity at diagnosis and in 12 treated patients with the same disease when recurrence of the tumor was recognized. Tumor histology and routine laboratory parameters were concomitantly determined. Urinary neopterin values showed no statistically significant correlation with tumor differentiation, tumor size or patient age, but they were significantly higher in patients with a recurrent tumor. Patients were followed for up to 4 years, and the ability of all variables to predict fatal outcome was assessed. In univariate analysis, only neopterin (p = 0.01) and the variable recurrent vs. first-diagnosed tumor were significant predictors of survival. In multivariate analysis, a combination of neopterin (p < 0.01) and the variable recurrent vs. first-diagnosed tumor (p = 0.06) was found to jointly predict survival. Thus, urinary neopterin concentrations provide valuable prognostic information in patients with squamous-cell carcinoma of the oral cavity.

Preoperative autologous blood donation in orthognathic surgery: a follow-up study of 179 patients.

Although there have been recent advances in maxillofacial surgery and anaesthetic techniques, blood replacement is still common in orthognathic surgery. 179 patients underwent elective orthognathic surgery and donated autologous blood preoperatively. Standardized questionnaires about the preoperative blood donation were distributed to the patients. Haemoglobin, haematocrit, red blood cells and platelets were measured before blood donation, presurgically and postsurgically, as well as one year after surgery. Nearly all patients (98%) would recommend preoperative autologous blood donation. 97% of the patients saw the benefits of autologous blood donation in avoiding transfusion-transmitted infectious diseases such as acquired immune deficiency syndrome (AIDS) and hepatitis. No serious side-effects have been observed after blood donation. In patients with bimaxillary osteotomies (65% of the predeposited autologous blood units) 41% were in cases having upper jaw osteotomies and only 22% of the preoperatively donated units were retransfused in patients having lower jaw osteotomies. After a postsurgical decrease, the mean haemoglobin and mean haematocrit levels regained the levels determined prior to the donation. Preoperative autologous blood donation of 2 to 3 units (900-1350 ml +/- 10%) of blood is recommended in bimaxillary osteotomies and 1 to 2 units (450-900 ml +/- 10%) of blood for upper jaw osteotomies. In lower jaw surgery, the acute isovolaemic haemodilution should be considered.

Trends in the incidence and cause of sport-related mandibular fractures: a retrospective analysis.

PURPOSE: This study assessed changes in the incidence and causes of mandibular fractures occurring in innsbruck, Austria between 1984 and 1993. PATIENTS AND METHODS: Records from 712 patients sustaining 982 mandibular fractures were reviewed and analyzed according to age, sex, date of fracture, place of trauma, cause, anatomic site of fracture, and associated orofacial and craniocerebral injuries. RESULTS: Sports were the most common cause of mandibular fractures, accounting for 31.5% of the entire sample, followed by road traffic accidents (27.2%) and falls (20.8%). The yearly distribution of sport-related mandibular fractures showed an increase from 28.6% in 1984 to 1988 to 34.5% in 1989 to 1993. The major causative factor in sports-related mandibular fractures was skiing (55.3%), whereas cycling and soccer accounted for 25.4% and 8.9%, respectively. Significant changes in the occurrence of cycling-related mandibular fractures were observed, with an increase of 19.3% from 1984 to 1988 to 1989 to 1993, whereas skiing-related mandibular fractures showed a decrease of similar magnitude (19.5%). Sex distribution showed a male-to-female ratio of 2.5:1, with the percentage of females involved increasing. In cases of cycling-related accidents, there was a considerable prevalence of associated injuries (133.3 injuries per 100 mandibular fractures), with significantly higher rates of facial lacerations (73.2), tooth fractures (39), tooth luxations (24.4), and orbital fractures (3.7) than in the case of skiing-related injuries, whereas in patients sustaining mandibular fractures caused by soccer, mucosal lacerations, tooth luxations, and cerebral concussions were the only associated injuries found. CONCLUSIONS: The results of this study indicate a considerable change in the cause of mandibular fractures, showing that sporting injuries are becoming increasingly common. The high incidence of associated maxillofacial injuries in patients involved in skiing and cycling accidents may suggest an increasing need for preventive and protective measures.

[Fractures of the mandibular collum in childhood--a long-term follow-up with orthopantomography]. / Kiefergelenkfortsatzfrakturen im Kindesalter--eine Langzeitstudie im Orthopantomogramm.

The study including fifty children younger than 10-years-old with dislocated unilateral collum fractures concerns the chronological development of morphological alterations in the orthopantomogramm. Regardless of fracture type, the radiographs indicate, that a very good restitution can be attained with an exclusive functional therapy using an activator in all analyzed patients. A realignment can not be found.

Urinary neopterin excretion in patients with squamous carcinoma of the oral cavity.

Urinary neopterin concentrations were studied in 30 patients with squamous carcinoma or adenoid cystic carcinoma of the oral cavity. Compared to healthy controls 19 patients (63%) had increased neopterin concentrations. There was a statistically significant correlation between neopterin levels and tumor differentiation but no correlation of neopterin values with tumor size. Longitudinal studies will be necessary to evaluate a potential usefulness of neopterin concentrations to predict prognosis in squamous carcinomas of the oral cavity.

[Reconstructive procedures for improving the facial contour]. / Rekonstruktive Massnahmen zur Verbesserung der Gesichtskontur.

From 1986 to 1992 in the Department of Oral and Maxillofacial Surgery in Innsbruck, in 102 patients with a congenital or acquired deformity of the face, 128 augmentations with Hydroxylapatite granules (in 36 cases) or with Ethylenoxid-sterilised lyophilised cartilage (in 92 cases) have been performed. Hydroxylapatite granules, filled in a Vicryl-tube and implanted subperiosteal solely, proved to be at well tolerated material and consistently in form. In different areas of the face implanted Ethylenoxid-sterilised lyophilised cartilage showed no loss of substance up to now.

Miniplate eminoplasty: a new surgical treatment for TMJ-dislocation.

UNLABELLED: The miniplate eminoplasty is a technically easy, extra-articular procedure for surgical treatment of TMJ-dislocation with a predictable functional result. OPERATIVE TECHNIQUE: A conventional preauricular incision is made. With the condyle in the therapeutic position the eminoplasty miniplate is inserted anterior to the articular eminence. The miniplate is fixed to the zygomatic arch with miniscrews in order to augment the articular eminence. No postoperative immobilization is required. Although muscular activity cannot be avoided after surgery, no recurrence of dislocation, fracture or loosening of the implants occurred. Results and examples are demonstrated.

[Sports-related maxillofacial trauma in young patients]. / Sportbedingte Gesichtsschädelverletzungen im Wachstumsalter.

314 young patients with sports-related maxillofacial trauma were classified into 34.7% facial fractures, 35.9% dentoalveolar trauma and 28.4% soft tissue injuries. In the alpine regions the distribution of fractures by aetiology is dominated by skiing accidents. 43% of the midface fractures are due to fractures of the zygomatic bone and arch. Children up to ten years are more prone to dentoalveolar trauma. Opportune preventive measures are recommended.

[AIDS--mucous membrane manifestations]. / AIDS--Schleimhautmanifestationen.

In the course of the infection with the human immunodeficiency virus (HIV), we frequently observe disorders of the mucous membranes and, occasionally, they present the first manifestation of HIV-induced immunodeficiency. Like in other organs, opportunistic infections and malignant tumors prevail as a result of the impaired immune system. Opportunistic infections are characterized by frequency (candidiasis), aggressive expansion, persistence, frequent recurrences, and resistance to therapy (gingivitis, parodontitis, herpes simplex, warts). Oral hairy leucoplakia is considered a specific lesion of HIV infection. Malignant tumors, such as Kaposi's sarcoma, non-Hodgkin's lymphoma, and squamous cell carcinoma, may cause marked morbidity in AIDS patients; occasionally, the clinical picture of Kaposi's sarcoma and non-Hodgkin's lymphoma is rather uncharacteristic. Other manifestations on the mucous membranes may arise in association with systemic reactions, such as drug eruptions, thrombocytopenic purpura, or acute HIV infection. The etiology of still other lesions of the mucous membranes (e.g. chronic recurrent ulcers, xerostomia, disorders of pigmentation) is incompletely understood. The awareness of these disorders of the mucous membranes in HIV infection is of diagnostic, therapeutic and epidemiological importance.

[Lyophilized cartilage--an antibiotic carrier]. / Lyophilisierter Knorpel--ein Antibiotikaträger.

Human lyophilized bruised costal cartilage was tested in vitro for its ability to act as a carrier medium for antibiotics. A remarkable capacity of accumulating streptomycin, gentamicin, tobramycin, vancomycin and ciprofloxacin was observed; whereas beta-lactum antibiotics and fosfomycin were released at a high rate. This release pattern was not influenced by the sterilization procedure, but rather by the size of the cartilage granula. Lyophilized cartilage--rehydrated in antibiotic-solutions--be helpful adjunct in the surgical management of osseous infections.

[Oral manifestations of HIV infection]. / Orale Manifestationen bei HIV-Infektion.

Skin and mucous membranes including the oral mucosa are among the preferential locations of opportunistic infections and secondary neoplasms in patients infected with the human immunodeficiency virus (HIV). Infections of the oral mucosa such as thrush occur in a high percentage of AIDS patients, patients with AIDS-related complex or HIV-seropositive individuals. The clinical appearance of the infections (herpes virus infection, periodontitis) is often marked by aggressive expansion, frequent recurrences or resistance to therapy. Oral "hairy" leukoplakia is considered to be a characteristic lesion in HIV-infected individuals. Tumors like Kaposi's sarcoma, squamous cell carcinoma and non-Hodgkin lymphoma of the oral mucosa may cause marked morbidity in AIDS patients. Such oral lesions are frequently the first indication of an HIV-infection. Dentists should be aware of the oral manifestations of HIV-infection and initiate diagnostic and therapeutic measures in the interest of the patients and for epidemiologic reasons.