[Dental X-ray diagnostics with the orthopantomography - Technique and typical imaging results]. / Dentale Röntgendiagnostik mit der Panoramaschichtaufnahme ­ Technik und typische Bildbefunde.

Despite the increasing use of modern digital cross-sectional imaging techniques (especially digital volume tomography) in dental X­ray examinations, orthopantomography remains the widely available, commonly used basic imaging modality for evaluating dental status prior to extensive treatment. It is also used for inflammatory and tumorous odontogenic osseous pathologies which are demonstrated with typical imaging findings. The classical X­ray tomography principle has been further developed for the presentation of the differently wide, shape variants of dental arches. The examination unit, consisting of a rigidly connected X­ray tube and detector, runs on an elliptical path around the facial skull. Thereby different rotation centers are controlled. Due to the different distances of the jaw sections to the X­ray tube and the image receiver, differencing velocities result and thus blurring effects as the basis of the layer or slice representation. Slit collimators lead to a narrow and continuous line-like representation of the different widths of the dental arch.

[Diagnostic imaging of drug-induced osteonecrosis of the jaw]. / Bildgebende Diagnostik bei medikamenteninduzierten Kiefernekrosen.

Drug-induced osteonecrosis of the jaw represents a relatively new, multifactor-induced disease. Diseases with increased bone resorption are widely treated with antiresorptive drugs. Due to the active bone metabolism, especially in the lower jaw, it can lead to osteonecrosis if the barrier function in the oral cavity is impaired and it may be complicated by systemic comorbidities depending on duration, intensity, and application of antiresorptive therapy. Due to the special influence of these changes on the quality of life and because of the complex therapy management, the early detection and determination of the extent of the lesion(s) by imaging is of particular importance. The orthopantomography (panoramic radiography) of the jaw provides a good basic examination, especially for the detection of dental causes as a possible differential diagnosis. Three-dimensional imaging techniques such as computed tomography and in particular magnetic resonance imaging can detect bone changes much more sensitively and detect the manifestation of complex pathologies in higher stages of disease.

[Adenoid cystic carcinoma of the lacrimal gland: report of two cases and literature review]. / Adenoidzystisches Karzinom der Tränendrüse: Bericht von zwei Fällen und Literaturüberblick.

The adenoid cystic carcinoma of the lacrimal gland is a rare malignant orbital tumour, which has a generally poor prognosis. The therapy for adenoid cystic carcinoma of the lacrimal gland remains controversial. We present two cases of patients with adenoid cystic carcinoma of the lacrimal gland, who were treated with radical surgery in combination with radiotherapy. The therapeutic results are discussed with reference to relevant literature reports.

[Tongue fixation system for therapy of sleeping disorders. A feasibility study]. / Implantatgebundene Zungenfixierung zur Therapie schlafbezogener Atmungsstörungen. Eine Machbarkeitsstudie.

INTRODUCTION: Forward displacement of the tongue is a verified principle in the therapy of sleep disorders which prevents the tongue from sinking backwards thus avoiding obstruction of the upper respiratory tract during sleep. In this feasibility study a novel oral appliance which connects to a pin implanted within the tongue was investigated. METHODS: A new tongue positioning system using previously implanted tongue piercings as a pivot was developed. By pulling the tongue forward the oral device prevents airway obstruction. In our study we fitted 10 subjects who already had the tongue pierced with the developed oral device. The subjects underwent two nights of polysomnography with and without using the tongue positioning system. Wearing comfort and side effects were evaluated using a questionnaire. Moderate alcohol consumption was used to provoke snoring or apnea in the subjects. Tongue positioning with and without the device was visualized with oropharyngeal MRI. RESULTS: Subjects did not report any discomfort or side effects wearing the device. Subjects showed only moderate snoring or apnea after alcohol consumption and snoring after alcohol consumption was reduced with the device. The average apnea/hypopnea index (AHI) was 0.8/h without the device. Using the device led to an increase of apnea in the subjects. MRI visualization showed that the device did not keep the upper airway space opened by fixing the tongue. CONCLUSION: The effectiveness of the tongue positioning system should be improved by a modification which should be investigated in patients with preexisting sleep disorders.

[Radiotherapy as therapeutic option for primary localised orbital lymphomas of low malignancy]. / Die Strahlentherapie als Therapieoption bei primären lokalisierten niedrig malignen orbitalen Lymphomen.

PURPOSE: The aim of this study was to assess the efficacy of radiotherapy as first line therapy for the treatment of primary localised orbital lymphomas of low malignancy (St IE) based on our cases. METHODS: 7 patients with histologically proven primary localised orbital lymphomas of low malignancy treated with radiotherapy were retrospectively reviewed. The dose was 40 Gy for unilateral and 36 Gy for bilateral lymphoma. The follow-up period was 12 - 60 months after the end of the therapy (mean follow-up period: 36 months). RESULTS: Complete regression was achieved in 6 patients 12 - 24 months after the end of radiotherapy. In one patient an increase of tumour mass was observed 3 months after radiotherapy. Chemotherapy was subsequently performed and the patient was free of disease 2 years later. In 2 cases cataract surgery had to be performed for post-radiotherapy cataract formation. CONCLUSION: The majority of orbital lymphomas are localised St. IE tumours of low malignancy. Radiotherapy is the first-line therapy in these cases. Success rates of > 90 % are reported in the literature.

[The methodology and accuracy of MRI-based orbital volume calculations]. / Zur Methodik und Genauigkeit der MR-Volumetrie der Orbita.

OBJECTIVE: The aim of the present work was to establish a method for orbital volume calculation based on MR scanning data for the sake of better radiation hygiene. MATERIALS AND METHODS: The orbital volumes of 35 ophthalmologically healthy children were calculated on the basis of MRI scans. After data transfer to a separate workstation, volumetric analysis was carried out by two independent radiologists using semi-automated software. The accuracy of the calculated values was compared with orbital volumes measured by anatomic preparations and given in studies by various authors. RESULTS: Volume calculation was possible in all patients using MRI data. There is an acceptable agreement with the presented anatomic facts and the measured values of Bentheley. In the Wilcoxon test there was not a big difference between the courses of the values (p = 0.507). CONCLUSION: Even though we can obtain a better image of the bizarre structure of the bony orbits with CT, MR-based volumetry of the orbit is a reliable method and is not burdened by radiation exposure. It can thus be an important condition for the planning and the controlling of modern therapeutic concepts in treating anophthalmos and microphthalmos.

[Orbital volume in congenital clinical anophthalmos]. / Orbitavolumetrie bei kongenitalem klinischen Anophthalmus.

INTRODUCTION: The purpose of this study is to report orbital volume measurement results in patients with congenital clinical anophthalmia before and after therapy and to compare them with normal values. PATIENTS AND METHOD: Normal values were obtained from 35 healthy children (22 boys, 13 girls; aged 3 month to 7 years) in whom MRI was done for non-ophthalmological reasons. 18 patients with congenital anophthalmos could be included, 9 with bilateral, 8 with unilateral disease and 1 microphthalmos. 6 of them had MRI follow-up (more than one examination). RESULTS: Orbital volume at birth is 7 ml and it increases with age: Orbital volume = 7.701 x age (month) (0.2484) ml. It is around 14.2 ml at the age 1 year, 17 ml with 2 years and reaches 23 ml with 7 years. In unilateral clinical anophthalmos orbital volume is 35 to 58 % compared with the healthy side and 31 to 65 % compared with the normal values. In bilateral cases the volume is 43 to 70 % of the normal value. During treatment it develops in parallel to the normal values. CONCLUSIONS: The normal values measured by our group are in accordance with the only published study by Bentley . MRI orbital volumetry is a reliable method without using radiation. It allows us to quantify the bony asymmetry and is suitable for therapy control when using orbital expanders. The congenital missing eye might be the most important reason why the orbit does not develop in the normal way to a normal size. Self-inflating high, hydrophilic hydrogel expanders do not seem to be able to compensate this, in spite of the fact that they work very well to prepare the socket for a prosthesis.

The influence of pre- and intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A magnetic resonance study.

OBJECTIVE: We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively. STUDY DESIGN: A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated. RESULTS: The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively. CONCLUSIONS: Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.

[An intraosseous hemangioma in the perpendicular lamina of the ethmoid bone]. / Intraossäres Hämangiom der Lamina perpendicularis ossis ethmoidalis.

The incidence of intraosseous hemangiomas is very low. Most of them occur in adult females. The mandible,the zygoma,the maxilla, and the frontal and nasal bones are the areas of most frequent localization in the facial region. The intraosseous hemangioma is a benign, slowly growing,bony hard tumor causing facial deformity. It is diagnosed histologically. We report a case of an 18-year-old male with an intraosseous cavernous hemangioma located in the perpendicular lamina of the ethmoid bone. Intraosseous hemangioma often has characteristic signs on a CT scan, with either coarsened trabeculae lying adjacent to the vascular channels or multifocal lytic areas creating a honeycomb pattern. Because of the age of the patient we considered a midline granuloma and a chondrosarcoma. The therapy of choice is surgical excision; radiation is done in exceptional cases only.

New osmotically active hydrogel expander for enlargement of the contracted anophthalmic socket.

BACKGROUND: Clinical anophthalmia is characterized by the absence of an eyeball within the orbit and can result in overall growth retardation of the facial skeleton. The goal of treatment consists of fitting a serial prosthesis following rapid expansion of the contracted socket as soon as possible to achieve cosmetically acceptable eyelid and orbital symmetry. METHODS: Four children, aged 3-11 months, were treated by implantation of an anhydrous, highly hydrophilic tissue expander into the rudimentary conjunctival sac. With hydration of up to 98% in 72 h, the copolymer of methylmethacrylate and vinylpyrrolidone acts like an osmotically self-inducing socket expander. RESULTS: In the course of 2 months the previous contracted socket was enlarged, the horizontal lid length increased and the hydrated expander could be exchanged for a custom-made glass prosthesis. CONCLUSION: Preliminary results suggest that this new device can be used to avoid early plastic surgery of the eyelid. In addition, it also may enlarge the volume of the bony orbit.

[Danger from exploding fireworks and blank firearms]. / Gefährdung durch explodierende Feuerwerkskörper oder Schreckschusswaffen.

Explosive amusement and deterrent articles such as New Year's Eve cannons and rockets, toy pistols, and blank guns are not at all harmless items. Their potential dangerousness is often extremely underestimated. Two damaging mechanisms are important: during explosions, high pressures and temperatures develop and a considerable sound pressure level can be measured. If the explosion happens near the human body (intentionally or inadvertently), not only superficial lesions can occur, but also (mainly due to contact shots) serious, deep-seated tissue damage, especially in the head and neck region with its endangered sense organs such as eye and ear, the vessels and nerves supplying the brain, the speech- and voice-forming apparatus, and in particular the face, can be the consequence. Their mutilation can lead to serious and extensive interpersonalchanges. Accidents are published in the relevant otological and forensic medical papers, but nevertheless it seems important to us to point out the dangerousness of these readily available items.

Detecting legionellosis by unselected culture of respiratory tract secretions and developing links to hospital water strains.

For a 13-month period, all respiratory tract secretions submitted for routine bacteriology from a large hospital complex were cultured for legionella, irrespective of clinical diagnosis and laboratory requests. Ten cases of legionellosis were detected in this manner, three of which met a strict epidemiological definition of hospital-acquired. Therefore, the 16 warm-water systems of the hospitals, spread out over two locations, were examined for the presence of legionella. Legionella pneumophila was found in 15 warm water systems, with a distinct pattern of serogroups between the two locations. Legionella of the same serogroups as those isolated from patients were present in each hospital water supply. The isolates were further typed by monoclonal antibodies and by genomic macrorestriction analysis. Similarity between clinical and environmental isolates was found in seven cases. In these cases, acquisition from the hospital water supply appears very likely. The strains of the remaining three patients did not match those in hospital water, suggesting that community-acquired legionellosis was occurring as well. This study suggests that routinely culturing respiratory tract secretions of pneumonia patients for legionella can help diagnose unsuspected cases of legionellosis. Typing legionella strains beyond the serogroup level with tools such as macrorestriction analysis is useful to define sources of infection, which can then be targeted for control measures.

[Optic nerve sheath meningioma with intraocular invasion--a case report]. / Optikusscheidenmeningeom mit intraokulärer Ausbreitung--Eine Kasuistik.

BACKGROUND: In case a sonographically high reflective intraocular tumor is detected, some different processes with calcium embedding could be considered. PATIENT: A 56 year-old female patient was seen in our department for the first time because of secondary glaucoma of the amaurotic right eye. The left eye has had no morphological changes and visual acuity was 5/5. CASE HISTORY: More than 20 years ago the patient had noticed decreased visual acuity of the right eye for the first time. 10 years ago in a first report from another eye hospital, a large white tumor in the area of the optic disc had been described. Sonographic size was 12 x 8 mm, 5.3 mm prominence. Visual acuity was perception of light with incorrect projection. A CT scan showed an inhomgeneous structure of calcification in the area of the right optic disc which continued along the optic nerve to intracranial structures. Enucleation was performed. Histopathological examination showed meningothelial meningeoma (grade I WHO) with its origin in the dural sheath of the optic nerve and intraocular growth. A postoperative MRI confirmed the intracranial spreading of the meningeoma along the dural sheath of the optical nerve. A meningeoma of the olfactorius region was found as a second independent tumor. CONCLUSION: The intraocular spread of an optical nerve sheath meningeoma is a rare case.