Histologic evidence of osseointegration in the irradiated and reconstructed mandible: a case report.

Osseointegrated implants are widely used in dental rehabilitation. They are particularly valuable if the structures supporting a denture had to be removed because of oral cancer. Additionally, many of these patients undergo radiotherapy, but cancer and radiotherapy are seen as relative contraindications for implant therapy. In the literature, there are few clinical studies documenting successful oral rehabilitation using implants in such patients. The authors report a clinical case in which histologic evidence of osseointegration can be demonstrated in an irradiated and reconstructed mandible. This observation should encourage the extended application of implants in rehabilitation following oral cancer surgery.

Development of the frontal sinus following bilateral fronto-orbital osteotomies.

The presence of frontal sinuses following bilateral fronto-orbital advancement is discussed controversially in the literature. In a retrospective study, 33 patients (18 male and 15 female) were operated on between 1982 and 1993, with at least one year postoperative follow-up and with a minimum age of 6 years at the end of the follow-up period following bilateral fronto-orbital remodelling, were included. The average age at which the procedure was performed was 29 months with a minimum of 3 months and a maximum of 7.8 years. The study presented shows a pneumatization of the frontal sinus in 72.7% of 33 patients following bilateral fronto-orbital advancement. The first radiographic signs of sinus development were detected between the ages of 4 and 11, average 8.3 years. There were no statistically proven correlations between frontal sinus pneumatization and age at operation or the amount of advancement or sex of the patients. Surgical enlargement of the cranium by frontal advancement with adequate stabilization results in an enlargement of the neurocranium, thereby decreasing pressure on the inner frontal cortex and allowing frontal sinus pneumatization to proceed normally. Hence, the development of a frontal sinus may be a reflection of the effectiveness of the surgical therapy.

[Obliteration of the frontal sinus with lyophilized cartilage in frontal fractures]. / Obliteration der Stirnhöhle mit lyophilisiertem Knorpel bei frontalen Frakturen.

Obliteration of the frontal sinus is frequently necessary in the appropriate treatment of major craniofacial trauma of the upper third of the face. Successful frontal sinus obliteration requires (1) meticulous removal of the frontal sinus mucosa, (2) permanent occlusion of the nasofrontal duct and (3) obliteration of the denuded cavity. The current techniques include implantation of autologous fat, bone or muscle. These techniques are effective when the appropriate guidelines are respected, but the problems of donor site morbidity, which has been as high as 5%, recipient site morbidity due to the shrinkage of the free graft, and the increase in the operative time must be pointed out. The unique characteristics of lyophilized cartilage, i.e. the low resorption rate and tendency to undergo osseous substitution, justify its use for obliteration of the frontal sinus. The present study reviews 51 patients with obliteration of the frontal sinus due to craniofacial trauma. In none of the patients were there clinical or radiological signs of postoperative mucocele formation. Progressive ossification of the implanted cartilage was verified in most of the patient population.

[Occipital correction in scapho- and plagiocephaly]. / Okzipitale Korrektur bei Skapho- und Plagiozephalie.

The operation technique and the results after occipital correction in children with plagiocephaly and scaphocephaly are reported. The indication for the intervention is provided by aesthetic and functional considerations. The outcome is very good; the growth of the skull follows the same range of percentiles as preoperatively and normal mental development is seen.

[Obliteration of the frontal sinus with lyophilized cartilage in frontal fractures]. / Obliteration der Stirnhöhle mit lyophilisiertem Knorpel bei frontalen Frakturen.

Obliteration of the frontal sinus is frequently necessary in the appropriate treatment of major craniofacial trauma of the upper third of the face. Successful frontal sinus obliteration requires (1) meticulous removal of the frontal sinus mucosa, (2) permanent occlusion of the nasofrontal duct and (3) obliteration of the denuded cavity. The current techniques include implantation of autologous fat, bone or muscle. These techniques are effective when the appropriate guidelines are respected, but the problems of donor site morbidity, which has been as high as 5%, recipient site morbidity due to the shrinkage of the free graft, and the increase in the operative time must be pointed out. The unique characteristics of lyophilized cartilage, i.e. the low resorption rate and tendency to undergo osseous substitution, justify its use for obliteration of the frontal sinus. The present study reviews 51 patients with obliteration of the frontal sinus due to craniofacial trauma. In none of the patients were there clinical or radiological signs of postoperative mucocele formation. Progressive ossification of the implanted cartilage was verified in most of the patient population.

[The occipital correction in plagiocephaly and scaphocephaly]. / Okzipitale Korrektur bei Skapho- und Plagiozephalie.

The operation technique and the results after occipital correction in children with plagiocephaly and scaphocephaly are reported. The indication for the intervention is provided by aesthetic and functional considerations. The outcome is very good; the growth of the skull follows the same range of percentiles as preoperatively and normal mental development is seen.

Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap.

Eleven patients underwent mandibular reconstruction with pedicled temporal muscle flaps combined with vascularised or free full thickness calvarial bone grafts. Six were primary and five secondary reconstructions. The indications were squamous cell carcinoma (n = 6), radio-osteonecrosis (n = 4), and gunshot wound (n = 1). Five patients also had endosseus implants, either simultaneously or delayed. The only major complications were necrosis of the whole calvarial bone (n = 1) and permanent facial nerve palsy (n = 1). The advantages of using full thickness calvarial bone are that it is thick enough to take an endosseous implant, morbidity is low, there is virtually no postoperative pain, the scar is invisible, and there is only one donor area for both hard and soft tissue. Transplantation of full thickness calvarial bone and temporal muscle is a viable alternative to an osseomyocutaneous microvascularised free flap for reconstruction of the mandible when the neck has been previously operated on or irradiated, and anastomosis may be critical.