Defining the neuroanatomic basis of motor coordination in children and its relationship with symptoms of attention-deficit/hyperactivity disorder.

BACKGROUND: When children have marked problems with motor coordination, they often have problems with attention and impulse control. Here, we map the neuroanatomic substrate of motor coordination in childhood and ask whether this substrate differs in the presence of concurrent symptoms of attention-deficit/hyperactivity disorder (ADHD). METHOD: Participants were 226 children. All completed Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-based assessment of ADHD symptoms and standardized tests of motor coordination skills assessing aiming/catching, manual dexterity and balance. Symptoms of developmental coordination disorder (DCD) were determined using parental questionnaires. Using 3 Tesla magnetic resonance data, four latent neuroanatomic variables (for the cerebral cortex, cerebellum, basal ganglia and thalamus) were extracted and mapped onto each motor coordination skill using partial least squares pathway modeling. RESULTS: The motor coordination skill of aiming/catching was significantly linked to latent variables for both the cerebral cortex (t = 4.31, p < 0.0001) and the cerebellum (t = 2.31, p = 0.02). This effect was driven by the premotor/motor cortical regions and the superior cerebellar lobules. These links were not moderated by the severity of symptoms of inattention, hyperactivity and impulsivity. In categorical analyses, the DCD group showed atypical reduction in the volumes of these regions. However, the group with DCD alone did not differ significantly from those with DCD and co-morbid ADHD. CONCLUSIONS: The superior cerebellar lobules and the premotor/motor cortex emerged as pivotal neural substrates of motor coordination in children. The dimensions of these motor coordination regions did not differ significantly between those who had DCD, with or without co-morbid ADHD.

[Combined sinus lift procedure and lateral augmentation. A treatment concept for the surgical and prosthodontic rehabilitation of the extremely atrophic maxilla]. / Kombination der Sinusliftoperation mit der lateralen Kieferkammaugmentation. Ein Behandlungskonzept zur chirurgisch-prothetischen Rehabilitation der extremen Oberkieferalveolarkammatrophie.

PURPOSE: This paper describes a surgical and prosthetic procedure for treating the extremely atrophic maxilla. It explains a two-staged surgical technique, donor and recipient site morbidity, implant survival, and the implant-retained prosthetic rehabilitation of the patients. PATIENTS AND METHODS: A total of 57 consecutive patients were treated with a sinus lifting procedure and a simultaneous lateral augmentation using autogenous corticocancellous block and particulate bone grafts from the iliac crest. After a 6-month bone healing period, a total of 284 endosteal Titanium screw implants were inserted. Following a 3-month osseointegration period, the implants were exposed and loaded with either fixed or removable prostheses. RESULTS: In three cases a partial bone graft loss was observed; however, enosseous implantation was possible as planned. During the observation period none of the 284 implants was lost; 3 implants exhibited treatable peri-implant infection. Complications at the donor and recipient sites were minimal and did not negatively influence the overall clinical result of the treatment. CONCLUSION: The combination of sinus lift procedure and lateral augmentation for the treatment of the extremely atrophied maxilla proved to be a safe method that produces good and reliable clinical results.

[Transparotidean approach to surgical management of condylar neck fractures. A prospective study]. / Der transparotideale Zugang zur operativen Versorgung von Collumfrakturen. Eine prospektive Studie.

AIM: Different surgical approaches for the open treatment of mandibular condylar fractures are described in the literature. We evaluated the morbidity of the transparotidean approach in a prospective study over 5 1/2 years. PATIENTS AND METHODS: A total of 48 patients with 52 condylar neck fractures class II and IV according to the Spiessl and Schroll classification were treated by a transparotidean approach. Rigid internal fixation was performed by means of miniplate fixation. After surgery, no mandibulomaxillary fixation was performed. The occurrence of surgical and functional complications was documented both during hospitalization and 1, 3, 6 and >9 months after surgery. RESULTS: In none of our patients were major problems in wound healing such as infection of the fracture site observed. At the beginning of the study, in four cases a fistula of the parotid gland was seen within the initial days after surgery; after careful wound closure of the parotid capsula in the following operations, no further complications involving fistulas were observed. Signs of temporary palsy of the facial nerve caused by the hooks occurred in ten (19.6%) of all patients but was completely reversible within the first 6 months after the procedure. One patient suffered temporarily from a minimal malocclusion and two patients from symptoms of the temporomandibular joint 6 months postoperatively. In three patients we observed miniplate fractures without consecutive dysfunction of the TMJ or malocclusion. CONCLUSION: Open reduction and rigid internal fixation of condylar neck fractures by transparotidean approach is a recommendable procedure in class II and IV fractures. With the advantages of minimal tissue alteration and rare complications on the one hand and sufficient exposure of the fracture site on the other hand, this technique has been established as a standard procedure in treating condylar neck fractures by open reduction.

[On the indications for and morbidity of segmental resection of the mandible for squamous cell carcinoma in the lower oral cavity]. / Zur Indikation und Morbidität der Kontinuitätsresektion des Unterkiefers beim Plattenepithelkarzinom der unteren Mundhöhlenetage.

BACKGROUND: Segmental resection of the mandibula in oral cancer surgery leads to both functional and aesthetic problems. The decision to preserve or resect the mandible depends on the vicinity of the lesion to the bone. Consequently, based on the rules of safety margins to all planes that are recommended for soft tissues, each lesion that is closer than 10 mm to the mandible needs resection of the bone. PATIENTS AND METHODS: To establish data-based treatment modalities, a retrospective study was initiated and the results from all preoperative staging investigations of 152 patients with intraoral squamous cell carcinoma who underwent continuity or marginal resection of the mandible were evaluated. The histological outcome of the resected bone was compared to the staging results. Functional rehabilitation and long-term follow-up including survival rates were evaluated. The study reports on typical complications following segmental resection such as fracture of the reconstruction plate and demonstrates experiences with secondary microsurgical reconstructive surgery. RESULTS: Mainly in cases of stage T1 and T2 carcinomas which are closer than 10 mm to the bone and clinically do not show any infiltration to the mandible, a marginal resection seems to be adequate. The decision about the extension of mandibular resection can be based on intraoperative cross sectional investigation of the periosteum. The survival rate of patients with intraoral carcinomas close to the mandible who underwent marginal mandibulectomy seems to be the same as in cases of continuity resection. A more conservative management of mandibular resection seems to be adequate and a data-based concept to standardize therapy of mandibular resection is presented.

[Mid-face distraction after LeFort III osteotomy in craniofacial dysmorphism]. / Mittelgesichtsdistraktion nach LeFort-III-Osteotomie bei kraniofazialen Dysmorphien.

BACKGROUND: The success of LeFort III-osteotomy with concurrent advancement of the midface in cases of severe, midfacial hypoplasia is limited by the soft covering tissue of the facial skeleton. There appear to be significant advantages in using distraction osteogenesis of the midface after surgery. CASE REPORT: We discuss the use of an extraoral distraction device after the osteotomy of a 10-year-old girl with Crouzon's disease. and the use of an internal device for a 6-year-old boy with severe midface hypoplasia following Apert's syndrome. RESULTS: In both patients a significant improvement of function, as well as harmonisation of the facial proportions, could be observed and the preoperatively planned distances of midface advancement of 18 and 15 mm respectively could be achieved. DISCUSSION: Distraction osteogenesis is an established procedure for the treatment of mandibular hypoplasia but few reports dealing with complex midface distraction are available outside of the specialist English language literature. We report on both external and internal distraction techniques with which good functional and aesthetic results were achieved.

[Resorbable osteosynthesis material in craniosynostosis]. / Resorbierbares Osteosynthesematerial bei Kraniosynostosen.

BACKGROUND: The results of using resorbable plates and screws (82% polylactic acid and 18% polyglycolic acid) in craniofacial surgery for the correction of craniosynostosis after more than 4 years of experience are presented. Special attention is focussed on the degree of stability and the clinical tissue response to the material employed to answer the question of whether the material is an adequate alternative to titanium. METHODS: Thirty patients who had been treated with this method for craniosynostoses were examined at regular intervals regarding the shape and stability of the forehead region, visibility and palpability of the plates, and tissue reactions. RESULTS: The technical handling of the osteosynthesis material proved to be simple and reliable. In one case the bone was not strong enough for the screw pitch. After an observation period of a maximum of 4 years and 1 month, the fixations were stable with no signs of adverse reactions. DISCUSSION: If the long-term results remain favorable, we consider the use of resorbable material a promising method for the stabilization of segments in craniofacial surgery in children.

[Peri-osseous intracranial translocation of titanium osteosynthesis plates and screws after fronto-orbital advancement]. / Perossäre intrakraniale Translokation von Titanosteosyntheseplatten und -schrauben nach frontoorbitalem Advancement.

BACKGROUND: Perossoeus intracranial translocation or passive intracranial transmission of titanium osteosynthesis plates and screws in the growing skull following surgical craniosynostosis corrections, also referred to as the PIT effect, has been described in the literature since 1995. It is a phenomenon which has not received due attention until recently and is explained by appositional and resorptional remodeling processes in the growing skull. CASE REPORT AND DISCUSSION: An impressive case of the PIT effect with a total intracranial dislocation of titanium plates and screws is used to demonstrate the problems associated with this phenomenon and to discuss the few clinical case reports in the English-language literature. The obvious advantages of a resorbable material are pointed out; however, it is still uncertain as to whether the resorption process is fast enough to avoid the PIT effect if used clinically.

[Hemostatic wound management in marcumar patients. Collagen fleece vs. tranexamic acid]. / Hämostyptische Wundversorgung bei Marcumarpatienten. Kollagenvlies vs. Tranexamsäure.

A total of 124 patients on oral anticoagulation therapy with coumarin were treated by orosurgical procedures and entered into a study to determine the hemostatic efficiency of different methods. The therapeutic anticoagulation level was determined in accordance with the recommendations of the American Heart Association (low risk: 2.0 < INR < 3.0; high risk: 2.5 < INR < 3.5) and maintained during treatment. In one group, the alveoli were treated with collagen, in a second group a mouthrinse regime with tranexamic acid was implemented. Twenty-three patients had to be excluded because anticoagulation levels differed from the recommended values. The group treated with collagen included 31 patients, the group with tranexamic acid mouthwashes, 32 patients. A third group was analyzed in which a controlled change in the anticoagulation level had been performed and all treated alveoli had been covered by mucosal flaps (n = 38); they were compared to the other two groups. The surgical proceedings were outlined precisely. Patients treated with collagen had a bleeding rate of 19%, patients with tranexamic acid mouthwash 6%, and those treated with mucosal flaps 40%. The data were not suited for statistical evaluation, they were objected to a descriptive analysis: the confidence intervals were determined by tables for binomial distributions. These did confirm the difference in the frequency of bleeding for the tranexamic acid and mucosal flap groups.

Oral findings in three different groups of immunocompromised patients.

The objective of this study was to determine the frequency of oral, dental and periodontal findings in three different groups of immunocompromised patients and in a healthy control group, to evaluate whether there is a correlation between manifestations of disease and immunologic parameters. The survey included 46 patients with a diagnosis of systemic lupus erythematosus, 48 heart transplant recipients, and 53 adult patients suffering from acute leukemias. Fifty matched healthy subjects were used as a control group. Each patient had to answer questions on medical and dental health and underwent a thorough oral, dental and serological investigation. Oral mucosal lesions were found in nearly half of all immunocompromised patients (49.6%), but in only 26% of control patients. No significant associations were found between different types of oral lesions and the underlying cause of immunosuppression. Leukemia patients showed age-unrelated higher scores in periodontal indices (P<0.05). Laboratory parameters failed to be significant in the assessment of oral health.

Basic surgical principles with ITI implants.

The basic surgical principles governing the placement of ITI implants are based on research-oriented developments in harmony with evidence-based and outcome-oriented clinical procedures. In the past 15 years, the range of implant indications has been significantly widened, and partially edentulous patients clearly represent the majority of patients seeking treatment with dental implants today. An important aspect of the successful rehabilitation of patients with ITI implants is the careful selection of implant candidates with respect to systemic and local risk factors. These factors are presented based on current knowledge. Today, solid-screw implants in various screw dimensions and neck configurations comprise the ITI Dental Implant System. These different implant types are necessary to handle the full range of implant indications, in particular in partially edentulous patients. The main clinical factors are presented for the selection of the appropriate implant type, length and diameter. These implants are utilized both in a non-submerged and in a submerged approach. The main goal of surgical therapy is low trauma and the least demanding surgical procedure for patient and clinician to optimize the cost-effectiveness of implant therapy. Hence, a non-submerged approach is preferred in all sites without esthetic priority, such as in fully edentulous patients or in posterior sites of partially edentulous patients. These indications clearly represent the majority of implant patients. In esthetic sites, a submerged approach is utilized to satisfy the specific esthetic demands. The possibility to successfully utilize short implants (6 and 8 mm) and a reduced healing period of 3 months are further advantages of ITI implants due to favorable properties of the rough TPS surface. With the introduction of the microrough SLA surface, a reduction of the healing period to 6 weeks facilitates further progress towards simplification of implant therapy. In summary, the ITI Dental Implant System represents a scientifically well-documented, complete implant system for the treatment of fully and partially edentulous patients, offering straightforward surgical concepts based on predictable treatment outcome and excellent cost-effectiveness.

Treatment of fully edentulous patients with ITI implants.

The use of ITI implants for rehabilitation of the edentulous patient has shown predictable results not only in the standard sites but also in cases of advanced alveolar ridge atrophy. Preoperative analysis, including clinical and radiological evaluation, implant selection, and determination of implant number and distribution in the edentulous maxilla and mandible, is described in this article. The surgical procedures used in standard sites are presented, the benefits of a nonsubmerged surgical approach in these cases are emphasized, and a protocol for postoperative management is recommended. Augmentation procedures in advanced osseointegration surgery call for submerged ITI implants when a simultaneous approach is chosen. Several types of advanced implant surgery that can be used are described, including membrane technique, sinus lift procedures, vertical ridge augmentation with iliac bone grafts, and correction of sagittal jaw relationship.

[Preliminary results of the use of resorbable plates and screws in craniofacial surgery]. / Resorbierbare Platten und Schrauben in der kraniofazialen Chirurgie. Vorläufige Ergebnisse.

In ten patients with craniosynostoses resorbable plates and screws (Lactosorb) consisting of poly-L-lactic acid (82%) and poly-glycolic acid (18%) were used to stabilize the segments after frontoorbital advancement. As our experience increased, an exact adaptation of the plates and simple handling proved to be possible. The plates were stable enough to retain a favorable functional and aesthetic result after redraping the soft tissue envelope. In one patient with Chotzen's syndrome the intended use of the resorbable material was abandoned: the thin osseous structures did not offer enough primary stability to the high pitch of the screws. During an observation period of up to 21 months no infection, exposure, instability or dislocation was observed. The clinical use of the resorbable material in frontoorbital advancement proved to be a stable method of segment fixation if the bone was of sufficient thickness. These promising preliminary results will have to observed in a larger group and over a longer period of time.

Use of a mandibular fracture score to predict the development of complications.

PURPOSE: Mandibular fractures are common facial injuries. Classifications are diverse and sometimes correlated with specific treatment modalities. Osteosynthesis using plate and screws is the standard method of fracture treatment. To evaluate the outcome of such fracture management in our clinic, we developed a numeric scoring system for mandibular fractures and investigated the relationship between the scoring of the fracture being treated and the incidence of complications after surgical treatment. PATIENTS AND METHODS: Seventy-six adult patients treated over a 2-year period were evaluated, and the fractures were classified using the mandibular trauma score. This score was based on clinical and radiologic evaluation of each fracture line and ranks from 0 to 15 points. Osteosynthesis was performed using the AO plate systems. Patients were followed-up postoperatively for the presence of complications. RESULTS: During the 2-year period, 76 patients with 134 fractures underwent plate osteosynthesis. Fracture scoring indicated a homogeneous distribution between uncomplicated and severe fractures. The incidence of complications increased with the fracture severity, assessed by the fracture score index. Severe fractures showed fewer complications when treated with a rigid plate system, whereas low-score fractures showed better results when treated with less rigid systems. CONCLUSIONS: The numeric scoring system for mandibular fractures allows an objective and standardized assessment of the degree of severity of a fracture and may facilitate decisions about the use of specific treatment modalities.

Heart transplants--assessment of dental procedures.

The object of this study was to evaluate the effects of dental foci on survival rates and rejection episodes in heart transplant recipients. Therefore, in a retrospective longitudinal study we studied 74 heart transplant recipients at the Department of Maxillofacial Surgery and Department of Thoracic and Cardiovascular Surgery, University of Münster. Study patients were divided into groups: those in which dental foci had been verified (n = 31) and those without dental foci (n = 43). Statistical analysis was performed using the chi-square test, Kaplan-Meier life table analysis, and the log-rank test. Before heart transplantation, patients were screened clinically and radiographically to determine the extent of dental foci. Postoperatively, patients were evaluated dentally and medically to identify the impact of dental foci on the incidence of systemic and oral infections, frequency and severity of rejection episodes, mortality, and complications arising during dental treatment. By comparing the mortality, infection and rejection rates in the various groups no statistically significant differences (P > 0.05) were found between patients. Despite immunosuppression, extended inflammatory processes such as abscess formation or viral stomatitis were not found in the oral cavity. We therefore suggest that patients suffering from the symptoms of severe heart failure need not be subjected to rigorous preoperative dental treatment.

[Surgical correction of the sagittal shift of the jaws in severe alveolar atrophy]. / La correction chirurgicale du décalage sagittal des maxillaires dans les atrophies alvéolaires majeures.

A method for treatment of sagittal discrepancy in edentulous patients is described, which includes simultaneous maxillary repositioning by means of a Le Fort I osteotomy and placement of endosseous implants. The technique of mandibular setback using the sagittal osteotomy of the mandible according to Obwegeser-Dal Pont's method and placement of implants in patients with extreme class III relationships is also presented. We outline the importance of thorough diagnosis, model surgery and its transfer at the time of the operation. The study of 12 consecutively treated patients with a follow up of 4.2 years showed functionally and esthetically good results after combined surgical and implantological treatment.

[Oral manifestations in patients with systemic lupus erythematosus]. / Orale Manifestationen bei Patienten mit systemischem Lupus erythematodes.

Forty-six patients with systemic lupus erythematosus underwent thorough dental examination to determine the frequency and severity of oral lesions and periodontal diseases. According to clinical criteria, disease was classified as severe (n = 26) or less severe (n = 20). The overall rate of mucosal involvement in the studied patients was 48%-from 54% in patients with severe disease, 40% in those with less severe disease. Patients with severe disease were found to have a higher rate of tooth loss and an increased rate of gingival inflammation. The severity of periodontal lesions correlated with alterations in the immunoglobulin pattern, particularly with an increase in gamma-immunoglobulins. Thus it is suspected that complex immunodysregulation in combination with immunosuppressive therapy is responsible for the high rate of oral and periodontal lesions in patients with systemic lupus erythematosus.

[Oral manifestations of acute leukemia]. / Orale Manifestationen der akuten Leukämie.

It is well known that non-specific mucosal alterations can occur during diseases of the leukopoetic system. In most cases they are an early sign and therefore provide the opportunity for timely diagnosis of the disease. In this clinical study type and frequency of oral lesions, gingival and periodontal indices, and hematologic status were examined at the time of diagnosis of the different types of acute leukemia. The results showed a significant difference in the frequency of oral lesions between acute myelogenous and acute lymphoblastic forms, irrespective of age and sex of the patient. There was no correlation between type and frequency of lesions and hematologic status.