[A comparative morphometrical study on development of anterior septonasal accessory organs in the cleft palate mice].

OBJECTIVE: The aim of this study was to investigate whether cleft palate is associated with the mal-development of the vomer, Jacobson's organ and para-septal cartilage. METHODS: Sixty craniomaxillary complexes, which came from 30 pairs of trisomy 18 with cleft palate (Ts + CP) and euploid mouse fetuses were precisely orientated in the coronal plane, and serially sectioned at 7 microns thickness. With the aid of computer imaging analysis system the vomer in coronal and sagittal direction, Jacobson's organ and para-septal cartilage in the boundary plane of the primary and secondary palate were measured and compared quantitatively. RESULTS: The hard tissues (including the vomer and para-septal cartilage) of the anterior nasal septum in Ts + CP foetuses show serious developmental hypoplasia, however, the Jacobson's organ had no significant different between the cleft and non-cleft samples. CONCLUSION: Development hypoplasia of these hard tissues may be more closely related with the autosomal trisomic condition more than the cleft palate.

An experimental study on the developmental malformations of the trisomy 18 NMRI mice.

OBJECTIVE: To study the incidence of trisomy 18 in NMRI mice and its developmental malformations. METHODS: Sixty female NMRI mice and 11 male mice with the Rb(2.18) 6 Rma and Rb (1 +/-18) 10 Rma chromosomes were used. On the gestational days 16 and 17, the pregnant mice were randomly killed by cervical dislocation. A total of 823 implants were gained from 60 litters; they comprised 569 living foetuses, and chromosomal examination was performed in the generated living foetuses. Gross morphological study was performed in all living fotuses. RESULTS: Ninety-five foetuses were identified as trisomic foetuses in all of 569 living foetuses. Among them, there were 68 trisomy 18 NMRI mice with cleft palate. Gross morphological study showed that trisomy 18 foetuses had significant body flexion. Some cases of trisomy 18 showed shortened limbs, oedematous body or exencephaly as additional symptoms. CONCLUSION: Developmental malformations in trisomy 18 NMRI mice showed a seried of abnormalities; they had not only the underdeveloped body weight, but also the highter incidence of congenital cleft palate.

Microvascular submandibular gland transfer for severe cases of keratoconjunctivitis sicca.

Free submandibular salivary gland transfer was investigated as a surgical method for the treatment of severe keratoconjunctivitis sicca. In an animal model, we examined the tolerance of warm ischemia of the submandibular gland. After temporary interruption of the blood supply (1 to 6 hours), the morphologic changes in the submandibular gland were analyzed histologically and immunohistochemically in 41 rabbits. From 1.5 hours ischemia onward, an increasing structural damage of the parenchyma with emphasis on the secretory cells was seen. Six hours of ischemia caused total necrosis of the salivary gland. Our clinical experience includes 24 highly selected patients suffering from keratoconjunctivitis sicca, in whom we transferred 31 autologous submandibular glands to the temple for permanent autologous tear substitution within the past 4 years. The glands were implanted into a pocket prepared in the temporalis muscle, and the nourishing vessels were anastomosed to the superficial temporal artery and vein. The submandibular duct was implanted into the upper lateral conjunctival fornix. The transferred glands were left denervated. In addition to the clinical examination, scintigraphy with Tc 99m pertechnetate was used to document the graft's viability after the transfer. Viable incorporation with longstanding secretory function occurred in 26 of the 30 transplanted denervated salivary glands. The resulting lubrication of the treated eyes was irregular for up to 3 months in almost even case. One year after surgery, all patients with a viable transplant developed at least occasional epiphora, which was surgically managed by reducing the size of the graft in 10 patients. No severe side effects were seen in this series. The ophthalmologic evaluation of the method included the assessment of dry eye symptoms and of the volume and quality of ocular lubrication (Schirmer test, fluorescein break-up time), the pathology of the ocular surface (rose bengal staining), and the need for pharmaceutical tear substitutes. One year after surgery, 18 of 27 cases assessed were judged as significantly improved by these tests.

[Flap-plasty of the face]. / Lappenplastiken im Gesicht.

While facial and craniofacial deformities and facial trauma comprise considerable amounts of bony surgery, the treatment of facial skin tumours requires essentially different approaches and skills of soft tissue surgery of the surface. Although the specialty of maxillofacial surgery developed during the World Wars in Europe, soft tissue reconstruction of the face has been greatly refined since then. A table of ten reconstructive principles is further elucidated in the text followed by 17 clinical examples, from the scalp to various areas of the face to the lips. As aesthetics play a dominant role in facial reconstruction, local flaps are the first choice, while pedicled flaps from the chest or microvascular free flaps are only considered for otherwise too-large defects. Only very few exceptions exist to this rule. Facial skin tumours show a great variety of size and localization and resulting excisional defects may confront the surgeon with individual problems. Only when we master a great variety of reconstructive methods for all such sizes and combinations of defects can we excise malignant tumours with sufficiently wide, clear margins without hesitations or compromise.

[Comparative histomorphological study on the craniomaxillary development of the trisomy-18 with cleft palate and euploid mice].

OBJECTIVE: The aim of this study is to compare histological morphology of craniomaxillary complex of Trisomy 18 with cleft palate (Ts + CP) and euploid mouse foetuses to understand whether cleft palate is associated with maldevelopment of the craniomaxillary complex or with hypoplasia of the adjacent tissues. METHODS: Thirty pairs of Ts + CP and euploid mouse foetuses with about equal body weight were selected, and sixty craniomaxillary complex were precisely orientated in the coronal plane, then serially sectioned with 7 microns thickness through the primary palate, the whole hard palate and the soft palate. Finally six sections were selected for comparative histomorphological study based on anatomical landmarks. RESULTS: The trisomy with cleft palate mouse foetuses had significantly developmental hypoplasia in the primary palatal shelves. The palatal shelves, vomer, palatal bone and nasal septal cartilage in cleft samples showed significantly developmental hypoplasia with a relatively wider nasal septum, nasal capsule and a bigger nasal airway volume, nasopharyngeal cavity. CONCLUSION: The hard tissues of the craniomaxillary complex in Ts + CP mouse foetuses, including bone and cartilage show serious maldevelopment or developmental hypoplasia, and these may be closely related to the autosomal trisomic condition.

[Morphometrical study on the development of the trisomy-18 with cleft palate and euploid mice].

OBJECTIVE: To quantitatively compare the whole body, the lateral maxillofacial profile in Ts18 foetuses with cleft palate (Ts + CP) and euploid foetuses in order to answer the question whether this animal model is associated with maldevelopment or hypoplasia of the craniomaxillofacial region. METHODS: Sixty female Hanmice and 11 male mice with the Rb(2.18) 6Rma and Rb(1.18) 10Rma chromosomes were used to generate 569 living foetuses. Of these, 52 pairs Ts + CP and euploid foetuses were selected according to about equal body weight, and used in gross morphometric study. RESULTS: Ts + 18 foetuses had greater body flexion, a significant maxillary and mandibular retrusion, also mandible in Ts + CP foetuses were smaller than in euploids without cleft. CONCLUSIONS: This animal model of congenital cleft palate developed hypoplasia of the maxilla and mandible.

Topical cyclosporin in oral lichen planus: a controlled, randomized, prospective trial.

The published studies of topical cyclosporin (CyA) therapy in chronic oral lichen planus (OLP) have shown conflicting results. We report an investigator-blinded study of 13 patients with OLP, who were randomly assigned to treatment with CyA (500 mg as a swish-and-spit medication for 5 min three times daily) or a corticosteroid oral paste (triamcinolone acetonide). The duration of treatment was 6 weeks. Thereafter, patients on corticosteroid therapy were treated with CyA. Only slight, transient clinical improvement was observed in both groups after 6 weeks of treatment, compared with baseline. No significant differences could be demonstrated between the two groups. CyA therapy following corticosteroid treatment did not produce any further clinical improvement. During follow-up of the disease for up to 1 year after treatment, neither the CyA nor the corticosteroid group exhibited long-term improvement in disease activity. Contradictory results from earlier reports are discussed.

The frontoorbital advancement--on the use of 3D-CT and the miniplate osteosynthesis.

Between 1987 and 1991 we performed a unilateral or bilateral frontoorbital advancement to correct trigono- or plagiocephaly in 10 children: Three-dimensional CT provides an exact basis for operation planning. Titanium miniplates allow an already primarily rather stable osteosynthesis. The best time for this intervention is the end of the third month of life.

Congenital prearticular temporo-mandibular ankylosis in two siblings.

A report of congenital ankylosis of the temporo-mandibular joint has only very rarely been published. The existence of this entity has been met with great scepticism and therefore believed to be due to perinatal trauma and subsequent development of the ankylosis. However, publications are now available of observations at birth after an uneventful pregnancy and spontaneous delivery. Our cases are the first publication of congenital TMJ ankylosis in two siblings, although there are hints in the histories in two other papers that a sibling may have suffered from the same condition. We discuss the hypothesis that the potential to ankylose in the temporomandibular area is a congenital disorder as in our cases, and that even later in life trauma or infection are only supervening initiating factors.

The double-door tongue flap for total cheek mucosa defects.

Lining of total cheek mucosa defects can be accomplished by opening the tongue along its lateral border and preparing two myomucosa flaps that can be swung upward and downward like a double door to be sutured into the defect. The tongue is released 3 weeks later in a second-stage operation. The operation is quick and easy compared with other methods to achieve lining for such defects. Tongue function is not impaired after healing of the second-stage operation.

[Changes in temporomandibular joint functions in various general anesthesia procedures]. / Untersuchungen zu Veränderungen der Kiefergelenkfunktionen unter verschiedenen Allgemeinanaesthesieverfahren.

In a clinical study conducted in 1986 on 100 patients, we were able to demonstrate that intubation leads to the occurrence of temporary disturbances of the stomatognathic system. To verify these results, a double-blind study was conducted involving 140 patients of ASA groups I and II. Further acceptance criteria were: operation outside of the head and neck area, no throat pack or gastric tube, and the requirement of dental antagonists on the left and right side. Group composition: Group A: oral intubation with a laryngoscope (n = 50); Group B: nasal intubation using a fiberoptic endoscope (n = 40); Group C: face mask (n = 50) Groups A and B were divided at random. Balanced anesthesia was performed for all patients. In group B, after nasal intubation the mandible was placed and fixed in the habitual occlusion position. The patients had a dental examination preoperatively and on 1st, 2nd and 3rd postoperative day. Parallel to this study, we also interviewed 400 patients after routine intubation anesthesia with regard to postoperative temporomandibular joint (TMJ) symptoms. Groups A, B, and C were comparable in age, sex, height, weight, preoperative values of maximal mandibular movement, and pathological findings of the TMJ (Tables 1-3); the only differences were a longer mean duration of surgery in groups A and B than in group C (P greater than 0.05) and that women described more stomatognathic disorders in the preoperative medical history than men.(ABSTRACT TRUNCATED AT 250 WORDS)

Ectopic thymus in the neck; a case report and review of the literature.

A soft, poorly defined mass in the right upper neck of a 7-week-old boy was shown on histology to be ectopic thymus. As aberrant thymic tissue often does change into cysts or neoplasms removal is the treatment of choice. Its persistence in the upper neck seems to be very rare. Embryology, incidence, differential diagnosis and treatment are discussed with a review of the literature.

[Effects of intubation anesthesia on the temporomandibular joint]. / Auswirkungen der Intubationsnarkose auf die Kiefergelenke.

Hardly any attention has so far been paid to temporomandibular joint (TMJ) dysfunction after endotracheal intubation. We examined perioperative lesions of the TMJ in 100 patients who underwent operations in areas other than the head and neck. Fifty of these patients were anesthetized with orotracheal intubation; the other 50 were operated under spinal or peridural anesthesia. The orotracheal intubations were carried out with Macintosh laryngoscopes (blatesize 3). Size 32 Kuhn tubes or Magill tubes were used in 25 patients each. Preoperatively and daily for the first 4 postoperative days, we repeated the history and examined the minimal distance between the occlusal edges of upper and lower incisors (SKD), deviations of the mandible during opening and closing movements, and snapping or grinding of the TMJ. We further measured the duration of intubation, technical difficulties, and the number of years of training of the anesthetist. Age, body length, and preoperative findings were compatible in both patient groups. Operating time was 25% longer in the spinal or peridural anesthesia group. Of the 50 patients with orotracheal intubation, 33 demonstrated a reduced ability of maximal oral opening of up to 35% on the 1st postoperative day. Snapping of the TMJ was observed in 80% of the orotracheally intubated patients on the 1st postoperative day, which was 20% above the preoperative value. TMJ grinding showed no significant changes. Two of the 50 intubated patients complained of TMJ pain, another two had occlusal disturbances, and two had a reduced SKD. There were no detectable differences within the group of intubated patients regarding type of tube or experience of the anesthetist.(ABSTRACT TRUNCATED AT 250 WORDS)

A lacrimal gland cyst in the orbit.

Of the many cysts encountered in the orbital region, cysts that originate from ducts of the lacrimal gland seem to be particularly rare. The lining of these cysts is characteristic and shows one to two layers of cuboidal-to-cylindrical cells without goblet cells. From as few as ten cases the author was able to collect from the literature, the impression prevails that these cysts originate from ectopic gland tissue. A girl of 26 months of age with such a lacrimal gland cyst in the orbit, behind the globe, is described. The young age of the patient and the location of the cyst in the depths of the orbit are rather unusual features. A lateral orbitotomy was used to remove the cyst.

The position effect in mice on day 14.

Previous publications have produced conflicting results concerning the effect and nature of uterine horn position on embryonic weight and development in the uterus bicornis. For this investigation we used 503 embryos from 41 litters of NMRI - mice on gestational day 14. The relative position of each embryo was determined by measuring the distance from the center of each placenta to the cervix in relation to the total length of the uterine horn. After cessation of shrinkage due to fixation the umbilical cord and remaining membranes were removed under the dissecting microscope and the embryos were weighed to the nearest 0.1 mg. Analysis of potential embryonic positions along the uterine horns indicated that 10% at the extreme ovarian and cervical ends were almost devoid of implantations. A mixed nested analysis of variance was used as the appropriate model to test a position on weight effect. Not only was a position effect found but, in contrast to other studies, it is also quantitatively represented. Embryos were lighter both at the ovarian and cervical ends, the mean weight difference being in the range of less than 10% of the average embryo weight.

[Dysplasia of the corneal limbus, the mesodermal iris layer and the jaw skeleton in a family]. / Dysplasie des Limbus corneae, des mesodermalen Irislagers sowie des Kieferskelettes in einer Familie.

Ten members of the family B./A. (belonging to two generations) who had dysplasia of the anterior mesodermal layer of the iris were examined. Several of them also had moderate microcornea. The shape of the skull was remarkable, with micrognathia, in some cases combined with mandibular prognathism and early loss of the teeth. Members of the older generation suffered from pannus, although only pingueculae had been present in youth and adolescence. The anomaly of the anterior part of the eye combined with "dysostosis maxillofacialis" (Peters and Hövels) may represent an abortive form of Rieger's syndrome. An aggressive pannus does not appear to have been described before in this syndrome or related diseases.