[Reconstructieve facial surgery in facial defects after the surgical removal of malignant skin tumours]. / Reconstructieve aangezichtschirurgie bij aangezichtsdefecten na chirurgische verwijdering van kwaadaardige huidtumoren.

Because of the enormous and continuing increase in cases of skin cancer in the Netherlands, dentists will increasingly see patients with skin cancer. The most common malignant skin cancers are basal cell carcinoma, squamous cell carcinoma and malignant melanoma. With resection of a skin tumour, the oncological principles should be applied. For the closure of the resulting defect, a choice for the individual patient is made out of numerous techniques. Facial reconstructive surgery aims to restore the face in form and function and to maintain the patient's quality of life. By early recognition of skin tumours of the face, damage to the tissue can be limited. Dentists, who see their patients periodically, can play an important role here.

[Orthodontics and vertical distraction osteogenesis of the maxilla]. / Orthodontie en verticale distractieosteogenese van de maxilla.

A female patient (age 26) visited the orthodontist for correction of the reduced exposure of the upper incisors during laughing. She also reported crowding of the lower incisors and an association between lisping and her open bite. The diagnosis in this case: a Class III malocclusion case with incisor crowding and an open bite. Because her main complaint was reduced upper incisor exposure while talking and laughing, which would not be corrected with orthodontic appliances only, the position of the maxilla was corrected during orthodontic treatment by means of vertical intra-oral maxillary distraction. An acceptable and relatively stable result was achieved.

[Development of speech and facial skull growth after primary velopharyngoplasty in lip-jaw-palate clefts]. / Entwicklung von Sprache und Gesichtsschädelwachstum nach primärer Velopharyngoplastik bei Lippen-Kiefer-Gaumen-Spalten.

BACKGROUND: A two-armed, prospective, randomized study was performed to evaluate the influence of primary velopharyngoplasty on speech and facial growth in patients with cleft lip and palate. PATIENTS AND METHODS: Forty-two patients born between 1978 and 1982 were included. All patients were treated with an intravelar veloplasty, and 21 patients simultaneously with a velopharyngoplasty according to Sanvenero-Rosselli. The patients were examined at the age of 5, 10, 15, and 18 years according to the recommendations of the research group of the German Association of Craniomaxillofacial Surgery for minimal documentation. RESULTS: Patients treated with primary velopharyngoplasty showed a higher deficit in transversal growth of the maxilla of 0.6 mm in the molar region in adolescence in comparison to the control group. The sagittal growth of the maxilla was reduced at 2.6 degrees in the SNA angle. A statistically significant decrease in growth of the maxilla caused by primary velopharyngoplasty was not detectable (p > 0.05). The incidence of rhinophonia and dyslalia did not differ significantly. Primary velopharyngoplasty did not lead to speech improvement either in childhood or in adolescence. CONCLUSION: With regard to a potential decrease in growth of the maxilla and the disadvantages of a hindered nasal respiration, a primary velopharyngoplasty therefore does not seem to be indicated.

Custom-made cast titanium implants produced with CAD/CAM for the reconstruction of cranium defects.

Titanium implants for the reconstruction of bony skull defects, using data from three-dimensional spiral computer tomography, have been described by other authors. Instead of milling the implants from a titanium block, an advanced method of rapid prototyping for a fine casting process is presented. Casting vs milling offers several advantages. It is possible to form very thinly tapered structures and to obtain more complex geometrical structures with smaller diameters. Many geometrical forms, which cannot be milled for technical reasons, can be produced using this technique.