RESUMO
Between March 1982 and December 2002 we did a total of 534 reconstructions with free flaps from various donor sites for 529 patients. The jejunum was the donor site in 181 reconstructions (34%), followed by the radial forearm flap in 173 reconstructions (32%); 86% of the reconstructions were immediately after excisions. Surgical re-exploration was necessary in 37 patients (7%); the failure rate from necrosis of the flap was 5%. Factors associated with complications were American Society of Anesthesiology (ASA) class and age.
Assuntos
Cabeça/cirurgia , Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo , Criança , Traumatismos Craniocerebrais/cirurgia , Anormalidades Craniofaciais/cirurgia , Feminino , Sobrevivência de Enxerto , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Jejuno/transplante , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Fatores de Risco , Transplante de PeleRESUMO
Maxillofacial surgery is a relatively young speciality of medicine and it was not established as an organized specialty until the second half of the 20th century. At first it was supported by general surgeons with particular interest in this field, and also by inspired, extremely talented dentists. During the past few years modern techniques have brought decisive progress also in maxillofacial surgery, leading to rapid further development of diagnostic and therapeutic possibilities. The development of our specialty in the past century is discussed on the four main points of our scope, traumatology, orthognathic, cleft and tumour surgery. Considering the future prospects of our specialty one should realize that in the near future maxillofacial surgery will also be influenced by further medical-technical progress in the field of micro-robots, by percutaneous endoscopic techniques and by minimal invasive or laser surgery. Basic research will also cause a more profound change in our specialty, especially in the field of tumour therapy. Molecular biological research shows some good signs, which could already be transmitted to the prevention, diagnosis and also the therapy of tumours. In the field of tissue transplantation it is no longer utopia that autogenous tissue sampling can be almost completely be avoided. By further developing 'tissue engineering' it will be possible to cultivate bones as well as soft tissue with the aid of gene technology and transplant them into the face using relevant carrier substances. Altogether, the complexity of maxillofacial surgery in the coming century will increase, necessitating the best and widely trained maxillofacial surgeons for successful accomplishment.
Assuntos
Traumatismos Faciais/história , Cirurgia Bucal/história , Anormalidades Craniofaciais/história , Anormalidades Craniofaciais/cirurgia , Traumatismos Faciais/cirurgia , Neoplasias de Cabeça e Pescoço/história , Neoplasias de Cabeça e Pescoço/cirurgia , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Má Oclusão/história , Má Oclusão/cirurgia , Maxila/lesões , Maxila/cirurgia , Cirurgia Bucal/tendênciasRESUMO
A case of an extensive congenital cystic hygroma in an unusual situation in the orbit is presented. The lesion occurred as an ulcerative, rapidly--growing and repeatedly--bleeding tumour with destruction of the left orbit, parts of the middle face, the nose and the base of skull. Despite X-ray investigation, computed tomography, nuclear magnetic resonance imaging and angiography it was impossible to give a reliable diagnosis. Because of the rapid growth of the tumour and its uncertain nature a radical resection with exenteration of the orbit, resection of the zygoma, the soft tissues of the cheek and parts of the nose and skull base was performed. One year after the resection there was no sign of recurrence.
Assuntos
Neoplasias Faciais/congênito , Linfangioma/congênito , Neoplasias Orbitárias/congênito , Neoplasias Faciais/diagnóstico , Neoplasias Faciais/cirurgia , Humanos , Lactente , Linfangioma/diagnóstico , Linfangioma/cirurgia , Masculino , Neoplasias Nasais/congênito , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/cirurgia , Neoplasias Cranianas/congênitoRESUMO
The position of the TMJ disc in 23 asymptomatic volunteers was determined by ultrasonography imaging. A very low incidence (2.1%) of internal derangements was revealed. The results are discussed in the light of current concepts on the aetiology of TMJ internal derangements. Since ultrasound imaging makes possible noninvasive dynamic investigation of the TMJ arrangements, performance of a prospective long-term study including a sufficiently large group of volunteers is suggested to clarify further the real incidence of TMJ internal derangements.
Assuntos
Cartilagem Articular/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Adulto , Feminino , Humanos , Incidência , Luxações Articulares/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Masculino , Côndilo Mandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , UltrassonografiaRESUMO
Between 1980 and 1989, 82 velopharyngoplasties have been carried out in the Department of Oral and Maxillofacial Surgery at the Medical University of Hannover. Speech results of 51 of these patients, including 39 patients with cleft lip and palate, could be followed up in the context of a clinical follow-up examination. Besides evaluation of speech results by two senior speech pathologists and two untrained listeners, a frequency analysis of the speech results with a sonograph was obtained. Nasal air loss was documented with a fogged-mirror test and computer aerometry. Whereas in 37 of 51 patients a normal or almost normal colloquial speech could be demonstrated, 30 of 39 patients with cleft lip and palate showed a normal or almost normal realization of the test sentences. Thirty of the 37 patients (81.08 percent) with normal or almost normal colloquial speech showed extensive mobility of the lateral pharyngeal wall. Symmetry of the velopharyngeal flaps seemed to have no influence on the speech result. With a fogged-mirror test, an average reduction of mirror fogging from 2.0 rings preoperatively to 0.9 rings postoperatively could be shown. In 31 patients, there was no longer any air loss postoperatively. Besides one rupture of a flap, two flaps had to be diminished in their lateral dimensions because of excessive size. We regard the cranially pedicled pharyngeal flap as an important operative procedure for improving speech results, especially in cleft lip and palate patients.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Retalhos Cirúrgicos/métodos , Insuficiência Velofaríngea/cirurgia , Adolescente , Fenda Labial/epidemiologia , Fenda Labial/fisiopatologia , Fissura Palatina/epidemiologia , Fissura Palatina/fisiopatologia , Feminino , Humanos , Masculino , Faringe/cirurgia , Prognóstico , Estudos Retrospectivos , Inteligibilidade da Fala , Medida da Produção da Fala , Fatores de Tempo , Insuficiência Velofaríngea/epidemiologia , Insuficiência Velofaríngea/fisiopatologiaRESUMO
The German-Austrian-Swiss working group on tumors in the maxillo-facial region (DOSAK) comprises 61 hospitals in German-speaking countries. The working group is concerned with multicentre problems of tumor documentation, tumor diagnosis and tumor therapy. DOSAK can look back on almost 20 years of work. It therefore seems appropriate to report on the organization, methods and objectives and to make previous work as well as future tasks known beyond German-speaking countries.
Assuntos
Neoplasias Faciais , Neoplasias Maxilomandibulares , Neoplasias Bucais , Sistema de Registros , Áustria , Neoplasias Faciais/classificação , Neoplasias Faciais/epidemiologia , Alemanha Ocidental , Humanos , Neoplasias Maxilomandibulares/classificação , Neoplasias Maxilomandibulares/epidemiologia , Neoplasias Bucais/classificação , Neoplasias Bucais/epidemiologia , Estudos Multicêntricos como Assunto , SuíçaRESUMO
An experimental study was conducted to evaluate the regenerative potential of the inferior alveolar nerve after nerve transection and microsurgical reconstruction at different intervals. Histomorphometric parameters of regenerating axons were assessed using a computer-assisted image analysis system. A continuous decrease in axon density and a reduction in axon diameter was noted in all groups. The average regeneration rate ranged from 42% to 60%. The results of this study indicate that microsurgical reconstruction of the inferior alveolar nerve is even possible 12 months after nerve transection.
Assuntos
Axônios/fisiologia , Nervo Mandibular/cirurgia , Microcirurgia , Regeneração Nervosa/fisiologia , Anastomose Cirúrgica , Animais , Axônios/ultraestrutura , Processamento de Imagem Assistida por Computador , Masculino , Nervo Mandibular/fisiopatologia , Nervo Mandibular/ultraestrutura , Bainha de Mielina/ultraestrutura , Fibras Nervosas/patologia , Fibras Nervosas/fisiologia , Fibras Nervosas Mielinizadas/patologia , Fibras Nervosas Mielinizadas/fisiologia , Coelhos , Nervo Tibial/transplante , Fatores de TempoRESUMO
The purpose of this study was to evaluate the oncologic effectiveness of radical and different types of modified neck dissections with preservation of the spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle and to identify prognostic factors for regional control and survival in univariate and multivariate analysis. This retrospective study included 373 patients with squamous cell carcinoma of the oral cavity who underwent 401 neck dissections between January 1986 and December 1997 at the Department for Oral and Maxillofacial Surgery, Hanover Medical School. The actuarial neck control rate after 5 years was estimated with 87%. Neck failure occured only within the first 2 years after neck dissection. The number of positive nodes, macroscopic extracapsular spread, peeling off metastases from carotid artery and cranial base and preoperative radiochemotherapy were significant prognostic factors. Grade of metastases, microscopic extracapsular spread, lymphangiosis carcinomatosa and postoperative radiation showed no prognostic significance. The comparison of neck failures after radical and modified neck dissection demonstrated a tendency to improved regional control after radical neck dissection with increasing extent of neck disease.
Assuntos
Neoplasias Bucais/cirurgia , Esvaziamento Cervical , Nervo Acessório/cirurgia , Análise Atuarial , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma de Células Escamosas/prevenção & controle , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Veias Jugulares/cirurgia , Funções Verossimilhança , Metástase Linfática/patologia , Metástase Linfática/prevenção & controle , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/prevenção & controle , Análise Multivariada , Músculos do Pescoço/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Prognóstico , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Análise de Regressão , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
In this retrospective study we give a clinical review of our experience with adenoid cystic carcinoma (ACC) and compare our results with those reported in the literature. Between 1981 and 2000, 74 patients with this disease were treated at our department. Complete resection was reached in 45 cases. Fourteen patients received postoperative radiation. Local control rates at 5, 10 and 15 years were 64%, 56% and 52% with a mean local control time of 11.1 years. Tumour size (PAssuntos
Carcinoma Adenoide Cístico/patologia
, Carcinoma Adenoide Cístico/cirurgia
, Neoplasias de Cabeça e Pescoço/patologia
, Neoplasias de Cabeça e Pescoço/cirurgia
, Adolescente
, Adulto
, Idoso
, Idoso de 80 Anos ou mais
, Neoplasias Ósseas/secundário
, Carcinoma Adenoide Cístico/radioterapia
, Feminino
, Neoplasias de Cabeça e Pescoço/radioterapia
, Humanos
, Neoplasias Pulmonares/secundário
, Masculino
, Pessoa de Meia-Idade
, Esvaziamento Cervical
, Invasividade Neoplásica
, Estadiamento de Neoplasias
, Radioterapia Adjuvante
, Estudos Retrospectivos
, Neoplasias das Glândulas Salivares/patologia
, Neoplasias das Glândulas Salivares/radioterapia
, Neoplasias das Glândulas Salivares/cirurgia
, Taxa de Sobrevida
, Resultado do Tratamento
RESUMO
A technique is presented in which resected mandibles are restored with a combination of microsurgically revascularized jejunal grafts and bone grafts. The bone grafts served as a recipient for Branemark implants. The preliminary results showed that the jejunal mucosa tolerates the implants well and the masticatory function was adequately restored in the patients discussed.
Assuntos
Transplante Ósseo , Implantação Dentária Endóssea/métodos , Implantes Dentários , Mucosa Intestinal/transplante , Mandíbula/cirurgia , Microcirurgia , Adolescente , Placas Ósseas , Criança , Feminino , Humanos , Ílio , Jejuno , Neoplasias Mandibulares/cirurgia , Mucosa Bucal/cirurgiaRESUMO
In this retrospective study we give a clinical review of our experience with different subtypes of salivary gland cancer. Between January 1983 and December 2002, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. There were 79 (51.0%) adenoid cystic carcinomas, 42 (27.1%) mucoepidermoid carcinomas, 12 (7.7%) adenocarcinomas, 10 (6.5%) polymorphous adenocarcinomas and 12 (7.7%) other tumor entities of smaller number. Complete resection was reached for 63.5% of patients with high grade carcinomas and for 80.0% of patients with low grade carcinomas. 26.2% of patients with high grade carcinomas and 13.3% of patients with low grade carcinomas received postoperative radiation. Overall survival rates at 5, 10 and 15 years were 65.9, 48.0 and 39.8% with significant difference for patients with high grade and low grade carcinomas. Histopathologic subtype, tumor stage and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation. In the future, patients with salivary gland carcinomas should be randomised for prospective multicentric clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer.
Assuntos
Neoplasias das Glândulas Salivares/epidemiologia , Adenocarcinoma/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoide Cístico/epidemiologia , Carcinoma Mucoepidermoide/epidemiologia , Criança , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante/estatística & dados numéricos , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
A multicentric, randomized study of squamous cell carcinoma (SCC) of the oral cavity and the oropharynx has been undertaken by DOSAK. The results after radical surgery alone have been compared with the results of combined preoperative radiochemotherapy followed by radical surgery. Patients with primary (biopsy proven) SCC of the oral cavity or the oropharynx with tumor nodes metastasis (TNM) stages T2-4, N0-3, M0 were included in the study. A total of 141 patients were treated by radical surgery alone, whereas 127 patients were treated by radical surgery preceded by preoperative radiochemotherapy. The preoperative treatment consisted of conventionally fractioned irradiation on the primary and the regional lymph nodes with a total dose of 36 Gy (5 x 2 Gy per week) and low-dose cisplatin chemotherapy with 5 x 12.5 mg cisplatin per m2 of body surface during the first week of treatment. Radical surgery according to the DOSAK definitions (DOSAK, 1982) was performed after a delay of 10-14 days. During the follow-up period, 28.2% of all patients suffered from locoregional recurrence, and 27.2% of the patients died. The percentages were higher after radical surgery alone for locoregional recurrence (31% and 15.6%) and for death (28% and 18.6%). The life-table analysis showed improved survival rates of 4.5% after 1 year and 8.3% after 2 years in the group of patients treated with combined therapy. The demonstrated improvement appeared to be significant with the Gehan-Wilcoxon test as well as with the log rank test below a P value of 5%.
Assuntos
Carcinoma de Células Escamosas/terapia , Neoplasias Bucais/terapia , Neoplasias Orofaríngeas/terapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Terapia Combinada , Feminino , Seguimentos , Humanos , Tábuas de Vida , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/radioterapia , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia , Neoplasias Orofaríngeas/tratamento farmacológico , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirurgia , Cuidados Pré-Operatórios , Estudos Prospectivos , Taxa de SobrevidaRESUMO
Many cleft palate teams currently schedule palatoplasty and veloplasty within the child's first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at approximately 18-24 months of age. It was questioned which speech and language outcome was achieved and whether it may be influenced by: (1) type and extent of the clefts; (2) velopharyngeal inadequacy; and (3) hearing disorders. A retrospective evaluation of data collected from 1985 to 1993 was performed summarizing receptive and expressive speech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and palate (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n = 86 had constant normal hearing, and n = 284 had conductive hearing loss > 20 dB (500-4000 Hz). Severe developmental phonology errors were found in 30-50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticulation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resonance and air emission was nearly normal in CLA, but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had significantly more and severely affected phonology, morphology, syntax, vocabulary, language comprehension, and auditory perception than normal hearing children. Findings indicated that speech and language function in CLP patients were predominantly related to the hearing status.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Audição , Desenvolvimento da Linguagem , Palato Mole/cirurgia , Palato/cirurgia , Fala , Transtornos da Articulação/diagnóstico , Transtornos da Articulação/etiologia , Criança , Pré-Escolar , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Perda Auditiva Condutiva/complicações , Perda Auditiva Condutiva/diagnóstico , Testes Auditivos , Humanos , Lactente , Masculino , Estudos Prospectivos , Insuficiência Velofaríngea/diagnóstico , Insuficiência Velofaríngea/etiologiaRESUMO
The choice of surgical approach to tumors of the cranial base in children is determined by strict criteria. The criteria include optimal visibility for the surgeon, minimal possible impairment of facial skull growth, and the preservation of motor and sensory nerve integrity. From 1993 to 1996, three children (6 years old, 22 months old, 6 months old, respectively) underwent surgery to resect cranial base tumors through a modified lateral transmandibular approach. In all three patients a preauricular incision with temporal and submandibular extensions was performed. After the mandible was prepared, an osteotomy was conducted cranially to the mandibular foramen. When the capitulum was temporarily disarticulated, wide access to the cranial base was provided and the tumors were resected. Two of these children were available for follow-up, and we continue to observe their development. Given the severity of their conditions, treatment yielded good results. Growth impairment of the mandible was corrected by the distraction osteogenesis technique.
RESUMO
Micronerve reconstruction of motor and sensitive nerves in the head and neck area currently has an established range of indications. Surgical procedures always follow a strict order, beginning with external neurolysis. In cases of complete separation of the nerve stumps or when tensionless coaptation of nerve ends can not be achieved, nerve grafts from suitable donor sites, for example the sural nerve, have to be interposed. Good functional results can be obtained following reconstruction of motor nerves, as with the accessory or the facial nerve. In contrast, reconstruction of sensory nerves has a lower success rate but very often leads to a subjective improvement of symptoms for the patient. In long-standing facial palsy with atrophy of the facial musculature, neurovascularly reanastomosed muscle grafts offer a good option.
Assuntos
Cabeça/inervação , Microcirurgia , Pescoço/inervação , Nervos Periféricos/cirurgia , Anastomose Cirúrgica , Atrofia , Músculos Faciais/inervação , Músculos Faciais/patologia , Músculos Faciais/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Humanos , Neurônios Motores , Músculo Esquelético/transplante , Neurônios Aferentes , Nervos Periféricos/transplante , Nervo Sural/transplanteRESUMO
A lesion of the IAN following endodontic treatment of the lower molars and premolars is not a rare event and presents an uncomfortable situation both for the dental surgeon and the patient. Injury can result on the one hand by direct intrusion of the instrument through the apex into the mandibular canal, and on the other by the filling material which becomes forced into the mandibular canal. In the latter case, a nerve lesion will only result when the filling material contains neurotoxic substances such as paraformaldehyde. With a direct lesion or when forcing of resorbable filling material into the mandibular canal is suspected, one should first employ a wait-and-see approach, because usually the only nerve damage is in the form of neuropraxy or axonotmesis for which there is a high rate of spontaneous regeneration. However, if neurotoxic filling material is introduced into the direct vicinity of the nerves, the mandibular canal should be opened and the filling material should be removed as early as possible. If the filling material is forced directly within the endoneurium between the nerve bundles, the damaged nerve sections must be resected and bridged using transplants from the sural or greater auricular nerves.
Assuntos
Doenças dos Nervos Cranianos/etiologia , Tratamento do Canal Radicular/efeitos adversos , Traumatismos do Nervo Trigêmeo , Adulto , Dente Pré-Molar , Doenças dos Nervos Cranianos/induzido quimicamente , Doenças dos Nervos Cranianos/cirurgia , Doenças dos Nervos Cranianos/terapia , Feminino , Humanos , Hipestesia/induzido quimicamente , Masculino , Nervo Mandibular/efeitos dos fármacos , Nervo Mandibular/cirurgia , Pessoa de Meia-Idade , Dente Molar , Síndromes de Compressão Nervosa/etiologia , Degeneração Retrógrada , Materiais Restauradores do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/instrumentação , Nervo Sural/transplanteRESUMO
The authors report their experiences with 62 patients with extensive defects of the oral mucosa replaced by jejunal grafts. They focus on the possibilities of combining the jejunal grafts with traditional methods of replacing bone and soft tissue in the maxillo facial region. Various techniques of combined reconstructions of different parts of the maxilla and the face are discussed and the results are presented. The problem of the jejunal graft in the maxillo facial region is the connection of the veins in the recipient site. Usually only the superior thyroid vein is available and it shows great anatomical variations. The transplantation of jejunal grafts is a technique which is indicated in many cases. It allows the functional replacement of intraoral mucosa with an almost unlimited supply of substitute tissue and with strong mesenteric arteries and veins which are to a large extent congruent with the neck vessels.
Assuntos
Face/cirurgia , Jejuno/transplante , Maxila/cirurgia , Mucosa Bucal/cirurgia , Adolescente , Feminino , Humanos , Masculino , Neoplasias Maxilares/cirurgia , Pessoa de Meia-Idade , Neoplasias Palatinas/cirurgia , Palato Mole , Sarcoma/cirurgia , Cirurgia PlásticaRESUMO
Our experience in reconstruction of extensive defects in the oral mucosa with free jejunal grafts in 15 patients is reported. The jejunum provides a well vascularised mucosal lining, which is resistant to mechanical stress and being a thin flap contours well in the mouth. Methods of avoiding technical failure are described. The technique permits radical resection of oral tumours.