The importance of preoperative digital subtraction angiography in microsurgically reanastomosed tissue transfer.

The importance of preoperative digital subtraction angiography (DSA) in revascularized tissue transfer in the maxillofacial area is demonstrated on the basis of 53 flaps: In 7 cases DSA revealed results which influenced the therapeutic procedure. Compared to conventional methods of vascular diagnosis, DSA has considerable advantages.

[Microvascular anastomosis of the iliac crest transplant in mandibular reconstruction]. / Das mikrovaskulär-anastomosierte Beckenkamm-Transplantat zur Unterkiefer-Rekonstruktion.

In 12 patients with extensive lower jaw defects following tumor removal or after radioosteonecrosis, a free osteocutaneous iliac crest flap with microvascular anastomoses was used to reconstruct the lower jaw in a single session. The results are reported in brief for this group, in many of whom conditions were not optimal for transplantation because of previous surgery, infection, or radiological tissue damage.

[Long-term outcome of the donor site after free, microvascular pedicled iliac crest transplantation: experiences with 95 cases]. / Spätergebnisse an der Hebestelle nach freier, mikrovaskulär gestielter Beckenkammtransplantation: Erfahrung in 95 Fällen.

Using the anterior iliac crest as donor-site for free osseous, osseomuscular, and osseomyocutaneous flaps has proven itself an important reconstructive instrument both in maxillofacial and in orthopaedic surgery. We present a long-term retrospective evaluation of the donor-site situation after vascularized free anterior iliac crest transfer. The study is based in 95 cases from the years 1985 to 1993 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined, looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Herniation developed in 3% of cases, loss of sensibility in the region of the N. cutaneous femoris lateralis occurred in 9.5% and was in 6% reversible. Scars were in 7% aesthetically not satisfying with no keloids or hypertrophic scarring after all wounds healed per primam intentionem. Mostly minor alteration of the outer surface of the donor site was notable in 20 to 25% of the patients. Pain was a problem for an average of 7% of cases. Impairment in private life was named in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases. Not content with the donor-site situation were 13.5%, not content with the preoperative information were 12% of the patients. Nonetheless were 98.8% of the patients willing to, if necessary, undergo the same operation again. Surprisingly, there is a negative correlation between objective and subjective results: Merely 25% of the patients with sensibility loss were not content with the donor-site result of the operation and vice versa only 1% of the dissatisfied patients had objectively measurable minor complications.

[Clinical aspect of herpes zoster and the pathogenesis of symptomatic cranial nerve zosters]. / Zur Klinik des Herpes zoster und zur Pathogenese des symptomatischen Zosters kranialer Nerven.

The prognosis of shingles is generally good, however if cranial nerves are affected, the course of disease may be very serious. It is still doubtful if latent virus-in the sense of a trigger mechanism-may be activated by dental surgical interventions and cause a symptomatic herpes zoster of cranial nerves. Serious loss of teeth as an oral manifestation of shingles, with panostitis and retarded healing show the seriousness of the tissue changes. The virus can invade the plexus between the facial and trigeminal nerves and can thus travel within the same epineural sheath from one nerve to the other. It follows that in each case of a herpes zoster of cranial nerves, irrespective of location, no dental surgery should be undertaken, even in the initial stage, because - it may increase the extension of the disease along the nerves - it may cause a viraemia - it may initiate uncalled for intraoperative and postoperative complications. Therapy with high doses of antibiotics is indicated.

[Material found on the cleaned diamond turbine drilling heads after injury cases]. / Wekstoffprüfungen zum Klären von Schadenfällen an diamantierten Turbinenschleifkörpern.

Grinding of the hard tissues of the teeth with diamond points and airotor led to bullet-like flying off of part of the instrument. The causes were investigated: Unsatisfactory fixation in the turbine head, deficient material in the rotating instrument, unnecessary notches in the shaft resulting in reduction of diameter, and finally the so far uncorrected radial vibration of the rotating instrument. All of these causes may result in plastic deformation or breakage of the points.

[Mechanic-technological and metallographical studies on soldering of dental alloys]. / Mechanisch-technologische und metallographische Untersuchungen an Lötungen von Dentallegierungen.

It can be proved that the reliability of soldering is in practice not very high, as properties of solidity and the quality of compounds very greatly. This is unavoidable in spite of the most careful execution of the welding and observation of the corresponding soldering directions. Low sigmaB-values are attributable to: 1. the insufficient filling of the soldering space (ca. 80%); 2. many lacunae in the solder commissures, which partly communicate with one another; 3. small diffusion zones and poor wettability in case of the pairing of the materials Co-Cr-Mo/Au-solder.

[The use of a focused arc welding technic for gold and cobalt-chromium-molybdenum alloys]. / Zum Einsatz des gebündelten Lichtbogens beim Verbindungsschweissen von Gold- und Kobalt-Chrom-Molybdän-Legierungen.

Joint work on small amounts of dental alloy Au-Ag-Cu (10 x 10 x 1 mm) and Co-Cr-Mo (20 x 10 x 1 mm) is relatively simple with the microplasma welding technique. The welding results are good after a short practice period. The welding technique should be improved in two points. The suitability and reliability of welding should be studied.

[Consequences of gunshot injuries of the face (author's transl)]. / Folgezustände nach Schussverletzungen im Kiefer-Gesichtsbereich.

During a 5 year period 59 patients with gunshot wounds were treated in the Department of Maxillo-facial Surgery at Munich University. Two patients, who developed local problems secondary to latent infection due to missiles retained for 31 and 32 years, are presented. These missiles were surgically removed. Today, compared to the past, the interval between the gunshot injury and the surgical removal of the missile from the mandible because of the use of antibiotics and improved surgery may be considerable.

[The static (latent) bone cavity. A contribution of 3 cases to the unknown etiology]. / Die statische (latente) Knochenhöhle. Ein Beitrag anhand von drei eigenen Fällen zur ungeklärten Atiologie.

During one year 3 patients with static (latent) bone cavities were observed in the Clinic and Policlinic for maxil-lofacial surgery of the University of Münich. The findings are compared with reports from the literature and possible causes are discussed.

[Osteomyocutaneous flap]. / Osteomyokutanlappen.

A method for the reconstruction of the bony chin contour with an iliac crest free flap is described. The skin pad may be used to replace mucosa or skin or both. Excessive bulk can be a problem, particularly where a relatively small bone and oral mucosal defect requires replacement. Attempts at minimizing this bulk risk the loss of blood supply to the overlying skin. Another procedure, such as the internal oblique-iliac crest osseomyocutaneous flap or inclusion of the thoracodorsal pedicle with the scapular osteocutaneous flap, should then be considered.

[Temporomandibular joint examination under general anesthesia--a case report]. / Zur Kiefergelenkuntersuchung in Allgemeinnarkose. Ein Fallbericht.

Surgical interventions involving the temporomandibular joint are subject to strict indications. It further requires the exhaustion of all conservative treatment possibilities before operative procedures are considered. This case report involves a patient with an impressive TMJ dysfunction. After a series of frustrating attempts at functional treatment, surgical intervention was finally decided. Under general anesthesia however, the patient examination showed not even the least pathologic change in the passive joint function. Besides considering the discrete signs of possible psychiatric-psychosomatic causalities for such alterations, it seems to us that a temporomandibular joint examination under general anesthesia in such suspected cases has a diagnostic and therapeutic significance.

[First results on the volumetric behaviour of osseous transplants after an avascular and reanastomosed transfer]. / Erste Ergebnisse zum Volumenverhalten der Knochenspäne nach avaskulärem und reanastomosiertem Transfer.

In this follow-up study the height of avascular and microsurgically reanastomosed osseous transplants serving for mandibular reconstruction is compared. For analysis a new computer-assisted method is applied which evaluates the plane of the transferred bone. As a result, it is revealed that the reanastomosed bone exhibits the better shape consistency than the avascular flap.

[Role of microsurgically revascularized flaps in the treatment of radionecrosis of the mandible]. / Der Stellenwert mikrochirurgisch revaskularisierter Lappen bei der Therapie der Radionekrose des Unterkiefers.

In spite of advances in radiation therapy of malignant tumours, osteoradionecrosis cannot always be prevented. This form of therapy causes problems particularly in reconstruction of the mandible. Seven cases are presented, and the advantages of microsurgically revascularized tissue transfer (over other methods of treatment) are pointed out and discussed.

The infected mandibular fracture.

The cause of most fracture gap infections is either a lack of or inadequate primary management. It is therefore imperative that jaw fractures be handled initially by an oral and maxillofacial surgeon. Surgical revision and absolute immobilization are essential in cases of osteomyelitis following mandibular fracture. In special cases, additional deposition of gentamycin-PMMA spheres and autologous osteoplasty may be necessary.

Treatment of isolated lateral midface fractures.

In the management of recent fractures of the zygomatic bone and arch we prefer transcutaneous repositioning with a sharp hook. If additional fixation is necessary, wire sutures are used. The advantages of osteosynthesis with wire suturing and the treatment of simultaneous fracture of the orbital floor are presented and discussed.

[Principles in the management of comminuted and defect fractures of the mandible]. / Prinzipien bei der Versorgung von Trümmer- und Defektbrüchen der Mandibula.

Advances in definitive primary surgery during peace time and the modern osteosynthesis techniques have contributed to an improvement in the treatment of comminuted and fractures with loss of bone. The procedure for mandibular reconstruction is described. The therapeutic aim is the complete rehabilitation of appearance and function including functional dentures.

[The role of the alloy-specific elements iron, cobalt, chromium and nickel in aseptic loosening of total hip joint prosthesis]. / Die Bedeutung der legierungsspezifischen Elemente Eisen, Kobalt, Chrom und Nickel für die aseptische Lockerung von Hüftgelenks-totalendoprothesen.

The cause of aseptic loosening of total hip joint prostheses is still largely unexplained. In addition to mechanical forces, material factors may also be instrumental. In 16 patients with loosened hip prostheses who underwent re-operation (8 X Huggler-Weber, 8 X McKee-Farrar), the concentration of the alloy-specific elements cobalt, chromium, nickel and iron were determined in 58 tissue samples by means of neutron activation and emission spectrum analysis. An increase in the element concentrations was found in all the tissue samples, and this was unrelated to the time elapsed since implantation. The chromium concentration in particular was significantly elevated in all the tissue samples, in some patients with McKee-Farrar prostheses up to 10,000 times the norm. In view of the known toxicity of cobalt, chromium and nickel in high doses it seems that the presence of unphysiologically high concentrations of these elements in the vicinity of total hip joint prostheses represents an explanation of some of the loosened prostheses.

[Augmentation of severely atrophied jaws with hydroxyapatite from a prosthodontics standpoint]. / Zur Augmentation des stark atrophierten Kiefers mit Hydroxylapatit aus prothetischer Sicht.

After 4 years of routine application of hydroxylapatite ridge augmentation 109 patients underwent a posttreatment examination. The quality of the alveolar ridge and the denture as well as the functional status of the craniomandibular system were evaluated in detail. For the maxilla good results were obtained in 80-90%, for the mandible in 70-80%. Further improvements seem more probable by the avoidance of prosthodontic faults and the elimination of functional disturbances than by additional surgical procedures such as vestibuloplasty.

[Application of granulate hydroxylapatite for mandibular augmentation]. / E epharmoge tou kokkode ydroxylapatite gia ten anypsose tes gnathikes akrolophias.

The already known surgical interventions for absolute induction of extensive mandibular atrophy, cannot be suggested as routine standardized methods. Use of Hydroxylapatite-ceramic for restoration of the atrophic alveolar process, shows several advantages; among those, simplicity of the operation use of local anesthesia, as well as very low percentage of unsuccessful interventions are taken into consideration. The clinical results of 102 cases are shown and discussed. Through the addition of H.A. ceramic in the field of preprosthetic surgery, there is a broadening of the spectrum of the therapeutic possibilities of patients with prosthetic problems to be expected.