Clinical use of tricalciumphosphate and hydroxyapatite in maxillofacial surgery.
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Biomedical subjects
Publications and source records attributed to E Dielert.
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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.
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.
In the orthopantomogram a reproducible determination of the gonial angle is possible. When comparing two orthopantomograms of the same patient, which were taken during routine clinical examination, a variation of the arithmetic mean of the gonial angle by 1 degrees was found. The value of the gonial angle measured in the orthopantomogram is 2.2 degrees to 3.6 degrees smaller than in the lateral cephalometric radiograph. In single cases, however, a wider range occurred. Therefore in determining the gonial angle, the lateral cephalometric radiograph should be preferred.
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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.
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