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Biomedical subjects

H P Freihofer

Publications and source records attributed to H P Freihofer.

At least 19 recordsLinked to original sources
PubMed1992

Long-term results on the quadrangular osteotomy.

The results of a follow-up study of 17 patients who underwent a quadrangular osteotomy, are presented. The indication for a quadrangular osteotomy includes a hypoplastic maxilla with retruded infra-orbital rims and infra-orbital area, but with normal nose projection. Almost all patients were satisfied with the result. Relapse in a horizontal direction appeared to be approximately 12%; however, considerable relapse was seen in the vertical direction (61.7%-158%). A major problem during operation appeared to be the high rate of fractures of the infra-orbital wing. Sensory loss in the area of the infra-orbital nerve occurred in 79% of the operated sides. Four patients needed surgical correction of conditions that should be considered complications resulting from the osteotomy, including a case of partial ischaemic necrosis of the premaxilla in a BCLP patient.

Adolescent↗
PubMed1992

The chin as a donor site in early secondary osteoplasty: a retrospective clinical and radiological evaluation.

26 unilateral cleft palate patients received an autogenous bicortical chin bone graft for early reconstruction of the alveolar process. In the evaluation of the donor site, 4% of the anterior teeth showed a negative pulpal sensibility, less than 1% a peri-apical granuloma and 12% pulp canal obliteration. The tooth buds of the canines showed developmental disturbances in 6%. Exposure of unerupted canines should be avoided, and a 5 mm safety margin is advised. Based on its architecture, topographic accessibility, minimal post-operative morbidity and absence of visible scars, the chin can be considered to be a very useful donor site in bone grafting procedures.

Alveolar Process↗
PubMed1991

Restricted opening of the mouth with an extra-articular cause in children.

Restricted opening of the mouth with an extra-articular cause (ROMEC) can have very different aetiologies. A series of 6 children, who have been operated on under 4 different diagnoses, are presented. Excluded are common problems such as recent trauma and posttraumatic scarring, craniomandibular dysfunction or elongated coronoid process, and also tumours. Problems of establishing the diagnosis, surgical treatment, postoperative physiotherapy and timing are discussed. It is shown that none of the cases is a perfect result, some outcomes are even very disappointing. It is therefore concluded that absolute trismus should be treated independently of age. The result expected will be mediocre. For final correction it is suggested that the operator should wait preferably until the second growth spurt has passed. The same goes for children presenting primarily with a mouth opening greater than 20 mm.

Child↗
PubMed1979

[Paresthesia].

Paresthesias originate from different causes, such as central nervous processes, accidental trauma, surgery, inflammations, tumors, general or systemic affections, degenerative processes of the TM Articulation or of the cervical vertebrae. Treatment may be conservative or surgical, but since paresthesias are always of inaccurate character, it is often difficult to choose adequate treatment.

Face↗
PubMed1978

[Retention of shape and function after jaw bone resection for tumor surgery].

Maintenance of form and function after resection of facial bones is of the utmost psychological importance. The potentialities for immediate rehabilitation are demonstrated. Defects in the maxilla are primarily closed by obturators, which must support the soft tissues of the orbit and the cheek, close the defect in the maxilla and restore masticatory function. Secondary reconstruction with split rib grafts is possible even after hemimaxillectomy. In the lower jaw, primary reconstruction with bone grafts at the same time as the resection is the most favourable course. Should the quality or quantity of soft tissues be inadequate, the defect is temporarily bridged with implants which can be replaced later with bone transplants. In all cases adequate mouth opening must be secured and deviation of the mandibular stumps avoided.

Female↗
PubMed1978

Facial duplication -- the unique case of Antonio.

A case of facial duplication with its surgical correction in childhood and the consequences on facial growth is reported. It is a unique case in the duration of observation. The following structures were fully duplicated: the nose, the premaxilla, the cribriform plate, the crista galli. In addition there was an enormous facial cleft including lip, alveolus and palate. Additionally there were two rudimentary eye sockets, eyes, and two supplementary eyebrows. The monstrous hypertelorism with the facial duplication was corrected at the age of ten. The surgical procedure is described and the postoperative complications are discussed. Gross lack of growth of the middle third of the facial skeleton was observed. This was probably the consequence of the initial corrective surgery. Overgrowth of the mandible created a gorilla-like appearance by the end of the growth period. This was corrected in one operation by advancement of the middle third in three sections and repositioning of the mandible as a whole together with the mandibular anterior alveolar segment. Finally all parts of the lower half of the nose had to be enlarged, both soft tissues as well as the cartilaginous framework. A pharyngoplasty in addition to the correction of the intermaxillary abnormalities did much to improve the speech quality of the patient. A large secondary cranial defect was successfully reconstructed with the use of 14 halved ribs. In spite of the removal of four ribs from one side and three ribs from the other, there were no postoperative respiratory problems. Spontaneous rib regeneration was found where ribs had been removed one year earlier.

Adolescent↗
PubMed1978

The behaviour of the maxilla in vertical movements after Le Fort I osteotomy.

In 15 cases of ordinary Le Fort I osteotomy with simultaneous vertical displacement, the behaviour of the maxilla in respect to vertical movement was examined. It was observed that out of 12 maxilla which had been tilted downwards, 10 moved upwards again. One maxilla remained stable and another one moved further downwards. Of 3 cases with upward movement, two remained stable whereas one moved further upwards. Therefore, the authors conclude that the downward displacement especially is unstable and that one has either to overcorrect or search for possibilities of stabilization other than wiring suspension. Since these movements occur during postoperative intermaxillary fixation, no occlusal changes are observed.

Adolescent↗
PubMed1978

[Clinical symptoms of precancerosis].

Clinically, praecancerosis of the oral mucosa may be classified into the following groups: Whitish, flat changes, reddish changes, papillary changes and ulcers. Combination of the various groups and flowing transition between them is often observed. It can be shown that praecancerosis can be neither clearly distinguished from benign tumors or changes, nor can it be differentiated from already existing malignomas. The same picture of a disease can occur in various clinical aspects. On the other hand, histologically very different changes may often hardly be distinguished clinically. A change in the oral mucosa must therefore be regarded as possibly malignous as long as not proven to the contrary. Also, it is important to check, at regular intervals, changes diagnosed benign, since the possibility of malignous change cannot be ignored.

Carcinoma, Squamous Cell↗
PubMed1977

Changes in nasal profile after maxillary advancement in cleft and non-cleft patients.

Based on 25 cases with unilateral clefts of lip, alveolus and palate with retromaxillism (CLAP) and 25 cases with pure retromaxillism (RM) the effect on the nose of advancing the maxilla by a Le Fort I osteotomy is analyzed. It can be shown that on average the base of the nose which is at the same time the base of the upper lip, follows the base of the maxilla in the ratio of 4 : 7 while the nasal tip is advanced in a ratio of 2 : 7. This means that to achieve a specified advancement of the nasal base, the maxilla has to be brought forward about twice this amount. A planned advancement of the tip of the nose can, on average, only be obtained by an advancement of the maxilla by three times this amount. The tangent to the columella is tilted considerably forewards and upwards. The movement is a little more marked in CLAP than in RM. The amount of maxillary advancement influences the ratios very little. It seems that they are slightly better after significant advancement. Leaving the nasal spine intact and tilting the maxilla forwards and upwards have a favourable influence on the advancement of the nasal tip. There is no satisfactory explanation of why the extremes in all groups for all measurements are placed so very far apart. As was found in the evaluation of lip movements (Freihofer 1976) this leads to the conclusion that in spite of careful planning the result in the individual case can differ considerably from that expected.

Adult↗
PubMed1977

[Model test on the change of position of the mandibular condyle after sagittal splitting of the mandible].

On two acrylic copies of a cranium with mandibular prognathy, the mandible was moved back by sagittal cut of the ascending ramus. It is shown that with both methods of immobilization, circumferential and screw-osteosynthesis, the segments cause a change in the position of the condyles. There are no clear advantages or disadvantages of either method. Observed cases of circumferential wiring showed practically no arthrotic symptoms after 2-10 years, which indicated that the t.m. joint has a large degree of adaptability. However, such a statement can be made definitely only after an observation time of 20-30 years.

Humans↗
PubMed1976

The lip profile after correction of retromaxillism in cleft and non-cleft patients.

Based on 25 cases with unilateral cleft of lip, alveolus and palate with retromaxillism (CLAP) and 25 cases with pure retromaxillism (RM), the effect on the lip of advancing the maxilla by Le Fort I osteotomy is analysed. It can be shown that on average the base of the upper lip follows the base of the maxilla in a ratio of 4:7. The free end of the upper lip is pushed forwards by the upper front teeth in a ratio of 5:9. This means that to achieve a specified lip advancement, the maxilla has to be brought forward about double the amount. No important between CLAP and RM could be seen. Leaving the nasal spine intact has a favourable influence on movements of the upper lip. The amount of maxillary advancement has no bearing on the ratios. It seems though that thin lips follow the movement of the maxilla better than voluminous lips. There is no satisfactory explanation why the extremes in all groups for all measurements are placed so very far apart. This leads to the conclusion that in spite of careful planning the result in the individual case can differ considerably from that expected.

Adult↗
PubMed1976

Simultaneous reconstruction of the area of the temporo-mandibular joint including the ramus of the mandible in a posttraumatic case. A case report.

A new technique for the simultaneous reconstruction of the glenoid fossa and the ramus of the mandible is described. By combining and adapting procedures already described, the missing bone of the zygomatic arch, temporo-mandibular joint and ramus was replaced in one operation in a post-traumatic case. The indication for this operation is discussed. It is rather limited. The technique can be used for reconstruction of skeletal defects after tumour resection and in congenital aplasias of this region.

Adolescent↗
PubMed1976

[Problems of the treatment of prognathism by sagittal splitting of the ascending mandibular branch].

The author reports 20 years of experience at the Zurich clinic with the treatment of mandibular prognathism by sagittal cutting of the ascending mandibular rami. The original method of Obwegeser and its modifications (1955, 1957) are discussed. After mentioning the indications, the technique of surgery is described, such as it is practised today at the clinic of maxillofacial surgery in Zurich. The classical method applies to tooth bearing arches, while modifications are necessary in edentulous mandibles. Further on, modifications as mentioned in the literature, particularly applying to the soft tissue cuts, the bone cuts, the position of the buccal cut of the cortical bone, the direction of partition, the technique of partition and the fixation of the segments, finally the intermaxillary splinting and drainage are mentioned. It is explained, why in the Zurich clinic the technique of Obwegeser is still prevalently used. The most prominent modifications are the blunt partition of the ramus and the control of the position of the condyle under the radiographic viewer. The use of the modification in the cut of the buccal cortical bone after Dal Pont (1959) was abandoned again.

Female↗