Biomedical subjects
Publications and source records attributed to K Hollmann.
The reconstruction after radical orbital exenteration and tumor resection in the anterior skull base may be difficult. To cover these particular perforations we introduce a calvarial bone flap vascularized by a pedicle of the temporal muscle. Technique and experience in 6 cases are reported.
We undertook a postoperative clinical study of 13 patients with ankylosis of the temporomandibular joints. The study consisted of an evaluation of the surgical concepts of resection and subsequent surgical reconstruction by osteotomy in previous height of the joint space and lining of the glenoid fossa with lyophilized dura. Early mobilization and aggressive physiotherapy are mandatory postoperative measures. According to the theory of mandibular growth as a result of functional matrix, early surgical intervention to correct ankylosis should be performed, regardless of the age of the patient, to prevent recurrence and later asymmetry or distoclusion.
37 patients had been reviewed after surgical (n = 25) or conservative (n = 12) treatment of condylar fractures. Morphologic and functional outcomes were equal in spite of the poorer starting position of the patients that had been operated on. Injuries and complications due to the operation, such as facial nerve palsy, growth inhibition or obvious scars have never been found. Conservatively treated and operated patients alike showed a moderate limitation of opening and mediotrusion on the fracture side, and both groups showed a flattening of the protrusion path.
At the Department of Oral Maxillo-Facial Surgery, University of Vienna, we have from January 1973 to September 1985, subjected 117 patients with inoperable malignant tumours in the maxillo-facial area to intra-arterial chemotherapy consisting of methotrexate and bleomycin. In this group 103 patients have also been given radiotherapy. In this report only 68 patients of the group of 103 patients who have undergone combined treatment have been considered eligible for evaluation on the basis of their post-therapeutic survival time, which ranged from 2 to 11 years. 10 cases with complete remission and 34 cases with partial remission were observed, indicating that 65% responded to combined treatment.
This study investigated the occurrence of primary and secondary complications following conservative versus surgical intervention in the treatment of midface and lower jaw fractures. Follow-up studies were undertaken on 81 patients who had been admitted to the above clinic with such fractures during their adolescence. It was found that more complications developed after surgical intervention.
A review of patient data of maxillofacial tumours invading the base of the skull shows a relatively high fatality rate as a result of surgical intervention but also an unexpectedly high life expectancy. Surgical intervention seems to be the right choice whenever clinical examination suggest tumour removal is possible even if a tumour cannot be extirpated in one operation and a further operation from a second access is needed.
In a prospective trial involving 17 patients with head and neck tumors an attempt was made to relate the occurrence of stomatitis during cytostatic chemotherapy to changes in the resident microbial population, if any. Of the 17 patients who received the same cytostatic regimen, 10 developed stomatitis after a mean interval of 12 days. Smears were taken of the 2 patient subgroups (with and without stomatitis) at the onset of treatment and after comparable intervals during treatment and compared to those of a normal control group. Pretreatment smears did not show any quantitative or qualitative differences in the aerobic and anaerobic microbial spectrum between the 3 subgroups examined. During treatment patients developing mucositis were found to show a statistically significant multiplication of pathogens, while the other 2 groups still did not differ from one another. Together with the direct cytostatic effect of chemotherapy, proliferation of pathogens in the oral cavity appears to contribute to the development of stomatitis.
The problems of therapy are described by comparing a retrospective (17 cases) to a prospective (12 cases) study of cases of traumatic lesions of the optic nerve. Intensive cooperation between specialists and a quick diagnosis facilitate the decision regarding treatment and lead to better results. Indication for surgical treatment-transcranial or transethmoidal approach-should be confined to posttraumatic deterioration of optic nerve function in combination with fractures of the optic canal, and to its deterioration in spite of proper conservative treatment-shock treatment and cortisone infusions-.
A new approach for osteotomy of the maxilla through a paranasal incision is described. Advantages and indications are discussed.
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The problems of therapy are demonstrated by comparing a retrospective study and a prospective study of 29 cases with lesion of the optic nerve. Intensive cooperation between specialists and a quick diagnostic procedure facilitate therapeutic decision-making and lead to better results.
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Between January 1973 and April 1982 66 evaluable patients with advanced inoperable orofacial tumours underwent intraarterial Bleomycin and Methotrexate with simultaneous radiotherapy in a prospective study. 32 patients had no previous treatment, 34 patients had initial surgery, radiotherapy and/or chemotherapy. 15 mg Bleomycin were administered through a catheter into the arteria externa carotis daily in the morning. 25 mg Methotrexate were given in the same way at night followed by 3 mg Calcium-Leucovorin i.m. every 8 hours. The cumulative dose was 300 mg Bleomycin and 500 mg Methotrexate. Four hours after the administration of Bleomycin the target volume was irradiated (single fraction 2 Gy, total dose 60 to 65 Gy). The overall response rate was 65% containing 17% complete and 48% partial remission. Destruction of the bone appeared to be the most important index at the start of the therapy. Further prognostic determinants as previous treatment, localisation of the primary tumours (maxilla and mandibula respectively oral cavity and oropharynx) and local regional lymphnode stage missed statistically significance in the survival time, may be due to a possible radiosensitizing effect of the simultaneous chemotherapy. Complete remission turned out to be the most important prognostic factor after the end of treatment. Patients responding with complete remission show a median disease free survival of 56+ months and a median survival time of 82 months. Acute reactions were reversible. Only in 14% of the patients the treatment could not be finished. Better results could be obtained by electron-affinic radiosensitizers and high LET radiation.
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