[Osteonecrosis of the jaws during treatment with bisphosphonates: diagnosis and therapy].
Explore the source record for details and available documents.
Diphosphonates↗
Biomedical subjects
K K Gundlach
Publications and source records attributed to K K Gundlach.
[Wavy incision of the soft palate. Modification of intravelar veloplasty].
PURPOSE: The problem with primary soft palate repair is shortness of the soft palate and a soft tissue deficit in this region. The authors introduce a modification of the intravelar veloplasty allowing lengthening of the soft palate at the time of primary closure. METHODS: The "soft palate wavy incision procedure" combines a wavy or undulating type of incision at the velar cleft margins with intravelar veloplasty. In 12 patients with complete clefts of the palate, postoperative breathing and speech was analyzed 3 years later. The investigator did not know whether a modification of the common procedure had been performed in these patients or not. RESULTS: It was found that the soft palate wavy line procedure is easy to perform and closure in three layers is possible even in wide clefts of the soft palate. No postoperative fistula was observed. An average lengthening of the soft palate of about 56% (24-83%) was achieved, measured immediately at the end of surgery. Three years later the patients have good speech results following this technique. CONCLUSIONS: Experience has shown that the soft palate wavy incision procedure is straightforward, safe, and easy. It seems that this technique leads to better results than classic intravelar veloplasty. This paper is only a first report, and further investigations are necessary.
Child, Preschool↗
The Eurocleft project 1996-2000: overview.
INTRODUCTION: The original Eurocleft project, a European intercentre comparison study, revealed dramatic differences in outcome, which were a powerful stimulus for improvement in the services of respective teams. The study developed a preliminary methodology to compare practices and the potential for wider European collaboration including opportunities for the promotion of clinical trials and intercentre comparison was recognized by the European Commission. Therefore, the project: 'Standards of Care for Cleft Lip and Palate in Europe: Eurocleft' ran between 1996 and 2000 and aimed to promote a broad uplift in the quality of care and research in the area of cleft lip and palate. RESULTS: The results of the 1996-2000 project include: a register of services in Europe, with details of professionals and teams involved in cleft care, service organization, clinical protocols and special facilities for research; a set of common Policy Statements governing clinical practice for European cleft teams, Practice Guidelines describing minimum recommendations for care that all European children with clefts should be entitled to and recommendations for Documentation governing minimum records that cleft teams should maintain; encouraging initial efforts to compare outcomes (results) of care between centres. A survey showed a wide diversity in models of care and national policies as well as clinical practices in Europe. Of the 201 centres that registered with the network, the survey showed 194 different protocols being followed for only unilateral clefts. CONCLUSION: Cleft services, treatment and research have undoubtedly suffered from haphazard development across Europe. Attainment of even minimum standards of care remains a major challenge in some communities and both the will to reform and a basic strategy to follow are overdue. It is hoped that the Eurocleft Consensus Recommendations reached during the present project will assist in improving the opportunities for tomorrow's patients. It is also hoped that the collaborative research now beginning under the European Commission's Framework V Programme will provide a focus for European researchers wishing to improve understanding, treatment and prevention of clefts of the lip, alveolus and palate in the years ahead.
Child↗
Closure of vertical alveolar bone defects with guided horizontal distraction osteogenesis: an experimental study in pigs and first clinical results.
PURPOSE: To evaluate the option of treating alveolar clefts by guided distraction osteogenesis instead of applying osteoplasty with autologous bone grafts from iliac crest, rib or fibula. MATERIAL AND METHODS: At first, 30 land-bred pigs were operated upon. Treatment of each animal included creating bony defects measuring 2, 4 or 8 mm in the maxilla, anterior to the canine region and up to the nasal periosteum. In 15 of the 30 animals, a new horizontal segment distractor was tested. The device was placed in situ prior to creating an alveolar segment posterior to the defect. This segment was then transported gradually by distraction, thus crossing and closing the defect. At the end of the distraction and stabilization periods the newly formed bony tissue was examined. RESULTS: The critical size of defects was found to be larger than 4 mm. In five of six animals with a horizontal defect of 8 mm, complete ossification of the defect had occurred following distraction osteogenesis. This technique was then applied to five patients successfully. CONCLUSION: It was shown that distraction osteogenesis is a valid alternative for treating alveolar clefts.
Adolescent↗
Is it possible to prevent cleft palate by prenatal administration of folic acid? An experimental study.
OBJECTIVE: In this study, folic acid was tested for its antiteratogenic effects on experimentally induced cleft palate in animals. DESIGN: Eleven pregnant Lew 1 A dams (75 fetuses) received 200 mg/kg procarbazine via gastric tubing on postconception (p.c.) day 14 to induce a cleft palate (CP); seven of the pregnant dams (45 fetuses) were additionally given 4 mg/kg folic acid subcutaneously from the 14th to the 17th day p.c. As a control group, three more pregnant dams (24 fetuses) were not treated with the drugs mentioned above. All fetuses were delivered by Caesarian section on day 20 p.c. OUTCOMES MEASURED: All fetuses were weighed and examined macroscopically with a stereomicroscope. Each fetal head was cut into 35 frontal sections and scrutinized histologically. RESULTS: None of the control fetuses (n = 24) exhibited a cleft. Without folate administration, 90% of the fetuses (27 of 30) that received procarbazine exhibited a CP. After additional prenatal folate administration, this rate remained virtually unchanged (91%; 41 of 45). However, the proportion of complete (total) CP (4%) was significantly (p <.0001) lower than in the group without folate (53%). Cleft-associated microgenia and microglossia were also significantly less frequent when folate was administered prenatally: microgenia was reduced by 22% (p =.029) and microglossia by 24% (p =.032). CONCLUSIONS: On the basis of these results, folate has a partial ameliorating effect on the teratogenicity of procarbazine given to pregnant rats. Additional studies are necessary on the effect of folate in different species, also taking cleft lip and CP into consideration.
Animals↗
[Odontogenic tumors].
The clinical symptoms of odontogenic tumors are non-specific. On the roentgenographs one most often sees radiolucencies within the bone, sometimes in combination with scattered or diffuse radioopacities. Root resorptions may be another important feature. After a short historical introduction on the development of today's classification of odontogenic tumors (WHO), each individual type of neoplasm is discussed briefly. Out of this, a therapeutic regime is developed that places each of the 22 entities into one of the following four groups: malignant, locally aggressive, tumors with recurrences, and non-recurrent ones.
Adult↗
[Components of antibacterial and fibrinolytic activity of human saliva in normal and disordered wound healing].
Following oral surgery, there are sometimes disturbances in wound healing. It was the aim of this investigation to look for relationships between the composition of saliva and disturbed wound healing. Resting as well as stimulated fasting whole saliva was collected from 96 patients (19 to 53 years of age) prior to oral surgery. Flow rate, pH, standard bicarbonate, total buffer bases, peroxidase, lysozyme, thiocyanate, secretory immunoglobulin A, lactoferrin, total protein, tissue type plasminogen activator, and plasminogen activator inhibitor were determined. The salivary data of eight patients who suffered from disturbed wound healing were compared to the data of 20 randomly selected patients with normal wound healing. Patients with disturbed wound healing revealed increased activities and secretion rates for peroxidase in resting saliva. In stimulated saliva, decreased secretion rates for thiocyanate and total protein were found. Not a single salivary factor was able to discriminate both groups of patients with sufficient accuracy, but with a combination of tissue type plasminogen activator, peroxidase, plus secretory immunoglobulin A measurements from resting whole saliva a clearly improved and acceptable discrimination of the two patient groups was possible. A discriminant function including six salivary factors could be used to completely separate both groups.
Adult↗
Malformations of the temporo-mandibular joint in laboratory animals and in man.
In 108 fetal mice and 67 rat fetuses the normal development of the temporomandibular joint was initially explored. Then malformations of the splanchnocranium were induced and studied histologically in 287 newborn rats and 67 mice. These animals had been delivered by caesarean section after treating the pregnant dams with one of 6 different teratogens. Finally, anomalous temporomandibular joints in 53 patients were analyzed radiographically and compared to the findings made in the above mentioned laboratory animals. Most malformations of the temporomandibular region detected were found to be embryopathies. They all fit into a new teratogenic order that was established by comparing the abnormal to the normal development of the structures involved.
Abnormalities, Drug-Induced↗
Treatment of congenital anophthalmos with self-inflating polymer expanders: a new method.
Congenital anophthalmos is a rare malformation in which the optic vesicle fails to develop. This leads to a small bony orbit, a constricted mucosal socket, short eyelids, reduced palpebral fissure and malar hypoplasia. The treatment includes both aesthetic and functional aspects. Therefore, a two-step procedure is described using a new self-inflating hydrogel expander. A lens-shaped expander with a diameter of 8 mm expands the lids and the mucosal socket to allow insertion of an eye prosthesis. As a second step, orbital expansion is performed with a spherical device. The expanders absorb lacrimal fluid from the mucosal socket or tissue fluid and start swelling when implanted in the orbital tissue. The insertion of an expander into the orbit as well as into the conjunctival pocket including its fixation by a single suture took only a few minutes and was an easy procedure. The expansion of the small conjunctival sockets was successfully completed in all cases within a period of 2-4 weeks. The weight (= volume in ml) of devices increased from 0.15-1.5 g (lens-shaped expander; weight in grams = volume in ml) respectively, 0.3-3.5 g (spherical device). The expanders inserted in orbital tissue increased from 0.4-4.4 g. This is equivalent to a 10 to 11 fold increase in their water-free volumes. Orbital expansion with spherical devices in combination with the inserted eye prosthesis enlarges the lid and palpebral fissures also. In contrast to conventional silicon balloon expanders, the procedure using self-inflating hydrogel expanders is simple and highly efficient.
Absorption↗
Perioperative antibiotic prophylaxis in maxillofacial surgery: penetration of clindamycin into various tissues.
Although clindamycin is recommended for prophylactic use in oral and maxillofacial surgery, there is little data available regarding its ability to provide sufficient tissue concentrations at the operative site. We investigated tissue samples from 31 patients, who had to undergo oral and maxillofacial surgery and who received at least one dose of 600 mg clindamycin i.v. preoperatively, to determine clindamycin tissue concentrations in muscle, oral mucosa, fatty tissue, skin and bone between 15 min and 8 h after administration. After homogenization, clindamycin concentration was determined by bioassay. It was demonstrated that clindamycin concentrations above the MIC90 of those pathogens most likely to cause contamination were reached in all kinds of tissues investigated. Already 15 min after administration, tissue concentrations above the MIC90 were reached and were still detectable in the last samples taken between 4 and 8 h after the last clindamycin administration. From the pharmacokinetic point of view, clindamycin is suitable for perioperative prophylaxis during oral and maxillofacial surgery providing sufficient tissue concentrations with no intraoperative additional dosage necessary unless procedures exceed 4 h duration.
Absorption↗
Hydro-jet cutting: a method for selective surgical dissection of nerve tissue. An experimental study on the sciatic nerve of rats.
The aim of this study was to answer the question: is it possible to save motor nerves when dissecting tissue with the hydro-jet dissector? In order to study the influence of the hydro-jet on motor nerves the function of the sciatic nerves of 10 Wistar rats was evaluated. The sciatic nerves were dissected bilaterally and only the left one was exposed to the hydro-jet. The water-jet emerged from a nozzle with a diameter of 0.1 mm and was applied to the nerve for 2, 5 or 10 s and with jet pressures of 80, 85 and 90 bar, respectively. After the operation the animals were observed for 5 months in order to monitor the degree of limping using a scale with 10 clinical grades of function. Five months postoperatively the animals were sacrificed and the sciatic nerves were studied by light and electron microscopy. It was found that hydro-jet pressures of 80 bar and exposure times of 2 s had already lead to irreversible damage to the sciatic nerve. Therefore further studies with lower pressures or shorter exposure times are required before considering hydro-jet cutting for parotid gland surgery. It must be confirmed as harmless to motor nerves before applying this method in humans.
Animals↗
Dental implants in alveolar cleft patients: a retrospective study.
Since 1994, 15 cleft patients have received dental implants after treatment of the alveolar clefts by osteoplastic measures. Altogether 23 dental implants were undertaken. Twelve implants were inserted after tertiary osteoplasty, 7 with simultaneous repeat-osteoplasty, and another 4 implants following two-stage re-osteoplasty. In 11 patients with a total of 17 implants clinical and radiological follow-ups were performed. An individual crown was constructed on each of the implants. The radiological evaluation revealed that 70% of the implants were fully embedded in bone. All implants except one remained in situ and stable. Thus, the success rate was 96% retention. It is believed that a dental implant in the alveolar cleft may be lost because of its unfavourable location in terms of stability and function or because it was inserted too late. Scars resulting from previous surgery can also play a role in the failure of an implant. Therefore it is proposed that dental implants should not be inserted later than 6 to 8 weeks following osteoplasty of the cleft alveolus.
Adolescent↗
[p53 mutations and HPV infections in squamous epithelial carcinomas of the head-neck region. Long-term follow-up].
Mutations of the p53 gene are the most commonly observed genetic alterations in malignant tumors and are often associated with a loss of the tumor suppressor function of the p53 protein. We have analyzed specimens of head and neck squamous cell carcinomas (HNSCC) from 110 patients for p53 gene mutations and 92 of them additionally for human papillomavirus (HPV) infection in order to evaluate the prognostic significance of these factors by comparison with clinical follow-up data. Using the method of polymerase chain reaction (PCR)/temperature gradient gel electrophoresis (TGGE), mutations within the exons 5 to 8 of the p53 gene were found in 48 tumors (44%). Sequencing revealed missense mutations in most cases (15/20). Frequency of p53 gene mutations was not related to the tumor stage, the grade of differentiation, the presence of lymph node metastases, or the smoking history of the patients. With the help of a highly sensitive PCR/hybridization assay, an infection with the high-risk HPV types 16 and 18 could be detected in 39/92 tumor specimens (42%). Follow-up data were obtained from 99 patients with a range of 2-112 months. No correlation of overall survival on the presence of p53 gene mutations or HPV infection could be observed. The absence of statistically significant correlations between p53 gene mutations and progressive disease, however, does not exclude its putative relevance in early phases of tumor development.
Adult↗
[What effect does using the Latham devices have on craniofacial growth in uni- and bilateral lip-jaw-palate clefts].
Primary gingivoperiosteoplasty according to Millard consists of active presurgical orthopedic treatment with the Latham device at the age of 4 months and surgical covering of the alveolar cleft by local mucoperiosteum flaps at the age of 6 months. The aim of this investigation was to evaluate the facial growth following use of the Latham device. Lateral head X-rays and plaster casts from 146 patients with unilateral and bilateral clefts of lip and palate were investigated (follow-up of 16 years). Ninety-one of these patients formed the control group and received no Latham device and no gingivoperiosteoplasty. The same surgeon and orthodontist treated all of the 146 patients. Three-dimensional growth disturbance was observed after application of the Latham device and gingivoperiosteoplasty. Forty-two percent of patients with UCLP and 40% patients with BCLP had an "open bite" following closure of the alveolar cleft (control group 5%-10%): the length of the upper jaw was shorter than in the control group and the frequency of cross-bite was higher. These results demonstrate that treatment with a Latham device followed by gingivoperiosteoplasty disturbs facial growth. Therefore this treatment should be rejected.
Adolescent↗
[Malignant epithelioid schwannoma of the inferior alveolar nerve.Case report with review of the literature].
Malignant epithelioid schwannoma is a very rare disease originating from the Schwann cells. It is a subtype of malignant schwannoma. The limbs are the main location of this entity. In our case study, the inferior alveolar nerve was involved in the mandible. The prognosis for patients with this disease is poor, because metastasis occurs in more than 50%. Clinical and histological features and treatment in a 42-year-old man are discussed in detail. In addition, a short review of the literature and treatment recommendations are given.
Adult↗
Analysis of primary gingivoperiosteoplasty in alveolar cleft repair. Part I: Facial growth.
The primary gingivoperiosteoplasty by Millard consists of presurgical active orthognathic treatment ('Latham device') of the alveolar margins at the age of 3 months and of surgical closure of the alveolar cleft with local gingivoperiosteal flaps at the age of 5 months. The aim of this investigation was to analyse the facial growth following this treatment. The following material was studied: lateral head X-rays and plaster casts from 146 patients with unilateral (UCLP) and bilateral (BCLP) clefts of lip and palate from birth to 16 years of age. Ninety-one of these patients formed the control group, who received neither gingivoperiosteoplasty nor pre-surgical active orthognathic treatment. The same surgeon and orthodontist treated all 146 patients. A three-dimensional growth disturbance after gingivoperiosteoplasty was observed: 42% patients with UCLP and 40% patients with BCLP had an 'open bite' following closure of the alveolar cleft (control group 5%/10%). The length of the upper jaw in patients who underwent gingivoperiosteoplasty was shorter than in the control group. The frequency of posterior cross bite was also higher in the gingivoperiosteoplasty group. These results demonstrate that treatment with a 'Latham device' disturbs facial growth. Therefore, this treatment should be abandoned.
Adolescent↗
p53 gene mutations and HPV infection in primary head and neck squamous cell carcinomas do not correlate with overall survival: a long-term follow-up study.
We analyzed specimens of head and neck squamous cell carcinomas (HNSCC) from 110 patients for p53 gene mutations, and 92 of them for human papillomavirus (HPV) infection, in order to evaluate the prognostic significance of these factors by comparison with clinical follow-up data. Mutations within the exons 5 to 8 of the p53 gene were found in 48 tumors (44%). Sequencing revealed in most cases mis-sense mutations (16/21). Frequency of p53 gene mutations was not related to the tumor stage or the presence of lymph node metastases. Of the 46 tumors that were analyzed by immunohistochemistry, 26 stained positively (56%). The number of positively stained nuclei increased slightly with decreasing differentiation of the tumors, whereas no correlation was found between tumor stage and immunoreactivity. An infection with the high-risk HPV types 16 and 18 could be detected in 39/92 tumor specimens (42%). Follow-up data were obtained from 99 patients within a range of 2 to 112 months. No dependence of overall survival on the presence of p53 gene mutations or HPV infection could be observed. The absence of statistically significant correlations between p53 gene mutation and progressive disease, however, does not deny its putative relevance in early phases of tumor development.
Adult↗
[Results of follow-up after apicoectomy with 2 different root canal filling materials].
Clinical and radiological findings in two groups of patients in whom apicectomies were done are presented. In one group root canal filling was by means of phosphate cementum; in the other, Diaket and guttapercha points were used. Evaluation was according to the methods applied already by Lüders in 1990. Preoperative diagnoses most often had been chronic periapical periodontitis followed by traumatic injuries to frontal teeth and complications encountered during endodontic treatment. In those persons in whom phosphate cementum had been applied, treatment was successful in 210 teeth (77.2%) and a failure was noted in 62 teeth (22.8%). In the Diaket/guttapercha group the success rate was 167 teeth (80.7%), while treatment was without success in 40 teeth (19.3%).
Adult↗