[Morphologic changes of the facial bone structure in Crouzon's syndrome].
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Osteosarcoma, involving mandible and zygoma in 3 patients is presented and discussed; their clinical, radiological and treatment results are detailed. As this disease is uncommon in these bones, the difficulty in the management merits attention.
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On purpose to achieve better and more controlled alveolar ridge augmentation, biodegradable polyglycolide (PGA) curved implants with porous, particulate hydroxylapatite (HA) were developed to be used in an experimental augmentation in sheep mandible. Prior to surgery curved PGA implants were loaded with particulate HA with help of a rather fast degrading adhesive, polyglycolide/polylactide (PGA/PLA) copolymer. This augmentation device was inserted into the ridge using a slight modification of the tunnelling technique. Macroscopically, a dehiscence with loss of HA particles was observed in 3 of the 16 augmentations. Bone ingrowth was seen in a noticeable degree in one sheep at 24 weeks. Instead, foreign body-type cells were shown at the interface of mandibular bone and hydroxylapatite deposit, as well as abundant connective tissue reaction inside HA deposits. The results of the study give rise to concern about bony integration in the presence of biodegradable polyglycolide substances in HA augmentation. The findings call in question even their use as a carrier for bone forming agents in combination with HA.
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The article reports on goals and results of therapeutic embolization in a total of 28 patients with vascular lesions of the skull base and maxillofacial region. Compared to other procedures of vascular occlusion the technique of arterial embolization offers crucial advantages, since, by using a microcatheter system under fluoroscopic control, it is more effective and extremely selective. In terms of the reduction of vascular degree, 27 out of 31 interventions were classified as "successful", with only one patient developing a complication. Therapeutic embolization is very useful in the treatment of highly vascularized tumors and vascular lesions of the maxillofacial region and skull base, whether in cases of hemorrhagic complications or as a preoperative method to improve visualization and complete tumor excision. A high degree of technical practice in the performance of superselective angiography is essential to reduce the risk of inadvertent embolization of unconcerned vessels.
Bone distraction has been used increasingly since McCarthy and associates showed in their clinical investigation new osseous formation in the elongated area while performing mandibular distraction in 1992. However, at the craniofacial skeletal level, the initial description of the classic technique of distraction osteogenesis should be credited to German craniofacial surgeons Rosenthal (for bone lengthening of the mandible in a microgenia patient around 1927) and Wassmund (for the clinical advancement of a maxilla in a patient with hypoplasia of the upper jaw in 1926). Both procedures are described, and their original schedules and cases are presented.
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Five cases of metastases in the mandible are reported. Conventional radiography and bone scintigraphy by 99Tcm-DP recorded by gamma camera were performed. Invariably the lesions were clearly demonstrated by scintigraphy when radiography revealed only minor structural changes of the bone tissue.
Fifty-four patients were examined clinically, radiographically and scintigraphically with respect to mandible bone involvement by oral carcinoma. Sixteen resected mandibular specimens were available for microscopic examination and the results were correlated to the clinical, scintigraphic and radiographic results. Clinical assessment overestimated and radiography underestimated oral carcinoma involvement of the mandible; scintigraphy was more accurate than was clinical assessment or radiography. Combination of clinical examination with both conventional radiography and bone scintigraphy is recommended for optimum diagnosis of mandible bone involvement by oral carcinoma.
The results from radiographic and scintigraphic examination of 28 patients with malignant tumors of the nasal, paranasal and palate regions, 23 patients with purulent maxillary sinuitis, and 15 control cases were compared. A combination of radiography and scintigraphy yielded the best information on the differentiation between an inflammatory condition and malignant tumor and the extent of malignant growth in adjacent bone.
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