- Email: [email protected]
A biochemical study on the nature of jaw cyst (last report)*: Investigation on growth and suppressing mechanism of jaw cyst from the behaviour of free radicals and lipoperoxides produced in cyst fluid and wall
Posters 155 Two cases of primary clinical manifestations of Laugerhans Cell Histiocytosis (LCH) in cranio-maxillofacial area are presented. A 2-year-old boy, presents with the tumour in the upper part of the gld. parotis area on the right side which penetrates diffusively into the temporal region. Ultrasound and computed tomography examination: tumour, size 3.4 x 2.5 x 1.8 cm with destruction of the os temporale, size 2.5 cm. After partial ablation of the tumour, the defect of the os temporale was confirmed. Destruction of lateral orbital margin and non-demarked tumour masses affecting the infratemporal area were also discovered. Scintigraphy: increased osteoblastic activity of temporal, infratemporal, pterygoidal and orbital region as well as distal diaphysis of tibia on the left side. Symptoms characteristic neither of Hand-Schfiller-Christian disease nor Letterer-Siewe disease. Case B is a 43-year-old woman with the osseous defect of the mandible on the left side later on the right. Diabetes insipidus and bilated reticulation even micronodulation were diagnosed. Scintigraphy: increased osteoblastic activity in mandibles/on the right, in the central part of os sternum, in the left leg and suspected in the trochanteric region of the femur on the left. This case represents a disseminated variant of Hand-Schiiller-Christian disease. Both patients were in chemotherapy treatment. Both cases show a typical morphology of the Langerhans cells proliferation with an admixture of numerous mature eosinophilic leukocytes and infiltrative growth pattern into the soft tissues. Immunohistochemically, the cells were positive for vimentin, S-100 protein and CD 1a, but negative for CD20, CD45, CD45RO, CD3 and CD30 antigens.
Titanium Screw Implants (Bonefit ®) in Vascular and Avascular Bone Grafts for Mandible Repair
Stoil P., Wiichter R. Department of Oral and Maxillofacial Surgery, University of Freiburg, Freiburg, Germany The aim of rehabilitation therapy after mandible resection is primarily the replacement of the resected bone and finally the restoration of oromandibular functions. The goals of such a reconstructibn include not only restoration of the bony continuity and aesthetic contour, but also preparation of favourable conditions for prosthodontic rehabilitation, including mastication, speech and swallowing. Interest has grown in the placement of osseointegrated implants into bone grafts to facilitate and improve dental function. The bony structures of vascular and avascular grafts, however, are different. After insertion of ITI-dental implants (Bonefit®) into avascular iliac bone grafts, problems with osseointegration may occur as well in early as in later phases. Free cancellous bone does not provide sufficient primary stability in all cases. On the other hand, vascularized bone grafts allow better anchorage of screw implants. Successful management of a resected mandible calls for a multidiscipline approach. The challenge of this condition requires maximum cooperation between surgeon and prosthodontist. The particular problems and advantages of implant-supported dental prostheses after avascular and vascular bony mandibular reconstructions are illustrated showing selected clinical examples. The results are based on a sample of 30 patients.
Qualitative and Quantitative Bone Responses to Metallic and HA Coated Implants
Stefanov V.1, De Bruijn Jfl, Dikov Vfl, Tzankov L 4
1Bulgarian Society of Oral/mplantology and Biomaterials, Pleven, Bulgaria 2Biomaterials Research Group, University of Leiden, The Netherlands 3Department of Non Metallic Materials, Technical University of Sofia, Sofia, Bulgaria 4Department of Orthopaedic Surgery, Medical University of Pleven, P/even, Bulgaria Aims: (i) To show the relevance, if any, between the kind and texture of implants' intraosseous surface and the percentage of bone-implant contact achieved 3 months after implant insertion in rabbit bone and (ii) To assess the quality of the bone contact achieved by implants with 4 different rough intraosseous surfaces 3 months after insertion in rabbit bone. Materials and Methods: Four different kind of implants HA low crystalline (HA lc), HA high crystalline (HA hc), titanium plasma sprayed (TPS), SDV-1 & 2 surface (SDV) have been inserted in rabbit femoral bone under general anaesthesia by one operator (KS.). Five implants of each kind have been placed. Three months later, all implants were taken out and evaluated by light microscopy, BEM and histomorphometric analysis in Leiden. Conclusions: Higher amounts of bone have been formed on HA lc than on HA hc implants (difference not significant). Higher bone apposition was observed on HA implants, than on metallic implants (difference not significant). Signs of resorption of both HA coatings have been documented. In the long run, results of this study suggest that, after a functional loading, SDV surface seems to have the best perspective.
Free Vascularized Grafts in Reconstruction of Mandibular Defects in War Wounds
Stosic So 1, Jovic N J, Panajotovic Lift, Novakovic 34.2, Kozarski J.2, Bogeski T. 1
1Clinic for Maxillofacial Surgery and :Clinic for Plastic Surgery, Military Medical Academy, Belgrade, Yugoslavia In the Clinic for Maxillofacial Surgery of the Military Medical Academy, 480 patients with war wound injuries of face and jaws were treated. There were 103 patients in whom, after the primary surgical management, different sizes of mandibular defects were left. In 31, we reconstructed these defects with free vascularized grafts. Until now, we have used radial in 11, scapula in 9, and fibulae grafts in 11 patients. In this paper we represent our experience in usage of these grafts.
A Biochemical Study on the Nature of Jaw Cyst (Last Report)*: Investigation on Growth and Suppressing Mechanism of Jaw Cyst from the Behaviour of Free Radicals and Lipoperoxides Produced in Cyst Fluid and Wall
Suzuki 3/1.
Department of Dental and Oral Surgery, Hirosaki University, Hirosaki-City, Japan When a cyst cavity is infected, 02 produced in the cyst cavity by neutrophilis chemotaxis, and O i l generation is progressed by influence of released Fe 2+ from breaking red blood cells. 02 and OH in the cyst cavity damaged the cells
156 Journal of Cranio-Maxillofacial Surgery in the cyst wall. The neutrophils are chemotaxied in to the connective tissue of the cyst wall together with 02 produced into cyst wall, inhibiting microcirculation in the cyst wall. In this study, 40 cysts were used as the irrigation method. It was examined that the scavenging of free radicals irrigated in to the cyst cavity by Solcoseryl and 20% glucose with containing antibiotics. Then, free radicals were measured with ESR spin-trapping and freeze-dried sample method using ESR, Iipid peroxides and prostaglandins was measured with CL-, RP-HPLC analysis systems. The component in the bone of surrounding cyst wall was analyzed with FT-IR. Results: The infection of the cyst cavity disappears by the treatment of irrigational solutions, and so the formation of free radicals as C-radical and lipoperoxides as TBARs, PC-OOH, prostaglandins as 12-,5-HETE, LTB4, PGE v and 6-keto-PGFla in the cyst wall are suppressed, TXB 2 generated in the cyst walls. The blood circulation recovered from the damage in the capillary vessels of the connective tissues in the cyst walls. The cyst gradually diminishes in size, and bone remodelling takes place before the operation. References 1. First report. J. Maxillofac. Surg. 3 (1975) 106-118 2. J. Maxillofac. Surg. 12 (1984) 213-224 3. J. Cranio. Max-. Fac. Surg. 16 (1988) 85-88
A Study to Evaluate Biogel Reveal Gloves in Maxillo-, Facial and Oral Surgery
Reconstruction of Large Mandibular Defects and Total Avulsion of the Scalp with Microsurgical Technique
Szentirmai A., Hankiss J.
Department of Maxillofacial Surgery, National Institute of Traumatology, Budapest, Hungary Primary and secondary reconstruction of large midfaee and mandibular defects with vascularized osteomyocutaneous free flap and outcome after 3 years are demonstrated in a patient who attempted suicide with a gun. Our second case presentation refers to a 4-year old boy; the total avulsion of the scalp (together with the pericranium) was torn away by a bloodhound and the left face was bitten out with the avulsion of the facial nerve. The total soft tissue defect was accompanied by injuries to the left orbit, maxilla, malar bone, mandible. Replantation of the mandibular fragment, containing milk teeth I, II, III, IV, V (71, 72, 73, 74, 75) and covering of the cranial defect with latissimus dorsi free flap transfer have been performed primarily. Further stages of the surgical treatment and results of the reparative procedure are to be demonstrated for discussion after a 6 month period.
Tumour Angiogenesis and Regional Metastasis in Squamous Cell Carcinoma of the Oral Mucosa
Takagi S., lkemura K. Swart L.C., GrotepassF. W. Department of Maxillo-, Facial and Oral Surgery, Louie Leipold Hospital, Stellenbosch, South Africa With the increase of blood pathogens, the surgical team needs protection against contaminated body fluids. The use of surgical gloves remains the surgical team's principal defence. This study evaluates the effectiveness of the double gloving technique introduced by Biogel as an early warning system to detect perforations. The inner glove is green, with fluid penetration of the outer glove, a very definite mark is left which can easily be seen. It further evaluates the protection offered by Biogel Reveal gloves compared to other gloves (Swart, Grotepass, Van der Westhuijzen). A hundred consecutive cases were put to the test, (60% in private practice and 40% in academic). Postoperatively, each glove was filled with 1000 cc of tap H20 and some H20 was distended into each digit, while checking for H20 escape. Notes were made of the type of operator (surgeon, assistant, scrub nurse), perforations, positions of perforation, whether orthodontic brackets were present or wire used and if the perforation was noted by the reveal system. Preliminary results show that there is a definite advantage in wearing the reveal system gloves for early detection of perforations. (92% of all perforations were noted by the reveal system). There does not seem to be a statistically significant difference between previous studies and this one in comparison to perforation rates. With the increase of high risk patients, these gloves give a definite advantage. Although it will not deter perforations, it will limit the contamination. Operators' subjective opinions were, firstly, it was difficult to work with these double gloves during long procedures (especially those that do not routinely double glove) and, secondly, some felt uncomfortable with the inner glove being bigger than the outer.
Department of Oral and Maxillofacial Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan Much experimental evidence shows that tumour growth and metastasis are dependent upon tumour angiogenesis. We investigated the significance of tumour angiogenesis in relation to cervical metastasis in squamous cell carcinoma of the oral mucosa. Materials and Methods" The specimens were obtained from 96 patients who had untreated oral cancers. Microvessels were highlighted by immunostaining endothelial cells for factor VIII-related antigen. The most active areas of neovascularization were selected and the number of microvessels were counted within a 200x field. The mean and the standard deviation of all cases were calculated and were divided into three groups according to this figure. Group 1 means fewer microvessels than the standard figure, Group 3 (cases) more than it and Group 2 has microvessels within standard. We investigated the correlation between grade of vascularization and lymphnode metastasis. Other possible contributory factors were also studied statistically. Statistical analysis was conducted by both univariate and multivariate analysis using Cox proportional hazards model. Results: The mean and standard deviation of total cases were 11.35 + 5.26. The patients of Group 1, Group 2 and Group 3 were 16, 67, 13, respectively. In 33 (34.3%) of 96 patients, regional metastasis was histologically confirmed and grade 3 meaning a high vascularization occupied 61.5%, grade 2 showed 34.3%, grade 1 was 12.5% A relationship between grade of vascularization and nodal metastasis was found (P = 0.0219). On the other hand, the patients with cervical metastasis represented 14.03 + 5.91
Titanium Screw Implants (Bonefit ®) in Vascular and Avascular Bone Grafts for Mandible Repair
Stoil P., Wiichter R. Department of Oral and Maxillofacial Surgery, University of Freiburg, Freiburg, Germany The aim of rehabilitation therapy after mandible resection is primarily the replacement of the resected bone and finally the restoration of oromandibular functions. The goals of such a reconstructibn include not only restoration of the bony continuity and aesthetic contour, but also preparation of favourable conditions for prosthodontic rehabilitation, including mastication, speech and swallowing. Interest has grown in the placement of osseointegrated implants into bone grafts to facilitate and improve dental function. The bony structures of vascular and avascular grafts, however, are different. After insertion of ITI-dental implants (Bonefit®) into avascular iliac bone grafts, problems with osseointegration may occur as well in early as in later phases. Free cancellous bone does not provide sufficient primary stability in all cases. On the other hand, vascularized bone grafts allow better anchorage of screw implants. Successful management of a resected mandible calls for a multidiscipline approach. The challenge of this condition requires maximum cooperation between surgeon and prosthodontist. The particular problems and advantages of implant-supported dental prostheses after avascular and vascular bony mandibular reconstructions are illustrated showing selected clinical examples. The results are based on a sample of 30 patients.
Qualitative and Quantitative Bone Responses to Metallic and HA Coated Implants
Stefanov V.1, De Bruijn Jfl, Dikov Vfl, Tzankov L 4
1Bulgarian Society of Oral/mplantology and Biomaterials, Pleven, Bulgaria 2Biomaterials Research Group, University of Leiden, The Netherlands 3Department of Non Metallic Materials, Technical University of Sofia, Sofia, Bulgaria 4Department of Orthopaedic Surgery, Medical University of Pleven, P/even, Bulgaria Aims: (i) To show the relevance, if any, between the kind and texture of implants' intraosseous surface and the percentage of bone-implant contact achieved 3 months after implant insertion in rabbit bone and (ii) To assess the quality of the bone contact achieved by implants with 4 different rough intraosseous surfaces 3 months after insertion in rabbit bone. Materials and Methods: Four different kind of implants HA low crystalline (HA lc), HA high crystalline (HA hc), titanium plasma sprayed (TPS), SDV-1 & 2 surface (SDV) have been inserted in rabbit femoral bone under general anaesthesia by one operator (KS.). Five implants of each kind have been placed. Three months later, all implants were taken out and evaluated by light microscopy, BEM and histomorphometric analysis in Leiden. Conclusions: Higher amounts of bone have been formed on HA lc than on HA hc implants (difference not significant). Higher bone apposition was observed on HA implants, than on metallic implants (difference not significant). Signs of resorption of both HA coatings have been documented. In the long run, results of this study suggest that, after a functional loading, SDV surface seems to have the best perspective.
Free Vascularized Grafts in Reconstruction of Mandibular Defects in War Wounds
Stosic So 1, Jovic N J, Panajotovic Lift, Novakovic 34.2, Kozarski J.2, Bogeski T. 1
1Clinic for Maxillofacial Surgery and :Clinic for Plastic Surgery, Military Medical Academy, Belgrade, Yugoslavia In the Clinic for Maxillofacial Surgery of the Military Medical Academy, 480 patients with war wound injuries of face and jaws were treated. There were 103 patients in whom, after the primary surgical management, different sizes of mandibular defects were left. In 31, we reconstructed these defects with free vascularized grafts. Until now, we have used radial in 11, scapula in 9, and fibulae grafts in 11 patients. In this paper we represent our experience in usage of these grafts.
A Biochemical Study on the Nature of Jaw Cyst (Last Report)*: Investigation on Growth and Suppressing Mechanism of Jaw Cyst from the Behaviour of Free Radicals and Lipoperoxides Produced in Cyst Fluid and Wall
Suzuki 3/1.
Department of Dental and Oral Surgery, Hirosaki University, Hirosaki-City, Japan When a cyst cavity is infected, 02 produced in the cyst cavity by neutrophilis chemotaxis, and O i l generation is progressed by influence of released Fe 2+ from breaking red blood cells. 02 and OH in the cyst cavity damaged the cells
156 Journal of Cranio-Maxillofacial Surgery in the cyst wall. The neutrophils are chemotaxied in to the connective tissue of the cyst wall together with 02 produced into cyst wall, inhibiting microcirculation in the cyst wall. In this study, 40 cysts were used as the irrigation method. It was examined that the scavenging of free radicals irrigated in to the cyst cavity by Solcoseryl and 20% glucose with containing antibiotics. Then, free radicals were measured with ESR spin-trapping and freeze-dried sample method using ESR, Iipid peroxides and prostaglandins was measured with CL-, RP-HPLC analysis systems. The component in the bone of surrounding cyst wall was analyzed with FT-IR. Results: The infection of the cyst cavity disappears by the treatment of irrigational solutions, and so the formation of free radicals as C-radical and lipoperoxides as TBARs, PC-OOH, prostaglandins as 12-,5-HETE, LTB4, PGE v and 6-keto-PGFla in the cyst wall are suppressed, TXB 2 generated in the cyst walls. The blood circulation recovered from the damage in the capillary vessels of the connective tissues in the cyst walls. The cyst gradually diminishes in size, and bone remodelling takes place before the operation. References 1. First report. J. Maxillofac. Surg. 3 (1975) 106-118 2. J. Maxillofac. Surg. 12 (1984) 213-224 3. J. Cranio. Max-. Fac. Surg. 16 (1988) 85-88
A Study to Evaluate Biogel Reveal Gloves in Maxillo-, Facial and Oral Surgery
Reconstruction of Large Mandibular Defects and Total Avulsion of the Scalp with Microsurgical Technique
Szentirmai A., Hankiss J.
Department of Maxillofacial Surgery, National Institute of Traumatology, Budapest, Hungary Primary and secondary reconstruction of large midfaee and mandibular defects with vascularized osteomyocutaneous free flap and outcome after 3 years are demonstrated in a patient who attempted suicide with a gun. Our second case presentation refers to a 4-year old boy; the total avulsion of the scalp (together with the pericranium) was torn away by a bloodhound and the left face was bitten out with the avulsion of the facial nerve. The total soft tissue defect was accompanied by injuries to the left orbit, maxilla, malar bone, mandible. Replantation of the mandibular fragment, containing milk teeth I, II, III, IV, V (71, 72, 73, 74, 75) and covering of the cranial defect with latissimus dorsi free flap transfer have been performed primarily. Further stages of the surgical treatment and results of the reparative procedure are to be demonstrated for discussion after a 6 month period.
Tumour Angiogenesis and Regional Metastasis in Squamous Cell Carcinoma of the Oral Mucosa
Takagi S., lkemura K. Swart L.C., GrotepassF. W. Department of Maxillo-, Facial and Oral Surgery, Louie Leipold Hospital, Stellenbosch, South Africa With the increase of blood pathogens, the surgical team needs protection against contaminated body fluids. The use of surgical gloves remains the surgical team's principal defence. This study evaluates the effectiveness of the double gloving technique introduced by Biogel as an early warning system to detect perforations. The inner glove is green, with fluid penetration of the outer glove, a very definite mark is left which can easily be seen. It further evaluates the protection offered by Biogel Reveal gloves compared to other gloves (Swart, Grotepass, Van der Westhuijzen). A hundred consecutive cases were put to the test, (60% in private practice and 40% in academic). Postoperatively, each glove was filled with 1000 cc of tap H20 and some H20 was distended into each digit, while checking for H20 escape. Notes were made of the type of operator (surgeon, assistant, scrub nurse), perforations, positions of perforation, whether orthodontic brackets were present or wire used and if the perforation was noted by the reveal system. Preliminary results show that there is a definite advantage in wearing the reveal system gloves for early detection of perforations. (92% of all perforations were noted by the reveal system). There does not seem to be a statistically significant difference between previous studies and this one in comparison to perforation rates. With the increase of high risk patients, these gloves give a definite advantage. Although it will not deter perforations, it will limit the contamination. Operators' subjective opinions were, firstly, it was difficult to work with these double gloves during long procedures (especially those that do not routinely double glove) and, secondly, some felt uncomfortable with the inner glove being bigger than the outer.
Department of Oral and Maxillofacial Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan Much experimental evidence shows that tumour growth and metastasis are dependent upon tumour angiogenesis. We investigated the significance of tumour angiogenesis in relation to cervical metastasis in squamous cell carcinoma of the oral mucosa. Materials and Methods" The specimens were obtained from 96 patients who had untreated oral cancers. Microvessels were highlighted by immunostaining endothelial cells for factor VIII-related antigen. The most active areas of neovascularization were selected and the number of microvessels were counted within a 200x field. The mean and the standard deviation of all cases were calculated and were divided into three groups according to this figure. Group 1 means fewer microvessels than the standard figure, Group 3 (cases) more than it and Group 2 has microvessels within standard. We investigated the correlation between grade of vascularization and lymphnode metastasis. Other possible contributory factors were also studied statistically. Statistical analysis was conducted by both univariate and multivariate analysis using Cox proportional hazards model. Results: The mean and standard deviation of total cases were 11.35 + 5.26. The patients of Group 1, Group 2 and Group 3 were 16, 67, 13, respectively. In 33 (34.3%) of 96 patients, regional metastasis was histologically confirmed and grade 3 meaning a high vascularization occupied 61.5%, grade 2 showed 34.3%, grade 1 was 12.5% A relationship between grade of vascularization and nodal metastasis was found (P = 0.0219). On the other hand, the patients with cervical metastasis represented 14.03 + 5.91