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Histology and mineralization of membranous bone distraction osteogenesis: Long-term follow-up
90 Journal of Cranio-Maxillofacial Surgery employed in 9 patients. The temporalis myofascial flap was performed in 10 patients. Results: Twenty-five patients were submitted for primary and secondary reconstruction of the cranio-maxillofacial area utilizing fascial and myofascial system of the head, A coronal or T-shaped incision was performed to harvest the galea-frontalis myofascial flap, the temporoparietal fascial flap and temporalis myofascial flap. Necrosis of the flaps never occurs. A minimal transient alopecia and. forehead anaesthesia in only one patient who underwent the reconstruction of the anterior skull base with galeopericranial flap. We performed I0 temporalis myofascial flaps with no evidence of facial nerve damage using always a safe subfascial approach. A restricted mouth opening in only one patient was observed in anterior muscle pedicle transposition. Conclusions: The frontal galea, the temporal galea and the temporalis muscle can be considered a fascial and myofascial anatomical system with excellent vascularization that allows the surgeon to perform very safe and simple flaps. We have obtained excellent aesthetic and functional results.
The Adenoid Cystic Carcinoma of Salivary Glands: A Ten-Year Experience
Popovski V., Tudzarov T., Vaskov L, Lazarevski S., Grcev A., Benedetti A.
Clinic of Maxillofacial Surgery, University St Cyril and Metodius, Skopje, Macedonia In spite of the fact that adenoid cystic carcinoma accounts for only about 5% of all malignancies in the maxillofacial region, it has to be observed and treated with respect because of its hidden malignant character. This review is a study of 18 patients treated in our clinic in the period from 1985 to 1994. Tumour site in 9 cases was in palatal region, in 7 it was affecting the parotid gland and in 2 cases the submandibular gland. Our follow-up study shows a high rate of recurrence (5 out of 18 patients), affinity for perineural infiltration(6 patients) and specific histopathological pattern. As for the treatment, extra-radical surgery is proved to be the most effective, whereas radio or chemotherapy were only useful as palliative measures. The purpose of this retrospective study to reveal the extension of this tumour along the neural branches and to stress out the necessity of exact and radical treatment.
cells onto porous, bioresorbable polymer constructs in vitro and transplanting the cell-polymer constructs into recipients. The porous material serves as a scaffold, which provides the cells with a substrate and organizes cell growth and tissue formation. Three-dimensional biodegradable scaffolds are used to mimic the extracellular matrix and serve temporarily both as physical support and adhesive substrate for transplanted cells, which subsequently secrete their own extracellular matrix to form natural tissue replacement. While the tissue matures the polymer may resorb. The creation of new structural cartilage and bone is described using bioresorbable polymers and living cells in an animal model.
One- or Two-Plate Fixation of Mandibular Angle Fractures?
Pytlik C., Schmelzeisen R., Schierle H., Rahn B.
Department of Oral and Maxillofacial Surgery, MHH Hannover, Hannover, Germany Standard treatment of mandibular angle fractures with miniplates according to the recommendation of Champy consists of fixation with one plate at the superior border of the mandible. In certain constellations, two-plate fixation may provide additional stability. In contrast, extremely high complications rates following two-plate fixation of mandibular angle fractures were reported by Ellis (1994). In a prospective randomized double-blind study, 31 consecutive patients were treated with 2.0 mm (mini-) plates (Synthes Co., Switzerland). One group was treated with one plate, the other with two plates. In none of the patients, intermaxillary immobilization was used. Patients were followed-up 6 months postoperatively with clinical and X-ray controls. No significant differences in postoperative short- or long-term complications were found between the two groups. Regarding our experimental investigations presented prior and our clinical study, two-plate fixation may not offer advantages over single-plate fixation in general. However, individual fracture constellations may benefit from variations in plate(s) location. Factors contributing to complications in mandibular angle fractures are discussed.
Histology and Mineralization of Membranous Bone Distraction Osteogenesis: Long-Term Follow-Up
Rachmiel Aft, Lewinson Dfl, Laufer Dfl, Jackson L T.3 Tissue Engineering: An Approach to Create New Structural Cartilage and Bone
Puelacher WJ, Vacanti C.A. 2
IDepartment of Oral and Maxillofacial Surgery, Leopold Franzens University, Innsbruck, Austria 2Laboratory of Transplantation and Tissue Engineering, University of Massachusetts, Worchester, Massachusetts, USA Tissue engineering is the application of principles and methods of engineering and the life sciences towards the fundamental understanding of structure/function relationships in normal and pathological mammalian tissues and the development of biological substitutes to restore, maintain or improve functions. The creation of tissue possessing the ability to restore function can be achieved by seeding
1Department of Oral and Maxillofacial Surgery, Technion-Faculty of Medicine, Haifa, Israel 2Division of Morphological Sciences, Technion-Faculty of Medicine, Haifa, Israel 3Craniofacial and Reconstructive Surgery, Providence Hospital, Southfield, Michigan, USA Midface bone lengthening, using the method of distraction was performed in 3 young adult sheep. The midface was gradually advanced, 2 mm per day, during 21 days, up to 40 mm. A marked midface advancement was noted. After a 6 week period of retention, the device was removed and the animals were followed for 1 year. Biopsies were taken from distracted area at the end of the distraction period, after 6 additional weeks of retention, and finally 1 year later. The non-distracted area served as control. The specimens were analyzed histologically and by the scanning electron microscope for the ultrastructural pattern, mineralization, mineral
Free oral communications content and approximate concentration. Clinically and radiographically, all sheep fully bridged the experimental gap. Histologically, at the completion of distraction, collagen bundles and slender bone trabeculae oriented in direction of the distraction could be seen. Six weeks later, the trabeculae thickened noticeably with mature lamellar bone, but in some areas it appeared woven. At the end of 1 year the pattern of distracted area resembled the control area. The mineralization, as reflected by quantitative calcium analysis in comparison to the non-distracted area demonstrated a low rate of mineralization after 3 weeks of lengthening (24.3%), increased 6 weeks later (72.8%) and after 1 year became nearly the same as in the non-distracted area (94%). In conclusion, the distraction osteogenesis method provides satisfactory quantitative and structural new bone.
An Anatomical Classification of Maxillary Ameloblastoma as an Aid to Surgical Treatment
Rachmiel A. 1, Ardekian L. 1, Laufer D.1, Fortd R.A. 2, Jackson L Z2 1Department of Oral and Maxillofacial Surgery, Technion-Faculty of Medicine, Haifa, Israel 2Craniofacial and Reconstructive Surgery, Providence Hospital, Southfield, Michigan, USA Ameloblastoma of the jaws is more common in the mandible than in the maxilla, with a relative frequency of 4:1. In 98% of the cases, this tumour occurs in the posterior part of the maxilla, with a potential of early spread to the maxillary sinus, pterygomaxillary fissure, infratemporal fossa, nasal cavity, orbit, and may even cause intracranial invasion. There is a tendency to local recurrence and it may exhibit malignant transformation. In this study, 18 patients with maxillary ameloblastoma have been treated over the past 7 years. Tumour resection was planned with safe margins of normal tissues. Because of relative confusion in the literature as to how maxillary ameloblastoma should be treated, we suggest a new classification, based on the anatomical location and extension of the tumour. Group 1, Tumours confined to the maxilla without involvement of the orbital floor. Group 2, Tumours involving the orbital floor but not the periorbital area. Group 3, Tumours involving the orbital contents. Group 4, Tumours involving the skull base. The treatment indicated in each group is as follows: Group 1, partial maxillectomy, Group 2, total maxillectomy, Group 3, total maxillectomy with orbital exenteration, and Group 4, total maxillectomy with anterior skull base resection and orbital exenteration as indicated. In our opinion the use of this classification allows a logical resection to be planned.
with oral squamous cell carcinoma were treated in our department. Forty-eight were female and 102 male (34% and 66% respectively). The age of the patients ranged from 37 to 96 years with a peak in the sixth and seventh decade for both sexes. The most common location of the primary tumour was the mobile tongue (37 patients) followed by mandibular alveolar ridge (33 patients), the floor of the mouth (25 patients), the lower lip (20 patients), the palate and the maxilla (20 patients), the cheek (8 patients) and the upper lip (3 patients), whereas in 4 cases the tumours extended in more than three anatomic locations. The degree of differentiation of the lesions was well differentiated in 42.4% of the cases, moderate in 28.2%, low differentiation showed 25.6% whereas 4.2% were verrucus carcinomas. Therapy included surgery alone in 90 cases, surgery and radiotherapy in 38, surgery, radiotherapy and chemotherapy in 12, radiotherapy alone in 5 and radiotherapy and chemotherapy in 5 patients. The follow-up ranges from 6 months to 5 years. The recurrence rate was found to be 40.8%. Fifty-one patients died from their disease. From the remaining patients, 68 are free from disease and 31 are alive with evidence of local or neck disease.
Orbital Melanomas: An Analysis of Four Cases
Rapidis A.D., Liarikos S., Abdela V., Angelopoulos E., Skouteris C., Angelopoulos A.P. Departments of Ophthalmology and Maxillofacial Surgery, Greek Anticancer Institute, St Savvas Hospital, University of Athens School of Dentistry, Athens, Greece Malignant tumours of the orbital region are relatively uncommon constituting 4-6% of head and neck malignancies. Orbital malignant melanomas are rare tumours that arise usually from extrabulbar extension of choroidal melanomas. During the years 1991-1995, 53 cases of malignant orbital and orbitomaxillary tumours were treated in our hospital. Of those, 4 were orbital melanomas (7.8%). All 4 patients were female aged between 60-70 years. The tumours presented as slow growing masses with minimal symptoms. Preoperative diagnosis with computed tomography (CT) or magnetic resonance imaging (MRI) was nonconclusive. No regional lymphadenopathy or evidence of distant metastases were present. All patients were treated surgically, with orbital exenteration and skin grafting in two cases and orbital exenteration and median forehead flap reconstruction in the remaining two cases. Diagnosis was established after histological examination. The patients received postoperative chemotherapy and radiotherapy. Follow-up ranges from 6 months to 3.5 years. All patients are alive with no evidence of local recurrence, regional or distant metastases.
Treatment of Squamous Cell Carcinoma of the Oral Mueosa: The Greek Anticancer Iustitute's Experience
Late Reconstruction of Scalp Burn Scaring Through the Use of Tissue Expander
Rapidis A.D., Andressakis D., Abdela E, Skouteris C., Angelopoulos A.P.
Rapis Z, Pappas V.
Department of Maxillofacial Surgery, Greek Anticancer Institute, St Savvas Hospital, University of Athens School of Dentistry, Athens, Greece Squamous cell carcinoma of the oral mucosa is the most common malignant tumour of the oral cavity covering over 90% of all cases. During the years 1991-1995, 150 patients
91
Department of Oral and Maxillofacial Surgery, P G Hospital, Ioannina, Greece Tissue expansion has became a widely used reconstructive technique over the past 10 years. It has the advantages of producing robust tissue, preserving sensation and adnexal structures and, therefore, provides an ideal tissue match with minimal donor defect. It has proved very useful in the
The Adenoid Cystic Carcinoma of Salivary Glands: A Ten-Year Experience
Popovski V., Tudzarov T., Vaskov L, Lazarevski S., Grcev A., Benedetti A.
Clinic of Maxillofacial Surgery, University St Cyril and Metodius, Skopje, Macedonia In spite of the fact that adenoid cystic carcinoma accounts for only about 5% of all malignancies in the maxillofacial region, it has to be observed and treated with respect because of its hidden malignant character. This review is a study of 18 patients treated in our clinic in the period from 1985 to 1994. Tumour site in 9 cases was in palatal region, in 7 it was affecting the parotid gland and in 2 cases the submandibular gland. Our follow-up study shows a high rate of recurrence (5 out of 18 patients), affinity for perineural infiltration(6 patients) and specific histopathological pattern. As for the treatment, extra-radical surgery is proved to be the most effective, whereas radio or chemotherapy were only useful as palliative measures. The purpose of this retrospective study to reveal the extension of this tumour along the neural branches and to stress out the necessity of exact and radical treatment.
cells onto porous, bioresorbable polymer constructs in vitro and transplanting the cell-polymer constructs into recipients. The porous material serves as a scaffold, which provides the cells with a substrate and organizes cell growth and tissue formation. Three-dimensional biodegradable scaffolds are used to mimic the extracellular matrix and serve temporarily both as physical support and adhesive substrate for transplanted cells, which subsequently secrete their own extracellular matrix to form natural tissue replacement. While the tissue matures the polymer may resorb. The creation of new structural cartilage and bone is described using bioresorbable polymers and living cells in an animal model.
One- or Two-Plate Fixation of Mandibular Angle Fractures?
Pytlik C., Schmelzeisen R., Schierle H., Rahn B.
Department of Oral and Maxillofacial Surgery, MHH Hannover, Hannover, Germany Standard treatment of mandibular angle fractures with miniplates according to the recommendation of Champy consists of fixation with one plate at the superior border of the mandible. In certain constellations, two-plate fixation may provide additional stability. In contrast, extremely high complications rates following two-plate fixation of mandibular angle fractures were reported by Ellis (1994). In a prospective randomized double-blind study, 31 consecutive patients were treated with 2.0 mm (mini-) plates (Synthes Co., Switzerland). One group was treated with one plate, the other with two plates. In none of the patients, intermaxillary immobilization was used. Patients were followed-up 6 months postoperatively with clinical and X-ray controls. No significant differences in postoperative short- or long-term complications were found between the two groups. Regarding our experimental investigations presented prior and our clinical study, two-plate fixation may not offer advantages over single-plate fixation in general. However, individual fracture constellations may benefit from variations in plate(s) location. Factors contributing to complications in mandibular angle fractures are discussed.
Histology and Mineralization of Membranous Bone Distraction Osteogenesis: Long-Term Follow-Up
Rachmiel Aft, Lewinson Dfl, Laufer Dfl, Jackson L T.3 Tissue Engineering: An Approach to Create New Structural Cartilage and Bone
Puelacher WJ, Vacanti C.A. 2
IDepartment of Oral and Maxillofacial Surgery, Leopold Franzens University, Innsbruck, Austria 2Laboratory of Transplantation and Tissue Engineering, University of Massachusetts, Worchester, Massachusetts, USA Tissue engineering is the application of principles and methods of engineering and the life sciences towards the fundamental understanding of structure/function relationships in normal and pathological mammalian tissues and the development of biological substitutes to restore, maintain or improve functions. The creation of tissue possessing the ability to restore function can be achieved by seeding
1Department of Oral and Maxillofacial Surgery, Technion-Faculty of Medicine, Haifa, Israel 2Division of Morphological Sciences, Technion-Faculty of Medicine, Haifa, Israel 3Craniofacial and Reconstructive Surgery, Providence Hospital, Southfield, Michigan, USA Midface bone lengthening, using the method of distraction was performed in 3 young adult sheep. The midface was gradually advanced, 2 mm per day, during 21 days, up to 40 mm. A marked midface advancement was noted. After a 6 week period of retention, the device was removed and the animals were followed for 1 year. Biopsies were taken from distracted area at the end of the distraction period, after 6 additional weeks of retention, and finally 1 year later. The non-distracted area served as control. The specimens were analyzed histologically and by the scanning electron microscope for the ultrastructural pattern, mineralization, mineral
Free oral communications content and approximate concentration. Clinically and radiographically, all sheep fully bridged the experimental gap. Histologically, at the completion of distraction, collagen bundles and slender bone trabeculae oriented in direction of the distraction could be seen. Six weeks later, the trabeculae thickened noticeably with mature lamellar bone, but in some areas it appeared woven. At the end of 1 year the pattern of distracted area resembled the control area. The mineralization, as reflected by quantitative calcium analysis in comparison to the non-distracted area demonstrated a low rate of mineralization after 3 weeks of lengthening (24.3%), increased 6 weeks later (72.8%) and after 1 year became nearly the same as in the non-distracted area (94%). In conclusion, the distraction osteogenesis method provides satisfactory quantitative and structural new bone.
An Anatomical Classification of Maxillary Ameloblastoma as an Aid to Surgical Treatment
Rachmiel A. 1, Ardekian L. 1, Laufer D.1, Fortd R.A. 2, Jackson L Z2 1Department of Oral and Maxillofacial Surgery, Technion-Faculty of Medicine, Haifa, Israel 2Craniofacial and Reconstructive Surgery, Providence Hospital, Southfield, Michigan, USA Ameloblastoma of the jaws is more common in the mandible than in the maxilla, with a relative frequency of 4:1. In 98% of the cases, this tumour occurs in the posterior part of the maxilla, with a potential of early spread to the maxillary sinus, pterygomaxillary fissure, infratemporal fossa, nasal cavity, orbit, and may even cause intracranial invasion. There is a tendency to local recurrence and it may exhibit malignant transformation. In this study, 18 patients with maxillary ameloblastoma have been treated over the past 7 years. Tumour resection was planned with safe margins of normal tissues. Because of relative confusion in the literature as to how maxillary ameloblastoma should be treated, we suggest a new classification, based on the anatomical location and extension of the tumour. Group 1, Tumours confined to the maxilla without involvement of the orbital floor. Group 2, Tumours involving the orbital floor but not the periorbital area. Group 3, Tumours involving the orbital contents. Group 4, Tumours involving the skull base. The treatment indicated in each group is as follows: Group 1, partial maxillectomy, Group 2, total maxillectomy, Group 3, total maxillectomy with orbital exenteration, and Group 4, total maxillectomy with anterior skull base resection and orbital exenteration as indicated. In our opinion the use of this classification allows a logical resection to be planned.
with oral squamous cell carcinoma were treated in our department. Forty-eight were female and 102 male (34% and 66% respectively). The age of the patients ranged from 37 to 96 years with a peak in the sixth and seventh decade for both sexes. The most common location of the primary tumour was the mobile tongue (37 patients) followed by mandibular alveolar ridge (33 patients), the floor of the mouth (25 patients), the lower lip (20 patients), the palate and the maxilla (20 patients), the cheek (8 patients) and the upper lip (3 patients), whereas in 4 cases the tumours extended in more than three anatomic locations. The degree of differentiation of the lesions was well differentiated in 42.4% of the cases, moderate in 28.2%, low differentiation showed 25.6% whereas 4.2% were verrucus carcinomas. Therapy included surgery alone in 90 cases, surgery and radiotherapy in 38, surgery, radiotherapy and chemotherapy in 12, radiotherapy alone in 5 and radiotherapy and chemotherapy in 5 patients. The follow-up ranges from 6 months to 5 years. The recurrence rate was found to be 40.8%. Fifty-one patients died from their disease. From the remaining patients, 68 are free from disease and 31 are alive with evidence of local or neck disease.
Orbital Melanomas: An Analysis of Four Cases
Rapidis A.D., Liarikos S., Abdela V., Angelopoulos E., Skouteris C., Angelopoulos A.P. Departments of Ophthalmology and Maxillofacial Surgery, Greek Anticancer Institute, St Savvas Hospital, University of Athens School of Dentistry, Athens, Greece Malignant tumours of the orbital region are relatively uncommon constituting 4-6% of head and neck malignancies. Orbital malignant melanomas are rare tumours that arise usually from extrabulbar extension of choroidal melanomas. During the years 1991-1995, 53 cases of malignant orbital and orbitomaxillary tumours were treated in our hospital. Of those, 4 were orbital melanomas (7.8%). All 4 patients were female aged between 60-70 years. The tumours presented as slow growing masses with minimal symptoms. Preoperative diagnosis with computed tomography (CT) or magnetic resonance imaging (MRI) was nonconclusive. No regional lymphadenopathy or evidence of distant metastases were present. All patients were treated surgically, with orbital exenteration and skin grafting in two cases and orbital exenteration and median forehead flap reconstruction in the remaining two cases. Diagnosis was established after histological examination. The patients received postoperative chemotherapy and radiotherapy. Follow-up ranges from 6 months to 3.5 years. All patients are alive with no evidence of local recurrence, regional or distant metastases.
Treatment of Squamous Cell Carcinoma of the Oral Mueosa: The Greek Anticancer Iustitute's Experience
Late Reconstruction of Scalp Burn Scaring Through the Use of Tissue Expander
Rapidis A.D., Andressakis D., Abdela E, Skouteris C., Angelopoulos A.P.
Rapis Z, Pappas V.
Department of Maxillofacial Surgery, Greek Anticancer Institute, St Savvas Hospital, University of Athens School of Dentistry, Athens, Greece Squamous cell carcinoma of the oral mucosa is the most common malignant tumour of the oral cavity covering over 90% of all cases. During the years 1991-1995, 150 patients
91
Department of Oral and Maxillofacial Surgery, P G Hospital, Ioannina, Greece Tissue expansion has became a widely used reconstructive technique over the past 10 years. It has the advantages of producing robust tissue, preserving sensation and adnexal structures and, therefore, provides an ideal tissue match with minimal donor defect. It has proved very useful in the