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Kraniosynostosen-Prinzipien und Risiken der chirurgischen Behandlung
Abstracts from Deutsche Zeitschvift ftir Mund-Kiefer-und
Gesichts-Chirurgie
(Volume 20 Number 4 1996) Mikroosteosynthese (Dtsch Z Mund
in der dentoalveolaren Chirurgie. Kiefer GesichtsChir 1996: 20: 4).
Kraniosynostosen-Prinzipien Behandlung. H. Collmunn, H. Pistner. (Dtsch Z Mund
W Engelke.
Microfixation systems have been developed mainly for use in maxillofacial traumatology. The Luhr micro-system makes use of a Vitalium alloy and currently represents the smallest fixation system worldwide. In this paper, we report on the application of microfixation in different situations in the field of oral surgery: alveolar extension osteoplasty, tooth transplantation, segmental alveolar osteotomy, fixation of bone transplants and osteoplastic sinus lift procedure. We discuss the indications for microfixation, dependent on the biomechdnical properties of the fixation material. A very low infection rate and uncomplicated healing in unloaded areas was observed. The recommendations for clinical use in oral surgery comprise: application in unloaded sites and avoidance of postoperative loading through chewing forces, Correspondence: PD Zahnarztliche Chirurgie, Koch-Str. 40, D-37075
Dr. Dr. Wilfried Universitatsklinikum Gbttingen.
Engelke, Gottingen.
Der
Stellenwert Kiinfg,
GesichtsChir
H.
des
Dental-CTs c/. G&n. 1996; 20: 4). Widlitrek.
Abteilung Robert-
Correspondence: Dr. Stefan Kiinig, Klinik Gesichtschirurgie, Plastische Operationen, haus, Ruhr-Universitat Bochum, In D-44892 Bochum.
GesichtsChir
PD Dr. H. Collmann. Neurochirurgische 11, D-97080 Wtirzburg.
chirurgischen E.
Reinhurt,
1996: 20: 4).
Abteilung fur PBdiatrische Universitatsklinik, Josef-
Klinik der kraniofazialen Syuostosen. J. Ziiller, Z Mund Kiefer GesichtsChir 1996: 20: 4).
W. Kwss.
(Dtsch
( Dtsch
Correspondence: Priv.-Doz. Dr. Dr. Joachim Zoller, Klinik und Poliklinik ftir Mund-, Kieferund Gesichtschirurgie, der Universitat Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg.
Spatresultate nach bilateralem frontoorbitalen Advancement und Le-Fort-III-Osteotomie bei Patienten mit pramaturen Kraniosynostosen. E. Reinhart. J. Reuther, J. Miihling, H. Collmann, Ch. Michrl. (Dtsch Z Mund Kiefer GesichtsChir 1996; 20: 4). The standardized bilateral fronto-orbital advancement established at the Wtirzburg University Hospital is applied in all forms of craniosynostoses except scaphocephalus. In severe forms of syndrome-linked facie-craniosynostoses midface-advancement might be necessary. Late results were analysed clinically and cephalometrically using the retrospective evaluations on file of 131 children with fronto-orbital advancement and of 26 patients with Le Fort III-Osteotomy. As a demarcation to linear craniectomy and so-called lateral canthal advancement only 11 relapses requiring renewed operation were found postoperatively in our own study. But fronto-orbital advancement can only affect the pathological growth pattern to a limited degree, especially when craniosynostosis is related to a syndrome. Cephalometric evaluation confirmed the limited potential of growth in the area of the anterior skull base as well as of the midfdce with syndrome-related facio-
Z
The classification of syndromic craniosynostosis on a clinical basis in the past often led to problems and contradictions. Several recent observations have clarified the underlying mutations in most of these syndromes. It is now possible to classify them on the basis of the molecular data in a simpler way, but the unexplained variability between genotype and phenotype raises a lot of new questions. Dr. Med. Tiemo Grimm, Institut Am Hubland, D-97074 Wtirzburg.
J. Mii/rling.
Clinical symptoms of craniofacial synostoses are determined by localization, number and extent of the synostoses. The time point of onset and form of manifestation also influence the clinical symptoms. The pathological form of skull growth causes several functional deficits as well as aesthetic interference of the proportions between neurocranium and viscerocranium. For operative treatment five groups of skull growth are defined. Classification by syndromes enables the physician to give a prognosis and to assess the rate of inheritance.
fur Mund-, Kieferund Knappschaftskrankender Schornau 23--2S,
Zur Genetik der Kraniosynostosen. T. Grimm. Mund Kiefer GesichtsChir 1996; 20: 4).
Professor Biozentrum,
Kiefer
der
J. Krauj,
bei Sinus-Lift-Operationen. (Dtsch Z Mund Kiefer
An exact spatial image of the anatomic structures is an indispensable prerequisite for dental implantology. In cases of advanced upper jaw atrophy Dental-CT is superior to OPT in indicating the width of the alveolar ridge and the downward extension of the maxillary sinus. This results in a better treatment plan for implant-based restorations and facilitates correct patient selection for sinus bone grafting. Postoperative Dental-CT provides an exquisite documentation of the augmentative operative result and serves as a baseline for evaluation of ensuing bone resorption. For these reasons we favour the use of Dental-CT in cases of advanced maxillary atrophy in the preoperative planning of implant restorations, sinus bone grafting and their postoperative followup, despite the higher radiation exposure and greater expenditure in time and money involved.
Correspondence: Humangenetik,
Risiken
Siirmsen,
Treatment of craniosynostosis is aimed at correcting disfiguring deformities, but basically has to provide for volume expansion of the intracranial, the orbital and the midfacial spaces. The various surgical techniques are based on two main principles: for passive remodelling the expansile forces of the growing brain are utilized, usually by means of a simple craniectomy. This technique should be confined to young infants up to 6 months of age. It is the method of chotce for non-syndromous scaphocephaly. Active remodelling is used for patients beyond that age, for frontobasal deformities and for correction of shallow orbits. Standard procedures include various types of cranial vault reconstruction and fronto-orbital advancement. Most of the surgical complications are closely related to blood loss during operation and postoperative haemorrhage. The surgical risks are reasonably low with careful preoperative planning and close interdisciplinary co-operation in an experienced team. Correspondence: Neurochirugie, Schneider-Str.
S.
und N.
fur 471
Gesichts-Chirurgie
(Volume 20 Number 4 1996) Mikroosteosynthese (Dtsch Z Mund
in der dentoalveolaren Chirurgie. Kiefer GesichtsChir 1996: 20: 4).
Kraniosynostosen-Prinzipien Behandlung. H. Collmunn, H. Pistner. (Dtsch Z Mund
W Engelke.
Microfixation systems have been developed mainly for use in maxillofacial traumatology. The Luhr micro-system makes use of a Vitalium alloy and currently represents the smallest fixation system worldwide. In this paper, we report on the application of microfixation in different situations in the field of oral surgery: alveolar extension osteoplasty, tooth transplantation, segmental alveolar osteotomy, fixation of bone transplants and osteoplastic sinus lift procedure. We discuss the indications for microfixation, dependent on the biomechdnical properties of the fixation material. A very low infection rate and uncomplicated healing in unloaded areas was observed. The recommendations for clinical use in oral surgery comprise: application in unloaded sites and avoidance of postoperative loading through chewing forces, Correspondence: PD Zahnarztliche Chirurgie, Koch-Str. 40, D-37075
Dr. Dr. Wilfried Universitatsklinikum Gbttingen.
Engelke, Gottingen.
Der
Stellenwert Kiinfg,
GesichtsChir
H.
des
Dental-CTs c/. G&n. 1996; 20: 4). Widlitrek.
Abteilung Robert-
Correspondence: Dr. Stefan Kiinig, Klinik Gesichtschirurgie, Plastische Operationen, haus, Ruhr-Universitat Bochum, In D-44892 Bochum.
GesichtsChir
PD Dr. H. Collmann. Neurochirurgische 11, D-97080 Wtirzburg.
chirurgischen E.
Reinhurt,
1996: 20: 4).
Abteilung fur PBdiatrische Universitatsklinik, Josef-
Klinik der kraniofazialen Syuostosen. J. Ziiller, Z Mund Kiefer GesichtsChir 1996: 20: 4).
W. Kwss.
(Dtsch
( Dtsch
Correspondence: Priv.-Doz. Dr. Dr. Joachim Zoller, Klinik und Poliklinik ftir Mund-, Kieferund Gesichtschirurgie, der Universitat Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg.
Spatresultate nach bilateralem frontoorbitalen Advancement und Le-Fort-III-Osteotomie bei Patienten mit pramaturen Kraniosynostosen. E. Reinhart. J. Reuther, J. Miihling, H. Collmann, Ch. Michrl. (Dtsch Z Mund Kiefer GesichtsChir 1996; 20: 4). The standardized bilateral fronto-orbital advancement established at the Wtirzburg University Hospital is applied in all forms of craniosynostoses except scaphocephalus. In severe forms of syndrome-linked facie-craniosynostoses midface-advancement might be necessary. Late results were analysed clinically and cephalometrically using the retrospective evaluations on file of 131 children with fronto-orbital advancement and of 26 patients with Le Fort III-Osteotomy. As a demarcation to linear craniectomy and so-called lateral canthal advancement only 11 relapses requiring renewed operation were found postoperatively in our own study. But fronto-orbital advancement can only affect the pathological growth pattern to a limited degree, especially when craniosynostosis is related to a syndrome. Cephalometric evaluation confirmed the limited potential of growth in the area of the anterior skull base as well as of the midfdce with syndrome-related facio-
Z
The classification of syndromic craniosynostosis on a clinical basis in the past often led to problems and contradictions. Several recent observations have clarified the underlying mutations in most of these syndromes. It is now possible to classify them on the basis of the molecular data in a simpler way, but the unexplained variability between genotype and phenotype raises a lot of new questions. Dr. Med. Tiemo Grimm, Institut Am Hubland, D-97074 Wtirzburg.
J. Mii/rling.
Clinical symptoms of craniofacial synostoses are determined by localization, number and extent of the synostoses. The time point of onset and form of manifestation also influence the clinical symptoms. The pathological form of skull growth causes several functional deficits as well as aesthetic interference of the proportions between neurocranium and viscerocranium. For operative treatment five groups of skull growth are defined. Classification by syndromes enables the physician to give a prognosis and to assess the rate of inheritance.
fur Mund-, Kieferund Knappschaftskrankender Schornau 23--2S,
Zur Genetik der Kraniosynostosen. T. Grimm. Mund Kiefer GesichtsChir 1996; 20: 4).
Professor Biozentrum,
Kiefer
der
J. Krauj,
bei Sinus-Lift-Operationen. (Dtsch Z Mund Kiefer
An exact spatial image of the anatomic structures is an indispensable prerequisite for dental implantology. In cases of advanced upper jaw atrophy Dental-CT is superior to OPT in indicating the width of the alveolar ridge and the downward extension of the maxillary sinus. This results in a better treatment plan for implant-based restorations and facilitates correct patient selection for sinus bone grafting. Postoperative Dental-CT provides an exquisite documentation of the augmentative operative result and serves as a baseline for evaluation of ensuing bone resorption. For these reasons we favour the use of Dental-CT in cases of advanced maxillary atrophy in the preoperative planning of implant restorations, sinus bone grafting and their postoperative followup, despite the higher radiation exposure and greater expenditure in time and money involved.
Correspondence: Humangenetik,
Risiken
Siirmsen,
Treatment of craniosynostosis is aimed at correcting disfiguring deformities, but basically has to provide for volume expansion of the intracranial, the orbital and the midfacial spaces. The various surgical techniques are based on two main principles: for passive remodelling the expansile forces of the growing brain are utilized, usually by means of a simple craniectomy. This technique should be confined to young infants up to 6 months of age. It is the method of chotce for non-syndromous scaphocephaly. Active remodelling is used for patients beyond that age, for frontobasal deformities and for correction of shallow orbits. Standard procedures include various types of cranial vault reconstruction and fronto-orbital advancement. Most of the surgical complications are closely related to blood loss during operation and postoperative haemorrhage. The surgical risks are reasonably low with careful preoperative planning and close interdisciplinary co-operation in an experienced team. Correspondence: Neurochirugie, Schneider-Str.
S.
und N.
fur 471