- Email: [email protected]
Testing of a hydroxyapatite ceramic coating plasma sprayed under vacuum conditions in a rabbit model
tk,i,\i, Jw,d of O,d o,,ri ,~l‘,,~,lhi/‘,~~~al S'urpv ( 199X) 36. 7I 72 C 199X The British Assoc~atvm of Oral and Maxilofacial Surgeons
Abstracts from Mund-, Kiefer- und Gesichtschirurgie
(Volume 1 Number 6 1997)
The value of long-term follow-up of mandibular advancement surgery in patients with a low to normal mandibular plane angle. 1 P B. Bouwnzun, D. B. T&zing, I? J: Kostense, R. A. wn Teeseling, H. M&itcrri (Mund Kiefer GesichtsChir 1997: 1: 311l315).
Correspon&nce: Dr Dr KieferMund-, und Universitat Heidelberg. Heidelberg. Germany.
The objective of this study was to evaluate retrospectively the stability of mandibular advancement via bilateral sagittal split osteotomiea Two fixation methods were compared: intermaxillary fixation (IMF) and rigid internal fixation (RIF). The hypothesis was that, in patients with a low to normal mandibular plane angle (MPA) in retrognathia. the bilateral sagittal split osteotomy (BSSO) to advance the mandible is a predictable and stable procedure and that no significant changes occur after I year. Twelve patients with mandibular deficiency with a low to normal MPA (mean 24.7”. range 20.3”-30.7”) underwent BSSO with IMF. The follow-up period was at least 5 years (mean 6.3, range 559.1 years). Cephalometric analysis using a commercial software package was performed on radiographs that were taken immediately preoperatively (TO), within 6 weeks postoperatively (Tl), 1 year postoperatively (T2), and at least 5 years postoperatively (T3). The average advancement at B point was 4.7mm (range: 337 mm). The assessment of B point in regard to relapse showed no significant change. One patient showed a relapse due to condylar resorption. Forty-five consecutive patients were treated with RIF. Radiographs were taken preoperatively (TO), 6 weeks postoperatively (Tl), and I year postoperatively (T2). This group had a mean MPA of 26.2”, range lo”32”. The average B-point advancement was 4.4 mm (range I-10 mm). No patient showed a clinically significant relapse at T2.
Magnetic resonance imaging versus three-phase bone scintigraphy in diagnosis and monitoring of lower jaw osteomyelitis. 7: Ktirnrr; 7: Krrusch, K. H. Bohuslnrizki, G Brinkmum. S. Ktihnleir~ (Mund Kiefer GesichtsChir 1997: 1: 324-327).
Correspondmce: Dr Kennemer Gasthuis. Netherlands.
S. HaOfeld, Klinik Gesichtschirurgie, Im Neuenheimer
und Poliklinik fur Ruprechts-KarlsFeld 400. D-69120
Bone scintigraphy is routinely used in the diagnosis of lower jaw osteomyelitis; however, the radiation dosage of 3.5 mSv is quite high. Magnetic resonance imaging (MRI) gives information about soft tissue and bone marrow alterations. This study compares the sensitivity of the two imaging modalities in the diagnosis of lower jaw osteomyelitis. Thirteen patients with clinical signs of the disease were examined and followed up using both methods, three-phase bone scintigraphy and MRI. Compared to three-phase bone scintigraphy, MRI has the same diagnostic sensitivity. However, in one case of active osteomyelitis. bone scintigraphy showed a falsenegative result. MRI once indicated a higher activity rate but never failed to provide the diagnosis. In addition, it gives exact information about the location, size and involvement of the soft tissue. A STIR sequence should be performed in addition to the native and contrast-enhanced Tl-weighted spin echo sequence. The metal artifacts of the antibiotic chain on the MRI can be eliminated by replacing the wire by nonresorbent suture material. In the diagnosis of lower jaw osteomyelitis, three-phase bone scintigraphy can be replaced by the MRI.
J. P. B. Bouwman. Afdeling, Kaakchirurgie, Post Bus 417. NL-2000 AK Haarlem. The
Correspondencr: Dr T. Kiirner, Klinik fur Gesichtschirurgie. Christian-Albrechts-Universitlt. StraBe 16, D-24105 Kiel. Germany.
Robotics in oral and maxillofacial surgery. Applications, opportunities and risks. S. HaJfeld, J. Ruc:kobvsky, P Bohwc C. Hofile, C. Hollw .I Miihling, C! Remhold. (Mund Kiefer GesichtsChir 1997: 1: 316-323).
Facial rejuvenation techniques. F: E. Burton. GesichtsChir 1997: I: 328-334).
Mund-,
(Mund
Kieferund Arnold-Heller-
Kiefer
The purpose of this paper is to review the author’s personal approach to rhytidectomy, including endoscopic techniques as well as resurfacing of the fine wrinkling of sun-damaged. aged skin.
Robot systems are being tested in stereotactic neurosurgical interventions, orthopedic surgery of the hip or knee and advancal endoscopic systems for minimally invasive surgery. In contrast to most industrially manufactured products, objects for medical treatment are characterized by plasticity as well as by complex and individual forms. Thus, features of robots in this field have to be further developed in terms of advanced sensory and specific micromotoric systems. Safety and cooperation between surgeon and robot on the patient in the operating room have to be guaranteed. Extensive three-dimensional diagnosis, computer-aided planning and simulation of the intervention as well as sensory systems that monitor the actual performance of the operation are mandatory parts of this concept. In our interdisciplinary study. we aim to examine whether a robot - given a complete preoperative planning and simulation procedure -is able to perform certain surgical operations more precisely than the surgeon. Examples are drilling with depth control, shaping of bone surface by milling, sawing with defined depth in cranial osteotomies, defined preparation of implant sites and the positioning and insertion of dental and other surgical implants. whereby autonomous employment of the robot is not what is aspired to in these interventions but rather the interactive support of the surgeon.
Correspondcvzce: Dr F. E. Barton, Division University of Texas, Southwestern Medical Hines Boulevard. Dallas. Texas. USA.
of Plastic Surgery, Center, 5323 Harry
Testing of a hydroxyapatite ceramic coating plasma sprayed under vacuum conditions in a rabbit model. R. Kettner, S. Jtinicke. H.-J Schmir:. (Mund Kiefer GesichtsChir 1997: I: 3355339). Implants that were coated with hydroxyapatite ceramic (H-A.C.) under atmospheric condition in vivo often showed local areas of delamination. By applying the H-A.C. coating using the vacuum plasma spraying (VPS) technique, the mechanical characteristics of the coating were decidedly improved. We used a standardized rabbit model to compare a coating produced by this new technique with an implant conventionally plasma sprayed under atmospheric condition (APS). Cylindrical implants, 6 x 4 mm in size with a region flattened to a depth of 800 pm, were inserted into distal rabbit 71
72
British
Journal
of Oral and Maxillofacial
Surgery
femurs underneath the patella. The flattened surfaces were coated with either a 150~Km APS-H-A.C. layer or a 150-pm VPS-H-A.C. layer plasma sprayed on an underlying 50-pm porous titanium layer. The animals were killed after 84 or 365 days. After 84 days histomorphologic evaluation revealed that more than 86% of each surface was covered with mature bone, while the VPS-H-A.C. coating demonstrated an almost two times greater tensile strength than the APS-H-A.C. coating. After 365 days both coatings showed a bony coverage of more than 94%. Again the tensile strength testing revealed much higher values for the VPS-H-A.C. coating. This study demonstrates that after 84 days as well as after 365 days in vivo, the VPS-H-A.C. coating had a significantly greater load capacity than an H-A.C. coating applied under atmospheric condition, and an equal affinity for bone. Correspondence: Dr Dr R. Kettner, KandelfeldstraDe 24, D-52074 Aachen, Germany.
Replantation of avulsed immature cases after 2.5 years on average. C Ruda, H. Hulla, K. Glockner,
permanent teeth: results in 39 K. A. Ebeleseder, S. Friehs, C. Pertl. (Mund Kiefer
GesichtsChir 1997; 1: 340-345). The aim of this investigation was a critical assessment of the shortand medium-term results of replantation of immature, avulsed permanent teeth. Thirty-nine teeth were investigated after 2.5 years on average. Only 7 teeth (18%) had been replanted within 5 min after avulsion. Sixteen teeth (41%) showed revascularisation or ingrowth of alveolar bone into the pulp. Twenty-two teeth (56%) showed signs of ankylosis, 6 (15%) had been exfoliated or extracted. Seventeen teeth (77% of the ankylotic ones) exhibited an alveolar growth arrest of 1.5 mm per 10 cm body growth. By planimetric assessment, the yearly loss of root dentin by replacement resorption was about 15%. The appearance was compromised in 11 cases (33%) by severe discoloration. In spite of intense therapeutic effort and partial success,the results must be classified as unsatisfactory. In avulsions of immature permanent teeth, replantation therefore has to be considered an intermediate solution. Since the main reason for a failure is extended extra-oral unphysiologic storage, replantation by lay helpers immediately after the accident should be propagated as a first-aid treatment to improve the situation of the replanted tooth. In addition, more attention should be paid to preserving teeth in tissue cultures before replantation. Correspondence: Dr K. A. Ebeleseder, Universitltsklinik fiir Zahn-, Mund und Kieferheilkunde, Abteilung fiir Zahnerhaltungskunde, Auenbruggerplatz 12, A-8010 Graz, Austria.
Inflammatory activity of the oral mucosa from patients leukaemia under q&static treatment. r Bieneigriiber, R.-M Teseler. 0. Anders. (Mund Kiefer GesichtsChir 346348).
acute leukaemia after treatmeni with cytotoxic drugs, even when the oral mucosa is clinically inconspicuous, as the inflammatory activity may take place subclinically in strongly stressed or vulnerable regions of mucosa. Correspondence: Prof. Dr Dr V. BienengrLber, Abteilung Experimentelle Zahnheilkunde, Klinik und Poliklinik fiir Zahn-, Mund- und Kieferheilkunde, Universitlt Restock. Postfach 100 888, D-18055, Restock, Germany
Synovial chondromatosis: a contribution to differential diagnosis of diseases of the temporomandibular joint. 7: Plath, H. Dallenbach, I. Ohnesorge, B. Hoffmeister. (Mund Kiefer GesichtsChir 1997; 1: 349-352).
A rare case of synovial chondromatosis of the temporomandibular joint with unspecific symptoms is presented. This causes difficulties in classifying the different clinically and technically acquired features at differential diagnosis. The concept of chondrometaplasia as being triphasic and self-limiting is strongly supported and extreme care should be taken during therapy in order to avoid any unnecessary destruction and mutilation. This case seems to indicate that chronic parafunctional overload was the initiating stimulus for this reactive metaplastic process. Non-physiologic overstrain of any cause should be diagnosed and corrected. Correspondence: Dr Dr Th. Plath, Klinik fiir Kieferchirurgie und Plastische Gesichtschirurgie, UniversiWtsklinikum Benjamin Franklin, Freie Universitlt Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany.
Synovial chondromatosis of the articular joint with invasion middle cranial fossa. I! Kessler, N Hardt, J Kuttenberger.
of the
(Mund Kiefer GesichtsChir 1997; 1: 353-355). Synovial chondromatosis of the temporomandibular joint is a rare occurrence. Resorption of the floor of the skull base caused by the tumour with invasion into the middle cranial fossa has only been described a few times. We report on diagnosis, histologic examination and therapy of a patient with synovial chondromatosis in the articular tubercle of the right temporomandibular joint invading the middle and cranial fossa. After tumour exstirpation the defect in the floor of the middle cranial fossa was reconstructed using a split-skull graft via an intracranial approach. Correspondence; Dr Dr P. Kessler, Klinik fiir Mund-, Kiefer- und Gesichtschirurgie, Kantonsspital Luzern, SpitalstraOe, CH-6000 Luzern 16, Switzerland.
with acute
1997: 1:
Angiosarcoma of the oral mucosa at multiple sites. C. M. Ziegler, C. Hofele, A. Kiibler, J ZLiller, A. Born. (Mund Kiefer GesichtsChir
1997; 1: 356-358). The aim of this study is the registration and the chronological control of inflammatory alterations in the oral mucosa of patients with acute leukaemia under cytostatic treatment. Thirteen patients with acute myeloid leukaemia or acute lymphatic leukaemia were investigated in three oral regions (gingiva, buccal and palatine mucosa) before, during and after cytotoxic drug application for a period of 46 weeks by means of exfoliative cytology. Before therapy, patients with leukaemia showed a significant increase in the number of cells from deeper epithelial layers and a significant decrease of the keratinization index for all investigated regions. This is a consequence of the general inflammatory alteration in all mucosal areas. During cytotoxic drug application these findings were modified only for the palatine mucosa. Immediately after the end of cytotoxic drug application only the buccal mucosa showed a slight but not significant tendency for normalization. At this time, only for the palatine mucosa was there a signifant tendency toward regression. The study underlines the necessity for intensive dental care of patients with
A 6&year-old man presented with a bluish, livid swelling in the region of the lateral alveolar processes of all four quadrants. Evaluation and histopathological findings resulted in the diagnosis of an angiosarcoma at multiple sites. A survey of the literature and an epidemiologic review of our own patients prove this to be an extremely rare occurrence. A partical resention of the maxilla and the mandible on both sides was performed in sano. After discharge, however, a sarcoma was detected in the region of the right scapula 5 months after surgery. Therefore radiation treatment was initiated. The patient died 4 weeks later. The course confirms the poor prognosis of this tumor. Correspondence; Dr Dr C. M. Ziegler, Klinik fiir Mund-, Kiefer-, Gesichtschirurgie, Universitlt Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Abstracts from Mund-, Kiefer- und Gesichtschirurgie
(Volume 1 Number 6 1997)
The value of long-term follow-up of mandibular advancement surgery in patients with a low to normal mandibular plane angle. 1 P B. Bouwnzun, D. B. T&zing, I? J: Kostense, R. A. wn Teeseling, H. M&itcrri (Mund Kiefer GesichtsChir 1997: 1: 311l315).
Correspon&nce: Dr Dr KieferMund-, und Universitat Heidelberg. Heidelberg. Germany.
The objective of this study was to evaluate retrospectively the stability of mandibular advancement via bilateral sagittal split osteotomiea Two fixation methods were compared: intermaxillary fixation (IMF) and rigid internal fixation (RIF). The hypothesis was that, in patients with a low to normal mandibular plane angle (MPA) in retrognathia. the bilateral sagittal split osteotomy (BSSO) to advance the mandible is a predictable and stable procedure and that no significant changes occur after I year. Twelve patients with mandibular deficiency with a low to normal MPA (mean 24.7”. range 20.3”-30.7”) underwent BSSO with IMF. The follow-up period was at least 5 years (mean 6.3, range 559.1 years). Cephalometric analysis using a commercial software package was performed on radiographs that were taken immediately preoperatively (TO), within 6 weeks postoperatively (Tl), 1 year postoperatively (T2), and at least 5 years postoperatively (T3). The average advancement at B point was 4.7mm (range: 337 mm). The assessment of B point in regard to relapse showed no significant change. One patient showed a relapse due to condylar resorption. Forty-five consecutive patients were treated with RIF. Radiographs were taken preoperatively (TO), 6 weeks postoperatively (Tl), and I year postoperatively (T2). This group had a mean MPA of 26.2”, range lo”32”. The average B-point advancement was 4.4 mm (range I-10 mm). No patient showed a clinically significant relapse at T2.
Magnetic resonance imaging versus three-phase bone scintigraphy in diagnosis and monitoring of lower jaw osteomyelitis. 7: Ktirnrr; 7: Krrusch, K. H. Bohuslnrizki, G Brinkmum. S. Ktihnleir~ (Mund Kiefer GesichtsChir 1997: 1: 324-327).
Correspondmce: Dr Kennemer Gasthuis. Netherlands.
S. HaOfeld, Klinik Gesichtschirurgie, Im Neuenheimer
und Poliklinik fur Ruprechts-KarlsFeld 400. D-69120
Bone scintigraphy is routinely used in the diagnosis of lower jaw osteomyelitis; however, the radiation dosage of 3.5 mSv is quite high. Magnetic resonance imaging (MRI) gives information about soft tissue and bone marrow alterations. This study compares the sensitivity of the two imaging modalities in the diagnosis of lower jaw osteomyelitis. Thirteen patients with clinical signs of the disease were examined and followed up using both methods, three-phase bone scintigraphy and MRI. Compared to three-phase bone scintigraphy, MRI has the same diagnostic sensitivity. However, in one case of active osteomyelitis. bone scintigraphy showed a falsenegative result. MRI once indicated a higher activity rate but never failed to provide the diagnosis. In addition, it gives exact information about the location, size and involvement of the soft tissue. A STIR sequence should be performed in addition to the native and contrast-enhanced Tl-weighted spin echo sequence. The metal artifacts of the antibiotic chain on the MRI can be eliminated by replacing the wire by nonresorbent suture material. In the diagnosis of lower jaw osteomyelitis, three-phase bone scintigraphy can be replaced by the MRI.
J. P. B. Bouwman. Afdeling, Kaakchirurgie, Post Bus 417. NL-2000 AK Haarlem. The
Correspondencr: Dr T. Kiirner, Klinik fur Gesichtschirurgie. Christian-Albrechts-Universitlt. StraBe 16, D-24105 Kiel. Germany.
Robotics in oral and maxillofacial surgery. Applications, opportunities and risks. S. HaJfeld, J. Ruc:kobvsky, P Bohwc C. Hofile, C. Hollw .I Miihling, C! Remhold. (Mund Kiefer GesichtsChir 1997: 1: 316-323).
Facial rejuvenation techniques. F: E. Burton. GesichtsChir 1997: I: 328-334).
Mund-,
(Mund
Kieferund Arnold-Heller-
Kiefer
The purpose of this paper is to review the author’s personal approach to rhytidectomy, including endoscopic techniques as well as resurfacing of the fine wrinkling of sun-damaged. aged skin.
Robot systems are being tested in stereotactic neurosurgical interventions, orthopedic surgery of the hip or knee and advancal endoscopic systems for minimally invasive surgery. In contrast to most industrially manufactured products, objects for medical treatment are characterized by plasticity as well as by complex and individual forms. Thus, features of robots in this field have to be further developed in terms of advanced sensory and specific micromotoric systems. Safety and cooperation between surgeon and robot on the patient in the operating room have to be guaranteed. Extensive three-dimensional diagnosis, computer-aided planning and simulation of the intervention as well as sensory systems that monitor the actual performance of the operation are mandatory parts of this concept. In our interdisciplinary study. we aim to examine whether a robot - given a complete preoperative planning and simulation procedure -is able to perform certain surgical operations more precisely than the surgeon. Examples are drilling with depth control, shaping of bone surface by milling, sawing with defined depth in cranial osteotomies, defined preparation of implant sites and the positioning and insertion of dental and other surgical implants. whereby autonomous employment of the robot is not what is aspired to in these interventions but rather the interactive support of the surgeon.
Correspondcvzce: Dr F. E. Barton, Division University of Texas, Southwestern Medical Hines Boulevard. Dallas. Texas. USA.
of Plastic Surgery, Center, 5323 Harry
Testing of a hydroxyapatite ceramic coating plasma sprayed under vacuum conditions in a rabbit model. R. Kettner, S. Jtinicke. H.-J Schmir:. (Mund Kiefer GesichtsChir 1997: I: 3355339). Implants that were coated with hydroxyapatite ceramic (H-A.C.) under atmospheric condition in vivo often showed local areas of delamination. By applying the H-A.C. coating using the vacuum plasma spraying (VPS) technique, the mechanical characteristics of the coating were decidedly improved. We used a standardized rabbit model to compare a coating produced by this new technique with an implant conventionally plasma sprayed under atmospheric condition (APS). Cylindrical implants, 6 x 4 mm in size with a region flattened to a depth of 800 pm, were inserted into distal rabbit 71
72
British
Journal
of Oral and Maxillofacial
Surgery
femurs underneath the patella. The flattened surfaces were coated with either a 150~Km APS-H-A.C. layer or a 150-pm VPS-H-A.C. layer plasma sprayed on an underlying 50-pm porous titanium layer. The animals were killed after 84 or 365 days. After 84 days histomorphologic evaluation revealed that more than 86% of each surface was covered with mature bone, while the VPS-H-A.C. coating demonstrated an almost two times greater tensile strength than the APS-H-A.C. coating. After 365 days both coatings showed a bony coverage of more than 94%. Again the tensile strength testing revealed much higher values for the VPS-H-A.C. coating. This study demonstrates that after 84 days as well as after 365 days in vivo, the VPS-H-A.C. coating had a significantly greater load capacity than an H-A.C. coating applied under atmospheric condition, and an equal affinity for bone. Correspondence: Dr Dr R. Kettner, KandelfeldstraDe 24, D-52074 Aachen, Germany.
Replantation of avulsed immature cases after 2.5 years on average. C Ruda, H. Hulla, K. Glockner,
permanent teeth: results in 39 K. A. Ebeleseder, S. Friehs, C. Pertl. (Mund Kiefer
GesichtsChir 1997; 1: 340-345). The aim of this investigation was a critical assessment of the shortand medium-term results of replantation of immature, avulsed permanent teeth. Thirty-nine teeth were investigated after 2.5 years on average. Only 7 teeth (18%) had been replanted within 5 min after avulsion. Sixteen teeth (41%) showed revascularisation or ingrowth of alveolar bone into the pulp. Twenty-two teeth (56%) showed signs of ankylosis, 6 (15%) had been exfoliated or extracted. Seventeen teeth (77% of the ankylotic ones) exhibited an alveolar growth arrest of 1.5 mm per 10 cm body growth. By planimetric assessment, the yearly loss of root dentin by replacement resorption was about 15%. The appearance was compromised in 11 cases (33%) by severe discoloration. In spite of intense therapeutic effort and partial success,the results must be classified as unsatisfactory. In avulsions of immature permanent teeth, replantation therefore has to be considered an intermediate solution. Since the main reason for a failure is extended extra-oral unphysiologic storage, replantation by lay helpers immediately after the accident should be propagated as a first-aid treatment to improve the situation of the replanted tooth. In addition, more attention should be paid to preserving teeth in tissue cultures before replantation. Correspondence: Dr K. A. Ebeleseder, Universitltsklinik fiir Zahn-, Mund und Kieferheilkunde, Abteilung fiir Zahnerhaltungskunde, Auenbruggerplatz 12, A-8010 Graz, Austria.
Inflammatory activity of the oral mucosa from patients leukaemia under q&static treatment. r Bieneigriiber, R.-M Teseler. 0. Anders. (Mund Kiefer GesichtsChir 346348).
acute leukaemia after treatmeni with cytotoxic drugs, even when the oral mucosa is clinically inconspicuous, as the inflammatory activity may take place subclinically in strongly stressed or vulnerable regions of mucosa. Correspondence: Prof. Dr Dr V. BienengrLber, Abteilung Experimentelle Zahnheilkunde, Klinik und Poliklinik fiir Zahn-, Mund- und Kieferheilkunde, Universitlt Restock. Postfach 100 888, D-18055, Restock, Germany
Synovial chondromatosis: a contribution to differential diagnosis of diseases of the temporomandibular joint. 7: Plath, H. Dallenbach, I. Ohnesorge, B. Hoffmeister. (Mund Kiefer GesichtsChir 1997; 1: 349-352).
A rare case of synovial chondromatosis of the temporomandibular joint with unspecific symptoms is presented. This causes difficulties in classifying the different clinically and technically acquired features at differential diagnosis. The concept of chondrometaplasia as being triphasic and self-limiting is strongly supported and extreme care should be taken during therapy in order to avoid any unnecessary destruction and mutilation. This case seems to indicate that chronic parafunctional overload was the initiating stimulus for this reactive metaplastic process. Non-physiologic overstrain of any cause should be diagnosed and corrected. Correspondence: Dr Dr Th. Plath, Klinik fiir Kieferchirurgie und Plastische Gesichtschirurgie, UniversiWtsklinikum Benjamin Franklin, Freie Universitlt Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany.
Synovial chondromatosis of the articular joint with invasion middle cranial fossa. I! Kessler, N Hardt, J Kuttenberger.
of the
(Mund Kiefer GesichtsChir 1997; 1: 353-355). Synovial chondromatosis of the temporomandibular joint is a rare occurrence. Resorption of the floor of the skull base caused by the tumour with invasion into the middle cranial fossa has only been described a few times. We report on diagnosis, histologic examination and therapy of a patient with synovial chondromatosis in the articular tubercle of the right temporomandibular joint invading the middle and cranial fossa. After tumour exstirpation the defect in the floor of the middle cranial fossa was reconstructed using a split-skull graft via an intracranial approach. Correspondence; Dr Dr P. Kessler, Klinik fiir Mund-, Kiefer- und Gesichtschirurgie, Kantonsspital Luzern, SpitalstraOe, CH-6000 Luzern 16, Switzerland.
with acute
1997: 1:
Angiosarcoma of the oral mucosa at multiple sites. C. M. Ziegler, C. Hofele, A. Kiibler, J ZLiller, A. Born. (Mund Kiefer GesichtsChir
1997; 1: 356-358). The aim of this study is the registration and the chronological control of inflammatory alterations in the oral mucosa of patients with acute leukaemia under cytostatic treatment. Thirteen patients with acute myeloid leukaemia or acute lymphatic leukaemia were investigated in three oral regions (gingiva, buccal and palatine mucosa) before, during and after cytotoxic drug application for a period of 46 weeks by means of exfoliative cytology. Before therapy, patients with leukaemia showed a significant increase in the number of cells from deeper epithelial layers and a significant decrease of the keratinization index for all investigated regions. This is a consequence of the general inflammatory alteration in all mucosal areas. During cytotoxic drug application these findings were modified only for the palatine mucosa. Immediately after the end of cytotoxic drug application only the buccal mucosa showed a slight but not significant tendency for normalization. At this time, only for the palatine mucosa was there a signifant tendency toward regression. The study underlines the necessity for intensive dental care of patients with
A 6&year-old man presented with a bluish, livid swelling in the region of the lateral alveolar processes of all four quadrants. Evaluation and histopathological findings resulted in the diagnosis of an angiosarcoma at multiple sites. A survey of the literature and an epidemiologic review of our own patients prove this to be an extremely rare occurrence. A partical resention of the maxilla and the mandible on both sides was performed in sano. After discharge, however, a sarcoma was detected in the region of the right scapula 5 months after surgery. Therefore radiation treatment was initiated. The patient died 4 weeks later. The course confirms the poor prognosis of this tumor. Correspondence; Dr Dr C. M. Ziegler, Klinik fiir Mund-, Kiefer-, Gesichtschirurgie, Universitlt Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.