Journal of maxillofacial surgery最新文献

Prostaglandin synthesis in the wall of radicular cysts was determined by immunohistochemistry and radiothinlayer chromatography. PGE₂ is predominantly produced by plasma cells and histiocytic elements, whereas much less is synthesized by fibroblasts and endothelial cells as estimated using immunohistochemistry. 6-oxo-PGF_1α, however, was primarily found to be generated by endothelial cells and fibroblasts; only small amounts seem to be derived from histiocytic elements and plasma cells. The response of the cystic epithelium to anti-PGE₂ and anti-6-oxo-PGF_1α antibodies was negative or showed only minimal staining. It can thus be concluded that the granulation tissue and its cellular components modulating the inflammatory process are the main source of prostaglandin synthesis in the wall of radicular cysts and may therefore be responsible for the resultant osteolytic activity.

Paroxysmal trigeminal neuralgia still remains a difficult condition to treat. Carbamazepine (Tegretol) has been a first line treatment, failing this surgery becomes necessary. However, many surgical procedures result in permanent sensory loss. Peripheral cryotherapy, along with the recently described Jannetta (1976) and Hakanson (1981) techniques, attempt to preserve sensation. Cryotherapy to 53 branches of the trigeminal nerve in 39 patients, who were followed up for 4 years, resulted in pain relief out-lasting return of sensation. These cases show that cryotherapy applied to the correctly located affected nerve branches can produce results which are unobtainable by other methods of pain control in paroxysmal trigeminal neuralgia.

A technique is described of true rebuilding of the mandibular crest using a combination of the visorosteotomy (Härle, 1975) and a subperiosteal rib graft (Obwegeser, 1963 b).

A preliminary report on 25 patients with a mean follow-up of 30 months leads to the following conclusions: the resorption in the anterior part ist 52% of the initial gain after 43 months. In the lateral regions 61% is lost. This compares favourably with other techniques. Impairment of sensibility, although usually acceptable, is the main drawback of the procedure.

Local recurrence and distant metastasis were studied in relation to treatment modality and histological findings in 17 patients with adenoid cystic carcinoma of the major and minor salivary glands. Fifteen patients underwent surgical resection with or without postoperative irradiation and the others were treated by irradiation alone. Local recurrence developed in nine patients (52.9%), mostly within two years of the treatment. Incomplete removal was the major reason for the failure to control the primary lesion. Postoperative irradiation was of value in preventing recurrence in patients who demonstrated microscopic residual disease at the surgical margins, whereas it was not effective if gross residual tumour was recognized.

Direct surgical intervention on the tumour tissue could have been the possible cause for the distant metastasis that developed in 10 (58.8%) of the 17 patients. Surgical excision with a wider safety margin than the visibly affected area, followed by postoperative irradiation and chemotherapy was essential to obtain a better prognosis.

This study is an investigation into the number and type of facial injuries due to sports and games, because no detailed information on these dental misfortunes could be found in the literature. The group investigated consisted of 319 patients, treated at the Department of Oral and Maxillo-Facial Surgery, Nijmegen in the period January 1, 1971–December 31, 1978.

Facial injuries were classified into different types of fractures according to site as also were further series of associated injuries. Males were shown to be more prone to facial injuries than females (2.4:1). In the age group 15–40 years, males proved to be more prone to such injuries than the age group under 15 years.

The major part of the injuries is due to fractures of the alveolar process and/or luxation of teeth (59.6%), the zygomatic bone and arch (24.2%) and the mandible (15.3%).

Fractures of the maxilla and the nose were rarely seen.

In 6 children, an ankylosed temporo-mandibular joint was replaced by a chondro-osseous graft from the iliac crest.

The technique is described. The long term results show that this procedure is technically successful. It is also demonstrated that the graft has the possibility to react to functional stimuli. This enables it to grow in a multidirectional manner.

The use of autoclaved bone grafts was studied in animal experiments.

First we checked the immunological response in inbred rats. No antigen-antibody reaction could be detected after syngenic and allogenic autoclaved bone grafting. The bone healing of autogenous autoclaved rib grafts of different length was tested in inbred dogs. After polychrome sequential marking we investigated the periostial and endosteal osteogenic repair of the transplant-area using different histological techniques. Simultaneously we observed the slow destruction and lysis of the autoclaved graft. In our opinion the use of autoclaved autogenous bone graft is possible, under stable conditions, for immediate reconstruction of the mandible in tumour surgery.