Heutzutage gilt der totale alloplastische Kiefergelenkersatz bei Pathologien mit irreversiblen Form- und Dimensionsänderungen des Processus condylaris mandibulae als verlässliche Behandlungsoption. Bei Defekten, die über den Gelenkfortsatz und die Gelenkgrube hinaus weitere Unterkiefereinheiten und/oder die Jochbogen/Jochbeinregion involvieren, lässt sich das Design individuell gefertigter Endoprothesen so gestalten, dass benachbarte Knochendefizite ausgeglichen werden können. Alloplastische Rekonstruktionen dieser Art kommen infrage, wenn autologe Rekonstruktionsverfahren mit erheblichem Zusatzaufwand verbunden oder nicht durchführbar sind. Während die anatomische Form und Konturgebung in ästhetisch und funktionell befriedigender Weise wiederhergestellt werden können, darf von einem alloplastischen Gelenkersatz mit Reduktion auf eine einfache Biomechanik von vornherein nicht erwartet werden, die Bewegungsabläufe und Interaktionen innerhalb des komplexen stomatognathen Systems vollkommen zu replizieren.

We evaluated the ocular and visual status in a group of patients with a non-surgically treated blowout fracture. Clinical examination with refraction, test of binocular function, and tear film evaluation was performed in 23 patients. These values were statistically correlated with the orbital volume measurements and ocular finding from the patient records at presentation. About 50% of the study group was symptomatic due to low visual acuity fromrefractive errors and decompensated phorias as a consequence of the blowout fracture. Several patients displayed changes in tear film production. There was no strong correlation between the measured parameters and orbital volume measurements. Patients with a non-surgically treated blowout fracture often display ocular and visual changes after discharge. A routine visual exam is advocated in all patients after the ocular status has stabilized after a blowout fracture.

Traditionally, each specialty involved in craniomaxillofacial trauma and orthognathic surgery had its own areas of interest and expertise. This introductory textbook is different in that it presents the combined and fo cused expertise and competence of the different specialties on the entire craniofacial skeleton. The principles described in this textbook represent the evolution of craniomaxillofacial buttress reconstruction over the last 60 years. In addition to standard procedures,techniques representing recent surgical advances and new developments are introduced as well. This textbook not only provides an overview on current concepts of craniomaxillofacial trauma care and orthognathic surgery, but also helps to understand the complexity of the craniofacial skeleton and its related soft tissues for an efficient and successful reconstruction of the face following trauma and congenital deformities.

Early temporomandibular joint (TMJ) prostheses articulated on material with poor wear resistance. Wear debris was deposited in the surrounding tissues, causing severe foreign body cell reactions. Recent TMJ prostheses use modern orthopaedic materials, such as ultra high molecular weight polyethylene (UHMWPE) for the fossa component, and cobalt-chromium, or cobalt-chromium-molybdenum for the condylar head. These designs are reliable in long-term follow-up studies. The authors report histological findings in soft tissue samples obtained from around two types of TMJ prostheses after up to 8 years of function. The devices were four Biomet (Biomet Microfixation, Jacksonville, FL, USA), and two TMJ Concepts (TMJ Concepts, Ventura, CA, USA). All joint capsule samples demonstrated dense, fibrous connective tissue with no inflammatory cells or foreign body reactions. The joint disc tissues showed even denser fibrous connective tissue, free from inflammatory reactions. Some samples from the junction between capsule and disk demonstrated synovial-like tissue. The observations reported in this paper indicate that modern TMJ prostheses with Cr-Co-Mb or Cr-Co articular condyles articulating on UHMWPE fossa components appear to function without foreign body reactions in he surrounding tissues.

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for surgical versus nonsurgical treatment of orbital floor fractures. This was a follow-up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. Patients were contacted by regular mail and invited to have a clinical eye examination. The volume of the orbital content was calculated digitally from the patients' computed tomography scans at the time of their injury. Eighteen subjects with no facial skeleton fracture were included for reference of orbital content volumes. Five of 23 patients showed 2 to 4 mm of enophthalmos, and only three of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmos. No statistical correlation supporting the supposition that 1 mL of herniated orbital content would result in 1 mm of enophthalmos was found. The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmos is unclear.

Temporomandibular joint (TMJ) reconstruction may be required in complex cases in which there are additional mandibular or zygomatic arch defects. The reconstructive options include autogenous tissue, alloplastic material, or combinations of these. The authors describe 4 cases in which TMJ reconstruction was performed with TMJ Concepts customized joint prostheses. The prosthetic components were designed to restore major defects in the zygomatic arch and the mandibular ramus and body, including one case in which the mandibular component was used to restore total mandibular continuity. The prosthetic components used in these cases provided excellent anatomical reconstruction, and were a viable treatment option in cases in which the pathological process made autogenous grafts unsuitable. The prostheses have been functioning for up to 6 years. In one case a revision operation was required because the lack of a pterygomasseteric sling resulted in the condyle dropping out of the fossa. The authors’ clinical experience with these cases suggests that a customized prosthesis combined with TMJ reconstruction can be a reliable treatment alternative for bridging complex, major maxillo-mandibular defects.

Surgery for tumors extending into the infratemporal fossa requires adequate exposure to identify and protect vital structures. We present a patient who had, at some time in the past, been treated by condylar resection of the right temporomandibular joint (TMJ) because of a pigmented villonodular synovitis. The condyle had been replaced with a standard reconstruction plate that had eroded deep into the skull base. Prosthetic reconstruction of the TMJ was performed 1.5 years later after renewed bone tumor excision from the infratemporal space. The standard preauricular and submandibular approaches for implantation of a total TMJ prosthesis did not offer adequate access for tumor removal from the infratemporal fossa. The tumor was excised successfully through an additional transparotid approach.

12 patients underwent temporomandibular joint (TMJ) reconstruction with Biomet total joint prostheses. Indications for TMJ reconstruction included ankylosis, rheumatoid arthritis, degenerative joint disease and condylar resorption. Five patients had unilateral procedures, seven had bilateral. The follow-up ranged between 2 and 8 years. Amongst the ankylotic patients the mean jaw-opening capacity increased from 3.8 mm preoperatively to 30.2 mm 1 year after surgery, and in most of those patients the opening capacity remained stable over the years. The other patients maintained a mean opening capacity of more than 35 mm. Joint related pain and interference with eating were eliminated after TMJ reconstruction. There were no permanent facial nerve disturbance, no postoperative infections and no device related complications. The outcome supports prosthetic TMJ reconstruction as a useful treatment modality in patients with advanced TMJ disease.

Hydroa vacciniforme is a rare, usually quite severe, photodermatosis. Association with Epstein-Barr virus infection and a possibly increased risk of lymphoproliferative malignancy have been demonstrated. We describe here four patients with Epstein-Barr virus-associated hydroa vacciniforme treated with acyclovir/valacyclovir therapy with a good clinical response. The children were reported to have less fatigue, fewer eruptions, less scarring, and increased ability to spend time outdoors without provoking new eruptions. This was also in agreement with clinical observations. However, one patient progressed into an anaplastic lymphoma kinase-1-negative anaplastic large-cell lymphoma in the upper jaw. This was preceded by an increase in EBV viral load. Acyclovir/valacyclovir therapy is a safe treatment. Further studies are required to confirm these results.

Prosthetic reconstruction of the temporomandibular joint (TMJ) is a controversial method of treatment. This paper presents 2 cases that illustrate the problem with prosthetic reconstruction of the condylar head with no fossa reconstruction. In both cases, severe erosion and heterotopic bone formation occurred, and the patients underwent installation of total TMJ prostheses to replace the previous, partial ones.

Objective. Basic fibroblast growth factor (bFGF) is important for wound healing and tissue repair. This study measures the concentration of bFGF in oral lichen planus (OLP) affected mucosa and in the saliva of patients with OLP.Study design. Samples of saliva, OLP-affected mucosa, and clinically healthy mucosa were obtained from 11 patients. Control samples were obtained from healthy volunteers. The bFGF content of tissue samples and saliva was examined by ELISA.Results. The mean bFGF concentration in saliva from OLP patients was 5.9 pg/mL, SD 2.9, compared with 0.3 pg/mL, SD 0.3, in the control group, (P>.01). The bFGF content in the OLP tissue was 90.6 mug/mg protein, SD 39.5, in clinically normal mucosa from OLP individuals it was 46.2 mug/mg protein, SD 12.0 (P=.02), and in the control group 46.2 mug/mg protein, SD 11.5 (P>.01).Conclusion. OLP-affected mucosa contained significant more bFGF than nonaffected mucosa in OLP and healthy mucosa in control group. There is no difference between nonaffected mucosa in OLP and control group. Saliva in OLP patients contained more bFGF than saliva in control patients.

Die Mandibula stellt eine sehr seltene Lokalisation für Magenkarzinommetastasen dar. Normalerweise bleibt der hohe kondyläre Bereich unberührt. Als Grund wird u. a. die eigenständige Blutversorgung diskutiert. Problematisch ist die Rekonstruktion nach einer Resektion, da häufig eine frühzeitige adjuvante systemische Therapie erforderlich ist. Am Beispiel dieser Metastasenresektion wird der Einsatz einer Quinn-Kiefergelenkprothese vorgestellt.

OBJECTIVE:Basic fibroblast growth factor (bFGF) has significant properties in wound healing and tissue repair and is suggested to be of importance for the maintenance of mucosal integrity in the upper digestive tract. The purpose of the present study was to identify any age-dependent variations in the concentration of bFGF in human saliva.STUDY DESIGN:Nonprospective, cross-sectional pilot study.METHODS:The study was based on findings from 182 healthy volunteers with ages ranging from 4 to 97 years. Mixed saliva samples were obtained by drooling. The saliva concentration of bFGF was determined with a commercially available enzyme-linked immunosorbent assay kit.RESULTS:The mean saliva concentration of bFGF was 0.41 pg/mL with no gender differences. In persons aged 4 to 19 years, the mean concentration was 0.72 pg/mL; in those aged 20 to 65 years, 0.33 pg/mL; and in those aged 66 to 97 years, 0.005 pg/mL. These age-dependent differences were highly significant. In the youngest group the saliva concentration of bFGF varied more than in the other groups.CONCLUSIONS:The saliva concentration of bFGF varies with individual age, with the highest levels among young individuals, even levels during a mature phase of life, and low levels toward the end of the life cycle. This strongly suggests a physiological implication of bFGF in saliva.

A 37-year-old man with a zygomatic fracture underwent surgical treatment with reduction of the fracture and osteosynthesis with a miniplate on the infraorbital rim. Postoperatively, he had numbness in the distribution area of the infraorbital nerve, but he also suffered from dysesthesia in the same area during periods when he was using his hand-held mobile phone. After surgical removal of the osteosynthesis plate, the dysesthesia associated with his mobile phone was no longer present. The plate was examined in a setup where we measured the electric current that developed on the surface of the plate under the influence of the magnetic field between the phone antenna and the metal plate. The highest currents measured on the actual plate were 141 mV in air, and 21 mV in saline. These findings indicate that there might have been a correlation between the presence of the miniplate close to the infraorbital nerve, and the dysesthesia experienced by the patient, under the influence of the energy emitted from the cellular phone.

Functional disturbances, together with esthetic considerations, are important reasons for patients to seek orthognathic surgical treatment. Functional disorders may include signs and symptoms of temporomandibular disorders (TMD), such as joint pain, chewing problems, joint noises, headaches, etc. This paper reports on TMD before and after orthognathic surgery in 1,516 patients. It is based upon the patients' own evaluations as recorded 2 years after surgery. Preoperatively 43% and postoperatively 28% of the patients reported subjective symptoms of TMD. This difference indicates an overall beneficial effect of orthognathic surgery on TMD signs and symptoms. Patients with mandibular retrognathia did not improve as much as patients with mandibular prognathia. Sagittal ramus osteotomy was less effective than vertical ramus osteotomy in relieving TMD symptoms when performed on similar diagnoses.

Basic fibroblast growth factor (bFGF) is a mediator with potent mitogenic properties. Increased amounts of this mediator have been demonstrated in damaged lung tissue, and it has been suggested to increase the healing of gastro-duodenal ulcers. In order to quantify the amounts and document the localization of bFGF in nasal polyps, polyp tissue from 12 patients undergoing polypectomy was analyzed by ELISA and immunohistochemistry. Mucosa from the inferior turbinate was analyzed in the same manner for comparison. The amount of bFGF detected in polyp tissue was significantly higher than that in turbinate mucosa. The amount of bFGF was also significantly higher in the group of patients with high degree of inflammation. The immunohistochemical findings demonstrated abundant bFGF activity mainly in the glandular acini, in the epithelium, in infiltrating inflammatory cells and in the vessel walls. We propose that bFGF may contribute in a significant way to the formation of nasal polyps.

Purpose: The purpose of this study was to determine the incidence of temporary and permanent sensory disturbance of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO) of the mandible and of the infraorbital nerve (ION) after Le Fort I osteotomy, as well as the rate of recovery of sensory function using subjective and objective measures. Patients and Methods: Preoperatively and after 1 week, and 1, 3, 6, and 12 months postoperatively, sensibility in the distribution of 36 IONs after Le Fort I osteotomy and 24 IANs after BSSO in 19 patients were investigated by using sharp-blunt testing, 2-point discrimination, electromyographic recording, and thermal sensitivity (Pain and Thermal Sensitivity Test Device [PATH]) tests of the Aδ and C nerve fibers. Results: With conventional clinical sharp-blunt and 2-point discrimination tests, the incidence of temporary impairment was 81% for the ION (29 of 36) and 83% for the IAN (20 of 24). The rate of permanent sensibility disturbance with conventional clinical testing was 6% for the ION and 15% for the IAN. Obvious recovery was found after 1 to 3 months for the ION, but it took 6 to 12 months for the IAN. In contrast, electromyography (EMG) testing showed lower rates of temporary sensory disturbance, namely, 54% (13 of 24) for the ION and 68% (15 of 22) for the IAN. Permanent sensory losses were not found. The results of the EMG test was confirmed by the PATH test. Conclusions: Objective tests for sensory disturbances show lower rates than the conventional tests. For quality control, preoperative and postoperative measurement and documentation of postoperative recovery of sensation is recommended. © 2001 American Association of Oral and Maxillofacial Surgeons

Basic fibroblast growth factor (bFGF) has significant properties in wound healing, tissue regeneration and ulcer repair of the upper digestive tract. The purpose of the present study was to identify and analyse factors affecting the concentration of bFGF in saliva from healthy human individuals. A commercially available enzyme-linked immunosolvent assay kit (ELISA) was used for the analyses of bFGF in saliva. In total, 56 samples were collected from 28 healthy subjects, 15 male and 13 female. Determination of bFGF was performed by spectrophotometer (wavelength 490 nm). bFGF was detected in all samples. Mean bFGF concentration was 0.87 pg/ml (SD 0.49) and the concentration ranged from 0.3 to 1.9 pg/ml. In subjects aged 22 to 49 years, no age-dependent variation in bFGF was present, females did not differ from males, and no difference was evident between European and Asian subjects. Smokers had significantly higher saliva concentrations of bFGF than non-smokers. Since bFGF, together with other growth factors, is involved in wound healing and tissue repair, we suggest that bFGF in saliva is involved in the reparative processes of mucous membranes.