Fragestellung. Ziel der Arbeit war es, die posttraumatische Bulbusmotilität in Bezug auf die Fraktursituation am Orbitaboden und eventuelle Begleitverletzungen zu untersuchen.

Study objective: To determine the agreement between rectal temperature and infrared tympanic membrane temperatures in marathon runners presenting to a field hospital at the finish line. Methods: The subjects of this prospective, blinded, controlled study were runners 18 years or older who were triaged to the acute care medical area at the finish line for suspected hypothermia, hyperthermia, dehydration, or altered mental status. Rectal and tympanic temperatures were measured simultaneously in all subjects for whom rectal temperature measurement had been deemed necessary and recorded on separate data cards. Results: Of the 239 runners treated in the acute care medical area, 37 required rectal temperature measurement and were enrolled in the study. The mean rectal temperature was 38.45º±1.20º C (range, 35.9º to 41.5º C). The mean tympanic membrane temperature was 37.81º±.95º C (range, 36.3º to 40.4º C). Pearson's correlation coefficient revealed a moderate correlation (r=.6902, P=.00023). The mean temperature difference between the two thermometers, mean rectal minus mean tympanic membrane, was .64º C (95% confidence interval, .35º to .93º C). Sixty-two percent of the tympanic membrane readings were within 1º C of their rectal counterparts. Agreement ranged from 1.16º (+2 SD) to -2.95º (-2 SD). The 95% confidence interval was 1.67º to -2.95º C. Conclusion: We were able to demonstrate only a moderate correlation between the two thermometer readings, with a wide spread between the limits of agreement. This spread could be clinically significant and therefore limits the usefulness of tympanic temperature in the marathon race setting. Because of the potentially large and clinically significant differences in rectal and tympanic temperatures and the limitations inherent in our study, we cannot endorse the use of tympanic temperature in the setting of a marathon event. [Roth RN, Verdile VP, Grollman LJ, Stone DA: Agreement between rectal and tympanic membrane temperatures in marathon runners. Ann Emerg Med October 1996;28:414-417.]

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.

The aim of the study was to investigate the diagnostic value of ultrasonography (US) in orbital floor fractures and orbital rim fractures with a curved array scanner. Over a period of 10 months, 60 patients with an orbital trauma have been investigated. Orbital trauma was defined by clinical and ophthalmologic investigation. Computed tomography (CT) was used as the reference method to evaluate the diagnostic value of US in the determination of an orbital floor fracture and was performed by a well-experienced radiologist. Coronal and sagittal images were made. The US investigation was performed with a 7.5 MHz curved array transducer.The US investigation of the infraorbital rim showed a sensitivity of 94% and a specificity of 92% with a diagnostic accuracy of 92%. The positive predictive value (PPV) reached 91% and the negative predictive value (NPV) reached 92%, while the US investigation of the orbital floor showed a sensitivity of 95% and a specificity of 100% with a diagnostic accuracy of 98%. PPV reached 100% and NPV reached 77%. Ultrasonography is a cost-effective and widely available method without disadvantages such as radiation exposure. The results in the current study imply that ultrasonography can be used as an alternative method in the investigation of orbital floor fractures.

PURPOSE:The aim of the study was to investigate whether orbital ultrasonography (US) with a curved-array transducer could be an alternative imaging method to computed tomography (CT) to detect orbital wall fractures and fractures of the infraorbital rim.MATERIALS AND METHODS:Fifty-eight patients with the clinical ophthalmologic or radiologic diagnosis of an orbital trauma were investigated prospectively by US and CT. The reference method was the intraoperative findings.RESULTS:CT evaluation of the infraorbital rim yielded a sensitivity of 79%, a specificity of 90%, and an accuracy of 94%. The positive predictive value (PPV) and the negative predictive value (NPV) of the infraorbital rim reached 69% and 83%, respectively. CT evaluation of the orbital floor showed a sensitivity of 96%, a specificity of 71%, and an accuracy of 96%. PPV and NPV resulted in 71% and 93%, respectively. US investigation of the infraorbital rim yielded a sensitivity of 77%, a specificity of 89%, and an accuracy of 97%, whereas PPV and NPV reached 65% and 83%, respectively. US investigation of the orbital floor reached a sensitivity of 94%, a specificity of 57%, and an accuracy of 96%, whereas PPV and NPV yielded 57% and 91%, respectively. No significant difference was found between US and CT in the investigation of the infraorbital rim (P =.809) and the orbital floor (P =.729).CONCLUSIONS:US with a curved-array transducer appears to be a useful alternative method in the investigation of orbital floor fractures. Further studies have to be conducted to reduce the presence of false-negative results.

PURPOSE:The purpose of the study was to evaluate the diagnostic value of a curved array scanner in the diagnosis of medial and lateral orbital wall fractures.MATERIAL AND METHODS:Fifty-three patients with the clinical diagnosis of an orbital trauma were investigated prospectively within a period of 16 months by CT and ultrasonography. The intraoperative findings were used as a reference.RESULTS:CT reached a sensitivity of 100% and a specificity of 96% in the diagnosis of medial orbital wall fractures, while ultrasound yielded a sensitivity of 80% and a specificity of 96%. There was no significant difference found between CT and ultrasonography ( p=0.402). In the investigation of lateral orbital wall fractures, CT reached a sensitivity of 88% and a specificity of 87%, while ultrasonography yielded a sensitivity of 97% and a specificity of 95%. Ultrasonography achieved significantly better results than CT ( p=0.008).CONCLUSION:The ultrasound investigation with a curved array scanner could be used as an additional method in the diagnosis of medial and lateral orbital wall fractures. Further technical improvements of the transducers need to be developed to increase the sensitivity of ultrasound in the diagnosis of medial orbital wall fractures.

Ziel der Untersuchung war es, die Häufigkeit von klinischen Kiefergelenkbeschwerden bei Kindern mit rheumatischen Erkrankungen zu erfassen und Zusammenhänge zwischen dem Stadium der rheumatischen Erkrankung und dem klinischen Bild einer Kiefergelenksymptomatik zu evaluieren.

OBJECTIVE:The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor.STUDY DESIGN:The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component.RESULTS:Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence (P =.001) of diplopia and exophthalmos (P =.039) than fractures without involvement of the medial wall.CONCLUSION:Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.

Ziel der Arbeit war es, den diagnostischen Wert der Sonographie mit einem gekrümmten Sektorschallkopf in der Diagnostik von medialen und lateralen Orbitawandfrakturen zu bestimmen.

The purpose of this study was to investigate the short- and long-term stability of bimaxillary surgery following LeFort I (LF-1) impaction with simultaneous bilateral sagittal split ramus osteotomy (BSSO) and mandibular advancement using the technique of rigid internal fixation (RIF). In order to assess the postoperative maxillary and mandibular movement pattern in 26 patients with vertical maxillary excess and mandibular deficiency, cephalograms were taken immediately preoperatively, and 1 week, 2 months, and 1 year after surgery. With paired t-test showing no statistically significant postoperative change for the point A of the maxilla from immediate postsurgery to longest follow-up (P> 0.05), the used technique of "RIF LF-I impaction and RIF BSSO advancement" tended to render excellent postsurgical stability in the horizontal (0.1+/-0.8mm mean posterior movement) and vertical (0.1+/-0.5mm mean inferior movement) direction. There was no instance of maxillary relapse of >2mm. Regarding mandibular BSSO advancement, the point B showed a significant vertical upward movement (1.6+/-1.2mm) (P< 0.001) and a slight horizontal forward movement (0.3+/-2.0mm) (P> 0.05) at 1-year follow-up. The incidence of posterior relapse of >2mm accounted for 11.5%. The data confirm the concept that the bimaxillary approach of "LF-I impaction and BSSO advancement" using the described technique of RIF is a stable procedure in the treatment of open bite patients classified as vertical maxillary excess in combination with mandibular deficiency.

The aim of the study was to investigate the incidence of temporomandibular disorders (TMD) in juvenile patients with rheumatic diseases. Furthermore, correlations between the degree of the rheumatic disease and the clinical symptoms were evaluated.In a prospective investigation the temporomandibular joints of 48 children with rheumatic diseases were evaluated clinically regarding clicking, crepitation, pain, duration of the rheumatic disease, and the number of affected peripheral joints. The degree of rheumatic disease was assessed with Steinbrocker's classification.26 patients (54.17%) showed clinical symptoms of TMD. No significant correlation was found between the degree of the rheumatic disease and the awareness of TMD. A high number of affected peripheral joints does not lead to a significant increase of TMD. A significant correlation between the duration of the rheumatic disease and TMD could be detected. A significant correlation between the duration of the rheumatic disease and clicking or crepitation was found ( p=0.011).Rheumatic diseases lead to a higher incidence of TMD in juvenile patients. A longer duration of rheumatic diseases leads to a higher incidence of TMD.

The purpose of this study was to evaluate ultrasonography (US) and computed tomography (CT) in detecting lymphnodes of the neck affected with squamous cell carcinoma. From 1987 to 1999 the data from 203 untreated patients with a diagnosis of cancer in the maxillofacial have been investigated. Of these, 115 had a primary squamous-cell carcinoma. US diagnosis was made by an oral- and maxillofacial surgeon experienced in US of the head and neck. CT diagnosis was made by a well-experienced radiologist. The following lymph node levels were assesed: level I (submental and submandibular lymphnodes), level II (lymphnodes distal to level I and confined to the region above the skin crease at or just below the level of the thyroid notch), level III (lymphnodes distal to level II and confined to the anterior cervical triangle including those deep to the sternocleidomastoid muscle), and level IV (lymphnodes distal to level III and confined to the posterior cervical triangle). For all levels US yielded a sensitivity of 71%, and a specificity of 87%, while CT showed a sensitivity of 32% and a specificity of 96%. The sensitivity of US decreased from level I to level IV, whereas the specificity increased from level I to level IV. For lymphnode levels I and II US may be useful for the detection of local metastases while for the other levels the application of advanced techniques of US may have to be investigated.

OBJECTIVE The purpose of the study was to investigate whether a flexible, biodegradable material (Ethisorb) shows better long-term results with regard to diplopia, bulbus motility, and exophthalmos/enophthalmos compared to the use of lyophilized dura-patches and polydioxanone (PDS) foils. METHODS During a period of 6 years 435 patients with an orbital fracture were investigated retrospectively. Inclusion criteria were patients with fractures of the orbital floor with a maximum size of 2 x 2 cm. Bulbus motility, exophthalmos, enophthalmos, and diplopia were investigated during a period of 2 years. RESULTS One hundred twenty orbital floors were reconstructed by lyophilized dura-patches, 81 by PDS, and 136 by Ethisorb. An exploration without an implantation was performed in 91 patients. The long-term investigation 12 to 15 months after surgery showed an exophthalmos and enophthalmos incidence of 1%, whereas a reduced bulbus motility and diplopia were found in 5% and 4%, respectively. Fifteen to 24 months after surgery 2% of the patients had an exophthalmos and 1% had an enophthalmos. A reduction of bulbus motility was found in 4% of the patients, and diplopia was found in 3%. The use of Ethisorb resulted in a significantly lower incidence of exophthalmos 3 months after surgery compared to PDS. CONCLUSION The low rate of acquired bulbus motility demonstrates acceptable results in using Ethisorb in the floor of the orbit.

the determination of the temporomandibular joint disc position. High-Resolution Ultrasonography (HR-US) was used to determine the disc position in the temporomandibular joint (TMJ). Magnetic resonance imaging (MRI) was used as a gold-standard. Within the sonographic evaluation the TMJ disc was investigated during the opening movement. 38 patients with TMJ internal derangements classified according to the clinical diagnostic criteria for temporomandibular disorders have been investigated by a 12,5 Mhz HR-US scanner. The results had been analyzed prospectively and retrospectively. The retrospective interpretation of the HR-US investigation yielded a sensitivity of 88%, a specificity of 81%, and a diagnostic accuracy of 85% at closed mouth position. At maximum mouth-opening position HR-US reached a sensitivity of 62%, a specificity of 88%, and a diagnostic accuracy of 75% in retrospective investigation. The prospective results at a closed mouth position yielded a sensitivity of 75%, a specificity of 74%, and a diagnostic accuracy of 75%. At maximum mouth-opening position the prospective results of HR-US reached a sensitivity of 50%, a specificity of 91%, and a diagnostic accuracy of 74%. Dynamic HR-US is a possibility to determine the TMJ joint disc position. Many of the prospective false interpretations did not occur in the retrospective investigation. Further studies may have to show whether an improvement in interpretation of HR-US images correlates with the experience of the investigator.

PURPOSE:The aim of this study was to evaluate post-traumatic ocular motility in orbital floor fractures in relation to the severity of the fracture and concomitant injuries.MATERIAL AND METHODS:Over a period of 6 years, data from 435 patients with orbital floor fractures were re-evaluated. Ocular motility was divided into abduction, adduction, upgaze and downgaze movements.RESULTS:In 54.3% of the cases, there was a reduction in ocular motility. A reduced motility with a movement >20 degrees was found in most of the cases. Concomitant injuries to the eye resulted in a significant increase in the reduction of motility. This reduction depended on the severity of the orbital floor fracture. A reduced upgaze movement was the most common complication in all types of fractures.CONCLUSION:Ocular motility can act as an indication of the severity of the orbital fracture. Concomitant injuries to the eye resulted in a higher incidence of reduced ocular motility.

PURPOSE:The aim of this retrospective study was to investigate the long-term outcomes of dental injuries. Subluxated and laterally luxated teeth were evaluated according to the findings of CO2 sensitivity, obliteration, pulpal sclerosis, and the duration of post-traumatic fixation of the injured teeth.MATERIAL AND METHODS:The data of 725 patients were analyzed retrospectively over a period of 14 years. Of these, 108 patients could be investigated for a long-term follow-up. Dental trauma was classified according to the degree of luxation (I-III).RESULTS:There was a significant correlation between the degree of luxation and the post-traumatic findings of CO2 sensitivity. There was no significant correlation between the degree of luxation and the post-traumatic findings of apical inflammation, pulpal sclerosis, and/or obliteration. Long-term fixation of injured teeth had no effect on the short- and long-term occurrence of pathologic processes at the root such as root resorption.CONCLUSION:The post-traumatic finding of CO2 sensitivity was related to the degree of luxation of the injured teeth. Apical inflammation, pulpal sclerosis, and obliteration were not related to the degree of luxation. The results suggest that long-term fixation of injured teeth has no negative effects on the long-term outcomes of subluxated and laterally luxated teeth.

Fragestellung. Ziel der vorliegenden Arbeit war es, Langzeitergebnisse erst- und zweitgradig luxierter Zähne zu erhalten. Es sollten die Sensibilität auf CO2-Schnee und Pulpenveränderungen in Abhängigkeit von der Schienungsdauer untersucht werden.

Mittelgesichtsfrakturen waren früher relativ seltene Ereignisse, und die Überlebenschancen bei ausgedehnten Verletzungen waren gering. In der Behandlung von Mittelgesichtsfrakturen hat in den vergangenen Jahrzehnten ein großer Wandel stattgefunden, sodass diese Verletzungen, die zudem stark zugenommen haben, heute erfolgreich behandelt werden können. Die primär konservative Schienungs- und Extensionsbehandlung wurde von der offenen Reposition abgelöst. Voraussetzungen dafür waren neben modernen Anästhesieverfahren und Antibiotika die Entwicklung von Platten- und Schraubenosteosynthesen für das Mittelgesicht, die die Drahtnähte ersetzt haben. Damit wurde erstmals eine exakte dreidimensionale Rekonstruktion möglich. Die Einführung bioresorbierbarer Osteosynthesematerialien erspart den Zweiteingriff zu ihrer Entnahme. Moderne bildgebende Verfahren sowie computerassistierte intraoperative Navigationshilfen dürften dazu führen, dass diese Frakturen in Zukunft von noch kleineren operativen Zugängen reponiert werden können.

Objective. Laser Doppler flowmetry is a noninvasive method of assessing pulpal blood-flow (PBF) to document pulpal vitality. Maxillary osteotomies have been associated with segment-related decreases in local PBF. The aim of this study was to assess the effect of a Le Fort I osteotomy on tooth-type–related PBF values. Patients And Methods. Maxillary incisors, canines, and premolars were investigated bilaterally by laser Doppler flowmetry in 14 volunteers to assess local PBF values before and after surgery. Perfusion units were taken in 3 sessions: on the day before surgery (time since osteotomy [TSO] 0) and at 4 days (TSO I) and 56 days (TSO II) after osteotomy. Results. Analysis of TSO-related PBF measurements revealed a significant difference between TSO 0 and TSO II for the first premolar and between TSO 0 and TSO I and II for the overall tooth-type–related values. Conclusions. The main findings of this study indicated Le Fort I osteotomy to be associated with a short-term and long-term decrease in maxillary PBF values. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:88-90)

In the past, treatment of maxillofacial fractures was characterized by low incidences of midface fractures, while severe cases were associated with a high death rate. Over the last decades the application of new techniques has provided a successful outcome in the management of these more frequently observed injuries. With the introduction of antibiotics and the principles of modern anesthesiology, conservative methods of fracture treatment such as intermaxillary fixation and the application of extension devices were increasingly replaced by surgical techniques. The development of different osteosynthesis plate and screw systems in the early 1970s has made three-dimensional reconstruction a standard of care in the surgical treatment of midface fractures. With the recent introduction of commercially available bioresorbable systems, removal of osteosynthesis material has become an unnecessary procedure. Further research in innovative techniques of maxillofacial surgery and imaging, such as image-guided surgery by computer navigation, may be warranted to minimize surgical approaches and decrease incidences of perioperative morbidity.