A new technique of manufacturing dual-colour stereolithographic models of hard and soft tissues of the temporomandibular joint (TMJ) is presented. Sagittal T1/PD weighted magnetic resonance (MR) images of joints with and without disc displacement were obtained in the closed and open mouth positions. Individual interactive contour identification of bony structures and the articular disc followed by binary interpolation provided the data for the generation of acrylic TMJ models. Three dimensional in vivo visualization of the articular disc in relation to bony structures in the closed and open mouth positions allows a new perception of normal and pathological TMJ anatomy.

The study was performed to evaluate abdominal complications related to jejunal segment resection for reconstruction after radical oropharyngeal tumor resection. Perioperative complications of 104 patients (median age, 53.7 years; 23 female; 81 male) who underwent surgery for oropharyngeal malignancy after radiochemotherapy and the long-term morbidity of 35 patients after a median follow-up period of 21 months are analyzed. The perioperative mortality was 8.7% (9/104); none of the perioperative deaths was caused by an abdominal complication associated with the jejunal resection. In three cases, repeat laparotomy was performed within 30 days of jejunal autotransplantation: in two of them the reason was not directly associated with bowel resection and one patient had an abdominal wall dehiscence. In six cases there were minor abdominal complications which could be treated nonsurgically. There was no anastomotic leakage, bowel obstruction or postoperative bleeding. In the follow-up re-examination, no late onset abdominal complications were noted except small incisional hernias in six of the 35 patients; only one required a hernia repair. Despite a potentially increased operative risk in these patients, the complication rate after bowel resection for jejunal autotransplantation was low. This is a safe procedure in patients with oropharyngeal carcinoma.

Grundlagen: Das Metastasierungsverhalten von Plattenepithelkarzinomen der Mundhöhle und des Oropharynx ist ein entscheidender Faktor in der Prognose. Im Rahmen der chirurgischen Behandlung der regionären Lymphknoten stehen verschiedene Formen der Dissektion und En-bloc-Resektion zur Verfügung.

Reconstruction after radical tumor resection in the oropharyngeal region still represents an interdisciplinary challenge. Autotransplantation of the jejunum is a popular procedure, in which the abdominal surgeon's main task is that of harvesting enteral tissue. To evaluate this technique, a careful analysis of accompanying perioperative abdominal complications was performed. Additionally, we reexamined 35 of 66 patients still living after a follow-up period of 21 (range 2-63) months on average. The perioperative mortality of 90 patients treated for oropharyngeal malignancy using the described procedure was 7.8%. None of the perioperative deaths was caused by an abdominal complication associated with enteral resection. One abdominal reoperation was performed because of abdominal wall dehiscence. For reasons not related to enteral resection, four further patients had to be relaparotomized, two of them during their hospital stay and two after leaving hospital. In five cases we observed minor complications which could be treated nonsurgically. In the followup reexamination we detected no abdominal late-onset complication except small incisional hernias in six cases. Finally, we concluded that despite an elevated overall operative risk in this population, complications owing to jejunal resection were comparably low. The data regarding the rate of complications classify jejunal resection as a safe procedure for reconstructive purposes in patients suffering from oropharyngeal malignancy.

The stable osteosynthesis of mandibular fractures with the modified lag screw (Krenkel) has proven superior to conventional lag screws in theoretical models and clinical use. Compared to osteosynthesis with plate systems, the lag screw technique is more difficult to learn for the unexperienced, but the reduction of fragments under compression with a lag screw and the stabilisation of lower jaw rotation with an additional short miniplate in our experience has proven successful in clinical use.