Abstracts
	Br J Oral Maxillofac Surg 2000 Aug;38(4):299-304 Sterilization of elastic ligatures for intraoperative mandibulomaxillary immobilization.   Terheyden H, Lee U, Ludwig K, Kreusch T, Hedderich J  Department of Oral and Maxillofacial Surgery, Propaedeutics and Dental Material Science. terheyden@mkg.uni-kiel.de  Sterilization can influence the mechanical properties of elastic ligatures used for mandibulomaxillary immobilization. The aim of this study was to compare different sterilization protocols (ethylene oxide, autoclave, irradiation, plasma sterilization, povidone-iodine for 24 hours and 70% isopropyl alcohol for 24 hours) of three elastomers (natural rubber, silicone rubber, and polyurethane). Three mechanical variables were assessed in a testing machine: breaking strength, tensile strength and tensile strength after a 24-hour load (material fatigue). Natural rubber was most susceptible to mechanical alteration by sterilization and lost 46% of its breaking strength and 43% of its tensile strength after autoclaving. Polyurethane was more resistant (multiple comparison, Tukey-Kramer), but polyurethane ligatures stuck together after autoclaving. The protocols for low-temperature sterilization, ethylene oxide, irradiation, and plasma were superior to autoclaving and the disinfecting solutions. These data suggest that polyurethane sterilized with ethylene oxide is the material of choice.  Clin Anat 2000;13(2):121-33 Position, shape, and dimension of the maxilla in unoperated cleft lip and palate patients: review of the literature. Lambrecht JT, Kreusch T, Schulz L   Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basle, Basle, Switzerland. lambrecht@ubaclu.unibas.ch  The inhibition of growth and development resulting from surgical treatment of the cleft lip and palate is a widely discussed topic. Various studies have been conducted in search of answers as to how the untreated upper jaw develops, focusing on individuals with untreated cleft lip and palate as found in so-called Third World countries. This study offers the opportunity to compile literature dealing with the research and description of untreated unilateral cleft lip and palate. The focus was to take a closer look at groups of individuals with complete unilateral cleft lip and palate, who had received no surgical treatment at all, as well as groups who had received surgical treatment of only the cleft lip. The upper jaw of untreated cleft lip and palate patients most often adopts a protruded position without enlarging the maxilla itself. The horizontal dimension tends to be reduced, whereas the vertical dimension is normal. The upper jaw of patients with unilateral cleft lip and palate who received surgical treatment of the lip more often adopted a retruded position. The model analysis showed no clear-cut tendencies. There seemed to be a degree of regional variation. Considering the relatively small number of recruitable individuals with untreated cleft lip and palate, the introduction of a standard method of evaluation is desirable. This would significantly facilitate the comparison of different studies with each other in the future. The first steps in this direction have already been initiated.  Mund Kiefer Gesichtschir 1997 Nov;1(6):324-7 [Magnetic resonance imaging vs. three-dimensional scintigraphy in the diagnosis and monitoring of mandibular osteomyelitis].   [Article in German]  Korner T, Kreusch T, Bohuslavizki KH, Brinkmann G, Kohnlein S   Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Christian-Albrechts-Universitat Kiel.  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 false-negative 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 T1-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.  Int Surg 1997 Oct-Dec;82(4):332-8 New trends in the 3D management of CT data in plastic and reconstructive surgery. Lambrecht JT, Schiel H, Kreusch T, Jacob AL, Hammert B   Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basel, Switzerland.  Introduction of computer aided tomography in 1972 provided surgeons with multiple 2D maps which they themselves had to conceptualize mentally into a third dimension. The later advent of computerized summation of these data made it possible to display a perspective view of the third dimension on a TV monitor. CT, with the further analytical refinement afforded by software processing (interactive data presentation, contour detection and summation, hypothetical 3D data construction and interactive visualization) now provides the basic information that is needed for the fabrication of an individual model. Such models can be milled from polyurethane. More recently, laser-hardened acrylic resins have proved to be a useful alternative. Both systems are described and their advantages and disadvantages in the planning and performance of plastic and reconstructive surgical procedures discussed in the light of present knowledge.  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1997 Jul;167(1):52-7 [Magnetic resonance tomography in the diagnosis of mandibular osteomyelitis].   [Article in German]  Kohnlein S, Brinkmann G, Korner T, Kreusch T, Bohuslavizki KH, Heller M   Klinik fur Radiologische Diagnostik, Christian-Albrechts-Universitat zu Kiel.  PURPOSE: A prospective study of the value of MRI in the diagnosis of osteomyelitis of the mandible with special reference to the suitability of different MR sequences. MATERIAL AND METHODS: In 13 patients, average age 55 years (12-82), with clinical suspicion of osteomyelitis of the mandible, 18 MRI examinations were carried out (STIR, TSE T2, proton and SE T1 weighted scans with and without contrast, slice thickness 3.5 to 6 mm). Image quality of the sequences was evaluated as well as the suitability of the various sequences for showing the lesion, its location and extent. Activity of the osteomyelitis was judged by the degree of contrast uptake and was correlated with 3-phase bone scintigraphy and with histological findings. RESULTS: In 9 of the 14 cases the findings on MRI and of the scintigraphy agreed with the histology. In two patients the activity of the inflammatory process was exaggerated by the MRI. In another follow-up examination it was slightly underestimated. All lesions were shown to be highly active by the histology were recognized as such by MRI. For the localisation and recognition of the extent of the inflammatory processes STIR sequences and T1 weighted non-enhanced SE sequences proved the most suitable. Contrast medium is essential to evaluate the inflammatory activity. CONCLUSION: MRI is a sensitive diagnostic method; it is as good as 3-phase bone scintigraphy in demonstrating osteomyelitis of the mandible and of its activity but is superior for showing the pathological anatomy.  Cleft Palate Craniofac J 1997 Jul;34(4):342-50 Examine your orofacial cleft patients for Gorlin-Goltz syndrome. Lambrecht JT, Kreusch T   Department of Oral Surgery, Radiology, and Medicine, School of Dentistry, University of Basel, Switzerland.  The Gorlin-Goltz syndrome is characterized by four primary symptoms: multiple nevoid basal cell epitheliomas that usually undergo malignant transformation; jaw keratocysts that show constant growth; skeletal anomalies; and intracranial calcifications. A myriad of additional findings may also be noted. Among the most frequent are: palmar and plantar pits, a characteristic flattened facies and broad nasal root, frontal and parietal bossing, mandibular prognathia, hypertelorism, strabismus, dystrophia of the canthi, and clefts of the lip, alveolus, and/or palate. In this study, we review the literature and our 25 cases of Gorlin-Goltz syndrome patients, questioning their incidence of cleft formations (8.5%) as compared to the general population (0.1%). It is our contention that all patients who present with an orofacial cleft warrant deeper investigation as to the presence of additional signs indicative of Gorlin-Goltz syndrome. The nevi turn malignant with time, and thus, early diagnosis, follow-up, and treatment are imperative.  Fortschr Kiefer Gesichtschir 1996;41:61-3 [Is miniplate osteosynthesis for combined mandibular body and bilateral mandibular condyle fractures adequate]?   [Article in German]  Kerscher A, Vees-Hoflsauer B, Kreusch T   Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Kiel.  Between 1980 and 1993 81 patients with a combined mandibular body and bilateral mandibular condyle fractures underwent open reduction and internal fixation of the mandibular body. The following methods were used: 29 x miniplate osteosynthesis, 28 x maxiplate osteosynthesis, 13 x lag screws, 10 x combinations and once titanium mesh. Reoperations because of occlusal disturbances were necessary in two cases of miniplate fixation, in one case of maxiplate fixation and in one case of lag screw fixation. In 1994 28 patients were reviewed. Posterior crossbite as operative sequela was noted in 2 (out of 14) patients after miniplate osteosynthesis, in 3 (out of 9) patients with maxiplate osteosynthesis, in 1 (out of 4) patients with combined miniplate and lag screw fixation and in 0 (out of 3) cases with lag screws. In cases of oblique mandibular body fractures we recommend the lag screw technique. Maxiplate osteosynthesis is more troublesome and more difficult in comparison with miniplate osteosynthesis. Therefore we recommend the miniplate osteosynthesis for the remaining types of mandibular body fracture and if needed the mandibular condyle.  Dentomaxillofac Radiol 1995 Aug;24(3):147-54 Individual model fabrication in maxillofacial radiology. Lambrecht JT, Hammer B, Jacob AL, Schiel H, Hunziker M, Kreusch T, Kliegis U   Department of Oral Surgery, Oral Radiology and Oral Medicine, University of Basle, Switzerland.  Oral and maxillofacial surgery has long needed a methodology for accurate definition of the third dimension. The introduction of computer-aided tomography in the 1970s provided surgeons with multiple 2-D maps which they themselves had to conceptualize into a third dimension. The later advent of computerized summation of these data made it possible to display a perspective view of the third dimension on a TV monitor. CT, and more recently MRI, with the further analytical refinement afforded by software processing (interactive data presentation, contour detection and summation, hypothetical 3-D construction and interactive visualization) now provide the basic information that is needed for the fabrication of an individual model. Such models can be milled from a variety of materials. More recently, laser-hardened acrylic resins have been shown to be a useful alternative. Both systems are described and their advantages and disadvantages in the planning and performance of oral and maxillofacial surgical procedures are discussed.  Fortschr Kiefer Gesichtschir 1994;39:82-4 [Intraoral approach to mandibular reconstruction in surgery of benign tumors].   [Article in German]  Kerscher A, Hoffmeister B, Kreusch T   Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Klinikum der Christian-Albrechts-Universitat Kiel.  Nowadays the exclusive intraoral approach is standard in the operative treatment of mandibular fractures. However there is still scepticism in the selection of the intraoral approach for mandibular reconstruction. Between 1980 and 1992 we performed in 21 patients mandibular reconstructions by rib or iliac bone grafts after resections of benign tumors in the mandible. One transplant was lost, the remaining transplants were incorporated without problems. According to our results the exclusive intraoral approach of primary mandibular reconstructions by free bone-grafts after removal is a reliable procedure.  Fortschr Kiefer Gesichtschir 1994;39:13-6 [Three-dimensional surgical planning using a model--a critical overview of the current status].   [Article in German]  Fleiner B, Hoffmeister B, Kreusch T, Lambrecht T   Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Kiel.  In the department of Oral and Maxillofacial Surgery, Kiel, 120 individual skull models have been fabricated from 1986 to 1992. The purpose of this study is to compare the results of the 3-D-operation simulation with those of the operation planning based on clinical, radiological and cast analyses. 62 models, used for simulation of skeletal reconstructions, osteotomies and transplantation of bone, have been analysed. In 38 cases the previous operation planning could be proved by the model operation. 24 operation simulations, including secondary reconstructions of the midface and the mandible, asymmetric craniofacial anomalies and large transplants of bone, lead to more exact results as the planning without a model. We therefore regard these types of operations as good indications for 3-D-model operation planning.  Dtsch Zahn Mund Kieferheilkd Zentralbl 1992;80(6):365-7 [The gingival margin incision as the surgical approach in cleft jaw osteoplasty--the technic, the healing process and postoperative complications].   [Article in German]  Fleiner B, Hoffmeister B, Kreusch T   Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Christian-Albrechts-Universitat Kiel.  Marginal incision became a common surgical approach in periodontal surgery because of its good healing results. Since 1983 we use this incision for bone grafting in cleft palate patients. Out of 120 cleft palate patients which had marginal incision for bone grafting, 9 developed local dehiscence, 3 times in combination with partial loss of the cancellous bone transplant. We saw one total loss of the transplant caused by infection. The good results of primary wound healing, the absence of horizontal scars and the possibility of mobilisation of epithelium from the cleft region to cover the transplant with mucosa from the alveolar process are the advantages of this procedure.  Int J Oral Maxillofac Surg 1991 Jun;20(3):144-8 Augmentation of the alveolar ridges with hydroxylapatite in a Vicryl tube. Harle F, Kreusch T   Department of Oral and Maxillofacial Surgery, University Hospital, Kiel, Germany.  The technique discussed describes the use of a Vicryl tube for maintaining hydroxylapatite (HA) granules in their correct position when augmenting the atrophic maxillary or mandibular alveolar ridge. The method involves simultaneous submucous vestibuloplasty in both the maxilla and the mandible and is also combined with lowering of the floor of the mouth. 118 patients (73 women and 45 men) were treated by this method. The results of augmentation in 64 maxillary and 54 mandibular cases are presented.  Dtsch Zahnarztl Z 1991 Jan;46(1):18-9 [Frequency of odontogenic tumors in the growth period].   [Article in German]  Mothes P, Kreusch T, Harms D, Donath K, Schmelzle R   Klinikum der Christian-Albrechts-Universitat zu Kiel.  424 odontogenic tumors were diagnosed at the Department of Oral Pathology in Hamburg Eppendorf and the Department of Maxillofacial Surgery in Kiel between 1965 and 1989. 106 of these odontogenic tumors were found in patients of 16 years and under. More often than not the odontogenic tumors of this age group were complex and compound odontomas, totalling 67%. When comparing these with other odontogenic tumors it must be taken into consideration that--although included in the WHO classification--odontomas are often referred to as hamartomas and not real tumors, because they lack the typical features of tumors. Compared with the adult age group, the relative frequency of ameloblastic fibromas, ameloblastic fibro-odontomas and odontogenic myxomas was remarkable. Nevertheless, because of the great differences between the two age groups, direct comparisons of these findings with each other should be made with reservation.