Andreas Bremerich

The innervation of the trapezius muscle in connection with radical neck-dissection. An anatomical study.

The accessory nerve, the cervical plexus, the sternocleidomastoid and trapezius muscles and neighbouring structures were examined in 47 corpses. Considerable inter- as well as intra-individual differences could be found both in the course and shape of the accessory nerve and in the participation of the cervical plexus in the innervation of the trapezius muscle. The great variation in the manifestation of the shoulder-arm-syndrome in patients after radical neck-dissection can thus be explained. Finally a new method of restoring the innervation of the trapezius muscle is proposed.

Bisphosphonate-associated osteonecrosis of the jaw: what do we currently know? A survey of knowledge given in the recent literature

Increasing application of bisphosphonates for therapy of osteopathies has led to reports of the severe associated adverse effects of osteonecrosis of the jaw (ONJ). We reviewed recent literature to assess several aspects of bisphosphonate-associated ONJ, and to provide healthcare professionals with an overview of treatment and preventive options. Literature databases were searched using keywords. Information of 54 articles were discussed and completed by additional literature. High-risk factors were application of nitrogen-containing bisphosphonates, teeth extractions, and ill-fitting dentures. Treatment included non-surgical options and radical surgery. Success and failure were described for all treatment options; further studies investigating long-term recovery and recurrence are warranted. Paying attention to effective prevention of ONJ before, during, and after treatment is essential.

The accuracy of two-dimensional planning for routine orthognathic surgery.

Two-dimensional cephalometric planning software should be helpful for prediction of hard tissue outcome after bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy, but transferring two-dimensional data to three-dimensions (including mock operation and surgery) may result in errors. The objective of this retrospective study was to analyze deviations between predicted results and postoperative outcome using cephalometric analyses, and to evaluate this procedure for daily use. Fifty-four subjects (mean (SD) age 26 (8) years) had a BSSRO (n=21) alone or in combination with Le Fort I osteotomy (n=33). Predictions were made for each case by cephalometric planning software and mock operations done with study models. Postoperative cephalograms were obtained after 14 days and compared with predicted cephalograms for sagittal (SNA, SNB, ANB,) and vertical (ArMeGo, ML-NSL, NL-NSL) measurements. Mean (SD) differences for all measurements varied between 1.3 degrees (1.1 degrees) and 2.2 degrees (1.6 degrees) for BSSRO; and between 1.1 degrees (1.3 degrees) and 2.2 degrees (1.6 degrees) for bimaxillary osteotomy. There were no significant differences between measurements or operations, indicating that the predictions were accurate. A difference of up to 8.5 degrees could be measured in a single case. Cephalometric prediction therefore remains an accurate tool for planning, particularly maxillary rearrangement in the vertical and sagittal dimension for routine operations. If greater shifts in the transversal dimension are necessary, exact planning should be adapted with three-dimensional planning devices to avoid significant differences.

Thermography and thermoregulation of the face

BackgroundAlthough clinical diagnosis of thermoregulation is gaining in importance there is no consistent evidence on the value of thermography of the facial region. In particular there are no reference values established with standardised methods.MethodsSkin temperatures were measured in the facial area at 32 fixed measuring sites in 26 health subjects (7–72 years) with the aid of a contact thermograph (Eidatherm). A total of 6 measurements were performed separately for the two sides of the face at intervals of equal lengths (4 hours) over a period of 24 hours. Thermoregulation was triggered by application of a cold stimulus in the region of the ipsilateral ear lobe.ResultsComparison of the sides revealed significant asymmetry of face temperature. The left side of the face showed a temperature that was on the average 0.1°C lower than on the right. No increase in temperature was found following application of the cold stimulus. However, a significant circadian rhythm with mean temperature differences of 0.7°C was observed.ConclusionThe results obtained should be seen as an initial basis for compiling an exact thermoprofile of the surface temperature of the facial region that takes into account the circadian rhythm, thus closing gaps in studies on physiological changes in the temperature of the skin of the face.

Analysis of patients with a cleft of the soft palate with special consideration to the problem of velopharyngeal insufficiency

The evaluation of therapy concepts for children suffering from cleft palate is an enormous challenge in modern oral and maxillofacial surgery and related disciplines. In the present retrospective survey 1300 patients having clefts, including the soft palate, were studied with special regard to speech improvement operations. Nine hundred fifty four patients had a cleft lip, alveolus and palate and 346 patients only isolated cleft palate. In 25.6% of the patients it was necessary to perform a secondary velopharyngoplasty for speech improvement after soft palate closure. Age of the subjects at the time of operation, primary or secondary soft palate closure, and the type of clefting were not significant factors for performing subsequent velopharyngoplasty. However, significant differences with respect to the need for a secondary velopharyngoplasty after soft palate closure were found when comparing the surgical experience of the surgeons.

Transcutaneous electric nerve stimulation (TENS) in the therapy of chronic facial pain: Preliminary report

Chronic facial pain remains a therapeutic problem. We report on 29 patients (37 nerves involved), who were treated with transcutaneous electric nerve stimulation (TENS). Pain reduction was achieved in 27 patients (93%) while in 5 patients it was possible to stop the treatment because they were constantly free from pain. Two patients did not respond to TENS therapy. It was possible to reduce or discontinue the use of analgesics in 79% of the cases. There were no severe side effects. Therefore, TENS should be seen as a simple, safe and effective method of treatment for many forms of chronic facial pain, as opposed to other invasive surgical procedures.

Frey-Syndrom@@@Frey’s syndrome

Fragestellung: Die bisherigen Literaturangaben zur Inzidenz des Frey-Syndroms nach Parotidektomien differieren stark. Ebenso werden Maßnahmen für eine erfolgreiche Behandlung unterschiedlich bewertet. Patienten: Im Krankengut der Bochumer ¶Klinik wurden im Zeitraum von 1980–1994 bei 364 Patienten 372 Parotidektomien durchgeführt. Ergebnisse: Bei 86 Patienten (23,5%) kam es durchschnittlich 18 Monate nach dem Eingriff zur Ausbildung eines Frey-Syndroms. Mit Scopolaminsalbe wurden 35 Patienten behandelt. Bei einer mittleren Therapiedauer von 25 Monaten konnte in 9 Fällen eine Besserung erzielt werden. Unbehandelte Patienten (n = 20) zeigten bei einem mittleren Nachuntersuchungszeitraum von 20 Monaten in 7 Fällen eine Befundbesserung. Die Therapie mit Scopolaminsalbe ergab im Vergleich zu unbehandelten Fällen keine signifikant besseren Ergebnisse. Schlussfolgerung: Das gustatorische Schwitzen nach Parotidektomie muss weiterhin als unangenehme und schwer zu therapierende Komplikation angesehen werden. Aims: The incidence of Frey’s syndrome after parotidectomy as cited in the literature varies distinctively. Strategies for successful treatment are also assessed differently. Patients: Between 1980 and 1994 a total ¶of 372 parotidectomies were performed in 364 patients at the Bochum University Hospital. Results: After an average of 18 months following parotidectomy, 86 patients (23.5%) developed Frey’s syndrome. Thirty-five patients were treated with scopolamine ointment. The symptoms improved in nine cases after an average of 25 months of therapy. Of the patients receiving no treatment (n = 20), seven improved after an average follow-up of 20 months. Therapy with scopolamine ointment did not elicit significantly better results compared to no treatment at all. Conclusion: Gustatory sweating after parotidectomy still has to be regarded as an unpleasant complication which is difficult to cure.

Assoziierte Anomalien bei Lippen-Kiefer-Gaumen-Spalten

Fragestellung. Die Diagnose von Lippen-Kiefer-Gaumen-Spalten verweist auf kein uniformes Krankheitsbild, sondern spiegelt das Resultat eines multifaktoriellen heterogenen Geschehens wider. Als Ausdruck dessen werden in der Literatur bei Spaltträgern die Häufigkeiten assoziierter Anomalien unterschiedlich angegeben. Patientengut. In einem Zeitraum von 1974–1998 wurden retrospektiv 1737 in der Klinik behandelte Patienten mit Spaltbildungen im Gesichtsbereich auf zusätzliche Fehlbildungen und Syndrome hin untersucht. Ergebnisse. Bei 33% der Spaltträger zeigten sich assoziierte Anomalien, von denen 48% bekannten Syndromen zugeordnet werden konnten. Patienten mit isolierten Gaumenspalten (45,6%) und mit doppelseitiger LKG-Spalte (35,3%) waren besonders häufig von zusätzlichen Fehlbildungen betroffen. Hohe Manifestationsraten ergaben sich hierbei für zerebrale Störungen (16%), zusätzliche Gesichtsfehlbildungen (14%), Herzfehler (13%), Extremitätenfehlbildungen (9%) und urogenitale ¶Anomalien (8%). Stoffwechselerkrankungen traten hingegen selten auf (0,5%), ein partieller Situs inversus war in nur 1 Fall zu diagnostizieren. Schlussfolgerung. Die hohe Koinzidenz von Fehlbildungen mit Lippen-Kiefer-Gaumen-Spalten unterstreicht den Stellenwert des umfangreichen interdisziplinären Neugeborenenscreenings bei Spaltträgern in unserer Klinik. Background. Retrospective studies of cleft lip and palate patients suggest a multifactorial aetiology for this condition. Many patients exhibit multiple defects, often removed from the orofacial region. The frequency and location of such coexistent abnormalities vary between studies. Patients. A retrospective case-note study of 1,737 individuals with orofacial cleft, treated between 1974 and 1998 at our centre, was undertaken to assess the frequency of associated malformations and syndromes. Results. Associated malformations were found to be present in 33% of all cases investigated. In nearly one half of these individuals (48%), defects could be attributed to recognisable syndromes. Patients with isolated palatal clefts (45.6%) and those with bilateral clefts of the lip and palate (35.3%) were particularly well-represented. The following problems were observed relatively frequently: Cerebral anomalies (16%), facial anomalies (14%), heart malformations (15%), anomalies of the extremities (9%) and urogenital tract abnormalities (8%). In contrast, endocrine aberrations were identified sporadically (0.5%). A partial situs inversus was found only in one case. Conclusion. As clefts of the lip and palate are frequently associated with additional malformations, the importance of thorough interdisciplinary neonatal screening cannot be over emphasised.

Methoden der Schmerztherapie in der Mund-, Kiefer- und Gesichtschirurgie

Pain therapy in the oral and maxillofacial region is still a problem. Before starting therapy, the genesis of pain has to be carefully clarified. The article presents the most important syndromes, aspects concerning diagnosis and differential diagnosis as well as therapeutic schemata.Schmerztherapie im Mund-, Kiefer- und Gesichtsbereich bereitet immer noch häufig Probleme. Vor Einleitung einer Therapie ist daher die Schmerzgenese sorgfältig abzuklären. Neben der Darstellung der wichtigsten Krankheitsbilder werden diagnostische und differenzialdiagnostische Aspekte sowie Therapieschemen dargestellt. Pain therapy in the oral and maxillofacial region is still a problem. Before starting therapy, the genesis of pain has to be carefully clarified. The article presents the most important syndromes, aspects concerning diagnosis and differential diagnosis as well as therapeutic schemata.

Prof. Dr. Dr. Elmar Esser zum 65. Geburtstag

Prof. Dr. med. Dr. med. dent. Elmar Esser, der aus einer traditionellen Apothekerfamilie stammt, wurde am 14. April 1942 in Gelsenkirchen geboren. Nach dem Abitur 1961 und dem Ableisten des Grundwehrdienstes bis 1962 folgte zunächst das Studium der Humanmedizin in Freiburg und Münster und ab 1966 bis 1970 zusätzlich das Studium der Zahnmedizin in Münster. 1970 legte Elmar Esser das Staatsexamen der Zahnmedizin ab und erhielt die Bestallung zum Zahnarzt. Im selben Jahr promovierte er ebenfalls an der WestfälischenWilhelms-Universität-Münster zum „Dr. med.“ mit dem