Christian Kermer

Local injection of corticosteroids for central giant cell granuloma. A case report

Central giant cell granulomas are benign, but occasionally aggressive lesions that traditionally have been treated surgically. A case of central giant cell granuloma of the mandible is reported that was successfully treated with intralesional injection of corticosteroids.

Preoperative stereolithographic model planning for primary reconstruction in craniomaxillofacial trauma surgery

High precision anatomical facsimile models of the patients skull, individually produced by stereolithography, have been used in the preoperative planning in 16 patients with acute craniomaxillofacial trauma. In late primary repair, when open reduction and internal fixation had to wait for a decrease in facial swelling or cerebral oedema, computer-aided surgery has proven to be useful in terms of facilitating anatomical reduction, minimizing surgical approaches, saving operating time and leading to improved postoperative results, which may reduce the number of secondary corrections of post-traumatic deformities.

Transoral miniplate osteosynthesis of condylar neck fractures

OBJECTIVE In a retrospective study, we reviewed a series of 55 consecutive patients with 57 fractures of the condylar neck that were treated with transoral miniplate osteosynthesis. STUDY DESIGN Forty-one patients were included in a clinical follow-up study; the median length of study was 26.5 months (minimum, 7 months; maximum, 79 months). In a radiographic study, the positions of the condyle before open reduction, after open reduction, and more than 6 months postoperatively were evaluated in 3 radiographic planes. A statistical analysis was performed to determine factors that lead to secondary instability of the reduced condyle and to correlate the actual position of the condyle with clinical parameters collected in follow-up examinations. RESULTS At the time of the follow-up examination, the median measurement of the mandibular openings was 48.3 +/- 8.0 mm (minimum, 32 mm; maximum, 66 mm). A deviation of 2 mm to the operated side when opening was observed in 7 patients. The median range of laterotrusion was 10.0 mm to the fracture side and 9. 0 mm to the opposite side. In 7 patients, radiographic follow-up more than 6 months postoperatively revealed a medial tilt of the proximal fragment of 15 to 40 degrees despite a good immediate postoperative position of the condyle. This may be attributed to bone resorption in the fracture gap, together with a bending instability observed when titanium miniplates with a thickness of 0. 9 mm were used. The position of the condyle at the follow-up examination did not correlate with clinical parameters. CONCLUSIONS Transoral approach miniplate osteosynthesis of dislocated condylar neck fractures is indicated when visible scars in the head and neck region, which are encountered with other fixation techniques, must be avoided.

Treatment of recurrent mandibular dislocation, part II : Eminectomy

Fourteen patients underwent eminectomy for recurrent mandibular dislocation. The clinical follow-up period ranged from 7 months to 5 years. The function of the temporomandibular joint before and after eminectomy was analysed clinically and by computer-aided axiography. There was no significant decrease in the condylar path angle postoperatively, though the articular eminence had been removed up to its most medial portion. Translatory border movements showed significant limitation six months after surgery and normal range of motion in the first and second year after the operation. Postoperative hypermobility of the condyle was not observed.

Treatment of recurrent mandibular dislocation, part I: Leclerc blocking procedure

Nine patients with recurrent mandibular dislocation, who underwent the blocking procedure of Leclerc and Girard, as modified by Gosserez and Dautrey, are presented. The follow-up period range from 2.5 to 5 years. An axiographic study revealed significant postoperative limitation of translation of the condyle when opening, while maximal mouth opening as measured between the incisors, as well as translation of the condyle in protrusion and mediotrusion, showed no significant limitation. Long-term evaluation showed a high incidence of clicking and pain, not evident prior to surgery. The causes for recurrence in three cases were analysed.

Clinical experience with interactive teleconsultation and teleassistance in craniomaxillofacial surgical procedures

PURPOSE The objective of this study was to evaluate the clinical value and feasibility of surgical telenavigation and teleassistance technology in the field of craniomaxillofacial surgery. MATERIALS AND METHODS The technology is based on the principles of augmented reality environment technology and remote stereotactic visualization. A consultant surgeon in a remote location receives video, audio, and stereotactic navigation data from the operation site almost in real-time and, using a head-mounted display, is emerged in the surgical augmented reality environment. By telepresence or teleconsultation, the composite images and superimposed graphics (instruments, target structures, landmarks, contours) can be seen and discussed in connected clinics with the possibility of interactive manipulation and assistance. RESULTS Interactive teleassistance was used in 27 cases of various types craniomaxillofacial surgery. The principles of computer-aided telenavigation were applied successfully. Technical problems in 6 cases did not cause a breakdown of overall system performance. CONCLUSION Teleconsultation with remote experts is a useful tool, although some shortcomings exist. The financial and personal effort involved is considerable.

Recurrent mandibular dislocation under neuroleptic drug therapy, treated by bilateral eminectomy

Acute mandibular dislocations caused by extrapyramidal syndromes under neuroleptic therapy have often been reported in the literature. However, the success of surgical therapy for recurrent mandibular dislocation in patients under long-term neuroleptic therapy has been discussed controversially. In our opinion, modifications in drug therapy--including the administration of so-called atypical neuroleptics--should be considered before advocating surgery. If the revised therapeutic approach proves to be unsuccessful because of psychotic relapse or persistence of extrapyramidal symptoms, good operative results may be achieved by bilateral eminectomy as reported on three psychiatric patients in this paper. In order to avoid postoperative subluxation and internal derangement due to increased muscular tension under chronic neuroleptic therapy, as much bone as possible should be removed when performing eminectomy.

Validity of sentinel lymph node (SLN) detection following adjuvant radiochemotherapy (RCT) in head and neck squamous cell carcinoma (HNSCC).

The effect of preoperative radio chemotherapy on lymphatic drainage and intraoperative gamma probe-guided sentinel lymph node detection has yet not been investigated. In this study, we study 13 patients with SCC. Sentinel lymph node (SLN) imaging of the patients was performed using SPECT-CT. Special care was taken to use identical injection sites for both studies. Imaging comprised planar and SPECT, iterative reconstruction and were viewed with the co-registered CT image. The results were validated by comparison with the histological results of intraoperative gamma probe detection and histology of the completed neck dissection. Identical SLNs were found in 6/13 patients. In 2/13 cases SLN biopsies were false-negative. In 4/13 patients preoperative SLN imaging identified more/additional nodes than the initial imaging, whereas fewer nodes were seen in 3/13 patients. Neither the primary tumor site nor the TNM stage was predictive for changes in the lymphatic drainage pattern. No constant effect of irradiation could be demonstrated. Preoperative radio chemotherapy has an unpredictable influence on the lymphatic drainage pattern in HNSCC. Consequently, the intraoperative gamma probe-guided sentinel lymph node detection after radio chemotherapy does not reveal the SLN of carcinogenesis. Thus, we advise fused functional/anatomical imaging (SPECT-CT) before and after radiochemotherapy if the SLN concept is utilized in HNSCC.