Christopher Mohr

Prospective flow cytometric analysis of head and neck carcinomas prognostic relevance of DNA-content and S-fraction

Flow cytometric data were obtained from 142 primary squamous cell carcinomas of the oral cavity or the oropharynx. Aneuploidy was found in 36.8% of the tumours. The DNA indices showed a significant correlation with the S-fraction, tumour size and evidence of suspicious lymphnodes. There was no clear correspondence between the S-fraction and the tumour stage. Tumour size, histopathologically-positive lymphnodes and the mode of treatment were significantly correlated with the survival rates. In contrast, there was no clear correlation between flow cytometric data and the prognosis of the whole group as well as several clinical subgroups. In 40 patients who received preoperative irradiation, DNA indices and S-fractions were compared before and after the preoperative treatment. In 12 of 14 aneuploid tumours irradiation led to a decrease in the DNA indices into the range of euploidy. Only 2 tumours remained aneuploid. After irradiation 26 of 37 tumours showed a decrease in S-fraction, 11 tumours showed an increase. Loss of aneuploidy after irradiation was associated with a histologically-proven increasing devitalization of tumour cells, decrease in S-fraction corresponded to a tendency to a better prognosis.

The current state of facial prosthetics – A multicenter analysis

Even though modern surgical techniques are dominating reconstructive facial procedures, the capability to use facial epitheses for reconstruction is still an important skill for the maxillofacial surgeon. We present an international multicenter analysis to clarify which techniques are used to fixate facial prostheses. We contacted all maxillofacial departments in Germany, Austria, Switzerland and Norway which were registered with the German society for oral and maxillofacial surgery (DGMKG). These centers were asked via electronical mail to provide information on the type of epithesis fixation systems currently in use. The return rate from 58 departments was 43.1% (n = 25). Overall, implant fixation was the preferred fixation system (92%). Plates were the second most common fixation technique (32%). No centers reported the standard use of non-invasive fixation techniques for permanent epithesis fixation. The main retention systems in use were magnets (24/25), other retention systems are used much less often. The current preferred fixation technique for facial epitheses consists of implant-based, magnet-fixated epitheses. For nasal prostheses, a plate-based, magnet-fixated system is often used.

Use of dermis-fat grafts in the prevention of Frey's syndrome after parotidectomy.

OBJECTIVE To examine the role of dermis-fat grafts in preventing gustatory sweating and in the reconstruction of facial contour defects after parotidectomy. PATIENTS Twenty-three patients with tumours of the parotid gland were enrolled in this prospective clinical study from January 2006 to February 2014. All of them were evaluated for wound complications, Freys syndrome, satisfaction, and tumour relapse. Follow-up periods ranged from 6 to 72 months. RESULTS Nineteen patients completed the study. Nine complications observed in six patients were assessed (two haematomas [10%], one seroma [5%], one sialocele [5%], and recurrent pain in five patients [26%]). None revealed Freys syndrome. Satisfactory results were found in relation to scar, facial contour, and overall outcomes. CONCLUSION Dermis-fat grafts appear to be an effective method of preventing Freys syndrome after parotidectomy. The stable long-term results and high patient satisfaction lead to the application of this operation technique in daily routine.

The surgical approach to orbital space-occupying lesions

From January 1985 to April 1987, 60 patients with orbital space-occupying lesions were treated surgically. Orientation and spatial localization of the lesion had already been achieved preoperatively by means of imaging methods. The decision on whether to use a neurosurgical transcranial, or a facial surgical approach, was made on this basis. The less elaborate procedure in each case was given preference to obtain a representative tissue sample. The definitive planning of the operation was then carried out with knowledge of the histology: a transcranial operation alone or as an additional measure was only necessary in six patients. Either definitive tumour therapy could be performed with or without temporal osteotomy in the remaining 54 patients exclusively via an anterior orbitotomy, or further oncological treatment was commenced after histological verification of the diagnosis.

Autologous dermis - fat grafts as primary and secondary orbital transplants before rehabilitation with artificial eyes

OBJECTIVE The aim of this study was to examine the role of autologous dermis-fat grafts in the reconstruction of orbital soft-tissue defects. PATIENTS Thirty-six patients (3-84 years) were enrolled in this retrospective study from 2002 to 2014. The dermis-fat graft was primarily transplanted in seven cases, and secondarily in 29 patients. All the patients were evaluated for complications, adequate prosthetic cavity, possibility of artificial eye supply and movement, as well as cosmetic results. Follow-up periods ranged from 25 to 144 months. RESULTS All the patients could be supplied with an artificial eye in the long term after dermis-fat transplantation. The clinical evaluation revealed 17 complications allocated to 11 patients. A major complication occurred in three patients (8.3%) so that a surgical correction was necessary. Thirty-three patients (91.7%) showed an aesthetically stable long-term outcome. CONCLUSION Dermis-fat grafts for reconstruction of anophthalmic orbit represent a reliable method with a low complication rate and good cosmetic and functional results. The graft can be used as primary and secondary transplants. The stable long-term results and high aesthetic satisfaction lead us to recommend this method as a routine operation.

Nasal Entrance Correction in Unilateral Cleft Lip Repair

PURPOSE Correction of cleft nose deformity in patients with unilateral cleft lip is challenging and involves primarily the nasal cartilage and the nasal entrance. No consensus on the most effective surgical technique has been reached. This article describes a surgical procedure for nasal entrance correction. PATIENTS AND METHODS In this retrospective study, 30 adult patients underwent secondary nasal entrance corrections. According to a modified Van der Meulen technique, a nasal alar rim flap with anatomic repositioning of the alar cartilage was applied. Symmetry and esthetic results were evaluated by semiquantitative photographic analysis. RESULTS In all patients, the nasal tip was narrowed considerably, and a lifting of the nasal tip was achieved. Columellar elongation averaged 40%, and the form of the nostril was changed from horizontally oval to longitudinally oval. CONCLUSION The described technique is well suited for a sustainable correction of complex cleft-induced deformities without visible scars in adult patients.