M. Feichtinger

Dentoalveolar changes after surgically assisted maxillary expansion: a three-dimensional evaluation.

OBJECTIVESnSurgically assisted rapid palatal expansion (SARPE) is a common procedure to correct maxillary transverse deficiency of >5 mm in patients with closed midpalatal suture. The aim of this study was to three-dimensionally analyze skeletal and dentoalveolar changes after SARPE.nnnSTUDY DESIGNnEighteen mature patients (mean age 26 years) with a palatal transverse deficiency underwent SARPE. The surgical procedure consisted of a lateral osteotomy combined with an interradicular osteotomy between the roots of the upper central incisors. Measuring points were defined on teeth as well as facial skeleton. Computerized tomography scans were performed preoperatively and immediately after the expansion period.nnnRESULTSnChanges of the dentoalveolar and maxillofacial complex were analyzed.nnnCONCLUSIONSnBilateral osteotomy combined with a sagittal osteotomy between the roots of the upper central incisors is a safe method of surgically assisted maxillary expansion. The amount of dentoalveolar tipping was smaller than reported in literature. The expansion was mostly achieved by maxillary expansion.

SAPHO syndrome with affection of the mandible: diagnosis, treatment, and review of literature

The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare syndrome of unknown etiology. Involvement of the mandible is found in almost 10% of cases. In the literature, conservative treatment is recommended most often, because decortication and partial resection are found to be ineffective and of temporary profit. We report a case of SAPHO syndrome in a 44-year-old women with unilateral hyperostosis of the mandible and massive painful swelling of the surrounding soft tissues. Owing to facial disfiguration and pain, resection of the affected bone followed by immediate reconstruction with a microvascular iliac crest flap were performed. The aim of this paper was to present the necessity of surgical intervention in SAPHO syndrome of the mandible in cases of esthetic and functional limitation.

Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method

UNLABELLEDnIntraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRIs and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between (18)F-FDG Positron Emission Tomography ((18)F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT).nnnMETHOD AND MATERIALnWe present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively ((18)F-FDG PET/CT or (18)F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia.nnnRESULTSn7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases.nnnCONCLUSIONnThere is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangioma, tumour of the lacrimal gland or dermoid cysts present a contraindication and have to be excluded.

Veränderung der Nasalanz nach Le Fort-I Osteotomie

Die Nasalität charakterisiert den nasalen Beiklang des Sprachschalls. Veränderungen der Nasalanz sind in der gängigen Literatur nach chirurgischen Eingriffen im Oberkiefer, die die suprapalatinalen Hohlräume betreffen, beschrieben. Ziel der vorliegenden, prospektiven Studie war es, Art und Ausmaß der Nasalanz-Änderung nach Le-Fort-I-Osteotomie zu bestimmen. Es wurden die Nasalanzwerte von 20 dysgnathen Patienten mit auditiv normaler Nasalität aus dem deutschsprachigen Sprachraum vor und 6 Wochen nach bimaxillärer Umstellungsosteotomie mit dem Nasometer Modell 6200 (Kay-Elemetrics, USA) bestimmt. Als Referenz wurden der Standardtext: Ein Kindergeburtstag, die Vokale /a/, /e/, /i/, /o/, /u/, sowie ein standardisierter Silben-Wiederholungstest verwendet. Für alle drei Untersuchungen zeigten sich bei allen Patienten 6 Wochen postoperativ veränderte Nasalanz-Werte. Während sich beim Lesen des Standardtextes keine signifikanten Unterschiede prä- und postoperativ ergaben, zeigte sich bei der Silbenwiederholung „ma ma ma“ und „na na na“ ein signifikanter Unterschied zum Ausgangsbefund (pu202f=u202f0,003, bzw. pu202f=u202f0,033). Bei der Intonation der Vokale erwies sich /a/ als signifikant (pu202f=u202f0,006). Die gemessenen Nasalanz-Erhöhungen konnten weder subjektiv durch den Patienten noch objektiv durch den begleitenden Logopäden verifiziert werden. Oberkiefer-Osteotomien bei Dysgnatie-Operationen können zu einer messbaren Änderung der Nasalanz beitragen. Die Veränderung der Nasalität hat jedoch keine Auswirkungen auf den subjektiv oder professionell bewerteten Sprachklang der Patienten. Nasalance represents axa0measure of the relative amount of oral and nasal acoustic energy produced by axa0speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy. Axa0total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: „Ein Kindergeburtstag“, the vowels: /a/, /e/, /i/, /o/, /u/ and axa0syllable repetition subtest. All patients showed changes in nasalance scores 6xa0weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of „ma ma ma“ and „na na na“ (pu202f=u202f0,003, respectively pu202f=u202f0,033). Intonation of the vowel /a/ also revealed significant changes regarding the pre- and postoperative values (pu202f=u202f0,006). However, the obtained values had no significant impact on the nasality characteristics of speech. This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.