Journal of Cranio-Maxillofacial Surgery (1998) 26, Suppl.
1 3 221
© 1998 European Association for Cranio-Maxillofacial Surgery
Abstracts of the European Association for Cranio-Maxillofacial Surgery Helsinki Congress -
1-5 September 1998
TRANSMENTAL SUCTION LIPECTOMY, AN
ADJUNCT TO G E N I O P L A S T Y - L O N G - T E R M
RESULTS
Abeioos, J.*, Mommaerts, 151.,De Clercq, C Neyt, L
Division of Maxillo-Facial Surgery, A Z St-Jan, Belgium
AIMS:
To describe the technique, indications and long-term out-
come of the chin osteotomy approach to the submental fat.
STUDY DESIGN:
A cohort of twenty patients, 16 female and 4 male, was
analysed prospectively for morbidity and aesthetic outcome.
Eighteen underwent other orthognathic procedures, while 2
underwent a genioplasty only. The submental fat was
approached via the chin osteotomy gap. The chin segment
was pulled down with a bone clamp. Access to the submental
region was gained by blunt dissection with a pair of scissors,
laterally to the insertion of the genioglossal and geniohyoid
muscles. Further tunnelling was performed with the liposuc-
tion canulas at the supra- and subplatysmal levels.
RESULTS:
The mean last follow-up control was 4.9 years postopera-
tively. Two (10%) had a resolving weakness of the marginal
branch of the facial nerve on one side of the face. Four
(20%) had had hypaesthesia of the lower lip lasting longer
than 6 months. One (5%) had an infection in the neck with,
later, some skin irregularity. Eight patients (40%) showed an
excellent clinical result. Eleven (55%) had a good result and
1 (5%) a moderate result.
CONCLUSION:
This technique is a useful adjunctive cosmetic procedure in
orthognatic surgery. It can only be performed in conjunc-
tion with simultaneous genioplasty. The complication rate
is low so that it can be adopted as a safe procedure.
Attention should be paid to the amount of fat and skin as in
other cases of suction lipectomy in the cervicomental region
when in combination with movements of the facial skeleton.
PERI-OPERATIVE C O M P L I C A T I O N S IN FACIAL
ORTHOPAEDIC SURGERY - A 5 YEAR
RETROSPECTIVE STUDY ON 1079 PATIENTS
A cebai Blanco, F. *, Vuyisteke, Ph., Mommaerts M.,
Abeloos, £ De Clercq, C., Neyt, L.
Division of Maxillo-Facial Surgery. A Z St-Jan. Belgium
AIMS
To describe the nature and incidence of complications
encountered in orthognathic & aesthetic facial orthopaedic
surgery.
STUDY DESIGN:
From 1992 to 1996, 1079 patients (720 female, 359 male)
with a mean age of 22 years (min. 13, max 73) underwent
facial orthopaedic surgery in our unit. Their records were
analysed retrospectively. Surgery consisted of 709 unimaxil-
lary, 330 bimaxillary and 31 isolated mental procedures.
Follow-up ranged from O to 66 months (mean 15).
Diagnostic planning, surgical approach, and pre- and post-
operative care were standardised.
RESULTS:
There were no fatalities. There were two life threatening
complications: bronchospasm at time of induction and
hypoxaemia due to clot aspiration Intra-operative complica-
tions consisted of neurovascular bundle injury (4) and
unfavourable sagittal split (9). Post-operative complications
consisted of hypercapnia (1), airway obstruction due to
oedema (1), haematoma (1 l), infection (49), impairment of
neurosensory function (lower lip: 294, lingual nerve: 17,
buccal nerve: 9, V2: 46), paresis of the marginal branch of
the facial nerve (3) and root trauma (1).
CONCLUSION:
The most frequently encountered complication was neu-
rosensory disturbance in the lower lip. Infection especially
after a sagittal split procedure, is our main concern nowa-
days.
[~ CENTRAL M U C O E P I D E R M O I D CARCINOMA O F
THE MANDIBLE: REPORT O F A CASE.
Acero, £*; N~ez, £; De Paz, V.; Cuesta, Mr.; Ferndndez-
Alba, J.; Concejo, C.
Department of Oral and Maxillofacial Surgery, Hospital
General Universitario " Gregorio Marafion", Universidad
Complutense de Madrid, Madrid, Spain.
Aim: To present a new case of central mucoepidermoid car-
cinoma. This neoplasm arising intraosseously is an
extremely rare condition, which accounts for only 2-3% of
all reported cases of mucoepidermoid carcinoma.
Material & Methods: We describe a clinical case of a 75
years old patient, presenting a 2 cm ulcerative lesion in the
mucosa over the right mandibular posterior area.
Radiological examination showed a large multilocular
lesion extending from the angle to the subcondylar region.
Biopsy of the lesion was carried out, the diagnosis being low
grade mucoepidermoid carcinoma. No palpable neck nodes
were found. Right mandibulectomy with resection of the
overlying soft tissues was perfomed. In order to restore the
defect, a free osseous fibular flap was transferred. We dis-
cuss the clinical, pathological and therapeutic features of
this type of tnmour.
Results: After histological confirmation, surgical treatment
of the intraosseous mucoepidermoid carcinoma by means
of a radical mandibulectomy is mandatory. A microsurgical
4 Journal of Cranio-MaxillofacialSurgery
fibular flap allowed good functional and aesthetic recon-
struction in this case.
Conclusions: Central mucoepidermoid carcinoma is a rare
condition which requires surgical treatment. Microsurgical
flaps allow good results to be achieved after radical
mandibulectomy.
@=~ RECONSTRUCTION O F THE MANDIBLE AT
D I S C O N T I N U I T Y DEFECTS - A REPORT ON 40
CONSECUTIVE CASES
Adell, R. *, Svensson, B., Johansson, G., Dahlin, C,
Jakobsson, 0., B61ander, L., Nilsson, C, Gertzdn, H.
Departments of Oral and Maxillofacial, Plastic and ENT
Surgery, Orebro Medical Centre Hospital, Orebro, Sweden
Aims: To evaluate the outcome of mostly immediate recon-
struction of mandibles at discontinuity defects by two prin-
cipally different methods - microvascularly anastomosed
free composite grafts and functionally stable reconstruction
plates, covered with thick soft tissue flaps.
Methods: 47 reconstructions were performed in 40 patients,
27 microvascularly anastomosed free composite grafts, gen-
erally osseomyo-cutaneous ilium or fibula grafts, were used
at compromised, i e irradiated or infected host tissues. 20
reconstructions were carried out with functionally stable
reconstruction plates, covered with thick soft tissue flaps,
when bone grafting was not considered indicated or unsuit-
able. Condyle prostheses were used in 6 of these cases. 3
reconstructions were performed becaues of mechanical
problems with earlier reconstructions, 5 were due to trauma
and 5 to chronic infections. The remaining ones were carried
out at removal of malignant turnouts. Follow-up times were
from 1 - 4 years with a mean of 1,5 years.
Results: Several temporary, but curable, flap dehiscencies
and minor postoperative infections were encountered.
Three plates and one supporting ramus fractured. 5 plates
loosened from mandible segments. Otherwise all recon-
structions fulfilled their purposes to various function levels,
as will be reviewed. Brfinemark implants were installed in 7
jaws.
Conclusions: Reconstruction by microvascularly anasto-
mosed composite grafts was the most demanding but by far
also the most versatile method providing options for almost
total functional, esthetic and psycho-social rehabilitation.
" L I T H O T R I P S Y O F THE SALIVARY STONES"
V. V. Afanassiev, V..M.Meshkov, M.R. Abdusalamov, C.M.
Brestovitsky, EL. Kudryash
(Moscow Medical Stomatology Institute, Center of Endo-
Surgery, Litho-Tripsy and New Medical Technologies of
Road Ministry Hospital 4)
Aims: Sialolithiasis forms 50% of all salivary glands dis-
eases. Till the present time it was treated only surgically,
sometimes the stone was ablated together with the salivary
gland. After ablating innergland concrements relapse can
appear. We used the method of lithotripsy for crushing sali-
vary stones in order to avoid surgical operation.
Method: Crushing was made on two types of the equipment,
such as M O D U L I T H SL X, (Company STORZ Med A.G.)
and EDAP LTo02 (France). The patient was placed on the
table, taking sight at the stone was made with the help of
roentgenography and ultrasound scanning with the fre-
quency of 7,5 Mgt. Crushing of the stone was made accord-
ing to the method "blow with a cue onto the billiard ball" or
the stone was placed "at the topof the closed acute angle"of
the ultrasound ray.Used 1500-3000 impulses per one crush-
ing.At the average 3-4 procedures were necessary for
lithotripsy of one stone. 1-2 procedures were made during a
week.The results of the lithotripsy efficiency on the different
equipment types were valued in the comparison aspect.
Results: Our experience showed that crushing of salivary
stones can be made on both types of the equipment. After
crushing bleeding from the taking out ducts is marked, and
in the tract of salivary gland the inflammatory reaction of
the tissues. The small parts of the stone are taken away after
the first crushing.The stone completely spills after the 2nd-
3rd crushing. In some cases dilatation of the duct mouth
should be made for the complete debridement of the gland
from the stone elements.
Conclusions: Lithotripsy can be used for crushing salivary
stones. Each type of the equipment has its own advantages
and disadvantages: Easy of finding and breaking of the
stone is possible by lithotipsy and early results seem good.
M A T H E M A T I C A L M E T H O D S O F P L A N N I N G THE
F O R M AND SIZE O F BONE GRAFTS.
*Agapov E, Gusev 0., Eroshin E, ltkinson E., Aivasian K.
Medical Stomatological Institute, Department of Oral and
Maxillo-Facial Surgery. Moscow. Russia.
AIMS: To find out relationship between sizes of bone graft
and receiving surfaces on mandible fragments with site and
size of the defect by means of biomechanical and com-
puter analysis.
M E T H O D S : Computer study of facial bones X-ray images,
biomechanical study of bone structures in jaw fractures and
defects.
RESULTS: In planning and performing osteoplastic oper-
ations in 35 patients using tested methods was deter-
mineted that the fixation elements are to be placed on the
perimeter of graft receiving surfaces along the lines per-
pendicular to the action of bending and side moving
forces. The measurements of acceptable exertions were
calculated.
CONCLUSION: Using developed methods of calculation
makes it possible to define the sizes of receiving surfaces,
the number and placement of fixing elements. This com-
puter modeling is minimizing a probability of inflamma-
tory complications and bone and graft malunion.
BIOACTIVE GLASS ($53P4) IN FRONTO-ORBITAL
TRAUMA A N D T U M O R SURGERY
Aitasalo, K.*, Suonpiiii, J., Yli-Urpo,
A1 Departments of Otorhinolaryngology, Head and Neck
Surgery, Turku University Central Hospital and Institute of
Dentistry, Turku, University, Turku, Finland
Aims: To show the stability of bioactive glass (BG) in recon-
structions of facial trauma and tumor and as filling in
fronto-orbital defects.

Method: Non-vascularized bone grafts that are used for
reconstruction of skeletal deformities of the face after
trauma or tumor surgery are prone to resorption. Since
1991 bone defects we have reconstructed with BG-granules
and plates in 37 orbital defects, 19 fronto-orbital defects and
7 in the skull defects after trauma, tumor or deformity
surgery. The mean follow-up period for the 63 patients has
been 15 months (range 4 mo to 6 yrs). BG-granules were
used in facial bone defects in subperiosteal pockets and
bone cavities, whereas BG plates were used in orbital floor
and wall reconstruction.
Results: Clinical follow-ups and postoperative middle face
radiographs and computed tomographs (CT) have shown
that BG material has been well tolerated and revealed no
resorptive changes at the BG-bone interface. BG granules or
plates we have not been removed for infections or foreign
body reactions during clinical follow-ups. Two defects has
been explored one year postoperatively and the retrived
specimens has analysed histologically. The clinical outcome
and histological analyse has shown no inflammatory
changes or foreign body reactions in the operation area.
Conclusions: BG is a promising and well-tolerated material in
reconst-ructions of the facial skeleton. In the solid block form it
does not resorb: Also BG granules are a well-tolerated and a sta-
bile Idling material in fronto-orbital trauma and tumor surgery.
D MAXILLARY RECONSTRUCTION USING
CALVARIAL BONE W I T H THE T E M P O R A L FASCIA
AND M U S C L E F L A P
Aitasalo, K. ~, Laine, J.1
Departments of Otorhinolaryngology, Head and Neck Surgery
and 1Oral SurgetT, Turku University Central Hospital, Turku,
Finland
Aims: To show the possibilities to reconstruct the maxillary
defects with temporal fascia or muscle flap with or without
clavarial bone.
Method: The optimal technique for repair of maxillary
defects is controversed. We report on 12 patients ranging in
age from 46 to 78 years who underwent reconstruction of
large subtotal maxillary defects between 1995 and 1997 was
performed. In nine cases we used calvarial osseous grafts
with the temporal muscle and fascia flaps and three cases
with the temporalis fascia and muscle flaps.
Results: In all cases, the extirpation and reconstruction is
well tolerated, and the advantage time of hospitalization
was 14 days and ranged from 7 to 21 days. The patients were
preoperatively irradiated from 60 to 65 Gy. One of 12
patients had complication and also he has recurrence. There
was two recurrences (17%) during the half year after opera-
tion. The follow-up ranged from 6 months to 3 years. The
success rate of these (10/12 preoperatively irradiated)
patients was 83%. Also we have rehabilitated 10 patients
with prosthesis.
Conclusions: Use of this calvarial bone with the temporal fas-
cia and muscle flap in maxillary reconstruction after preoper-
ative irradiation is well tolerated. But it is also associated with
a low morbidity, a good functional and aesthetic result.
THE INCIDENCE O F CLEFT LIP AND/OR PALATE
(CL AND/OR P) IN LATVIA
Akota, I.*, Barkane, B., Grasmane, N.
EACMFS- Abstracts, Helsinki Congress 1998 5
Department of Oral and Maxillofacial Surgery, Medical
Academy of Latvia, Riga, Latvia
Aim: To estimate the incidence of CL and/or P in Latvia,
and variability related to forms, gender, seasons and geo-
graphical areas.
Method: This was a retrospective study. The source of infor-
mation was the records of the cleft team (the only one in
Latvia), registered on special cards. The material comprised
cleft children born in Latvia during the years 1960 - 1996.
Results: Out of 1480 children (54% males and 46% females)
there were 537 (36%) patients with CLP, 329 (22%) with
CL, 584 (40%) with CR and 30 (2%) patients with other
cleft types.
The estimated incidence of CL and/or P in Latvia was
1.2 per thousand live births. Considerable year-to-year vari-
ations were found with the rates ranging from 0.7 (year
1995) to 1.6 (year 1990). There were no remarkable seasonal
variations if all cleft types were considered. Despite the
small area (64.6 thousand km2), wide differences in CL
and/or P incidence among geographic regions were estab-
lished.
Conclusion: The incidence of CL and/or P was quite low,
however, and in the range of previously reported studies.
Variability related to their forms, seasonal variations and
patients' gender in Latvia was similar to that reported previ-
ously in other countries.
SURGICAL APPROACH OF METASTASIS TO THE
PAROTID GLAND
Albertos, JM., Junquera, LM., Villarreal, P., Garcla-
Consuegra, L.
Department of OMFS, Central Hospital of Asturias,
University of Oviedo.
Aims: At the present time, the treatment of parotid metasta-
sis is not standardized. The question was addressed whether
resection of the facial nerve resulted in an improvement in
the patient's long-term prognosis.
Subject: The clinical course of patients who underwent
parotid surgery in the Central Hospital of Oviedo during
the period 1976-1996 as a result of metastasis was studied.
In all cases, a neck dissection with total (preserving the
facial nerve) or radical parotidectomy was performed.
Results: During the period analysed a total of 60l parotid
tumours was operated on. Histologically, 536 cases were
benign and 65 malignant. Metastasis to the parotid gland
occurred in 24 patients. Squamous cell carcinoma of the
skin and malignant melanoma were the principal causes of
metastasis. Five patients were free of illness twenty months
alter surgery. Radical parotidectomy does not increase the
patient's life expectancy compared with total parotidec-
tomy.
Conclusion: In the parotid gland metastasis, the long-term
prognosis is influenced by the type and extension of the pri-
mary tumour. Radical parotid surgery does not influence
the prognosis.
THE USE O F BUCCAL FAT PAD IN THE
R E C O N S T R U C T I O N O F ORAL DEFECTS
Alexandridis, C.*, Rapidis, A.D ,. Eleftheriadis, E.
Angelopoulos, A P
6 Journal of Cranio-Maxillofacial Surgery
Departments of Maxillofacial Surgery Greek Anticaneer
Institute, St. Savvas Hospital and University of Athens,
School of Dentistry, Athens, Greece
AIMS:
The Buccal Fat Pad (BFP) as an anatomic element was
described almost two hundred years ago by Buchat. Its use
though in oral reconstruction was proposed twenty years
ago by Egyedi. The BFP as a pedicled graft was originally
used as a method for the closure of oro-antral and oro-
nasal communications. During the last five years an
increasing number of studies reporting the use of BFP in
the reconstruction of post-surgical oral defects have been
published.
METHODS:
From January 1995 to December 1997 we used this method
to reconstruct medium sized acquired defects of the oral
soft and hard tissues in 12 patients suffering from oral
malignant tumours, Four of the defects were in the maxillas,
two in the retromandibular area, and eight in the cheek. In
all patients reconstruction was simultaneously carried out
with surgical treatment of the primary tumour. In 11
patients the BFP was left uncovered to epithelilise and in
one it was covered with Iyo-dura.
RESULTS:
In 10 cases the BFP healed without complications within 2
to 3 weeks; in two patients with maxillary defects there was
a partial loss of the graft requiring the additional use of an
obturator to prevent oro-nasal leakage. The procedure for
the harvesting of the graft proved to be an extremely easy
one and extra care was only necessary to avoid severing the
supporting vascular plexus and the thin stroma that covered
the BFR
CONCLUSIONS:
We could therefore conclude that the BFP is a useful alter-
native in the reconstruction of small to medium sized
acquired defects of the oral tissues.
THE EFFICACY O F INTRAARTICULAR
I N J E C T I O N O F S O D I U M HYALURONATE ON
T E M P O R O M A N D I B U L A R J O I N T DISC
DISPLACEMENT WITH REDUCTION
Alpaslan, C*., Alpasan, G.
Department of Oral & Maxillofacial Surgery, Faculty of
Dentistry, Gazi Universi04 Ankara, Turkey
Aims: The success of TMJ arthrocentesis in the treatment
of closed lock has clearly been demonstrated.
Intraarticular injection of sodium hyaluronate, one of the
essential components of synovial fluid following TMJ
arthrocentesis has also been found to be superior than
arthrocentesis alone in the treatment of closed lock.
Efficacy of this treatment on patients only with TMJ disc
displacement with reduction (DDwR) and the efficacy of
sodium hyaluronate alon in resolving in symptoms were
evaluated in this study.
Method: Patients with D D w R were treated either with
arthrocentesis followed by intraarticular injection of 1 mL
sodium hyaluronate (Orthovisc, Anika Research Inc
Woburn, MA, USA) or only with intraarticular injection
of 1 mL Sodium Hyaluronate. Pain, joint noises, and jaw
functions were assessed by means of visual analog scale
prior to the procedure, 1 day, 1, 2, 3 and 6 months postoper-
atively.
Results: The results showed that jaw functions were
improved with a reduction in jaw noises and pain during a 6-
months follow-up period in both groups.
Conclusions: Intraarticular injection of sodium hyaluronate
either alone or following arthrocentesis relieves the symp-
toms of DDwR.
HISTOCHEMICAL DEMONSTRATION OF
VASCULARISATION O F F U L L - T H I C K N E S S SKIN
WOUNDS F O L L O W I N G THE USE O F L Y O P H I L I Z E D
PORCINE DERMIS
Alpaslan G*.
Department of Oral & Maxillofacial Surgery, Faculty of
Dentistry, Gazi University, Ankara, Turkey.
Aims: To demonstrate vascularization of full-thickness
skin wounds following the use of lyophilized porcine
dermis by means of Alkaline Phosphatase
Histochemistry.
Method: Twentyone eight weeks old Wistar rats, weighing
180-220 grams of both sexes were used in the present
study. Aloask D (Taiho, Japan) was made by lyophilizing
porcine epidermis and dermis, After preparing dorsal skin
aseptically, two elliptical 15X8 ram. full-thickness skin
wounds were created. Previously cut Aloask D sheath hav-
ing same dimensions was sutured to one of the wound
sites. Other wound site served as control with normal skin
was left healing secondarily. Animals killed on days 1, 3, 7,
15, 21, 30 and 45; operative sites retrieved en bloc. Samples
were processed for Alkaline Phosphatase (ALP) histo-
chemistry by A Z O dye method and routine light
microscopy.
Results: In the present study, the sign of neovascularization
was observed on postoperative day 3 in the wound bed. As
regarding regeneration of capillary networks, our observa-
tions have confirmed that formations of surface capillary
networks do not precede epithelization of the wound sur-
face and that it takes almost 30 days at secondary healing,
and 21 days at experimental groups before a regular
arrangement of ALP reactive subepidermal capillary net-
work is reestablished.
Conelusious: Since the use of lyophilized porcine dermis
accomplishes well vascularised tissue without wound
contraction and accelerates epithelization in healing
process, its use is recommended when host tissues are not
available.
CLOSURE O F CLEFT PALATE W I T H O U T
SURGICAL F L A P
Alruhaimi, Khalid A. BDS, MSe,
Dr. Med. Dent. Dept. of Oral & Maxillofacial Surgery, King
Saud University Riyadh, Saudi Arabia

AIM:
To assess the effect of the resorbable calcium sulfate barrier
as inducer to guide soft tissue regeneration to close insuffi-
cient palatal mucoperiostum and guide bone regeneration in
cases of cleft palate with and without bone grafting.
METHODS:
Eighteen New Zealand rabbits were used in this experiment.
At right side of each animal 1 cm. wide of mucoperiosteum
was removed intra orally and vertically from middle of the
palate to the buccal sulcus between incisor and molar teeth.
The same width of cut was made and removed from the
palatal and buccal surfaces of maxillary bone. The bony
cuts were extended vertically to the mid line of nasal bone
through an extra oral incision. The nasal mucous mem-
brane of the cut lines was also removed to complete the cre-
ated cleft. Extra oral incision in all animals were closed after
completing surgery. Created gaps were left open and unfilled
in 6 animals as a control, bony gasps were packed with cot-
ton gauzes mixed with gentamycin ointment for one week.
In second group of 6 animals the intra oral gasps were cov-
ered with calcium sulfate barrier. In the last 6 animals group
bony gaps were filled with bovine bone granules and covered
with calcium sulfate barrier. Several 3 zero black silk
sutures were used passing through incision surfaces in order
to help stabilizing the barrier without closing soft tissue gap.
After three months of surgery all animals were sacrified.
RESULTS AND CONCLUSION:
Photographs of the gaps were taken after completing the
surgery, two weeks and one month post operatively.
Macroscopically all soft tissue gaps covered with calcium bar-
tier with or without bovine bone filling showed complete soft
tissue closure. Whereas gaps in control animal revealed an oro-
antral fistulae. No infection was revealed in all tested animals.
Microscopically resorbable barrier has resorbed and
mucoperiosteum of the filled gaps in both active groups of
calcium sulfate coverage compared to the contra lateral
mucopetiosteum showed normal structure. However, amount
and quality of bone filled the bony gaps were better in cases
of bovine bone grafting and calcium sulfate cover than gaps
covered with calcium sulfate barrier only. In conclusion the
application of the described resorbable calcium sulfate bone
barrier can be a good alternative method to make closure of
cleft palate easier or avoid pedicled or large flaps in cases of
large cleft defect or insufficient soft tissue. Bone grafts filling
the bony cleft will fasten bone regeneration and help to
support calcium sulfate barrier. To my best knowledge this
method were first reported in this application.
MINIPLATES AND RESORBABLE SCREWS IN
CRANIOFACIAL SURGERY IN CHILDREN.
Francisco Hernandez Aitemir* Sofia Hernandez Montero
Aims: In this video we present the surgical use of resorbable
material for the correction of a craniofacial malformation in
an 8-month-old girl with Crouzon syndrome.
Method:There are two different surgical phases: the cranial
phase and the facial phase. After the exposure of the cranio-
facial structures we perform the osteotomies and the fi'onto-
orbito-nasal block is exposed and mobilised. Few materials
are needed in the reconstruction: miniplates, reabsorbable
screws, drill with a stop, diestock and screwdriver.
The plates are moulded with the heat produced by an
exothermic reaction in what we, colloquially, call a "sand-
wicher" Manually, we prefix the new position of the orbital-
EACMFS - Abstracts, Helsinki Congress 1998 7
fronto-nasal group; in this case it was a global advance and
in the same primitive level o approximately 1 cm. The plates
with the absorbable screws are fixed at both sides in this
order: 1. Bone drilling with an engine drill with a stop. 2.
Diestock. 3. Facing and screw!ng. The screw head is broken
off after the screw fixation. The same operation is per-
formed assembling the fronto-nasal region and the three
fragments of the frontal area.
We also place another resorbable plate in the nasoglabel-
lar region.
After the bony reconstruction has been completed, the
periosteum and scalp are replaced.
Conclusions: This resorbable material allows remodelling of
the bone without any sequel and /or leaving any foreign
body in the human organism, as it is resorbed within a year
and that period of time is long enough to allow the fractures
to consolidate.
LARYNGEAL MASK THROUGH THE
RETRONASAL ROUTE. A NEW TECHNIQUE
Francisco Hernandez Altemiv
Department of Oral and MaxillofacialSurgery Zaragoza (Spain)
Method: To carry out this technique it is only necessary, just
as in our retronasal intubation technique, to have a ringed
Rusch catheter, of a size that fits the nasal fossa. A laryngeal
mask, adequate for the patient, will also be necesary.
Once the patient has been conveniently monitored and pre-
pared, as if he/she were to be intubated through the oral route
and still maintaining spontaneous respiration, the ringed catheter
is passed through the chosen nasal aperture to the oropharyngeal
cavity, where it is pulled out of the mouth with a Magill damp (it
may be helpful to have previously placed an intermaxillary gag to
make this procedure easier). Then, the proximal end of the venti-
lation tube of the laryngeal mask is attached to the distal extrao-
ral end of the tinged tube, and we push the mask carefully
towards the pharyngeal region and cavum, with the cuff deflated.
The next step is to pull the tinged catheter out through the nose in
order to carry there the tube of the laryngeal mask. As this tube
could be too short to pass through the nasal fossa, the ventilator
connection can be attached to our tinged Rusch catheter (we
hope that a laryngeal mask, with a ventilation tube more ade-
quate for passing through the retronasal route, will be produced)
Immediately the cuff, already placed at the glosopharyngeal cav-
ity, is deflated and carried with a firm approaching movement to
the supraglotic region, then continuing the procedure in the con-
ventional way for the laryngeal mask. The laryngeal mask is
deflated and pulled out, either manually or with a Magill damp ;
obviously, before extracting the laryngeal mask, the Rusch
catheter must have been detached In case it were necessary, if it
were impossible to insert the laryngeal mask, the tinged Rusch
catheter can be passed into the trachea in the conventional way.
CONVERSION FROM NASOTRACHEAL
INTUBATION TO OROTRACHEAL.
Francisco Hernandez Altemir M.D.
Department of Oral and 2¢laxillofacia[ Surgery Zaragoza
(Spain)
Aims: In order to avoid the inconvenience that may result
from the change from nasotracheal to orotracheal intuba-
8 Journal of Cranio-Maxillofacial Surgery
tion, we have developed a new method which improves this
manoeuvre, making it unnecessary to remove the nasotra-
cheal tube from its tracheal location to pass it to the orotra-
cheal position, and avoiding any interruption of the
patient's ventilation, so as to prevent not always unimpor-
tant risks.
Method: We simply use a ringed Rusch tube that can be
adapted to the nasotracheal Rusch tube through which the
patient is breathing. We act as follows: First we attach the new
Rusch tube to the nasotracheal one the patient is using; to do
that we join the proximal end of that tube to the distal end of
the new tube that is to be adapted to the connection to the
ventilator. The surgeon will apply traction to the nasotracheal
tube at the oropharyngeal level making a loop towards the
oral cavity; at the same time he must be pushing the assembled
tubes towards the corresponding nasal fossa until the ringlet is
in an extraoral position with the joined tubes outside and with
the cuff deflated. At that moment it is sufficient to detach the
tubes and connect the ventilator again. The conversion is com-
pleted without stopping the ventilation at any time.
Conclusions: It is a safe technique, easy to perform, that has
different applications in Oral and Maxillofacial Surgery,
Intensive Care Units and Anaesthesiology. If it were needed,
the orotracheal tube could be changed into a submental one.
RETRONASAL INTUBATION. A NEW TECHNIQUE
Francisco Hernandez Altemir
Department of Oral and Maxillofacial Surgery Zaragoza
(Spain)
Method: The patient is intubated orallly with a ringed tube
of the size we would use for a nasal intubation. Whenever
needed during the surgical procedure, we introduce through
the chosen nasal aperture a ringed Rusch catheter (rather
than a cava catheter) of a diameter one unit below that of
the orotracheal tube in the patient, pushing it to the oropha-
ryngeal cavity. Then, either manually or by some type of
clamp (a Magill clamp, for instance), it is pulled out
through the oral cavity. Immediately, the orotracheal tube is
detached from the ventilator and attached to the distal end
of the Rusch catheter, in such a way that both tubes are
tightly joined to stand the progressive traction and slight
turns that are necessary to pull them out through
rhynopharinx, choana of the nasal fossa and nose, just as in
a nasal intubation. All these manoeuvres must take place
with the cuff deflated, as it must pass through the same
spaces as the nasotracheal tube, of which it is a part.
Conclusions: In this way it is possible to change an oral intu-
bation into nasal intubation without removing the tracheal
tube from its conventional place in the trachea. This manoeu-
vre enables us to work without the annoyance that would be
caused if the tube were placed in the nasal region from the
first moment. Besides, placing it in the nasal region from the
mouth allows us to perform intermaxillary blockades and as
many intra or extraoral manoeuvres as we consider necessary.
[~ THE SUBMENTAL ROUTE FOR ENDOTRACHEAL
INTUBATION
Franeisco Hernandez Altemir
Department of Oral and Maxillofacial Surgery Zaragoza
(Spain)
Aims: The submental route can be an alternative to tra-
cheostomies in oral and maxillofacial surgery. The aim of
the technique is to achieve a free working space and to avoid
tracheostomies.
Method: No special equipment is required. After oral intu-
bation, a 2cm. long incision is made in the submental and
paramedial region ; this gives access to the floor of the
mouth. The pneumatic cuff is deflated ; with the help of
forceps, the tube and the cuff -one after the other- are
passed through the channel that has been created. After
checking the position is correct, the tube is fixed with
stitches at the submental level. Intraorally, the endotra-
cheal tube must have free movement. Extubation is per-
formed as in any other patient. The submental wound is
sutured using some sutures that were inserted there in
advance.
Conclusions: This technique has indications in traumatol-
ogy, craniofacial and skull base surgery.
[~ CRANIOFACIAL TRACTION ARCH
Francisco Hernandez Altemir* Sofia Hernandez.
Montero Department of Oral and Maxillofacial Surgery
Zaragoza (Spain)
Aims: We present a craniofacial traction device that allows
us to shift craniomaxillary blocks after osteotomies to facil-
itate the access to different regions and/or structures of the
craniofacial area.
Method: After submental intubation, three different
approaches, with incisions, detachments and osteotomies,
are made: Modified LeFort IlI, LeFort I and LeFort II, that
allows us to perform the maxillo-mandibular block mobi-
lization and access to the subcranial space, in the first case;
to obtain a better surgical field for treatment of regions such
as retropharyngeal, hypophyseal, retropharyngeal, retro-
maxillary, prevertebral and clivus, in the second case and
access to structures of the skull base, in the third case.
Results: All these maneouvres are easier with our device, the
craniofacial traction arch, as can be seen in a case with right
temporo-mandibulary anchylosis.
[~ SKULL BASE SURGERY. CRANIOFACIAL
PEDICULATION SURGERY. A NEW METHOD.
(POSTER I)
Francisco Hernandez Altemir
Department of Oraland MaxillofacialSurgery Zaragoza (Spain)
Aims: The technique of unilateral craniofacial pediculation
permits us to combine the transfacial and craniofacial
surgery in a more rational way, avoiding multifracturing of
the craniofacial bones (which is necessary if both are per-
formed separately). Thus, access is improved and the recon-
struction procedures facilitated thanks to a medial
craniofacial stepped incision, plus periorbital incision, uni
or bilateral.
Method: The figures clearly show the osteotomy and inci-
sion lines that are needed to perform this technique, the
removal of the frontal bone, the sectioned flap, the craniofa-
cial disjunction, the pedicled craniofacial region and the
sutures completed.

[~ SKULL BASE SURGERY. CRANIOFACIAL
PEDICULATION SURGERY. A NEW METHOD.
(POSTER II)
Francisco Hernandez Altemir
Department of Oraland MaxilloJacialSurgery Zaragoza (Spain)
Aims: Using the technique of unilateral craniofacial pedicula-
tion, excluding the alveolomaxillary and dental components, it is
possible to combine transfacial and craniofacial surgery in a
more rational way, avoiding multifracturing of the craniofacial
bones (which is necessary if both are performed separately).
Method: The figures show the osteotomy and incision lines,
the removal of the frontal bone, the sectioned flap, the facial
osteotomy and the begining of the craniofacial disjunction,
the pedicled craniofacial region and the sutures completed.
Thus, the access is improved and the reconstruction proce-
dures facilitated thanks to a medial craniofacial stepped
incision, plus a uni or bilateral periorbital incision.
[~ SKULL BASE SURGERY. CRANIOFACIAL
P E D I C U L A T I O N SURGERY. A NEW METHOD.
(POSTER III)
Francisco Hernandez Altemir
Department of Oral and Maxillofacial Surgery Zaragoza (Spain)
Aims: By means of the technique of bilateral craniofacial
pediculation, it is possible to combine transfacial and cran-
iofacial surgery in a more rational way, avoiding multifrac-
turing of the craniofacial bones (which is necessary if both
are performed separately).
Method: The figures clearly show the osteotomy and inci-
sion lines needed to perform this technique, the removal of
the frontal bone, the sectioned flap, the craniofacial disjunc-
tion and how the whole craniofacial mass is pedicled. Thus,
access is improved and the reconstruction procedures facili-
tated thanks to a medial craniofacial stepped incision, plus a
uni or bilateral periorbital incision.
Vh SKULL BASE SURGERY. CRANIOFACIAL
PEDICULATION SURGERY. A NEW METHOD.
(POSTER IV)
Francisco Hernandez Altemir
Department of Oral and MaxilloJitcialSurgery Zaragoza (Spain)
Aims: By means of the technique of bilateral craniofacial pedic-
ulation, including alveolar, maxillary and dental components, it is
possible to combine transfacial and craniofacial surgery in a
more rational way, avoiding multifracturing of the craniofacial
bones (which is necessary if both are performed separately).
Method: The figures clearly show the osteotomy and inci-
sion lines, the removal of the frontal bone, the sectioned
flap, the craniofacial disjunction, how the whole craniofa-
cial and alveolo-maxillary-dental mass is removed and then
the sutures completed. Thus, access to that area is improved
and the reconstruction procedures facilitated thanks to a
medial craniofacial stepped incision, plus a uni or bilateral
periorbital incision.
EACMFS - Abstracts, Helsinki Congress 1998 9
C H A N G I N G PATTERNS O F MAXILLOFACIAL
I N J U R I E S IN SRI LANKA
Amaratunga, N.A. de S.,
Department of Oral Surgery, Faculty of Dental Sciences,
University of Peradeniya, Sri Lanka
Aims: Because injury patterns differ with social change it
was necessary to determine the nature and the causes of
change in the facial injury pattern in Sri Lanka during the
period 1970-1990 and to establish the treatment require-
ments of these injuries.
Method: A prospective study was carried out to determine
the incidence, the site and the cause of maxillofacial frac-
tures, using the standard methods of clinical and investiga-
tive methods. Standard treatment methods were employed
and the results were analysed to determine how these
aspects have changed over the years.
Influence of road traffic volume, alcohol consumption,
safety measures etc were determined.
Results: It was found that incidence of maxillofacial injuries
increased three fold during the period from 1970 to 1990
and a significant (p < 0.05) rise in the incidence of middle
third fractures was observed. These changes could be
attributed to social changes such as increased mobility, road
traffic volume, influence of alcohol etc.
SURGICAL SOLUTION O F A GREAT L O S S OF
BONE IN THE MANDIBLE, W I T H THE USE O F A
TISSULAR EXPANDER.
Aneili L., Baldassarre V., GabrielloniP., lorio P., ProcacciniM.
Institute of Odontostomato[ogy Sciences, University of
Ancona. Chief of Services Prof. M. Procaccini.
Aims: Resolution of the problem of cortical mandibular
bone's reabsorption, in a edentulous patient, by apposition
of autologous bone, retrieved from iliac crest.
Method: Edentulous patient in left posterior mandibular sec-
tor, 34 years. Surgical phases: 1) The tunnel positioning of a
tissular expander in a mandibular muco-periosteal space,
filled with phisyological solution (1/2 cc each week, for 3
weeks). 2) By the peridural anaesthesia of the n. sciatic it's
taken off a piece of iliac bone. 3) It's made flat and grafted to
the mandibular one in the obtained space. 4) Suture.
Results: 4-6 mounths after, there's the take of the graft to the
acceptor bone, able to harbour prospective implants.
Conclusions: Aesthetic cicatrix on the iliac level. Bone increase
on the mandible. Prosthetic solution on implants, very simple.
THE P R O G N O S T I C S I G N I F I C A N C E OF
R E G I O N A L NECK METASTASES IN PATIENTS
W I T H ORAL CANCER
Angelopoulos, A.P.*, Rapidis, A.D., Skouteris, C.A.,
Vaisamis, S.
Departments of Maxillofacial Surgery, Greek Anticancer
Institute, St, Savvas Hospital and Athens University School
of Dentistry, Athens, Greece
10 Journal of Cranio-Maxillofacial Surgery
Aims: In oral cancer patients the status of the regional
lymph nodes at presentation represents the most important
prognostic factor. The biological behaviour of regional
neck metastases, although extensively discussed, still elicits
many controversies regarding treatment modalities.
Methods: During the years 1991-1995, 150 patients with
squamous cell carcinoma of the oral mucosa were treated in
our department. Of those 70 (47%) were found to have pal-
pable lymphnodes at presentation. Fifty six were male and 14
female. The anatomic location with the highest incidence of
palpable nodes was the floor of the mouth (22 of 25 cases),
followed by the tongue (22 of 37 cases), the mandibular alve-
olus (14 of 33 cases) and the maxilla (5 of 20 cases). Sixty
one of the 70 patients with initial lymphadenopathy were
treated surgically by various types of neck dissections. In 32
cases, the histological examination of the specimen showed
evidence of metastatic disease, whereas in 29 the neck speci-
men was negative. Recurrence of the neck disease developed
post-operatively in 24 patients. Despite surgical treatment
and the use of radiotherapy and chemotherapy in various
combinations, 51 patients died from their disease, 6 months
to 5 years post-operatively.
Results: In an attempt to correlate the mortality findings
with the state of the cervical lymph nodes at presentation it
was found that regardless of the treatment employed to con-
trol disease (a) the mortality of patients with both a clinically
and histologically negative neck was 12%; (b) the mortality
of patients with a clinically positive but histologically nega-
tive neck was 26% and c) the mortality of patients with both
a clinically and histologically positive neck was 62%.
Conclusion: We therefore support the view that the status of
the cervical lymphnodes at presentation is the most impor-
tant prognostic factor in oral cancer patients as the presence
of metastatic neck disease decreases the survival of the
patient by more than 50% compared with those with similar
primary tumours without nodal metastases, regardless of
the treatment protocol employed.
P R O G N O S T I C INDICATORS FOR SQUAMOUS
CELL CARCINOMA OF THE LIP: A
C L I N I C O P A T H O L O G I C A L CORRELATION
Antoniades K ~, Vahtsevanos K, Kiziridou A, Hatzistilianou
3/1, Tsamis I, Keramidas G.
Department of OMFS, eTheagenion~) Cancer Hospital of
Thessaloniki, Greece.
Several studies have focussed on tumour depth and it has been
concluded that thickness is one of the most significant predic-
tors of occult metastasis. Sixty-five patients with T1-T 2 squa-
mous cell cancer of the lower lip, with a known clinical
outcome, were retrospectively analyzed and arbitrarily divided
into aggressive (28 cases) and non-aggressive (37cases) groups
based on their clinical behaviour. The purpose of the paper
was to determine the value of tumour thickness as a potential
predictive factor in tumour behaviour.
Of the 65 patients, 46 were men and 19 were women.
The cases were drawn from a larger group of 123 lower lip
cancer patients with the final selection dependent on
tumour size and the fact that they had undergone surgical
therapy (excision with adequate margins) and a known
clinical outcome with at least a 2-year follow-up. The
histopathological evaluation was restricted to tumour dif-
ferentiation, invasion mode, and depth of invasion.
Tumour thickness was arbitrarily divided into superficial
(0 to 3 mm) and deep (4 to 15 mm), The presence of local
recurrence (one case) or nodal metastasis either at the time
of presentation (three cases) or during the follow-up
period (eight cases) were the criteria used to label a cancer
aggressive in behaviour. Although the overall recurrence
and metastatic rate was 18.46% (n=12/65) statistical differ-
ences were found between aggressive and non aggressive
groups when tumour thickness and depth of invasion were
analyzed. Thus, in the group in which tumour depth
exceeded 3mm, the aggressive behaviour was 39.3%
(11/28).
The depth of tumour invasion appears to be one of the
most significant prognostic indicators for squamous cell carci-
noma of the lower lip. Thus, it should be always documented
as accurately as possible. Tumour thickness and T stage may
be additional factors used to predict the regional risk.
Address for correspondence
Dr.,Dr., Antoniades Kostas, Dept. of Oral and
Maxillofacial Surgery
Aristotle University,Dental School, 540 06
Thessaloniki, Greece
GIGANTIC MANDIBULAR ODONTOGENYC
CYST. TOTAL H E M I M A N D I B U L E C T O M Y ,
PRIMARY R E C O N S T R U C T I O N W I T H H U M A N
L Y O P H I L I Z E D M A N D I B L E AND MARX PLATE
SYSTEM.
Aparicio-Martinez P. MD. Fellow E.B.O.M.ES. Salazar *1
C Ph.D.I Delgado M.J. Ph.D.lOral and Maxillofacial
Department. Virgen Macarena University Hospital. Sevilla.
Spain. Avda. Dr. Fedriani n°3 41071 Sevilla. Gigant
Mandibular Dentigerus Cyst. Surgical Treatment. Liofilizated
Mandibular Implant, Ramus and Condylar Reconstruction
by Liofilizated Human Mandibular, Cancellous Bone
Autogarft.
AIMS: We presents a rare case of mandibular gigant cyst,
which involves corpus, ramus an condylar bone, with
destruction of both corticals. Ussually, mandibular cyst are
sample for diagnostic, in this case Rx and Scan study where
no definitivy for a apropiated diagnostic, so, we need a
intraoperative diagnostic.
M E T H O D S : Mandibulectomy total, from corpus to condy-
lar, was realized, an reconstruction was made with human
mandibular liofilizated, and cancellous bone auto chips,
fixed with plate reconstruction MARX,incluiding metalic
condylar. Surgical aproach was external witl identification
an preservation of facial ramus. No facial paresia or paraly-
sis was observed.
RESULTS: We present results one year after, achieved
osseus integrationan adecuate remodelation are stablished,
with partial absortion of transplanted bone.
A successfull mouth open, an lateral movility are
observed, and no exposition of osseus implants, or recon-
struction plate where observed.
BACKGROUND OF HAEMOSTASIS EFFECT
M. Arao, D.D.S.
First Dept of Oral & Maxillofacial Surgery, Aichi-Gakuin
University, Nagoya, Japan

To examine the effect of lasers on the microcirculatory net-
work of tongue wounds in rats caused by the Nd:YAG laser,
semiconductor laser and C02 laser; injection replica scan-
ning electron microscope (SEM) methods were used.
Results indicated that laser irradiation of the tongue's
microcirculatory network caused the blood vessels at the
edge of the wound to be cut straight off, as if cauterized.
The cauterization of the blood vessels was most clearly
observed with the Nd:YAG laser. Observations of the net-
work during the healing of the wound showed that capillary
loops had been restored and were related to the papillae fili-
formes.
Due to the wide variability of tissue interaction, the pos-
sibility of specific applications, superior haemostasis and
coagulating effects, the Nd:YAG laser is the most valuable
surgical laser. With the adequate choice of application mode
and relationship between interaction time and power den-
sity, it can be used for benign tumours, especially haeman-
giomas.
~7 PAIN RELEASE OF TMJ D I S O R D E R PATIENTS
(MYOFACIAL PAIN, CLOSED LOCK,
OSTEOARTHROSIS) USING LOW POWER LASER
( S E M I C O N D U C T O R LASER, Nd:YAG LASER ETC.)
M. Arao, D.D.S.
First Dept. of Oral & Maxillofacial Surgery, Aichi-Gakuin
University, Nagoya, Japan
Many different treatment concepts have bee n advocated
for the management of patients with t e m p o r o m a n d i b u -
lar joint disorders (TMD). Acupuncture to the meridian
point of " G e k a n " has long been used to treat T M D
patients. Instead of using a needle, the author irradiated
the inferior articulation several times, with a low power
laser. The position of " G e k a n " is located at the hollow
point which is created by the zygomatic bone and
mandibular notch. As a low power laser treatment, I use
the N d : Y A G Laser at 350roW for patients with the M P D
(myofacial pain-dysfunction) syndrome. For each
patient, the low power laser treatment on " G e k a n " for 15
minutes was done from the first examination. Patients
with bad facial habits were instructed to discontinue
them. For example, if the locus o f the mouth opening
was skewed, they were advised to correct it by them-
selves. Within several months, the symptoms of tem-
p o r o m a n d i b u l a r joint dysfunction were thus remedied.
For patients with closed lock and osteoarthrosis, this
treatment was also effective. These findings suggest that
this therapy could be a very effective, conservative and
reversible treatment for TMD.
Recently, a new semiconductor laser has been developed
which is compact, high power and not very expensive. Using
this semiconductor laser, the author treated the T M D
patients in the same way and was able to obtain almost the
same results.
E O S I N O P H I L I C G R A N U L O M A OF THE JAWS - A
CLINICAL AND R A D I O L O G I C A L STUDY.
Ardekian L., Rachmiel A., Laufer 1).
Department of OMFS, Rambam Medical Center, Haifa,
Israel.
EACMFS Abstracts, Helsinki Congress 1998 11
Aim: To review and analyze our experience in treating 41
lesions of eosinophilic granuloma diagnosed in our depart-
ment. Method: A retrospective study was done by reviewing
the charts of 25 patients who exhibited a total of 41
eosinophilic granuloma lesions. Data from the charts
regarding age, sex, symptoms, clinical aspects, radiographic
appearance, treatment and recurrence were tabulated and
analyzed. Results: 17 of the patients were male and 8 female.
Regarding ethnic distribution, 8 of the patients were
Oriental jews, 7 Ashkenazi Jews and 10 were Arabs. A total
of 41 lesions was found in the 25 patients of which 26
(63.5%) were located in the mandible, and 15 lesions (36.5%)
were in the maxilla. The mean age at the time of the initial
diagnosis was 16.5 years. In the 27 lesions (66%) curettage
and debulking were performed, while in the remaining 14
lesions (34%) an excisional biopsy was the only surgical
treatment rendered. All 41 lesions (100%) received low dose
radiotherapy. 3 lesions (7%) in 3 patients, have recurred, and
treatment for these lesions consisted of more aggressive sur-
gical intervention. One of the recurrent lesions (33%)
returned a third time., and treatment consisted of surgical
excision with wide borders and marginal resection of the
surrounding bone. Conclusion: The present study shows
that the combination of surgery and radiotherapy offers
good results in treating eosinophilic granuloma.
Establishing a definitive treatment plan for eosinophilic
granuloma requires further studies with long term follow-
up.
[~ OUR F I N D I N G THE O D O N T O M A
Arifi, B.*, Vasilevski, B., Janev, J., Benedeti, A., Demh'i, A.,
"Sanodent"-Gostivar, Clinic of Maxillofacial Surgery and
Clinic of Oral Surgery, University "'St. Cyril and Metodius",
Skopje, R. Macedonia
Aims: Odontomes of the jaw are associated with a variety of
clinical histories and physical findings. The authors would
like to compare their own experience and findings with the
theory and scientific literature in this field of tumours,
Method: In general, the patient is usually asymptomatic,
and their diagnosis is always made following a routine den-
tal or jaw radigraphic examination. The various tooth ele-
ments are well developed on macroscopic and histological
examination.
Results: In a period of 3 years (01.01.95-31.12.97), we dis-
covered 9 odontomes in patients of age 8-55 years. Of all
the diagnosed odontomes only 4 were found in the
mandible, localized in the molar area, the other 5 were
located in the maxilla: 2 anterior, 2 in the bicuspid and 1 in
the molar regions. Only 4 were simplex, while the remainig
5 were complex. On the posterer is presented one complex
odontome in the region of the first bicuspid teeth in the
maxilla with radiographic findings showing a well defined,
irregular, radiopaque, dense mass, surrounded by a radi-
olucent zone. After surgical removal of the complex odon-
tome the authors discovered about 150 small toothlike
structures.
Conclusions: Odontomes in most cases are discovered by
accident in younger patients. They rarely cause disturbance
or malposition of the neighbouring permanent teeth or neu-
ralgic difficulties. Odontomes do not cause diagnostic and
therapeutic problems and they are never aggresive.
Histologically, the complex odontome is characterised by a
high degree of morphodifferentiation and histodifferentia-
tion findings.
12 Journal of Cranio-Maxillofacial Surgery
RELATION BETWEEN 3D CT IMAGING AND
CLINICAL RESULTS IN SEVERE ORBITAL
TRAUMA.
Arturi L. *, Ferrero R., Pezzuto C., Cassano P., Mozzati
M. (1), Valentini M. (7. (2)
Divisione di Chirurgia Plastica Traumatologica- Azienda
Ospedaliera C. T. O.-C R.F-M. Adelaide di Torino-Italy
(Primario Prof. Magliacani G.). (1) Clinica
Odontostomatologica deIl"Universitgl di Torino-Italy
(Direttore Prof. Preti G.). (2) Radiologia 2. Servizio di
Neuroradiologia Azienda Ospedaliera C. T.O.-C.R.F-M.
Adelaide di Torino-Italy ( Primario Prof. Toscano G.).
Aims: Find a relationship between 3D imaging and clinical
results.
Method: Twenty patients with complex midface fractures
and orbital trauma underwent 3D C.T. scanning (60% of
them had monolateral lesions).
Results: Tomography assessment and evaluation of preoper-
ative and postoperative images demonstrate a strictly con-
nected relation between surgical volumetric orbital
reconstruction and the clinical final results.
Conclusions: Midface fractures take up the surgeon in
reconstruction of the orbit.
The final aesthetic and functional results are directly
depending from the bony architecture restoration (bone
correct repositioning), if there aren't so evident lesions of
the other orbital tissues.
Improving 3d Ct imaging and analysis of data can use-
fully help us in patients' postoperative observation and are a
precious aid in clinical follow-up and secondary reconstruction.
COMPARISON RESULTS OF POSTERIOR AND
ANTERIOR OTOPLASTY TECHNIQUES
Astrauskas T., Viksraitis S.,
Plastic Surgery Centre, Kaunas Lithuania
AIMS:
Our purpose is to compare the results of the operations on
anterior and posterior otoplasty.
METHOD:
Between 1993 and 1995 112 patients were operated on
according to improved method of Mustardy (I patients
group - posterior otoplasty): posterior skin excision, abrasio
of posterior surface of cartilagine in antihelix region, anti-
helix tubulation sutures.
Between 1995 and 1997 73 patients were operated on
according to improved method of Nicholas (11 patient
group - anterior otoplasty): posterior skin excision, abrasio
of anterior surface of cartilagine in antihelix region through
slightly curved incision in external antihelix border, antihe-
lix stabilization sutures.
30 patients from each group were being examined in
between 6th and 24th month after the operation. We classi-
fied the data into subjective (patient's questionnaire con-
sisting of 15 questions about operation, post - operative
period, results and complications) and objective (measure-
ments of the ear, symmetry, natural appearance of sepa-
rate components of the ear, evaluation of postoperative
scars).
RESULTS:
The results showed that the cases of recurrences (13,3%),
fistulas of suture knots (6,7%), protruding antihelix
(13,3%), deformations in fossa scaphoidea region (10%) are
more frequent among patients from group I . Patients from
group II more often complained about the pain after the
operation (20%), longer lasting swelling (average 19 days)
and longer time of full recovery of sensitivity (approxi-
mately 3 months).
CONCLUSIONS:
1. Posterior otoplasty technique does not reduce resistance
of cartilage, that's why the recurrences are more frequent
and unnaturally antihelix occurs.
2. Anterior otoplasty technique provides refolding antihe-
lix naturally and the closure requires no tension on the
sutures.
PRE-FORMED HYDROXYAPATITE CEMENT
(BONESOURCE TM)GRAFTS IN MAXILLOFACIAL
SURGERY
Ayliffe PR* Johnson PA, Langdon JD.
Department of Maxillofacial Surgery, Royal Surrey County
Hospital Guildford, Surrey; England, UK & Kings College
Hospital, London UK.
Aims: The new bone substitute material BoneSourceTM is
marketed for use as a paste or cement. In this form it can-
not be used for structural deformities due to it's inherent
lack of strength. This study was designed to discover if
the material could be modified by pre-hardening or com-
bining with other bioresorbable materials and thus used
for augmentation of the facial skeleton or spanning bony
defects.
Method: In this clinical study patients presenting with bony
defects or requiring augmentation of the facial skeleton
were selected. The patients in the sample were followed up
and if possible biopsies were obtained at 2 weeks, 2 months
and 6 months post operatively.
Results: The study sample contained patients requiring
orbital wall or floor repair, augmentation of mid-face
defects, alveolar ridge augmentation and interpositional
grafts for maxillary osteotomies and genioplasties.
Complications included graft failure in orbital floor repair
(1/34, 2.9%) malar asymetry and skin thining (1/26, 3.8%).
Complete or partial graft rejection when used for alveolar
ridge augmentation (8/24, 33.3%).
Conclusions: BoneSourceTM can be successfully modified,
pre-set and easily fashioned for use as a dimensionally stable
pre-formed grafting material. It has advantages over other
synthetic bone substitutes. It can be cemented or rigidly fixed
and is replaced by normal bone when examined histologically.
O=~ COMPLICATIONS FOLLOWING
ORTHOGNATHIC SURGERY THAT REQUIRED
IMMEDIATE INTERVENTION; 10 YEARS
EXPERIENCE
Ayoub, A., * Lalani, Z., Wood, G., Moos, If.,
Departments of OMFS at Canniesburn Hospital, and the
University of Glasgow, Scotland, UK.

Aim: The aim of this study was to analyse cases which had
orthognathic surgical correction and developed immediate
postoperative complications that required a second surgical
intervention within two weeks of the first operation.
Method: This investigation was conducted on 1000 orthog-
nathic patients which were treated at Canniesburn Hospital
over the last ten years.
Results: Ten cases developed postoperative complications
that required second operation. Four cases presented with
anterior open bite as a result of incorrect positioning of the
maxilla. These patients had bimaxillary osteotomies and the
maxillary impaction was inadequate. This required further
posterior maxillary impaction. In four other cases the
condylar segments sagged posteriorly and inferiorly losing
contact with the distal segment. The condylar segments
were repositioned and fixed on to the distal segment. In
another case profuse bleeding following advancement
genioplasty occurred which required exploration of the
genial segments and cauterisation of the muscular bed. In
the last case a malocclusion was noted following incorrect
positioning of an anterior mandibular segment after bilat-
eral body osteotomies. This was corrected by surgical repo-
sitioning.
Conclusions: This study has identified orthognathic cases
which required an urgent second operation and discusses
their management and possible ways in which these compli-
cations might be prevented.
@~ ARTHROPATHY OF THE TMJ AND DISORDERS
OF THE ENDOCAPSULAR DYNAMICS: ANALYSES
WITH MRI AND ARTHROSCOPY
Baciliero, U.* (1), Padula, E. (1), Bernaseoni, G.* (2)
(1) Maxillo-Facial Surgery Department Regional Hospital,
Vicenza, Italy. (2) Department of DentistJT, Pavia
University, L R. C. C.S. Policlinico San Matteo, Pavia, Italy.
The development of new investigation technics in radiol-
ogy, in arthroscopy and in articular surgery, likewise in his-
tological and morphological studies, have permitted a
much better understanding of TMJ Arthropathy.
Recent research has clarified that TMJ Arthropathy has
some particular dysfunctional aspects, due to its anatomi-
cal and functional peculiarity; it has also been demon-
strated it belongs to the category of synovial joints
degenerative diseases.
In the past, the term "internal derangement" was used
to identify TMJ dysfunction and to attribute a mechanical
cause to the aetiology and pathogenesis of this articular
disease.
The video presented is based on our clinical, radiologi-
cal, arthroscopical, surgical and histomorphological 6 year
experience during which we have applied our diagnostic
and therapeutic protocol to (156) patients.
The video is useful to clarify some aspects of the con-
nection between TMJ anatomy, TMJ function and its his-
tomorphological and metabolical equilibrium.
The MRI and the arthroscopic examination of TMJ
show that the pathological lesions observed in the articular
cavity can modify the endocapsular dynamics and can
influence the evolution of TMJ pathology.
These observations confirm that a good range of
movement in the joint maintains its functional and meta-
bolical equilibrium and that, on the contrary, the joint
immobility facilitates the loss of its functional and meta-
bolic capacity.
EACMFS- Abstracts, Helsinki Congress 1998 13
MANDIBULAR RECONSTRUCTION WITH
PEDICLED AND MICROSURGICAL FREE
TRANSFERRED FLAPS
Gr. B~ciut, Mihaela Popa*, R. S. C~mpian,
Department of Oral and Maxillofacial Surgery, "Iuliu
Hatieganu" University of Medicine and Pharmacy,
Cluj-Napoea, Romdnia
AIMS:
Reconstruction of extensive mandibular defects can be
extremely tedious, owing to the complex conformation of
the mandibular bone. Association with defective intra- and
extraoral tissue subsequent to malignant tumour resection
further enhances the difficulty of the procedure. The aim of
this study is to present some alternatives for rehabilitation of
bone defects in the face: a morphologic restoration of the
facial contour and functional rehabilitation of the lost
tissue.
METHODS:
The authors have used vascularized pedicled bone, as well as
microsurgical free transferred bone for restorations in 12
patients between 1995 - 1997 in the Clinic for Oral and
Maxillofacial Surgery, Cluj-Napoca, Romania. The patients
were admitted with benign or malignant tumours of the
mandible and hemifacial microsomia. Seven cases under-
went reconstruction with vascularized cranial bone, while 5
cases were treated using free transferred fibula grafts. The
cranial bone grafts were pre-elevated as pedicled osteofas-
cial parietal flaps, based on the temporal vessels. The fibula
graft, vascularized by the peroneal vessels, was used in
reconstruction of the mandibular ramus and body. The spe-
cific contour of the mandible could be restored by harvest-
ing bone of adequate shape in the case of osteofascial
cranial flaps, whereas in the case of fibula grafts, multiple
osteotomies were sustained by the excellent periosteal blood
supply
RESULTS:
The osteofascial parietal flaps, as well as the fibula grafts
were perfectly integrated. Formation of osseous callus could
be observed at 6 months postoperatively. No pathological
changes occurred in the temporo-mandibular joint. The
structure of the fibula allowed the insertion of osteointe-
grated implants, which offered good support for fixed pros-
thetic restorations.
CONCLUSIONS:
From the range of available bone grafts, the authors have
delimited two types of grafts for transplantation, which
ensure advantages over conventional restoration
techniques.
Fh DEVELOPMENTS OF N O M A DISEASE (CANCER
AQUATICUS) FROM THE P O S I T I O N S OF MODERN
MEDICINE
Badalyan Kh. *, Avagyan A., Badalyan (7,.,Petrosyan A.
Departments of OMFS, Yerevanstate Medical University,
Yerevan, Armenia.
14 Journal of Cranio-MaxillofacialSurgery
Aims: To study noma disease using the achievements of
modern medicine, and also considering, that the disease, in
accordance with literary data, gives a high death-rate.
Subject: During the 1997, 4 patients and their case histories
were investigated (aged 2-35) with the noma diagnosis, one
of them being a doctor infected during rendering medical
help.
Results: Due to early diagnostics, and also timely conserva-
tive and surgical measures, for all patients recovery is
marked, though for three of them, defects of soft tissues
and scarred changes are marked. The leading role in confir-
mation of the diagnosis of noma disease has played the
detected anaerobes of genus Clostridium.
Conclusions: Due to correctly organized diagnostics, timely
intense therapy and surgical interference, avoidance of fatal
outcome for noma disease is quite possible.
AN EVALUATION O F THE SUCCESS O F O P E N
SURGERY F O R T E M P O R O M A N D I B U L A R J O I N T
INTERNAL D E R A N G E M E N T
Baldwin, A *.
Department of Oraland MaxillofacialSurgery, University
Hospital of South Manchester, Withington, Manchester,England
AIMS:
To determine a patient and clinician based evaluation of the
success of surgical management for internal derangement of
the temporomandibular joint.
METHODS:
A retrospective postal survey of 92 patients who had under-
gone eminectomy and meniscal plication for internal
derangement of the temporomandibular joint over a 10 year
period was performed. In addition, the corresponding med-
ical notes were reviewed to obtain information relating to
the clinicians' assessment of surgical success.
RESULTS:
Symptoms of pain, joint noise, and limited joint mobility were
reported by patients to have improved in 68%, 61% and 74%
of all cases respectively. Overall, operative intervention was
considered successful in only 61% of joints but 92% of
patients were prepared to undergo further surgery if indicated.
Few complications occurred and were mainly transient in
nature.
CONCLUSIONS:
Eminectomy and meniscal plication can result in a good
reduction of symptoms in internal derangement, but
patients need to be warned that success is not guaranteed
and that the condition may worsen following surgery.
RESIDUAL TRAUMATIC MAXILLO-FACIAL
D E F O R M I T I E S AND I N J U R I E S
Barabds J., VeliehN., Szab6 G., Kienk G., Urbdn G.
Aim: To investigate the cause of the relatively high inci-
dence of residual traumatic maxillo-facial deformities
among our patients, and the possibilities available for their
care.
Method: In the period 1994-97, a total of 366 maxillo-facial
injuries were treated. 56 patients arrived with inveterate or
residual traumatic deformities, 32 of whom unambigu-
ously had residual traumatic deformities (9% of the total
cases). A study was made of the types of department in
which these patients had received primary care, and of the
reasons for the deformities. The deformities were further
analysed with respect to the treatment possibilities, and the
methods applied are presented in connection with concrete
cases.
Results: In Hungary, those who suffer maxillo-facial injuries
may be treated in specialist oral surgical departments, but
equally they may receive treatment in traumatological,
otorhinolaryngological, ophthalmological or neurosurgical
departments where, with a few exceptions, a maxillofacial
surgeon is not available. Accordingly, the patients do not
always participate in the necessary high level of primary
care.
Conclusions: In the course of secondary care, even if the
most up-to-date diagnostic and surgical methods and equip-
ment are used, restoration of the original condition can not
be guaranteed, and the patient is faced with a higher surgi-
cal risk and greatly increased costs of care. Attention is
therefore drawn to the importance of appropriate primary
care.
[~ MANDIBULAR RETROGNATHIA CAUSED BY
EARLY INFANTILE O S T E O M Y E L I T I S AND ITS
CORRECTION BY MEANS O F CALLUS
DISTRACTION
Z J. Barth* A. Stellzig#, A. Kubler*, St. HassfeM*, J.
Muhling*
Department of Oral and Maxillofacial Surgery
#Department o2/ Orthodontics University of Heidelberg,
Germany
In recent years, the method of gradual callus distraction
has gained considerable recognition in the augmentation
of hypoplastic mandibles. Mandibular bone distraction
was performed especially in children who were at risk of
obstructive sleep apnoea (Pierre Robin sequence, Treacher
Collins syndrome). We report a case of a patient who had
suffered from early infantile osteomyelitis. Inflammatory
disease in the temporomandibular joint led to severe
mandibular micro- and retrognathia. In this case the
mouth opening was reduced to 17 mm. At the age of nine,
we resected the cranial parts of the joint; however, after
surgery the limitation of mouth opening recurred within
one year. At a further resection of the caput of the left
temporomandibular joint implantation of a silastic-
spacer was performed. Postoperatively, orthodontic treat-
ment and myofunctional training followed.
Cephalometric measurements showed marked mandibu-
larretrognathism (SNB angle 65°). Due to the patient's
inability to protrude the mandible orthodontic correction
of the malposition seemed impossible. In addition,
because of space deficiency, an extraction in all four seg-
ments was necessary.
For psycho-social reasons, unilateral callus distraction
was decided upon. Due to the underlying disease, the bilat-
eral distraction was limited to the horizontal ramus. For
relapse compensation, a slight overcorrection was made. At
the end of distraction we had attained a distance of 19 mm,
the SNB angle was then 76 °. Despite premolar extraction,
space deficiency in the lower jaw required a slight distalisa-
tion of the first molars and a lip bumper distalisation of the
molars into the callus was performed.

Conclusion: For the first time, callus distraction has been
reported in a case of early infantile osteomyelitis. The surgi-
cal intervention created the necessary conditions for ortho-
dontic correction of the malocclusion.
M A N A G E M E N T OF A N G I O M A S OF T H E FACE,
NECK AND ORAL CAVITY. RESULTS O F SURGICAL
TREATMENT.
Bartkowski, S.B.*, Zapala, J., Modelska, D.E.,
Department of Maxillo-Facial Surgery, the Jagiellonian
University, Krak6w, Poland
The aim of this study is to present the difficulties in surgical treat-
ment of extensive angiomas of the face, neck and oral cavity.
Subject: 42 patients with angiomas of the face, neck and
oral cavity were treated in the last 15 years. The group
included 7 patients with huge angiomas infiltrating several
anatomical regions. The patients were aged from 2 to 72
years (average age 24.6 years).There were 26 female and 16
male patients (including 7 children up to 15 years). The
treatment of angiomas comprised intratumoural ligations,
cryotherapy, turnout excision or combined treatment. After
radical excision of angiomas the defects were reconstructed
by tubed, regional and local flaps in combination.
Results of treatment were evaluated on the basis of our own
anatomical, functional and aesthetic classification.
CONCLUSIONS:
1. Radical surgery of extensive angiomas presents serious
difficulties and puts the patient's life in jeopardy.
2. Multidimensional postoperative defects resulting from
excision of huge angiomas require combined, multistage
reconstructions by distant flaps to achieve proper func-
tion and appearance of the patient.
3. Course of surgery and final results of reconstruction should
give the patient an opportunity of leading a normal life.
ENDOSCOPIC ORBITAL FLOOR REPOSITION
Baumann, A.*, Moser A.**, Ewers, R.
Clinic of Oral and Maxillofacial Surgel% A K H Vienna,
Waehringer Guerte118-20, A- 1090 Vienna, Austria,
** University Clinic of Ophthalmolog2v; Medical School, Vienna,
Tel.." 01-4040014259, Fax.: 4253 e mail." ref H Y P E R L I N K
mailto:r.ewers@akh-wien.ac.at ~ewers@akh-wien.acat
Orbital floor fractures are mostly diagnosed by a CT-scan
and the operative treatment is decided depending on the
diagnostic result. The fracture size can not be evaluated on
the CT-scan, but much more easily with an endoscope.
Already Converse had recommended transantral orbital
floor palpation to diagnose significant floor fractures to
determine which fracture required open orbital floor explo-
ration.
Material and Methods: Since 1997, 10 orbital blow out frac-
tures were operated on and reconstructed using transantral
endoscopic control without an additional lid approach. The
floor was stabilized by the insertion of PDS-sheets of
Ethisorb-patches in 8 cases. Pre- and postop, controls were
done by CT-scanning. Also pre- and postop, controls of the
eye were performed.
EACMFS Abstracts, Helsinki Congress 1998 15
Results: The fracture size could be determined endoscopi-
cally. The orbital fat was visible only in two of the 10 cases.
The fracture was situated in 8 casers medial to the infraor-
bital nerve, in two cases also in the lateral part of the floor.
There were no eye complications after transantral endo-
scopic repos-itioning.
Conclusion: Transantral endoscopy should be performed for
diagnostic reasons. Repositioning and insertion of implants
can be done under endoscopic control without an addi-
tional lid approach. Distortion of the orbital contents by
surgery can be avoided.
ANALYSIS O F OSSEOINTEGRATED I M P L A N T S
IN EDENTULOUS M A X I L L A E W I T H OR W I T H O U T
BONE AUGMENTATION
Becktor JP, lsaksson S, Blomquist JE.
Department of Oral and Maxillofacial Surgery,
Liinssjukhuset, Halmstad, Sweden
Aims: To analyse data from cases with implant treatment in
the edentulous maxilla with or without bone augmentation.
Material and Method: A retrospective study was made on
105 patients who received 607 Brfinemark implants, all in
edentulous maxillae without bone augmentation. Follow-up
time was 6-95 months, with a mean of 48 months, after
abutment connection. Bone quantity, type of implant, local-
isation of implant, number of implants, implant loss and
prosthetic result were registered.
A combined retrospective and prospective study was
made on each 49 and 50 patients with implant treatment in
maxillae with bone augmentation. 99 patients received 485
Brgmemark implants. Follow-up time was 2-48 months after
abutment connection. Bone quantity, type of implant, local-
isation of implant, number of implants, implant loss and
prosthetic result were registered.
Results: From the group of maxillae, 105 patients and 607
implants, without bone augmentation the calculated sur-
vival rate for individual implants from the time of implant
placement was 83 percent after a mean follow-up time of 6-
95 months. 75 of the patients were provided with fixed pros-
theses and 20 with overdentures.
From the group of maxillae, 99 patients and 485
implants, with bone augmentation the calculated survival
rate for individual implants from the time of implant place-
ment was 82 percent after a mean follow-up time of 2-48
months. 73 of the patients were provided with fixed prosthe-
ses and 7 with overdentures
Conclusions: This study showed that the overall implant sur-
vival rates are comparable with other reports. The results
indicate that implant survival rate in maxillae with or with-
out augmented bone seem to be the same.
THE BLINK REFLEX AS AN AID IN THE
NEUROLOGICAL DIAGNOSTIC IN
ORTHOGNATHIC SURGERY
A.Bene ch *- E.Madaro - D. Cocito ~~
Clinical Physiopathology Department Division of Maxillo-Facial
Surgery **Division of Neurology University of Turin ITALY
During orthognathic surgery operations on the maxilla and
especially during the execution of mandibular osteotomies
16 Journal of Cranio-Maxillofacial Surgery
according to Obwegeser, nerves responsible for sensitation
in some cutaneous areas of the face can be damaged.
Phenomena of disaesthesia that are useful, in particular
in their time of recovery and whether total or partial recov-
ery, can arise.
To this aim, patients are subjected regularly to neurolog-
ical test pre- and post-surgically in order to show if the cuta-
neous sensory nerves of the face are damaged or not.
The Blink Reflex (B.R.) is generally evoked by stimulat-
ing the first trigeminal branch, recording the activity of the
orbicularis muscle.
Nevertheless, recent works have shown that its R.r. com-
ponent is also elicitable by stimulating the second and third
branches, always recording activity in the orbicularis mus-
cle. It is evident that this method, if the integrity of the
facial circuit is intact, can monitor the integrity of the sec-
ond and third trigeminal branches in the orthognathic
surgery operations.
We report the results of a group of twenty patients from
whom, 15 days before and 180 days after operation, we have
obtained:
Time of the central conduction orbicularis muscle cortex
of the eye obtained with a peripheral transcranial stimula-
tion of the motor cortex and the facial N.
Response R.r. of the Blink Reflex obtained with an elec-
trical stimulation of the second and third trigeminal
branches.
[~ MYXOMA O F T H E MAXILLA: A CASE R E P O R T
eBenedetti A., Vasilevski B., Naumovski S., Kirkov A.,
Pancevski G., Arifi B.
Skopje, Republic of Macedonia
The case of a 65-year old woman with a one year history of
non-painful odema in the left maxilla is reported.
Radiographic examination showed cystic destruction of the
bone and deformation of the maxilla. Based on our experi-
ence, complete resection may result in a significant func-
tional and aesthetic mutilation, incomplete primary removal
results in a high recurrence rate. Therefore a radical primary
resection of the tumour with maximal preservation of sur-
rounding anatomical structures is necessary. We used the
correct primary treatment with total extirpation of the
tumour. Histologically the tumour proved to be a myxoma 5
x 4 cm in size. Six months follow-up of clinical and radi-
ographic examination indicated a good result and there has
been no recurrence of the tumour. Long term follow-up is
necessary, of course.
T7 A D V E R S E R E A C T I O N S C A U S E D BY
BIODEGRADABLE MATERIALS.
Bergsma J.E.*, Bos R.R.M., Rozema F.R., Joziasse C.A.P. #
University Hospital Groningen, Department of Oral and
Maxillofacial Surgery, Groningen The Netherlands, #
Department of Polymer Chemistry, University of Groningen,
The Netherlands
Today, biodegradables such as poly(L-lactide) (PLLA),
polyglycolide (PGA) or copolymers are widely used for
internal fracture fixation and are generally considered to be
a reliable method of achieving good fracture healing. In a
number of studies however, adverse reactions have been
reported concerning their degradation. Late complications
have been described with as-polymerized bone plates and
screws in patients. The degradation rate of as-polymerized
PLLA is very low, it takes more than 8 years for total
resorption. More important, the degradation products of
these P L L A implants - numerous highly crystalline particles
- are related to persistent subcutaneous swellings. An expla-
nation for this swelling may be that during degradation of
the P L L A implant at some point, low molecular weight par-
ticles are formed with free carboxyl groups and polar groups
that elevate osmotic pressure. This osmotic pressure and a
relatively low resistance of the subcutaneous tissue that acts
as a semipermeable membrane, causes the increase in vol-
ume. After the increase in volume, macrophages show a high
influx towards the crystalline PLLA particles, resulting in
large areas with foamy macrophages that have ingested
these debris particles. Since these particles are very stable
due to their high crystallinity, macrophages can not actively
digest the particles and remain in situ, thus inducing a ster-
ile foreign body reaction. In our patient group the swellings
persisted for many years. The slow degradation and the
presence of a foreign body reaction is not unique to as-poly-
merized PLLA. In a study using polyglycolide or polylac-
tide-glycolide rods, B6stman et al. (1992) reported a foreign
body reaction in all cases and in 8% of patients a clinically
manifest reaction. In a study using self-reinforced PLLA,
Suuronen et al. (1998) described that after 5 years of
implantation, bone plates had become increasingly fragile
but retained their macroscopic form. Loss of mass of the
plates was limited to 50% after 5 year in vivo degradation.
Also large fields of foamy macrophages were observed with
ingested P L L A particles. Other groups using PLLA or
copolymers of PLLA did not show clinical and especially
histological evidence that the implants had completely
resorbed and did not induce foreign body reactions on the
long-term.
It is our conclusion that, for safe long-term application of a
degradable polymer, the charactestics of the tissue of implanta-
tion as well as the quantity, degradation characteristics and
associated changes in the morphology of the implanted mater-
ial are entities that should be studied extensively.
THE C O R R E C T I O N O F THE TIP IN CLEFT-LIP
PATIENTS. E X P E R I E N C E OF 10 YEARS.
Bertossi D. *, Bedogni A., Fior A., D'Agostino A. and Nocini
P.E
Department of Oral and Maxillo-Facial Surgery, University
of Verona, Italy
The principles of surgical technique of cleft-lip are based on
the necessity of solving the problems that can compromise
the nasal airway and can cause alterations in breathing.
These alterations can influence dentofacial development
and general health.
In some cases the surgical repair is made with a primary
approach, because there is a body of evidence that no
demonstrable interference with growth or subsequent surg-
eries.
The frequent residual imbalances are corrected after
alveolar arch modelling, bone grafting, maxillary skeletal
segment alignment. In our experience, the best results are
achieved with the monitoring of the development of the

lip-nose complex, following the reconstruction of the
architectural bone support. The secondary step is to
achieve a good aesthetic result, but only with the satisfac-
tion of the purpose of a long term functional result. The
rhinoplasty in cleft-lip patients is not easy because of the
tension of the lip-nasal-maxillary complex. We have seen
that these imbalances are a consequence of the previous
suture lines and of the lack of tissues. The experience
shows that a good projection of the tip associated with a
good correction of the nostrils can hide other imperfec-
tions often present in these patients. The Authors report
the experience on 84 cleft-lip outcomes treated between
1987 and 1997 with different techniques into whom we
have experimented one method employing a plastic mater-
ial to maintain the nostril shape.
COMPUTER-ASSISTED ORTHOGNATHIC
SURGERY: A N E W C O N D Y L E R E P O S I T I O N I N G
METHOD
Bettega .12 (7., Cinquin 2 P., Lavall(e ~ S., Lebeau 1 J.,
Raphael 1 B.
Service de chirurgie plastique et maxillo-faciale. Hdpital A.
Michallon. BP 217. 38043 Grenoble cedex 09. France.
Laboratoire TIMCIlMAG UMR CNRS 5525, Facult~ de
Mddecine de Grenoble - Domaine de la Merci. 38706 La
Tronche cedex. France.
Aims: Mandibular condyle positioning is one the critical
challenges in orthognathic surgery. A bad placement may
produce an alteration of the surgical result (bone relapse or
unstable dental occlusion), temporo-mandibular dysfunc-
tion, or a reduction of masticatory efficiency. A lot of sys-
tems have been described. But none of them have proved
their superiority, because none of them have been subject to
clinical assessment.
Method: We present an original method based on three-
dimensional optical localisation of infrared emitting diodes.
The system is described. Clinical improvement due to a pre-
cise repositioning is clearly demonstrated from data
obtained after 30 interventions. Ten patients have been
operated upon using an empirical repositioning method
(standard technique), the other 20 have been treated with
the help of the computer assisted system.
Results: Fifty percent of the patients of the first group do
not have the expected surgical result taking into account
EACMFS - Abstracts, Helsinki Congress 1998 17
anatomical and functional criteria. All the patients of the
second group have a good result, corresponding to the surgi-
cal planning. The method of evaluation and the results are
detailed.
Conclusions: The benefit of such a condyle positioning sys-
tem is:established. But the results need to be confirmed by a
large multicentre study.
[~ CLEFT-ASSOCIATED D I S T U R B A N C E S O F
O D O N T O G E N E S I S - E X P E R I M E N T A L STUDY
Bienengriiber, V.; *Malek, F.A.; Sch6n, 0.; *Fanghiinel, J.
Department of OMF-Surgery, University of Rostock,
Germany
*Institute of Anatomy, E. M. Arndt University, Greifswald,
Germany
The aim of this study was to determine whether there is a
correlation between disturbed palatogenesis and odontoge-
nesis.
Palatogenesis was interfered with by the cytostatic drug
Procarbacine (200 mg/kg body weight) administered orally to
pregnant Wistar rats (n=7) on day 14 postconception. These
50 foetuses as well as the control foetuses (n=22) were scree-
ned by means of macro- and micromorphological examina-
tions after caesarian section on day 20 postconception.
Based on histological investigations, 94% of the foetuses
that had received Procarbacine had clefts - predominantly
of the secondary palate. The following types of tooth germ
damages were noted most often in association with cleft for-
mation: retardation of development (25%*), various types
of necroses of the pulp (presumably due to vascular distur-
bances, 13%*), and missing tooth germs (12%*). Maxillary
tooth germs were more often affected than those in the man-
dible (p < 0.002**). In both jaws, the incisor germs were pri-
marily affected (p < 0.01"*).
Based on these results, we consider the frequently
observed anomalies of form, position and number of
permanent teeth in cleft patients to represent a complex dis-
ruption of the development of the jaws accompanying cleft
formation. Therefore, thorough examination of all teeth
must precede any dental or surgical treatment of cleft
patients.
* Average values independent of location
** chi square test
18 Journal of Cranio-Maxillofacial Surgery
[~ REGIONAL BLOOD FLOW OF ORAL CANCER
PATIENTS
Kornevs E., Skagers A., Bigestans A., Salms G., Leitane
A.*% Tars J. *
Department of Oral and Maxillofacial Surgery Medical
Academy of Latvia
* Department of Head and Neck Surgery Latvian
Oncological Center
** Diagnostical Center Riga, Latvia
Aims: To evaluate the regional blood flow in external
carotid arteries during radiotherapy and surgery of oral
cancer patients.
Method: Colour doppler imaging by doppler scanner
Acuson - 128 USA was used for the estimation of the func-
tional conditions in the common carotid and external
carotid systems, in 55 patients. Blood flow disturbances
were controlled and the diameter of the lumen was mea-
sured. Doppler waveform analysis was than carried out at a
point 1 cm below the carotid bifurcation and the resistivity
index was estimated.
Results: The mean values of the resistivity index in the
group having preoperative irradiation < 40 Gy with the
surgery 3 - 4 weeks after a course of irradiation: before
treatment 0.610 ± 0.030, after irradiation 0.625 ± 0.025,
before operation 0.635 ± 0.025, 6 month after treatment
0.710 ± 0.040. In the group having preoperative irradiation
40 - 55 Gy and surgery 2 - 4 weeks after irradiation; RI
before treatment 0.647 ± 0.026; after finishing irradiation
0.667 + 0.028; before surgery 0.683 ± 0.022; I week after
surgery 0.708 £ 0.018; 6 month after surgery 0.707 ± 0.032.
In the group having surgery 1 - 3 month after irradiation. RI
before treatment 0.620 ± 0.029; just after irradiation 0.633 m
0.022; before surgery 0.680 ± 0.016; 1 week after surgery
0.710 ± 0.022; 6 month after surgery 0.730 ± 0.014. In the
group having preoperative irradiation to 9 patients with
irradiation 40 - 55 Gy, erythema of the oral mucosa was
obseved in 3 patients. The mean values of RI before treat-
ment of these patients were 0.637 i 0.026, after irradiation
0.643 + 0.025. The statistically significant difference was 1 )
just after irradiation = 1,108; 0,2 < p < 0.3; 2 ) before opera-
tion + = 2.744; 0,01 < 0.02; 3 ) 1 week after operation + =
4.542; p < 0.001, 4 ) 6 month after operation + = 5.041;
p < 0.001.
Conclusions: The functional evaluation of the regional
blood flow may give additional data in the choice of treat-
ment methods and surgical technique in oral cancer
patients.
MAXILLARY SINUSFLOOR ELEVATION,
EVALUATION BY C O M P U T E R T O M O G R A P H Y ON
20 PATIENTS.
Blankestijn, J.*, Bun, R.J., Berns, R.M., Onland, J.M.,
Sehoen, J.
Department of OMFS, Medisch Centrum Alkmaar,
Alkmaar, The Netherlands
Aims: To investigate the stability of bone transplants in
sinusfloor elevation.
Method: 40 sinusfloor elevations combined with bone-
grafting on the lateral and/or labial aspect of the maxilla
in 20 patients were followed by CT scanning. Scans were
made pre-op, one week post op. and before mplants were
placed.
Results: Even when sinus mucosa was damaged during oper-
ation very little problems arose post-operatively. Mucosal
reactions post operatively diminished in a few months.
Bonegrafts inside the sinus are pretty stabile, but onlay
grafts seem to vanish quickly. A higher quality of trans-
planted spongiosa can be achieved by bone condensing.
Bone biopsies during implantation are related to a higher
risk of implant loss.
Conclusions: Sinusfloor elevation is a safe and long-lasting
procedure.
CONSERVATIVE TREATMENT OF
NONSYNOSTOTIC HEAD DEFORMITIES IN
INFANTS
Biecher* J.-C., Dederichs A., Howaidt H.-P.
Giessen, Germany
In all craniofacial deformities the differential diagnosis
between synostotic and non-synostotic conditions has to be
made. While the first group is usually subject to intracranial
surgical intervention, the treatment of nonsynostotic defor-
mities is discussed controversally. Often associated with pre-
mature birth, restrictive intrauterine environment or
tort±coil±s, these conditions, also defined as positional defor-
mations can lead to severe plagiocephalic head shapes.
We are presenting a conservative method to treat these
deformities in early childhood by means of an individually
fabricated head band. This is produced from an impression
taken from the infant's head by using ordinary piaster.
Basically, dynamic pressure is applied to prominent parts
while leaving space for growth in depressed areas. The device
must be worn 23 hours a day over a period of approximately
3-5 months depending on the grade of deformation and the
child's age.
Within two years we have treated 15 children suffering
from various degrees of nonsynostotic head deformations.
Through clinical, anthropometric and radiographic evalu-
ation it has be shown that this treatment corrects posi-
tional deformities of the cranial vault, skull base and
upper face with no relapse following treatment at this
time.
It must be emphasized that the method is simple, easy to
handle and very effective when treatment starts within the
first 6 months of age. Therefore its potentials should be
known by pediatricians and craniofacial surgeons.
ONLAY AUGMENTATION OF THE CLASS 1V
MANDIBLE
Blijdorp P.A.
Department of OMFS, Rijnstate Hospital, Arnhem, the
Netherlands
The Class IV atrophic mandible and maxilla is characterised
by a knife-edge ridge, while the height is generally main-
tained to its original level. Patients with a Class IV resorp-
tion pattern usually show very little collapse of the
circumoral soft tissues. When an implant supported pros-

thesis is planned, the issue arises whether the alveolar ridge
height should be reduced in order to reach a level where the
mandible is wide enough to accommodate endosteal
implants. This would inevitably go along with loss of sup-
port for the lips.
Indications for augmentation, i.e. widening of the nar-
row ridge depend on patient's age, general health and aes-
thetic needs apart from prosthetic criteria such as
maintenance of intermaxillary space and intermaxillary
relationship.
This presentation will deal with the experience gained
with about 15 patients who were treated with onlay grafts in
order to accommodate endosteal implants. The technique
and results will be "presented and the pro's and con's of this
method will be discussed.
INCREASED EXPRESSION OF THE TUMOR-
ASSOCIATED PROTEASES UROKINASE-TYPE
P L A S M I N O G E N ACTIVATOR (UPA) AND ITS
INHIBITOR PAI-1 IN ORAL S Q U A M O U S CELL
CARCINOMA (OSCC)
Bock KP* Zeilhofer HF, Dettmar P, Hundsdorfer B, Schmitt
M, Sader R, Geletu G, Gagl X, Kiircher H, Horch HH,
Dpt. of Oral and Maxillofacial Surgery, University of
Technology, Munich, Germany
Purpose: Several cell biological studies have shown that the
invasiveness of a variety of solid malignant tumors
depends at least in part on the serine protease urokinase-
type plasminogen activator (uPA) and its inhibitor PAI-1.
uPA is secreted as the zymogen pro-uPA by tumor cells and
a variety of normal cells. Cathepsin L activates pro-uPA to
the enzymatically active uPA which binds to its receptor
uPA-R. Receptor-bound uPA converts plasminogen into
plasmin. Plasmin degrades tumor matrix components (e.g.
fibrin, fibronectin, laminin). Thus tumor invasion and
metastasis are enabled, uPA is inhibited by PAI-1 which is
also synthesized by tumor cells. Various independent stud-
ies on different kinds of cancer (e.g. cancer of the breast,
ovary or kidney) have proved the prognostic impact of uPA
and PAI-I. Elevated levels of uPA and/or PAI-1 correlated
with increased malignancy of these diseases (reduced
relapse free and/or overall survival of the patients). For
OSCC, however, the possible prognostic revelance of the
tumor-associated proteolytic factors uPA and PAI-1 to the
malignant process has to be evaluated. Up to now the only
survival-related statistically independent factors in OSCC
are histomorphological parameters as nodal status, grading
or tumor size.
Methods: In the present study in tissue extracts (Triton X-
100) of oral cancer and mucosa specimens taken from the
same patients (71 patients), uPA and PAI-1 antigen concen-
trations were determined by highly sensitive enzyme-linked
immunoassays (ELISA).
Results: uPA and PAL1 were highly elevated in cancer tis-
sues in contrast to tissue extracts obtained from normal
mucosa (uPA: about 23-fold, PAI: about 5-fold). There was
no correlation between the uPA and PAI-1 antigen concen-
trations and classic prognostic factors as nodal status (uPA:
p = 0.47; PAI-I: p : 0.26), grading (uPA: p ~- 0.36; PAI-I: p
= 0.42) and tumor size (uPA: p = 0.08; PAL-l: p : 0,09).
Conclusion: These results suggest that the invasive and
metastatic potential of OSCC and the overexpression of uPA
and PAI-1 are correlated. The clinical impact for prognosis,
overall survival and therapeutic strategy (surgery, chemother-
EACMFS Abstracts, Helsinki Congress 1998 19
apy, radiotherapy ) for patients has to be evaluated in the
future. Within the last years evidence has been accumulated
that the plasminogen activation system could be a new target
for cancer therapy, e.g. by antibodies to uPA or PAL 1.
STABILITY OF OSTEOSYNTHESIS FOLLOWING
SAGITTAL SPLIT OSTEOTOMY OF THE
MANDIBLE USING RESORBABLE SCREWS A
COMPARATIVE BIOMECHANICAL IN VITRO
MODEL IN THE PIG MANDIBLE
H. B6hm*, M. Merwald, H. Pistner, J. Reuther
Department of Oral and Maxillofacial Surgery, University of
Wiirzburg, Germany
Aim: Sagittal split osteotomy is a frequently performed pro-
cedure. Rigid fixation using plates and screws can be consid-
ered as standard for the osteosynthesis. Our aim was to
gather information about the stability of osteosynthesis
using different methods and materials. A newly developed
resorbable screw consisting of a totally biodegradable poly-
lactide copolymer-blend material ([Poly-(L-co-DL-LA)
(90/10)]/(Poly (DL-LA) 80/20] was of special interest.
Method: Fresh pig mandibles were split according to
Obwegeser-Dal Pont. The ascending ramus was fixed into a
frame and mounted into a universal testing machine. The
segments of the mandible were positioned at a distance of 2
mm and fixed to each other by 7 different methods. We
tested different types of metal-screws (titanium 3.5 mm zE,
2.7 mm ZE and 2.0 mm iE; CrCoMb 2.7 mm A~) and the
new copolymer screw (3,5 mm A~). Three screws of each
group were inserted in the classical triangular geometry.
Furthermore, we examined 3 2.0 mm A2 titanium-screws in
a linear formation and also a six-hole titanium miniplate.
Simulating the conditions in humans, a load was applied to
the teeth with a lever-arm of 50 mm to the inner angle of the
mandibek The testing machine proceeded until a drop in
resistance of at least 10 % occured.
Results: An average maximum stability of 160 N in the 3.5
mm titanium screws, of 183 N in the 2.7 mm titanium
screws and of 173 N in the 2.7 mm CrCoMb screws was
observed. The stability (121 N) of the polylactide screw was
statistically equivalent to the 2.0 mm titanium screw in a tri-
angular array (136N) and in a linear formation (113 N).
Conclusion: All metallic plates and screws tested in this
study are routinely successfully used for fixation after
orthognathic surgery. The newly developed polylactide
screw proved to be equivalent to the 2.0 mm titanium
screws for osteosynthesis. We conclude that the resorbable
screw is promising for clinical use in sagittal split
osteotomy.
@=~ THE SURGICAL I M P L I C A T I O N S OF AN
ALVEOLAR BONE GRAFT AUDIT
Peter Ward-Booth F.R.C.S,F.D.S., Allan Thom F.D.S.
Queen Victoria Hospital, East Grinstead UK
Alveolar bone grafting plays an important role in the man-
agement of cleft lip and palate patients. It helps ensure nor-
mal eruption of teeth, creates support for the alar base, and
forms an intact arch. Some reports show mixed results from
high success to poor outcomes.
20 Journal of Cranio-Maxillofacial Surgery
A recent audit of 70 cases in our unit showed generally
good outcomes, when the following parameters were
examined:
* eruption of teeth
* alveolar height
* periodontal pocketing
* donor site morbidity
The study however also demonstrated improvements
may be possible with the following modifications:
* changes in design of the flap
* selection of another donor site, tibia
* pre operative extraction of deciduous teeth.
HISTORY AND DEVELOPMENT OF
BIODEGRADABLE MATERIALS
*R.R.M. Bos, DDS, PhD.
Dept. of Oral and Maxillofacial Surgery University Hospital
Groningen, The Netherlands
In the internal fixation of cranio maxillofacial fractures and
osteotomies, but also in orthopaedic surgery, bioresorbable
polymeric plates and screws may be a good alternative for
metallic ones because functional stresses are gradually
transduced to the bone and if total resorption is accom-
plished, a second operation for the removal of the plates
and screws will be unnecessary.
In the late sixties and early seventies the first few studies
on biodegradable polylactide and polyglycolide were pub-
lished. Kulkarni et al. and Cutright et al. successfully used
biodegradable poly(lactide) acid polymers as suture material
and osteosynthesis material. Cutright et al. also tested poly-
lactide for the fixation of mandibular fractures in dogs and as
orbital floor sheets in monkeys with good results. Another
field of interest in this period were polylactic or
polylactic/glycolic acid copolymers developed for drug deliv-
ery systems. It can be concluded that in the early seventies a
wide variety of applications of degradable biomaterials were
investigated.
in the second half of the seventies, experiments with
polymer blends and copolymerisation of mainly polylac-
tide (PLA) and polyglycolide (PGA) were performed.
These polymers were widely used as drug delivery systems,
uteral implants, suture material or as a vascular prosthesis.
In the eighties, experiments were not only performed to
study the clinical applications but also to study the chemical
and mechanical properties of a polymer during degrada-
tion. Low molecular weight samples degraded faster than
hight molecular weight samples. A number of experiments
on differently processed polylactides and stereo-copolymers
with varying amounts of D-lactide and L-lactide used for
bone plates and screws proved that PLA 100 (100% L-lac-
tide) had the best mechanical properties and a slow degra-
dation rate. In Finland a synthesis was developed in which a
selfreinforcement procedure resulted in better mechanical
properties of polyglycolide and polylactide implants.
The development of mainly polylactides with good
mechanical properties and a favourable degradation rate,
stimulated in a number of surgical fields research on the
replacement of metallic devices by resorbable materials dur-
ing the late eighties and nineties.
Despite being extensively studied for more than 30 years,
biodegradable materials have not replaced metallic
osteosynthesis devices except for some limited indications.
Current and future research will have to solve problems
like limited mechanical properties, appropriate degrada-
tion, biocompatibility, sterilisation, shelf life and han-
dling before biodegradable devices will be as save and
effective as metallic ones. However, it is worthwhile trying
hard.
VARIATION OF LE FORT OSTEOTOMIES IN
CLASS IlI PATIENTS WITH N O R M A L AND
INCREASED FACIAL DIVERGENCE.
Bottini D.J. * ; Brunelli A. ; Sassano P.P. ; de Ponte F.S.
"La Sapienza" University of Rome Italy Maxillo-Facial
Unit (dir. Prof G. Iannetti)
Spatial jaws' repositioning and facial divergence correc-
tion are important aims of orthognatic surgery per-
formed on class III patients . A bimaxillary surgical
treatment is the most indicated way to reach these goals
because of the frequent involving of both the maxilla
and the mandible in facial skeletal malformations. A
careful preoperative surgical planning of maxillary set-
tings is basic in order to reach a better spatial correction
of the mandible and of facial divergence. A clockwise
rotation of the bispinal plane permits a better correction
of mandibular protrusion and a opening of the facial
divergence angle.
In this study 40 patients, affected by class III malforma-
tions, treated by bimaxillary Le Fort and bilateral sagittal
split osteotomies with RIF osteosyntesis, where selected
and divided into two groups differing on kind of maxillary
settings. In the first group all patients underwent a clock-
wise rotation of the bispinal plane, while in the second the
inclination of the maxilla was not changed. Normo- and
hyperdivergent patients were distinguished in the two
groups. All patients underwent a pre- and post-operative
clinical-photographic and cephalometric analisys in order
to make a correct diagnosis of site and entity of the malfor-
mation and to check skeletal and soft tissues aesthetic and
functional result.
The results of the study confirmed that the clockwise
rotation of the maxilla gives a better correction of the sagit-
tal projection of the mandible and a highering of the facial
divergence angle.
The study comes to conclusion that, for a better aesthetic
and functional result, clockwise rotations of the bispinal
plane, carried out by le Fort osteotomies, are preferred in
class III patients with normal facial divergence angle, in
order to reach a better sagittal skeletal correction of the
mandible. Furthermore in hyperdivergent patients maxillary
settings should be performed without changing the inclina-
tion of the maxilla itself; surgical changings on the gonial
angle opening (by the use of allopalstic or homologous
grafts) are infact more difficult to carry out rather than a
genioplasty for an addictional correction of chin
protrusion.
TWO DIMENSIONAL PROFILE CHANGES
MODELISATION AND PREDICTION FOR FACIAL
OSTEOTOMIES - A NEW COMPUTER DESIGN
PROCEDURE.
Boutault F. *(1), Laborie 3/[. (2), Lauwers F. (3), Dodart L.
(1), Paoli J.R. (3)

Maxillofac. Surg. Unit - Purpan University H o s p i t a l -
Toulouse - France Institut de Recherche en Informatique -
Toulouse - France Maxillofac. Surg. Unit - R a n g u e i l
University H o s p i t a l - Toulouse - France
Aims: To elaborate a computer-design procedure in order to
obtain automatically an immediate and realistic profile pre-
diction simulation for patients who are going to undergo
maxillary and/or mandibular osteotomy
Method: This study was made on 31 patients with pre-
and post-operative lateral cephalographs. Typical
osseous and cutaneous landmarks were recorded and
cutaneous profile lines were modellized (using Beziers
curves).A statistical evaluation of the key-points modifi-
cations was made regarding correlations with bony and
dental structure movements.Thus, it became possible to
apply these rules to each case and to compare with the
real result. Furthermore, the same procedure was applied
in new cases where bony movements were known retro-
spectively.
Results: Although the appreciation of the result is obvi-
ously subjective, this procedure has been proved to be bet-
ter than usual procedures based on statistical (or
non-statistical) knowledge of cutaneous landmark move-
ments in about 70% of the cases. For the others, however,
poor results were seen, especially for patients presenting a
pre-operative lip maloclusion or a very severe facial
deformity.
Conclusion: Even if there are many problems to solve before
using this method as a routine procedure, this new approach
seems more reliable than all others previously published. On
the other hand, we need further studies, particularly con-
cerning unusual cases since we do not have enough study
cases.
V I D E O - E N D O S C O P I C ANTRAL CONTROL
DURING SINUS LIFT GRAFT AUGMENTATION
Boutault F.*(1), Lauwers F.(2), Paoli J.R.(2), Dodart
L.H)
Maxillofac. Surg. Unit - Purpan University H o s p i t a l -
Toulouse - France Maxillofac. Surg. Unit - Rangueil
University H o s p i t a l - Toulouse - France
Aims: Over the past ten years, sinus lift graft augmentation
has become a routine procedure. Meanwhile, mucosal dam-
age or bone graft malposition can still occur. We have tried
to investigate whether simultaneous sinusoscopy could
make surgery more reliable.
Method: The material is simply a rigid sinusocope which is
passed into the antrum via the nasal airway. A control mon-
itor displays the endoscopic view while the mucosa is ele-
vated by a standard procedure.
Results: As can be clearly seen on the video, mucosal dam-
age can easily be avoided thanks to direct vision of the
mucosal elevation. On the other hand, it seems rather hard
to appreciate the exact anatomical conditions of the graft.
More experience is obviously needed.
Conclusion: Even if endoscopic control needs a specific
device and is time consuming, it provides better security and
seems really interesting. This is particularly true for surgeons
in training or having less experience in the sinus lift
procedure.
EACMFS Abstracts, Helsinki Congress 1998 21
[~ MULTIDISCIPLINARY APPROACH IN THE
MANAGEMENT OF PATIENTS PRESENTING WITH
GRAVE'S DISEASE
Gas C (1), Boutault F.*(1), Caron P.(2), lmbert P.(3),
Bachaud J.M. (4), Arrue P. (5), Dodart L. (1), Lauwers F.
(6), Paoli J.R. (6)
Maxillofac. Surg. Unit - Purpan University Hospital - Toulouse
- France Endocrinology Depart.- Rangueil University Hospital
- Toulouse - France Ophthalmologist - Privatepractice -
Toulouse - France Radiotherapy - Centre Claudius R e g a u d -
Toulouse - France Radiology Depart.- Rangueil University
Hospital - Toulouse - France Maxillofac.Surg Unit - Rangueil
University Hospital - Toulouse - F r a n e e
Aims: Grave's ophthalmopathy leads to several functional
and aesthetic disturbances which are always badly tolerated
by the patients. M a w types of treatment have been used
with rather good published results. On the other hand, these
procedures are generally focussed on a specific aspect of the
disease and some of them seem contradictory. We present
the preliminary results of a multidisciplinary approach
implicating five different medical or surgical specialities.
Method: From 1995 to 1997, 35 patients were examined
explored and treated, representing almost all aspects of
Grave's disease. All outpatient sessions were carried out with
at least three different physicians including an endocrinolo-
gist. The first step was to restore or maintain euthyroidism
before oculo-orbito-palpebral therapy. The medical treat-
ments were based on steroid therapy or radiotherapy. The
sm'gical procedures included orbital enlargment bone surgery
and myo-palpebral surgery with or without lipectomy.
Results: A decisional chart was elaborated and a therapeutic
sequence was specified at the end of this study. Some inter-
esting results were obtained.
Conclusion: Even if it is obvious that more cases and experi-
ence are needed, one can expect a real improvement in the
results by such an approach.
r7 THE ROLE F O R LASERS IN THE FIELD O F ORAL
AND MAXILLOFACIAL SURGERY, SAFETY
MEASURES AND FUTURE SCOPE.
Paul F. Bradley MD; BDS; FRCS; FDS
INTRODUCTION:
Lasers offer a major innovation in the field of surgery in that
they allow the precisely controlled application of energy to the
tissues, either by beam or fibre. Laser radiation has three main
characteristics: coherence, collimation and mono-chromatic-
ity. These allow great precision and predictabillity of effect
which may be at a microscopic or macroscopic level. The pro
facial region is very well suited to laser usage in that it is read-
ily accessible for treatment and subsequent assessment
CLASSIFICATION:
Laser treatment may be considered under three main
headings:
1. High Intensity Laser Therapy (HILT) for the ablation or
cutting of soft and hard tissues. In soft tissue cutting may
be achieved with haemostasis and obivation of the need
for sutures. In the case of hard tissue there may be less
noise, vibration and pain than with conventional drills.
22 Journal of Cranio-Maxillofacial Surgery
2. Selective Laser Therapy (SELT). Lasers may selectively
destroy one cellular population while leaving an adjacent
or overlying one intact. This may achieved by the careful
consideration of wavelengths and absorption coefficients
as in the treatment of port wine stains by tuneable dye
lasers. Alternativley it may be attained by giving a sensi-
tising agent which localises in the tissue of interest as in
photodynaminc therapy.
Low Intensity Laser Therapy (LILT). Here deeply penetrat-
ing wavelengths mainly in the near infra red are used with
minimal thermal effect for pain control and promotion of
healing.
All of these aspects will considered In the symposium.
SAFTEY CONSIDERATION:
Precautions need to be taken during laser therapy as fol-
lows:-
Ocular damage. Far infra red wavelengths may damage
the cornea but mid and near infra red plus some visible
wavelengths can penetrate the lens to damage the retina. It
is essential that protective goggles for the appropiate wave-
length are employed for both patient and doctor.
THE FIRST EXPERIENCE W I T H INTRA-
ARTERIAL A D M I N I S T R A T I O N O F PACLITAXEL
(TAXOL) IN THE TREATMENT O F HEAD AND
NECK CARCINOMAS
Br~zda , A.
Clinicfor Maxillofacial Surgery, University Hospital,
Olomouc, The Czech Republic
Aims: To review the first clinical experience with treatment
of squamous cell carcinomas (scc) of
the head and neck region by intraarterial (i.a.) Taxol admin-
istration. There has not been any
information reported thereon until today.
Method: Thirty patients with scc of the head and neck
region were
undergoing complex antitumour treatment.The first step in
this management was i.a. Taxol application
according to our own regimen. Surgery and radiotherapy
followed this perfusion
Results: The author classified the main effect of Taxol on
the tumours in 4 categories complete response (CR), partial
response (PR), static disease (SD) and progressive dis-
ease(PD). He also noted several side effects. Results showed
a significantly increased C R + P R (30 %) than those after
i.v.application of Taxol. All the side effects were restricted
to tolerable levels.
Conel.: On the basis of the results we can claim that our
regimen of Taxol application i.a. was confirmed. The good
therapeutic responses with minimal side effects give encour-
agement to the further use of Taxol i.a. administration in
head and neck cancers.
I M M E D I A T E VERSUS SECONDARY
RECONSTRUCTION OF THE MANDIBLE BY
FIBULAR F L A P AFTER RESECTION FOR T U M O R
OR RADIONECROSIS (19 CASES)
Breton, P.*, Cresseaux, P., Gounot, N. , Souch~re,
B.,Freidel, M.
Department of Maxillo-Facial Surgery, Hopital Lyon-Sud,
Lyon, France
Aims: To define in which cases a secondary reconstruction
with fibular flap after resection of the mandible is indicated
(except post-trauma or congenital defect reconstruction)
Material: 19 cases are reported (10 osteoradionecrosis, 3
squamous-cell carcinome involving mandible, 3 extensive
benign tumors, 3 sarcomas)
Results: 13 cases had immediate reconstruction ( 8 0 R N , 3
S.C.C, 2 benign tumors). 6 cases had secondary reconstruc-
tion ( 2 0 R N , 1 benign tumor, 3 sarcomas). The main rea-
sons for secondary reconstruction were: necessity of final
histologic results (sarcoma), age of patient (1 year old), sta-
tus of patient (2 cases of ORN), former resection without
planning for tumour immediate reconstruction (1 case of
benign). Alternative technics and surgical procedure are
discussed. Quality of results are compared.
Conclusions: Immediate reconstruction with fibular free
flap after mandibular resection is not always available for
different reasons histologic findings, age or status of the
patient, technical reasons). If a secondary reconstruction
is considered, some technicalprocedures are indicated.
[~ EYEBROWS ASYMMETRY AND ORBITAL
TRAUMATOLOGY
Muriel Brix, Bernard Ricbourg, Ludovic Lecornu, Philippe
Chanavaz
Dept. of MaxilloJacial Surgery, CHU Besanfon - Fr.
The eyebrow is the converging point of muscular forces. The
frontalis muscle interdigitates with the orbital orbicularis
muscle, the corrugator superciliaris muscle, and the pro-
cerus. Eyebrows position is the result of this muscular
antagonism, except for the lateral one-third, which only
depends on the support from deeper structures (supraor-
bital rim, zygomatic bone, eyebrows fat pad).
Each one can be altered in orbital traumatology.
Therefore, the authors propose a radiological prospective
study, which includes all
Patients with facial trauma. It's based on a cephalometric X-
ray after eyebrows opacification.
The authors insist on the importance of a good anatom-
ical restitution, to prevent eyebrows malpositioning and
asymmetry. In fact, these corrections remain surgically difficult.
COMBINATION O F
CARBOPLATIN/IPHOSFAMIDE W I T H LOCAL
H Y P E R T H E R M I A IN H U M A N ORAL SQUAMOUS
CELL CARCINOMAS TRANSPLANTED TO NUDE
MICE.
C. Briicker" P. Sieg, G. Wiedemann
Luebeck / Germany
The therapeutic efficacy of carboplatin (CP) and
ifosphamide (IF) with and without local hyperthermia
(41°C resp. 43°C for 60 rain) was measured in human
derived oral squamous cell carcinomas (n=97, average vol-
ume 180 _+ 80 mm3) growing on the thigh of nude mice.
Untreated turnouts showed an exponential tumour

growth. The animals were randomly assigned to 10 different
treatment groups (n = 9-10). The average tumour volume of
the treated animals was compared with the untreated con-
trols and statistically evaluated. CP alone demonstrated
only a significant growth delay (duration 60 days). I F (62.5
and 125 mg/kg b.w.) alone caused partial tumour regression.
Combination of CP or I F with hyperthermia demonstrated
significant tumour regression. Tumourfree survival 60 days
after treatment was observed just as well after applicmion of
CP (6 mg/kg b.w.) and hyperthermia (43°C) as I F (125
mg/kg b.w.) and hyperthermia (41°C). These preclinical
dates indicate a clinical phase I/II - study using CP or I F in
combination with hyperthermia in patients with advanced
squamous cell carcinoma of the head and neck region.
[ ~ A P P L I C A T I O N O F SILOCSANE IN FACE
R E C O N S T R U C T I O N SURGERY
L.A. Brusova,
Department of Face Neck Plastic Surgery, Central Research
Institute of Stomatology, Moscow, Russia
AIMS:
The demonstration of usage of individually modelled siloxane
implants in elimination of nose and mandible deformities.
METHOD:
Methods of individual production of silicon implants were
developed in purpose of maximum filling of defect and
exact adequacy of made implant to current person.
RESULTS:
Application of siloxane implants in patients with post-trau-
matic and congenital deformities allows recovering aesthetic
proportions of face. There is shown a possibility of recovering
the contour of mandible after osteo-reconstructive operations.
CONCLUSIONS:
Long-term observations allow making a conclusion that
surgical method of treatment using siloxane materials is less
traumatic and allows achieving good functional and social
rehabilitation.
[ ~ FDL~.TION OF FRONTOORBITAL OSTEOTOS~_S
BY MEANS OF RESORBABLE MINIPLATES
Bschorer R.
Klinikum Schwerin, Departement of OMFS, Clinic Schwerin,
Wismarsche Strafle 397, 19049 Schwerin, Germany
VIDEO PRESENTATION:
The surgical technique of frontoorbital osteotoy in aperts
syndrome and its stabisisation by means of resobable mini-
plates (Lactosorb) is shown. First results show the advan-
tage of the technique in comparison to titanium miniplates.
ONE STAGE TREATMENT M E T H O D O F
ZYGOMATIC FRACTURES BY MEANS O F
RESORBABLE M E S H E S AND A
TRANSCONJUNCTIVAL APPROACH
Bschorer R., Knauf U.
EACMFS - Abstracts, Helsinki Congress 1998 23
Klinikum Schwerin, Departement of OMFS, Clinic
Schwerin, Wismarsche StraJ3e 397, 19049 Schwerin,
Germany
AIM:
Usually the removal of metal plates is done a half year after
fixation of fractures of. Our method concerning the orbital
floor and the zygomatic bone avoids this additional mea-
surement and shows some interesting aspects.
METHOD:
20 patients with fractures of the zygoma and the orbital
floor were treated by the standard technique (subcilliary
approach, titanium miniplate fixationm, ethisorb patch lin-
ing of the orbital floor). Another 20 patients with the same
kind of fracture were treated by the transconjunctivally
approach together with a lateral canthotomy and fixation
was done with resorbable meshes which at the same time are
used to reconstruct the orbital floor. Advantages and disad-
vantages of the techniques were analyzed (costs, time, aes-
thetic results, complications).
RESULTS:
Nevertheless costs of the resorbable plates are high, the
averall treatment costs were low. The additional removal of
plates is avoided. Additionally the aesthetic result is supe-
rior when using the transconjunctival approach while no
complication was observed in both groups.
CONCLUSION:
Whenever the patients are young and therefore have no visi-
ble subcilliary folds and when there are no open wounds we
recommend the one stage treatment method.
ANTIBIOTIC PROPHYLAXIS IN MAXILLOFACIAL
SURGERY: P E N I C I L L I N VERSUS CLINDAMYCIN
Bublitz R., Denis R., Petrin G. *, Weingart D.:
Department of Oral, Maxillo and Facial Plastic Surgery,
Katharinenhospital, Stuttgart, Germany
Aim" To compare the efficiency and economic aspects of the
use of penicillin G compared with clindamycin in the antibi-
otic prophylaxis of surgical wound infections in maxillofa-
cial surgery.
Method: A total of 178 patients having had orthognathic
operations or open zygomatic reductions were analyzed.
The study was begun on the date the treatment regime was
changed. A prospective group received one-shot Penicillin.
As control group we used a retrospectively analyzed group,
having received Clindamycin, including the same number of
patients. Exclusion criteria were defined. Both groups were
homogeneous in their composition and established risk-fac-
tors for surgical wound-infection, such as the ASA-status,
wound-classification, duration of the operation and type of
surgery. The frequency of surgical wound infections, as
defined by the Centers of Disease Control in 1992, and the
costs per case were to be compared and evaluated statisti-
cally.
Result- The frequency of surgical wound infection was 5.9 %
in the penicillin group versus 11.1% in the clindamycin
group. The difference was not statistically significant. The
costs per case were 23 times higher for clindamycin. There
were no adverse side-effects recorded for penicillin, but five
such side-effects for clindamycin.
24 Journal of Cranio-MaxillofacialSurgery
Conclusion: We conclude that penicillin G in the single shot
mode is an effective and economic method of choice in
antibiotic prophylaxis of surgical wound infection in the
cases studied.
INTRAORAL M I C R O S U R G I C A L A N A S T O M O S I S
OF THE RADIAL F O R E A R M F L A P
Bublitz R. *, Weingart D., Denis R.:
Department of Oral, Maxillo and Facial Plastic Surgery,
Katharinenhospital, Stuttgart, Germany
Aim: The radial forearm flap has evolved as "the work-
horse" in micro-surgically-assisted reconstruction of intrao-
ral defects that need pliable tissue from a distant donor site.
Its recipient vessels are easily accessible if the neck has to be
approached anyhow. If this is not the case, the common
extraoral approach to the neck vessels risks considerable
additional morbidity solely for the purpose of gaining
access to the recipient vessels. In these selected cases an
intraoral access to the anastomosis site may minimize the
surgical trauma and benefit the patient. This approach has
not been described in the current literature.
Subject: Among 25 radial forearm flaps that were trans-
planted at our institution within the preceding 18 months,
only 1 was applied in a non-oncological case. An attempt
had been made elsewhere, numerous times, to close a persis-
tent oro-nasal fistula in a 30-year old bilateral cleft patient
(male). A radial forearm flap was chosen to serve as the
appropriate tissue for fistula closure. Access to the facial
vessels was gained through an intraoral exposure via the
buccal plane.
Result: The case demonstrates the technical feasibility of an
intraoral approach and small vessel-anastomosis. A single
horizontal trans-buceal incision was used. Parotid duct and
facial nerve damage did not occur. The flap's circulation was
never compromised, healing was uneventful. Secondary
trimming, thinning and adaptation of the flap was, however,
needed to achieve a smooth and watertight closure.
Conclusion: In selected cases where no external scars are
present and the only reason to open the neck is for access to
the vessels, an intraoral approach should be considered.
This approach requires considerable technical experience in
the microsurgical team working in such a restricted surgical
field.
HAEMOSTATIC PROCEDURES IN ORAL
SURGERY ON PATIENTS RECEIVING ORAL ANTI-
COAGULATION THERAPY: COLLAGEN VERSUS
TRANEXAMICACID M O U T H W A S H
Bublitz R., Hofmann S., Denis R.*, Weingart D.:
Department of Oral, Maxillo and Facial Plastic Surgery,
KatharinenhospitaI, Stuttgart, Germany
Aim: The literature recommends the local application of
tranexamic acid to surgical wounds or as a mouthwash in
oral surgery on patients who are on an anticoagulation
therapy. This study evaluates the benefits of such
treatment.
Method: In a clinical prospective and randomized study on
a total of 101 patients, we evaluated the effects of different
local haemostyptic techniques. In all patients, the individ-
ual anticoagulation medication remained unchanged. I N R
values were recorded. The type and number of surgical
interventions was noted. Twenty eight patients were treated
by local application of tranexamic acid into the surgical
wound intraoperatively, and by regular mouthwashes post-
operatively (10 ml 5 % Tranexamic acid, four times daily).
Thirty three patients were treated by local application of
collagen into the surgical site and a postoperative protec-
tive splint. A third group received no local treatment but
surgical wound closure by local flaps as well as a postoper-
ative splint.
Result: With tranexamic acid 7 . 1 % of the patients experi-
enced an episode of bleeding postoperatively. Collagen
patients had post-operative bleeding in 21.2 %. Wounds that
had been surgically closed had an incidence of 36,6 % post-
operative bleeding episodes.
Conclusion: The low rate of postoperative haemorrhage in
patients with an intraoperative wound rinse and postopera-
tive mouthwashes with tranexamic acid proved this to be the
most effective way of preventing bleeding.
Costs per case were higher in this group, however. In the
clinical situation higher costs per case will have to be
weighed against the benefit of a reduced frequency of post-
operative bleeding episodes and probably hospitalization
and treatment time.
INTRAORAL RECONSTRUCTION W I T H
BUCCINATOR ARTERIAL M Y O M U C O S A L AND
MUCOSA-LIKE FLAPS.
Buric N. *, Krasic D., Visnjie M.
Medicine Faculty - Clinic of Stomatology Oral and
Maxillofacial Surgery, Clinic of Surgery-Plastic Surgery,
Nis, Serbia (Yugoslavia)
Aims: To investigate the possibilities of 'like-to-like' recon-
struction of oral cavity defects of various origins.
Method: A group of 28 patients with intraoral defects has
been treated, in the period from 1991 to 1997, in the age
group from 22 to 75 yrs. male/female ratio 2:1. The defects
were created as follows: after turnout surgery in 15 (53.5%)
pts, creation of extensive oro-antral communication 4
(14.2%/) pts, oro-nasal fistula in 1 (3.5%) pts,. posterior part
of mandible in 3 (10.7%) pts. buccal region in 3 (10.7%) pts.
and floor of the mouth in 2(7.1%) pts. The anteriorly based
on facial artery buccinator myomucosal flap was used in 5
(17.8%) pts, posteriorly based on buccal artery myomucoc-
sal flap was used in 18 (64.2%), myomucosal nasolabial
island flap based on the facial artery in 2 (7.1%) pts, and in
8 (10.7%) pts, galeal flap was used in the reconstruction of
the buccal region.
Defects were created due to: ablative surgery of carci-
noma(T2NoMo ) in 20 pts, a cystic lesion in 7 pts, oro-nasal
fistula as a consequence of previous cleft palate surgery in 1
pt. Direct complications such as infection, haematoma,
dehiscence occurred in 4 (14.2%) pt. All complications were
successfully treated with conservative therapy. Donor site
morbidity was minimal in the group with buccinator
myomucosal flaps, with recovery time of approx 7-9 days; in
galeal group it was 12-14 days.
Conclusions: Due to easy harvesting and minimal mor-
bidity of buccinator myomucosal flaps and the flaps
being of the same tissue as the intraoral defects, it is pos-
sible to achieve 'like-to-like' reconstruction of intraoral
defects.

K A P O S I SARCOMA AND K A P O S I HIV S A R C O M A
Burlibasa, C. Chiril~ L
Clinical Hospital of Stomatology, Department of Maxillo
Facial Surgery, Carol's Davila University, Bucharest,
Romania
Kaposi sarcoma was known since 1872, but only in 1981 did
it become important because of its association with HIV
infections.
It is considered as a multifocal systemic cancer. It is his-
tologically characterised by the proliferation of fibroblastic
and microvascular elements.
The lesions can be situated on the limbs, head, neck and
oral mucous membrane. However, they can also be found in
lung, liver, spleen and lymph nodes.
We present a case of Kaposi sarcoma with extremely
agressive manifestations on the extremities.
A partial glossectomy was performed 15 years ago
followed by radiotherapy treatment on the extremities.
There was no morbidity and no recurrancies to this patient.
Another case in which primary manifestations of HIV
infection were located on the face and oral mucous mem-
brane, the subject survived only 6 months.
A R T H R O S C O P I C MANAGEMENT O F T M J
DISORDERS: OUR EXPERIENCE
Burlini D., Ferrari Parabita S., Zanetti If.
Department of Maxillo Facial Surgery-Civic Hospital of
Brescia-Italy. (Head. Prof. Ferrari Parabita G.)
AIMS:
To know the real impotance of diagnostic and therapeutic
TMJ arthroscopy.
METHOD:
In the last few years temporo-mandibular arthroscopy has
become a successful method for diagnosing and treating
TMJ disorders. This type of analysis allows a direct view of
the upper joint cavity and the meniscus without altering the
joint's anatomic integrity. It also permits dynamic investiga-
tion and at the same time to do articular surgery.
RESULTS:
Our study includes 256 patients (that is 221 females and 35
males)aged between 17 and 68 years and admitted between
1987 and 1998 to the Division of Maxillo Facial Surgery of
Civic Hospital of Brescia. Thanks to direct intraoperational
view on the monitor, arthroscopy permits a rapid exploration of
the joint as a follow up and addition to X-ray pictures.
Therefore degenerative pathological diagnosis can be easily con-
firmed and at the same time a surgical treatment is organized.
CONCLUSION:
In diagnostic terms, arthroscopy offers all the data provided by
traditional radiology, plus pathological details observable only
ha direct view. In therapeutic terms, washing and cortisone infil-
tration alone are sufficient to eliminate symptoms in a large
number of cases. Then specific arthoroscopic surgical proce-
dures may be performed in the superior joint. In the last months
the laser is introduced in the treatment of TMJ disorders.
EACMFS - Abstracts, Helsinki Congress 1998 25
A NEW S M A L L INTERNAL FIXATOR F O R EASY
AND FAST INSERTION IN MAXILLOFACIAL
APPLICATIONS
Biischer, Ph.,.Hehli, 3/1.
A 0 Development Institut, Davos, Switzerland
SUBJECT.
Conventional screw-plate systems for maxillofacial surgery
require: 1) a hole to be drilled before insertion of each self-tap-
ping screw, which is time-consuming; and 2) pressure of the
plate on the bone surface during screw tightening. This screw-
plate-bone interaction frequently causes intra-operative strip-
ping of the bone thread during screw insertion. To avoid this
significant problem, the maximum torque should not be
exceeded. The problem is that a feel for maximum torque is
subjective, and requires surgical practice and experience.
THE NEW INTERNAL FIXATOR FOR
MAXILLOFACIAL APPLICATIONS.
In order to simplify the surgical technique and decrease the
operative time, a new internal fixator has been developed for
maxillofacial applications. This new fixator uses self-drilling
and self-tapping screws which are inserted by machine. To pre-
vent screw pull-out, screw insertion in the bone stops auto-
matically at a pre-determined insertion depth. This is achieved
with a conical thread around the screw head which locks into
a corresponding conical, threaded hole in the fixator. This
locking effect produces an increase in insertion torque. The
maximum insertion torque is reached when the screw head
reaches its final position. The machine is designed to stop at
this point in order to prevent screw damage. The locking
mechanism works even if the fixator is bent or twisted. After
bending and twisting the fixator, the screws can still be
inserted into the threaded fixator holes. Test results will follow.
Since the new system functions as an internal fixato~; there is
no compression between the fixator and the bone surface
which occurs with conventional systems. Thus, the risk of
stripping the bone thread is minimized. In addition, the risk of
instability of the new fixator due to screw loosening in the
bone is reduced since the screw is now locked in the fixator.
Conclusions. The new internal fixator simplifies the surgical
technique due to the automated, one-step insertion of the
self-drilling / self-tapping screw. This one-step procedure
has the additional advantage of eliminating the problem of
re-locating pre-drilled holes in the bone for screw insertion.
TITANIUM/TITANIUM NITRIDE
T E M P O R O M A N D I B U L A R J O I N T PROSTHESIS:
CLINICAL A P P L I C A T I O N AND 5-YEAR
ASSESSMENT
Biitow*, Kurt- W and Biackbeard, CA.
Department of Maxillo-Fac&l and Oral Surgery, University
of Pretoria, and Southern Implants (Pty) Ltd, Irene, South
Africa
Aim: The new anatomically-simulated prosthesis, manufac-
tured from pure Titanium and the articulation surface
coated with Titanium Nitride (the condylar-head-ramus
and the glenoid-fossa parts), was published in 1994 (Hands-
On, 1994;6:23-26). The clinical application and clinical and
research assessment over five years, will be presented.
26 Journal of Cranio-MaxillofacialSurgery
Subject: Two separate baboon studies were undertaken, I)
1992-1994, ii) 1997-1998. Since 1995 the
Titanium/Titanium Nitride Temporomandibular prosthesis
has been placed in 27 patients in South Africa and
Australia. The application in 1 l baboons and patients will
be presented.
Results: The prosthesis was placed in vitro, under stringent
abrasion-resistant tests with very positive results. The two
parts are placed through a pre-auricular and submandibular
incision. In the animal study, significant bone regeneration
and partial encapsulation around the ramus and glenoid-fossa
parts took place. The patients who had developed an end-
stage temporo-mandibular joint disease - some had had up to
six previous surgical interventions - were reconstructed surgi-
cally. Four patients had complications such as a slight squeak-
ing sound during the first three weeks, post-operatively.
C o n c l u s i o n : Based on the data obtained in the baboons as
well as in the patients, the short-term results in regard to
comfortable function are very promising and the planned
objectives of this long-term research have been achieved.
THE ANATOMICAL L I P PLASTY FOR THE
PRIMARY SURGICAL REPAIR OF THE CLEFT LIP
AND NOSE: L O N G - T E R M A S S E S S M E N T
Biitow ~, Kurt- W.
Department of Maxillo-Facial and Oral Surgery, University
of Pretoria, Pretoria, South Africa
Aim: The re-assessment of the "anatomical lip plasty" in
primary unilateral cleft lip and nose surgery, which was pre-
sented in 1989 (6th Int. Congr. on Cleft Palate and related
Craniofacial Anomalies) and published in 1990 ( J Cranio-
Max. Fac. Surg.)
M e t h o d : One hundred children in the 8-11 year age group,
were re-assessed in respect of this particular deformity. The
assessment took into consideration the aesthetic appearance
of the lip, including lip skin with philtrum edges, the lip
red/white junction,the lip red dry/wet junction and the nasal
sill with the nasal base rotating. The original surgical proce-
dure was then compared with the same procedure with
modification as is presently being done.
R e s u l t s : There are certain discrepancies in the alignment of
the scar tissue in regard to the objective and its final result.
Further flattening of the original lip to the present form has
been assessed by the difference in appearance. The alar base
rotation was achieved in all cases, however the flattening of
the unilateral nasal dome is less marked in the latter group.
Conclusion:Based on the results of this study, a more cen-
tralising philtrum cut in the skin has to be implemented the
wider the cleft deformity present at surgery. Extensive dis-
section between the nasal mucosa and alar cartilage for the
repositioning of the cartilage on the cleft side, is advisable,
without dissection of the nasal dome.
ILIAC CREST FREE F L A P : PREVENTION O F
C O M P L I C A T I O N S IN DONOR-SITE CLOSURE.
CalderOn J% Ferndndez-Alba J,, Concejo C, Ochandiano S,
Navarro- Vila C.
Department of Maxillofacial Surgery. Gregorio Mara~6n
Universitary Hospital. Madrid. Spain.
INTRODUCTION: Iliac crest free flap provides the bone
with better quality and volume for mandibular reconstruc-
tion and placement of osseointegrated dental
implants.However, there are still some concerns about the
complex anatomy of the inguinal region and the possible
morbidity and complications in the donor site secondary to
harvesting of this flap.
AIM: To demonstrate that morbidity of the donor site can
be strongly reduced with an adecuate closure procedure and
some post-operatory cares.
M E T H O D S : We analyze our experience with the iliac crest
free flap in 28 patients for 5 years. In 7 cases the flap
included the internal oblique muscle. We show step by step
the method of closure of the iliac crest donor site defect,
with eschemes and photographs from cadaveric dissections.
When internal oblique muscle is harvested too, we utilize a
synthetic mesh to repair the abdominal wall defect. To
decrease postoperative pain we also place a catheter in the
surgical wound to instilate local anesthesia through, that
makes easier beginnnig ambulation..
RESULTS: We had only 2 cases of abdominal hernia, one
in the beginning of our serie and the other one in a 68 years
old patient with postoperative infection of the donor site.
One of the 7 patients closed with a ynthetic mesh developed
a seroma, that healed without mesh removal. 18 patients
referred anesthesia in the lateral femoral cutaneus nerve ter-
ritory, but only after asking about it, not before. No other
major complications arose.
CONCLUSIONS: Iliac crest free flap is our first choice for
reconstruction of mandibular defects < 12 cm.
Complications and sequelae of the donor site can be
strongly reduced by a meticulous technique of closure that
we show in this communication.
Javier Calder6n
C/. Joaquin Costa 25, 3° A. Santander. Spain.
(34)-29-243090
USE OF B I O C O R A L ®MASSIVE F O R M S IN
MAXILLO-FACIAL SURGERY. RESULTS O F A
MULTICENTRIC STUDY DONE IN 14 F R E N C H
H O S P I T A L S AND C O N C E R N I N G 1 9 8 PATIENTS
Cantaloube* D, Patat J.L.
Percy militalT hospital Clamart France
Maxillo-facial and plastic surgery department
AIMS :
To determine biocompatibility, efficacy and therapeutic
value of biocoral ®(natural coral in massive form) as well as
specific indications and directions for use.
METHOD :
- Multicentre study in 14 hospital maxillo-facial depart-
ments in France.
- 198 adult patients included within a period of 19 months
(from1992 May to 1993 December)
- 2 years follow up (December 1995)
- Use for recent traumatic lesions (64%), congenital dysmor-
phy (29%) and diverse lesion s(7%)
RESULTS :
- 149 patients were followed over one year (average of 22,5
months follow up)
- No bad event

- 20 patients showed complications, but none where directly
related to biomaterial.
CONCLUSIONS :
1. Coral has large indications in traumatology and facial
dysmorphy surgery (especially for genioplasty).
2. Tolerance is excellent when used as indicated and if con-
traindications are respected.
3. Clinical evolution of coral implant at middle term is
interesting and generally good with the volumes maintained
and no local complications.
Q=~ CRANIOFACIAL RESECTION AND
RECONSTRUCTION FOR MALIGNANT TUMOURS
Cantit G.*, Solero C., Mattavelli F., Salvatori P., Pizzi N.,
Podrecca S., Riggio iF..,Nardo L.
Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano,
Italy.
Aims: To assess the results of cranio-facial resection for
malignant tumours.
Method: Between 1987 and 1995 we performed 151 cranio-
facial resections for malignant tumours. According to the
histology there were: 65 adenocarcinomas, 32 squamous
cell carcinomas, 25 adenoidcystic carcinomas, 11 aesthe-
sioneuroblastomas, 5 melanomas, 3 sarcomas and 10 other
malignancies. All tumours were T4 involving the anterior
or middle cranial fossa, or both. In all patients we per-
formed a cranio-facial resection, anterior in 107, lateral in
29 and antero-lateral in 15. We performed a dural resection
in 55 cases and in 8 a brain resection too. Fourteen patients
underwent orbital exenteration. Our surgical technique was
the classical anterior cranio-facial resection for tumours
involving the ethmoid. The frontal craniotomy was low and
small (6x3 centimetres). The transfacial approach, in
patients not having a maxillectomy, was a paranasal inci-
sion. We used a free pericranial patch for dural repair in
intradural resections and a pedicled pericranial flap for
anterior cranial base reconstruction. The medial orbital
wall, always resected, was reconstructed with 2 X shaped
wires passing through holes in the residual roof and floor
of the orbit. In this simple way we could avoid herniation of
the orbital fat and the resulting enophthalmos. For
tumours involving the infratemporal and middle cranial
fossae we used an infratemporal approach, preauricular in
22 cases and retroauricular in 7. In 15 patients with
tumours involving both the anterior and middle cranial fos-
sae we used, at the same time, an anterior and infratempo-
ral transcranial approach. In 3 of these cases we performed
very large craniotomies allowing us an overview of both the
anterior and middle cranial fossa in one operation field. In
the lateral and antero-lateral resections (or in anterior
approaches with maxillectomy), we used the temporalis
muscle (23) or a free flap of rectus abdominis muscle (21)
for reconstruction.
Results: The overall cure rate, with a minimum follow-up of
24 months, is 50% (62% in previously untreated cases and
38% in relapses after previous surgery). In patients without
dural involvement the cure rate was 53%, in those with
dural extension, 45% and in patient with brain resection,
16%.
Conclusions: Our large series proves that cranio-facial
resection is the surgical approach of choice for visualiza-
tion and en bloc resection of neoplasms of the cranial
base.
EACMFS- Abstracts, Helsinki Congress 1998 27
MAXILLARY CHEEK FLAP FOR THE
TREATMENT OF BENIGN TUMOURS IN THE
ETHMOID-MAXILLARY REGION.
Castellani A., Meneghini F., Zanetti U.
Department of Maxillo Facial Surgery Civic Hospital of
Brescia-Italy (Head." Prof. G. Ferrari Parabita G.)
AIMS:
Describe the use of M C F (Maxillary Cheek Flap) for the
treatment of benign ethmoid-maxillary tumours.
METHODS:
In recent years, the M C F has been used with increasing suc-
cess in the surgery of growths lodged deep within the face
and nasopharynx.
The technique is based on the preparation of an osteo-
musculocutaneous maxillary cheek flap with its stem in the
cheek, to allow an ample exposure of the whole nasopha-
ryngeal region, with greater chances of radical surgery and
morphological and functional success. Though employed at
first to eradicate malignant tumours, this method is useful
also for the treatment of benign forms, where a good aes-
thetic outcome is always advisable.
RESULTS AND CONCLUSIONS:
Among the patients operated in our ward, we shall illustrate
a case of "rare benign mesenchymal" tumour, in the eth-
moid-maxillary region, excised by radical transfacial abscis-
sion with maxillary cheek flap. The morphological
follow-up and oncological screening confirmed that maxil-
lary cheek flap allow ample surgical exposure with mini-
mum aesthetic and functional damage.
A T E M P L A T E GUIDE FOR HARVESTING ILIAC
BONE F O R P R E P R O S T H E T I C ATROPHIC JAW
AUGMENTATION.
A J Sidebottom, MA Boyle, J l Cawooae.
Maxillofacial Unit, Countess of Chester Hospital, Chester,
UK.
AIM
Reconstruction of the edentulous jaws with corticocancel-
lous block bone grafts prior to implant placement is a time
consuming procedure. We present a technique utilising a
custom made sterilisable template as a guide to harvest the
iliac bone in the precise dimensions required.
METHODS
The laboratory stage follows standard protocol until the try-
in stage. The teeth are set up in the desired position and a
suck down splint is placed over. The wax is burnt out and
the resulting defect between the ridge and the teeth is cast
into soft putty impression material as will be described. This
provides for the template which can be cold sterilised prior to
use in theatre. The template can then be used to guide the
harvest of the iliac crest graft to the dimensions required.
The laboratory and the intraoperative procedures will be
illustrated with photographs. The technique saves both
intraoperative time and permits a more accurate adaptation
of the graft to the edentulous defect.
28 Journal of Cranio-MaxillofacialSurgery
S P L I T T I N G THE T H I N ALVEOLAR RIDGE
(CLASS IV) W I T H OR W I T H O U T GRAFTING
John L Cawoo~
Department of Oral & Maxillofacial Surgery, Countess of
Chester Hospital, Chester, England.
A survey of 300 consecutive edentulous patients indicated
that the incidence of the Class IV residual ridge was 53% in
the edentulous maxilla and 28% in the edentulous mandible.
The Class IV ridge is characterised by minimal loss of verti-
cal height of the alveolar process but loss of labial and buc-
cal bone to produce a thin knife-edge residual ridge form.
Consequently there is insufficient width of residual bone to
accommodate endosteal implants. In this group of patients
pre-implant surgery is required to augment the thin ridge.
Choice of the augmentation technique is influenced by the
existing nasolabial and labial mental support, presence of
intervening %ancellous bone between the cortical plates, or
fusion of the cortical plates, and the type of prosthesis
(fixed or removable).
Ridge splitting techniques are indicated if there is interven-
ing cancellous bone between the outer and inner cortical
plates. This can best be demonstrated with a CT scan.
Ridge manipulation without bone grafting is indicated
when the nasolabial or labial mental support is adequate.
If the nasolabial or labial mental support is inadequate then
osteoplasty and interpositional bone grafting is indicated.
This presentation will address the assessment of the Class
IV residual ridge and the results of ridge splitting tech-
niques with or without bone grafts.
I M M U N O H I S T O C H E M I C A L ANALYSIS O F
CYTOKERATIN AND P53 E X P R E S S I O N IN
DYSPLASTIC AND M A L I G N A N T L E S I O N S O F
ORAL M U C O S A
Cema, L *, Stengel, B.
*Department of Maxillofacial Surgery, Medical Academy of
Latvia
Institute of Pathologie, University of Rostock, Germany
Aims: The aim of the present study was to determine the
first changes of cell differentiation on molecular level in
normal oral mucosa, leucoplakies without and with dyspla-
sia, as well as peculiarities of cytokeratin and p53 expres-
sion in squamous cell carcinoma.
Method: Several monoclonal antibodies to cytokeratins and
p53 immunohistochemical staining were used. To define
correlation of results the method of two and multifactoral
linear regression was used.
Results : The pattern of cytokeratin immuno expression in
dysplastic and malignant tissue were stated. The crucial
parameter characterized grade of dysplasia ( A F 1; CK~ 0/13;
CK5/6; p53; p < 0,01 ) and squamous cell carcinoma ( C K
5/6; CKI7; p53; p < 0,01 ) were stated.
Conclusions : Peculiarities of cytokeratin immunoexpression
indicate the first changes of cell differentiation on molecular
level. We recommend divide dysplasias diagnosed in mouth
epithelia into two grades mild and marked.
FINITE ELEMENTS METHOD ANALYSIS OF DOUBLE
MIN1PLATE FIXATION OF FREE BONE GRAFTS IN
MANDIBULAR RECONSTRUCTIVE SURGERY
Dalsanto J, Champy M*, Mille P, Cornet A, Rousseau D,
Segard J, Rosenstie134.
*26 rue Ducrot 67000 STRASBOURG (France) tkl. fax :
(33) 03 88 36 38 84
Aims : To describe by the computer aided analysis the
mechanical behaviour of the double miniplate fixation of
free bone grafts in reconstructive surgery of the mandible.
Method : The shape of four types of bone defect are digi-
tized by means of a three dimensional coordinate retrieval
device and drawn on a computer screen, allowing its analy-
sis by the finite elements method.
Results : The titanium ininiplates used in twin plates fixation have
the required mechanical characteristics to ensure the stability of
the reconstructed mandible during the healing phase of the graft.
The elasticity of the double miniplate fixation is respon-
sible of micro motion and mechanical stimulation of the
graft and along the contacting surfaces between the
mandibular fragments and the graft.
The mechanical stimulations caused by the masticatory
forces are distributed on the plates, the mandibular frag-
ments and the bone graft.
Conclusion : All these factors confirm the value of this
method of fixation inaugurated by D. H. Pape.
[~ INFERIOR ALVEOLAR NERVE R E P O S I T I O N I N G
FOR IMPLANT M A N A G E M E N T OF M A N D I B U L A R
B O N E DEFICIENCIES.
Chanavaz.' Philippe, Ricbourg' Bernard, Chanavaz Manuel,
Francke Jean-Paul
1- Dept. of Maxillofacial Surgery, CHU Besanfon - Fr.
2- Dept. of Oral and Maxillofacial Implantology, School of
Medicine, Lille University lI- Fr
The Inferior alveolar nerve is one of the terminal branches
of the mandibular nerve which in itself is the third compo-
nent of the trigeminal nerve. The presence and the trajec-
tory of this sensitive nerve conditions the surgical phase of
the mandibular implantology. A perfect knowledge of its
infra-osseous anatomy within the nerve canal, through the
ramo-corporal and incisive portions of the mandible and its
extra-osseous anatomy before penetrating the lingula and
after emerging from foramen mentalis is indispensable.
The possible occurrence of three basic atypical morphology
of the inferior alveolar nerve, especially in relation to the incisive
neurovascular bundle and its incisive canal make the study of this
nerve more critical. Various lesions of this nerve and its terminal
branches could cause paresthesias or anesthesias (whether transi-
tory or permanent, partial or incomplete), are file source of many
headaches and possible medico-legal incidents. The authors pre-
sent the precautions which have to be taken to avoid the definitive
lesions of this nerve and underline the courses of treatment on
the occasion of the occurrence of accidental lesions.
The combination of vertical atrophy and the location of
the inferior alveolar canal limits the available bone for
implant placement in the body of many mandibles. This can
often be overcome by relocating the inferior alveolar neu-
rovascular bundle. However this is only indicated when the
final restorative treatment produces desirable result. During

a twenty year experience of practising this procedure several
different surgical approaches have been conceived. These
include: 1) degloving the mandibular canals, creating a new
foramen in the posterior mandible and cutting the incisive
nerve and relocating the inferior alveolar neurovascular
bundle within the new foramen, 2) degloving the canal, lat-
eralizing the inferior alveolar nerve within the bone and
simultaneous implant placement, 3) removing the mental
foramen with the nerve, exposing the canals and reposition-
ing the nerve, 4) removing the buccal plate of bone with its
soft tissue attachments intact, relocating the inferior alveo-
lar nerve through a posterior foramen, cutting the incisive
nerve and replacing the buccal plate, 5) combining the nerve
repositioning with a sagittal split mandibular osteotomy.
C E P H A L O M E T R I C CONSTRAINTS IN
PREPROSTHETIC AND IMPLANT SURGERY
Chanavaz M. *, Vdron C., Biocquei H., Donazzan M.
Department of Oral and Maxillofacial Implantology, Lille
University-2 Medical School, France.
The surgical and restorative phases of implantology have
now become highly predictable and documented. However,
many centres round the world actively pursue their multidis-
ciplinary research and clinical trials to further improve the
success rates. The reconstructive and implant rehabilitation
of the edentulous patients suffering from advanced atrophies
of the jaw bones with or without anomalies of the intermax-
illary relationship, require meticulously prepared treatment
planning. In these patients, where many anatomical land-
marks have disappeared, the optimal height, length and
width of the bone substituting grafts, the dimension and
location of the implants and the disposition of the prosthetic
restorations can be precisely evaluated by the application of
identifiable cephalometric references. The phylogenetic stud-
ies in primates and the analysis of the growth in mankind
have led to the observation of a number of osseous morpho-
logic constants. These constants are essentially in reference
to the stability of a cranial triad zone supported by the ptery-
goid plates and the superior aspect of the sphenoid clivus.
These show that there is an ideal and constant 108 ° angle
between the plane tangent to the inferior half of the pterygo-
maxillary suture and the axial plane tangent to the occlusal
surface of the first maxillary molar and premolars. This lat-
ter plane is also parallel to the trajectory of the maxillary
nerve (V2) in its suborbital portion. Similarly the plane
through the longitudinal axis of the canine is parallel to the
pterygomaxillary plane. The resultant parallelogram corre-
sponds to a central zone or mesoface which is constant in all
facial morphologies. The presentation will produce the prin-
cipal constants used in this clinically orientated analysis and
will discuss their validity. In addition to its impact on
advanced surgery, clinical examples will illustrate its practi-
cal impact on routine implantology both in the preprosthetic
phase and in the elaboration of the surgical guides.
Fh SOFT TISSUE TREATMENT: THE USE OF
KERATINIZED MUCOSA AROUND DENTAL
IMPLANTS PLACED IN VASCULARIZED BONE
Chang, YM., Wei, FC. +
Department of OMFS*,Department of PRS +
Chang-Gung Memorial Hospital, Taipei, Taiwan.
EACMFS - Abstracts, Helsinki Congress 1998 29
Aims: Thickness and mobility of overlying soft tissue and
obliteration of the vestibular sulcus were challenging prob-
lems for dental rehabilitation when using vascularized bone
grafts for oro-mandibular reconstruction. We introduce the
use of palatal mucosa grafting and design a simple resin
stent to solve these problems.
Method: At stage II of the surgical implant procedure, vestibu-
loplasty and lowing of the floor of the mouth was performed.
The subperiosteal incision was carried out only around the
implant fixtures. At the same time, implant cover screws with
an 8 mm length of healing abutment were placed .We placed
self-cure resin at the dough stage to fit the boundary of the
created vestibular area. Healing abutments were used as resin
stent retainers and normal saline was used to cool the stent.
Take a palatal mucosa graft to cover the surroundings of the
implant fixtures and hold the graft in proper position with
periosteal sutures. Periodontal dressing material was placed
on the underside of the resin stent. After one week, the resin
stent was removed the graft site was examined. If necessary, a
new periodontal dressing was placed and the stent was reat-
tatched for a further healing period. To prevent relapse caused
by the lip and cheek, continuous use of the resin stent until
implant prosthetic treatment was complete was important.
Results: In our 10 cases, 26 dental implants were inserted in
the vascularized bone graft, during six month to 4 years
occlusal loading force follow up, the average marginal bone
loss was less than 2 ram.
Conclusions: The keratinized palatal mucosa graft around
dental implants provided maintenance of good oral hygiene
for reconstruction patients.
RELATION BETWEEN THE PROCESSES OF
REPARATIVE REGENERATION AND IMMUNE
RESPONSE IN MANDIBULAR FRACTURES
*Chergeshtov Y,, Baidina N., Mustafajev M., Markina M.,
Naumova iV.
Medical Stomatological Institute, Postgraduate Oral and
Maxillo-Facial Surgery Department. Moscow. Russia.
AIM: The role of immune defence deficiency in inflamma-
tory complications of mandible fractures.
METHODS: Clinical, radiological and immunological
examination of 60 patients with traumatic injuries of the
mandible which were complicated by inflammation. In addi-
tion to traditional diagnostic and treatment methods the
immunological tests were made on immunoglobulins, T-
lymphocytes and phagocytic activity of leukocytes,
RES tILTS: Regeneration process by inflammation develops
as a rule with substantial decrease of T-lymphocyte helpers
and leukocytes phagocytic activity. These changes are more
pronounced in cases of purulent bone wounds.
CONCLUSION: One of the important factors in complex
treatment of mandible fractures in regards to prevention of
inflammatory complication is immunocorrection therapy.
ANATOMY OF THE P O S T E R I O R MAXILLA
RELATING TO LE FORT I OSTEOTOMY
Cheung, L.K. *, Fung, S.C., Samman, N., Tideman, H.
Oral and Maxillofacial Surgery, University of Hong Kong,
Hong Kong, China
30 Journal of Cranio-Maxillofacial Surgery
Aims: To study the osteology of the posterior maxilla and
establish clinical safety guidelines for Le Fort I
osteotomy.
Methods:Thirty dry human skulls were selected and
assessed by a combination of direct inspection, computer-
ized imaging and CT scan analysis.
Results: The presence of wisdom teeth influenced the trans-
verse angulation of the posterior vertical cut. Synostosis of
the pterygomaxillary junction was noted in 12% of samples.
The mean length of the medial sinus wall from the piriform
rim to the descending palatine canal at the Le Fort I level
was 34ram with a range from 23.8 - 41 ram. The 3-dimen-
sionally CT reconstructed descending palatine canal was
running at 60 ° antero-inferior to the palatine plane and
slightly medially to exit through the greater palatine fora-
men.
Conclusions: An improved understanding of the posterior
maxillary region relating to the descending palatine vessels
will minimise complications from Le Fort I osteotomy such
as haemorrhage and avascular necrosis.
The study was supported by Hong Kong University CRCG
grant 337/253/0003.
[~ A COMPARATIVE CLINIC STUDY BETWEEN
LINGUAL TUBERCULOSIS AND CARCINOMA O F
THE TONGUE
L. Chirii~, M. Burlibasa, C. Burlibasa,
Clinical Hospital of Stomatology, Department of Maxillo
Facial Surgery, Carol's Davila University, Bucharest,
Romania
The tuberculous infection of the tongue is a reality that has
to be taken into consideration. The disease can be either pri-
mary or secondary.
The clinical aspects are very similar to that of a carci-
noma and can create confusions.
The clinical aspects of tuberculosis and carcinoma of the
tongue are presented comparatively.
THERAPEUTIC ARTHROSCOPY IN THE
TREATMENT O F RECURRENT
T E M P O R O M A N D I B U L A R J O I N T DISLOCATION. A
PRELIMINARY STUDY
Chossegros, C., Cheynet, F., Blanc, J.L.,
Oral and Maxillofacial Department, Timone's Hospital,
Marseille, France
Aim: to evaluate arthroscopy in recurrent temporomandibu-
lar joint (tmj) dislocation
Method: This prospective study concerned six patients
arthroscopycally treated for recurrent tmj dislocation after
conservative treatment failure. The retrodiscal tissue coagu-
lation technique was performed under general anaesthesia
through a double-puncture approach. During follow-up
recurrence of dislocation, mouth opening, quality of diet
and joint noises were noted.
Results: The mean follow-up was 3.1 years. The results on the
recurrence of dislocation were considered to be good in 66%
of cases. The study of diet or noise shows little difference
between before and after surgery. The results of mouth open-
ing shows a mean regression of 10 mm after surgery, corre-
lated with good results in respect of dislocation recurrence.
Conclusion: TMJ arthroscopy can be first recommended in
recurrent dislocation. In the event of failure, Myrhaug
eminecectomy can be performed.
GUIDED LAG SCREW TECHNIQUE IN
MANDIBULAR FRACTURES
Gregory C. Chotkowski,
New York, USA
Under certain conditions the application of a lag screw can
be difficult in mandibular fractures and the direction and
position of lag screws is not always predictable by the con-
ventional lag screw technique. The guided lag screw tech-
nique differs from conventional lag screw techniques in that
it eliminates the uncertainties and decreases the number of
operative steps. The drill guide enables the surgeon to
adjust the drill bit to accurately predict where the drill bit
will exit. This ensures that anatomic structures, roots of
teeth and associated neurovascular bundle will be avoided
when drilling. The pointer, which functions as an external
depth gauge, runs parallel to the direction of the drill bit
and measures the length for proper guided lag screw selec-
tion. Surgical time is also decreased with the use of the
stepped drill bit and adjustable countersink. The stepped
drill bit tapers from 2.3mm to 1.7mm. The countersink,
gliding and pilot holes can be prepared in one pass. This
reduces the risk of malalignment of the holes when multiple
drill bits are passed. The guided lag screw technique utilizes
precision instrumentation along with a specialized screw for
fixation of mandibular fractures. It provides a predictable
method of rigid internal fixation with minimal hardware
through use of a conservative surgical access in a short oper-
ative time.
ACUPUNCTURE IN THE TREATMENT OF
PATIENTS W I T H F A L L O P I A N NEURITIS DUE TO
TRAUMA
Chudakova I*., Chudakov O.
Maxillofacial And Plastic Surgery Clinical Centre,
Minsk Medical Institute, Minsk, Belarus.
Aims. Acupuncture as a method of choice for combined or
monotherapy of fallopian neuritis due to trauma was studied.
Methods. Corporal acupuncture and Su-jok technique
(conformity points) were used to treat the above condition
in addition to surgery, i.e. musculus temporalis transplan-
tation. Biologically active points of general purpose CI4;
CIlo; CIll and VB20 as well as local points IG18; IG19; Es;
E6i E7(2); GIl8 on. face and arterior cervical surface in the
epacutaneous nerve trunks outcropping area and extra-
channel point in the epicutaneous mandibular mental
foramen area were subjected to acupuncture. To fulfill Su-
j o k technique the conformity points on hand were used.
Acupuncture points were stimulated by expressed
inhibitory action technique using silver needles to achieve
a full spectrum of expected sensations within 30 minutes
period of exposure. The whole course consisted of 10 ses-
sions: one per day.

Results. The study of the abovedescribed acupuncture
method used in 75 cases showed 80% improvement in the
outcome of surgical treatment as well as significant
improvement of its esthetical and functional results; and
consequently, the rehabilitation period appeared to be
reduced in 95% of cases.
Conclusions. Acupuncture can be recommended for treat-
ment of fallopian neuritis due to trauma at maxillofacial in-
patient departments.
E P I T H E L I Z E D SKIN F L A P IN SURGICAL
REHABILITATION O F O N C O L O G I C PATIENTS
Chudakov 0., Chudakova T.,
Belorussian Collaborating Centre of EA CMFS, Minsk,
Belarus
Aims. By now early plastic repair of penetrating face and
neck defects following surgery for oncologic conditions has
become vitally important. We have developed a method of
epithelized skin flap [FESF] harvesting and grounded scien-
tifically its use in the repair of such defects.
Materials and Methods. The flap is characterized by great
biologic potential; it consists of proper tissues of the patient:
cellulocutaneous mono - or bipedical flap and split autoge-
nous graft (SAG) which is submerged into the defect mar-
ginal tissues. This activates slow proliferation processes in the
irradiated derma tissues both in the face and neck and in the
F E S F tissues. Due to activation of F E S F tissue regeneration
process and its high plasticity the flap and defect margins
exposed to topical ionized irradiation integrate successfully.
The method of F E S F harvesting under submerging condi-
tions improves defect tissue margins nutrition providing their
softness, elasticity and increasing their blood supply.
Results. Such a flap was used to repair penetrating neck and
skin defects in 275 patients operated for malignant tumours
at the ages of 2 to 75 years. There were 160 male and 115
female patients. The areas repaired included lips, eyelids,
hard palate, nasal septum, cervical portion of esophagus
and trachea. In 101 case the defect was repaired when the
tumour was being removed. In 174 cases the repairing pro-
cedure followed irradiation (20 days to 4,5 months), com-
plete wound clearing and indurated edema disappearance.
The time period for plastic repair with F E S F is individual
for each patient. In 139 cases FESFs were harvested from
the adjacent to the defect areas, in 36 - from distal areas. In
case of distal harvesting F E S F transportation to the defect
area was manual.
Conclusions.Plastic defect repair with FESF technique fol-
lowing malignant face and neck tumours removal is both pos-
sible and reasonable. Due to this technique the number of
stages and treatment period duration can be reduced. In addi-
tion it provides successful medical and social rehabilitation.
[~ DENTAL O C C L U S I O N R E P R O D U C T I O N ON
S T E R E O L I T H O G R A P H I C M O D E L S IN
MAXILLOFACIAL SURGERY P L A N N I N G
C~rincione, M., Gheno, E., Grecchi, F., Bianeo, R., Scolari,
M.*, Sforza, R.**
Department of Maxillofacial Surgery, CD T. ( *) , Mirus-Lab
(**), Niguarda Ca' Granda Hospital, Milan, Italy
EACMFS Abstracts, HelsinkiCongress 1998 31
Aims: In our department, since 1993 three-dimensional
reconstructions of computed tomographic images and
solid stereolithographic models have been widely studied
and applicated in orthognathic surgery and maxillofacial
traumatology. Accurate replication of patients perfect
occlusal status is mandatory in preoperative planning
using solid models. The present study allows the transfer
of occlusal relation from casts to stereolithograhic
models.
Method: Two female patients (1 mandibular prognathism,
1 mandibular asymmetry) , 26 and 21 aged have been
studied with cephalometric analysis, CT Scans, casts in
articulator and stereolithographic models. Casts obtained
and developped at the beginning and at the end of ortho-
dontic treatment with facial bow have been mounted in
articulator. From the later the occlusion has been repli-
cated. The utilized technic consisted in repositioning the
maxilla of the stereolithgraphic model in the articulartor,
by stabilizing the same with the facial bow fork and using
classical reference marks. Afterwards the maxilla model
was sectioned according to an horizontal plane and was
replaced by replicating the occlusal plane through match-
ing. With the same technique the mandible was
positioned.
Results: The exact reconstruction of correct dental rela-
tions on 3-D models has permitted in both the studied
cases the perfect simulation of bone movements and the
preparation of occlusal splints to be used during the
operation.
Conclusions: The method allows to go over the serious limi-
tation of the approximate reproduction on 3-D models of
the dental shape and occlusal relation.
EXPANDING CRANIAL BASE SURGERY: TUMORS,
TRAUMA, AND CONGENITAL DEFORMITIES.
Clauser, L. *, GaliO, M., Curioni, C.
*Department of Cranio Maxillo Facial Surgery, Ferrara
Professor of Maxillo Facial Surgery Vicenza (Italy)
This paper has three basic goals:
To outline fundamental principles of cranial base
surgery.
To demonstrate direct application of cranial base surgery
to the treatment of craniofacial tumors, trauma, and con-
genital deformities, and
To translate complex diagnostic and surgical techniques
more practically useful to a head and neck surgeon.
Tumors. F r o m the perspective of oncologic surgery, we
will focus on the most versatile a p p r o a c h e s to cranial
base, emphasizing the "surgical operative ratio" for
o p t i m a l t u m o r exposure and control of vital struc-
tures.
Trauma. The surgical concepts of treatment of craniofacial
trauma will highlight the importance of primary rigid mini-
plate fixation and bone grafting, orbital reconstruction, and
optic nerve decompression in order to achieve the best func-
tional and aesthetic balance.
Congenital Deformities. After review of the treatment
planning, the surgical options will be reviewed, with spe-
cial emphasis on treatment of facial syndromes (Treacher
Collins, craniosyntosis, etc.), as well as facial dysmor-
phias.
32 Journal of Cranio-MaxillofacialSurgery
SEGMENTAL RESECTION AND ILIAC BONE
F R E E - F L A P RECONSTRUCTION AS T H E
TREATMENT O F C H O I C E F O R SOLID
A M E L O B L A S T O M A OF THE MANDIBULAR BODY
Concejo, C. *, Cuesta, 34., Acero, J., Fernandez-Alba, J.,
Salmerdn, J.L.
Department of Maxillofacial Surgery, Hospital Gregorio
MaraBon, Madrid, Spain.
Aims: To determine the advantages of mandibular segmen-
tal resection by means of an and iliac crest free-flap and
implant-supported dental prothesis as the treatment of
choice in solid ameloblastoma of the mandibular body.
Methods: A retrospective study of 7 patients whose ages
ranged between 17 and 41 years who had a solid ameloblas-
toma of the mandibular body and who were treated by seg-
mental resection and thereafter with an implant-supported
dental prothesis, during the period 1992 to 1997, in the
Department of Oral and Maxillofacial Surgery, Hospital
Gregorio Marafion, Madrid, Spain. The patients were eval-
uated from an aesthetic point of view, as assessed both by
the medical team, and by the patients themselves; as
regards function, chewing, temporomandibular joint func-
tion and phonation were evaluated; and also the pychoso-
cial situation of the patients was evaluated as seen from the
point of view of the patients themselves and their families.
Results: In all 7 patients, results could be considered excel-
lent. The patients demonstrated complete recovery and
adaptation to this method and there were no significant
sequelae caused by the surgery in any of the cases.
Conclusion: Mandibular segmental resection and iliac crest
free-flap with an implant-supported dental prothesis, in our
judgement, constitutes the treatment of choice for solid
ameloblastoma of the mandibular body with a minimal
rate of relapse and excellent aesthetic and functional results.
Carlos Concejo
C/Narvaez N ° 62, 7° C Phone: (91) 504-6796
28009 Madrid. Spain E-mail : cconcejo ©xpress.es
7h ATLO-AXIOID-OCCIPITAL J U N C T I O N
D E R A N G E M E N T IN THE MANDIBULAR
ASIMMETRY.
Corbacelli A., Lupi E.*, Di Emidio P., Cutilli T.
Maxillofacial Institute, Department of Surgery - L'Aquila
University - L'Aquila - Italy (Head." Prof. A. Corbacelli)
Aims: The atlo-occipital and atlo-axioid articular system,
that realize the junction between occipital bone and cervical
spine was studied in subjects with mandibular asimmetry to
assess anatomical and clinical atlo-axioid-occipital disorders.
Method: The research was carried out on 25 subjects
affected by different degrees of mandibular asymmetry, of
which 16 males and 9 females, of ages between 18 and 25
years. In this study cases of combined maxillomandibular
asimmetry were not taken into consideration. The study
was carried out using high-resolution CT of the maxillofa-
cial region and of atlo-axioid-occipital junction, combined
with 3D-CT. Study of the soft tissues was executed using
MR.
Results: Significant modifications of the trim of the atlo-
epistrophic articulation were observed in the investigated
subjects. In particular: 1) A constant modification of the
relation between the atlo-axioid and the atlo-occipital artic-
ulations. 2) The atlas was counter-rotated with respect to
the upper maxilla. 3) Consequently, there is a constant
degree of subluxation of the faces of the atlo-occipital artic-
ulations. 4) The atlas rotation follows the deviation and the
direction of the mandibular asimmetry. 5) The axis of the
epistropheus is subluxated on the side of the atlas rotation
and seems to be displaced on the same side. This aspect can
also be evaluated using M R imaging which shows it in front
of atlo-epistrophic (trasversal) ligament.
Conclusions: The A A believe that these articular modifica-
tions represent a musculo-skeletric compensation in
response to postural craniomaxillofacial modifications
subsequent to mandibular asimmetry.
These modifications explane the even severe occipito-cer-
vical algias and the arthrosic processes of the vertebral col-
umn.
THE VALUE AND VERSATILITY O F S U P P O R T
SERVICES F O R PATIENTS W I T H MALIGNANT
DISEASE O F THE HEAD AND NECK.
GCS Cousin & SG Langton
East Lancashire Maxillofacial Service, Blackburn Royal
Infirmary, UK.
The philosophy of a team approach to the management
of malignant disease in the head and neck is increasingly
important.(1) Following the recommendations of the
Calman report(2), federation of maxillofacial services in
our area has resulted in the development of a central head
and neck oncology service. This serves a population of
approximately 1.2 million people in the north-west of
England. The "core" clinical input is provided by maxillofa-
cial and ENT surgeons together with a radiation oncologist
and palliative care physician.
In addition to these clinicians, the clinic has allowed the
development of specialised complementary services includ-
ing speech and swallowing therapy, dietetics, implantology,
restorative dentistry and a depilatory technician to remove
hair from cutaneous flaps.
The important role played by these complementary ser-
vices within the oncology service and their value in the over-
all management of patients with head and neck cancer is
reviewed.
In particular the new and expanding role of specialist
nurse practitioners is discussed, and the resultant benefits
for the patients and clinicians outlined.
References
Tobias JS. Management of head and neck cancer in Britain.
Br Med J 1997;315:1556.
Expert Advisory Group on Cancer Services. A policy
framework for commissioning services. Report of an expert
advisory group on cancer to the Chief Medical Officers of
England and Wales. 1995. London: HMSO
FUNCTIONAL STATUS AND QUALITY O F LIFE IN
PATIENTS W I T H G L O S S E C T O M Y
RECONSTRUCTED W I T H A FREE F O R E A R M FLAP.
Cuesta, M.*; Perez, JE.; Ferndndez-Alba, J.; Lopez, J.;
Navarro, C.; Ochandiano, S.

Department of Oral and Maxillofacial Surgery, Hospital
General Universitario "Gregorio Mara~on", Universidad
Complutense de Madrid, Madrid, Spain.
Aim: The aim of this video is to present, in an objective way,
the aesthetic and functional condition of several operated
patient with malignant neoplasms of oral soft tissues, who
were reconstructed with free forearm flap; analyzing, basi-
cally, the swallowing, phonation and mastication functions
and the shortcomings caused in the donor area, as well as
the adaptation to their occupational, social and familiar
environment.
M & Methods: In our service from five years ago we are
accomplishing microvascular techniques in the patients
reconstruction with advanced head and neck cancer.
Those methods have replaced, in many cases, the conven-
tionals pedicled flaps. Fasciocutaneous forearm flap com-
bine the suitable conditions for the reconstruction of oral
soft tissues, being the main indication of most of these
shortcomings, since provide a most anatomical restora-
tion and better functional results than those obtained
with direct closing or pedicled flaps. Three male of middle
or old age with cancer of tongue, floor of the mouth, ton-
sillar fossa and lateral pharinx wall were treated in this
way.
Results: All patients have been rehabilitated. The radial free
flap has been adapted perfectly to their prosthesis. Lingual
mobility is excellent. And the patients are able to masticate
and swallow all type of foodstuffs, have a suitable phonation
and accomplishes a practically normal life.
Conclusion: The oropharingeal reconstruction with this flap,
provides an excellent result, avoiding lingual fixation and
permitting a perfect swallowing and phonation.
THE SMILING AREA - FROM ORAL
REHABILITATION TO TOTAL FACIAL
RECONSTRUCTIVE SURGERY
Curioni, C *, Clauser, L.
*Professor of Maxillo Facial Surgery Vieenza
Department of Cranio Maxillo Facial Surgery Ferrara
(Italy)
Total facial rehabilitation requires an understanding of
the contributing components of the so called aging face
syndrome. This syndrome may be due to atrophy of the
jaws, to ablative surgery for cancer or to traumatic seque-
lae. The aging face requires correction of every anatomi-
cal component i.e. facial skeleton, dental-alveolar part
and soft tissues. The surgical armamentarium includes:
maxillofacial osteotomies, autogenous bone grafts, bio-
materials, internal rigid fixation and other ancillary pro-
cedures.
The introduction of endosseous implants has allowed
the surgeon to use a stable base on which a proshesis can
be made with functional and aesthetic long-lasting
results. Last, but not least, repositioning of the facial
mask is the "final touch" for these complex reconstruc-
tive procedures.
The concept of total facial rehabilitation may be considered
as an evolution of reconstructive surgery. The impact of this
surgery involves the facial skeleton, the soft tissues, the look
as well as the smiling area of the patient.
Surgical strategies, new technologies and clinical cases
will be presented.
EACMFS- Abstracts, Helsinki Congress 1998 33
[ ~ DISMANTLING AND REASSEMBLY OF THE
FACIAL SKELETON IN TUMOR SURGERY OF THE
CRANIOMAXILLOFACIAL AREA
Curioni, C. *, Clauser, L., Zanetti, U., Cristiano, G.
*Professor of Maxillofacial Surgery - Vicenza
Head of Department of Maxillofacial Surgery - Hospital St.
Anna Ferrara Division of Maxillofacial Surgery, Spedali
Riuniti - Brescia
Postgraduate School of Maxillofacial, Surgery - University
of Ferrara (Italy)
One of the major surgical challenges in tumor surgery has
been to provide access and exposure to permit controlled
resection of the lesion, while preserving critically important
structures not directly involved by the tumor.
Advancement in technology plays a key role. Imaging
studies have improved capabilities for localising the tumol,
its extension and help the surgical team to delineate the
proper approach.
Major advantages of this surgical approach, dismantling
of the facial skeleton, include wide exposure of complex
anatomical structures and good visualization of the tumor,
deeply situated in the facial area.
So the concept of the facial splitting has been extended,
allowing a wider exposure of the anterior cranial base. By
splitting the face, in combination with the cranial route, the
skull base is easily accessible for resection.
At present the following facial structures can be mobi-
lized with a viable pedicle: maxillo-cheek flap, nasal-cheek
flap, nasal-maxillo-cheek flap, nasal-maxillo-cheek flap and
controlateral maxillo-cheek flap, (asymmetrical facial bipar-
tition) mandibular- cheek flap, combination.
The reachable areas are: orbital, infratemporal, retro-
maxillary area, parapharyngeal space, rhinopharyngeal
space, rhinopharynx, ethmoid, anterior skull base, clivus,
upper cervical spine.
The advantages of the pedicled bone-cheek flaps are
the preservation of anatomical unit bone (maxilla), soft
tissue (cheek), blood supply with less reabsorption after
Rx therapy, and preservation of the morphology and
function. Side effects on facial growth in children are
reduced.
The introduction of internal rigid fixation by using
plates and screws, (pre adaptation plates before osteotomies
are mandatory) has facilitated the realignment of the pedi-
cled bone fragments in a correct position.
In conclusion radical resection with preservation of non
involved structures permit morphological and functional
recovery.
Best option for surgeon and patient.
[h TRANSANTRAL ETHMOID-FRONTAL-
SPHENOIDECTOMY IN THE ODONTOGENIC
POLYSINUSITIS TREATMENT.
Cutilli T*., Di Fabio D., Corbacelli A.
Maxillofacial Institute, Department of Surgery - L'Aquila
University - L'Aquila - Italy (Head." Prof. A. Corbaeelli)
Aims: The odontogenic cause of maxillary inflammation,
due to well-know anatomical and functional correlations
often reachs to the ethmoid in first, then to the other
paranasal sinusal cavities (sphenoidal and also frontal). The
34 Journal of Cranio-Maxillofacial Surgery
classical Caldwell-Luc procedure, universally utilized in the
odontogenic maxillary sinusitis, is unable to resolve this
inflammatory pathology.
It is proposed to use of transantral ethmoid-frontal-
sphenoidectomy. They point out the role of the diagnostic
methodologies ( " high-resolution" CT with digital densito-
metric analysis and MR imaging) and of the disposable
microsurgical instruments that at present allow him the best
safety to prevent the minor and major (endocranic, vascular
and nervous) complications and also the best confidence in
order to the results of the phlogistic foci extirpation and
their persistence in the time.
Subject: The experience of the unit concerns 35 cases of odon-
togenic polysinusitis that comprehend: 19 wide periapex
inflammation of the upper premolars and molars; 9 oro-antral
communications; 3 penetrations of dental filling material into
the maxillary sinus; 4 purulent parasinusal odontogenic cysts.
Results: The unit uderline: a) the absence of complications
in this treated group; b) the effectiveness of this surgical
procedure expecially in the serious oro-antral communica-
tions complicated by polysinusal inflammation; c) lastly,
the absence of relapses in a 10 years follow up.
Conclusions: The unit consider the transantral ethmoid-
frontal-sphenoidectomy the better surgical procedure in the
odontogenic wide inflammatory sinus pathology.
[~ RECONSTRUCTION OF FACIAL DESTRUCTIONS
CAUSED BY EXPLOSIONS
Miomir Cvetinovic% Nebojsa Jovic, Srboljub Stosic
Clinic for maxillofacial surgery, MilitalT Medical Academy,
Belgrade, Yugoslavia
Injuries inflicted by explosions are characteristic for war
operations, while they are rare in peace time. Their principal
characteristic is that it is a concomittant injury of more tis-
sues, that there is only one incoming hole, margins of the
wound are irregular, there is a bone in the wound canal with
small fragments around it and there is great namber of for-
eign bodies both in the wound and its vicinity.
These injuries always cause defects of different extent in tis-
sue requiring several successive operations to be repaired.
Maxillofacial region is, with no doubt, the most complex
region for successful functional, anatomical and esthetic repair.
In this presetation we have followed up the course of the
facial reconstruction in a 12 years old boy with totally
destroyed middle and lower third of the face when the fuse
for initial mine activation exploded in his mouth. The boy
has undergone more than 20 operations within the 7-year
period and his rehabilitation has not been completed, yet.
LATERALLY AND MEDIALLY BASED
CERVICOPECTORAL ROTATION FLAP FOR
LOWER CHEEK RECONSTRUCTION
Dalabiras S * Mangudi D.
Aristotle University, Thessaloniki, Greece
Our experience from the use of the laterally and medially
based cervicopectoral flap is presented.
The medially based flap is a fasciocutaneous flap that
can be raised quickly and provides excellent color and
texture match with the tissues of the face. The laterally
based cervicopectoral flap is a versatile flap used in anteri-
orly positioned cheek defects.
We have found both flaps to be very reliable for recon-
struction of defects of the lower cheek and more specifically
below a line connecting the tragus and the oral commisure.
The flap colour, skin texture and hairbearing characteristics
make them an aesthetically ideal replacement for cheek
tissues.
NEWLY FORMED BONE, IN POROUS
HYDROXYAPATITE CERAMIC LOADED WITH
H U M A N BONE MARROW, IMPLANTED
SUBCUTANEOUSLY IN THE NUDE MOUSE
Bareiile R. (l), Lafage-Proust M. H. (2), Faucheux C (1),
Verrier S. (1), Laroche N. (1), Wenz R. (3), * Dard M.
(3), Amddde J. (1)
(1) I N S E R M U443, Victor Segalen University, Bordeaux,
France (2) Bone Biology Laboratol% Medical School, Saint
Etienne, France (3) Merck Biomaterial Research,
Darmstadt, Germany
Aims: In consideration of the limited amount of autoge-
nous grafts and the risks of allogenic bone rafting materials,
calcium-phosphate ceramics are being increasingly used as
bone substitutes in oral and cranio-maxillofacial surgery.
Due to their osteoconductive properties, their implantation
in small and medium-sized bony defects (< 3 cm) allows
osteogenesis. In the case of large bone defects, these ceram-
ics have to be supplemented with growth factors or with
bone marrow, to produce osteoinductive properties. As
Growth Factors Delivery Systems (GFDSs) present still
unsolved problems (Dard M., Cell. Engineering, 1997, 2:
84), the aim of this work was to investigate bony ingrowth
through an hybrid material elaborated with a porous inter-
connected hydroxyapatite ceramic (Endobon®, Merck
Biomaterial GmbH, Germany) (Faucheux C. et al., J.
Mater. Sci.: Mat. Med,, 1994, 5 : 635) supplemented with
human bone marrow and implanted subcutaneously in
athymic mice (Bareille R. et al, submitted).
Methods: Histological analysis of decalcified and undecalci-
fled sections, cytochemistry to detect tartrate-resistant acid
phosphatase (TRAP) activity, immuno-histochemistry to
observe the synthesis of extra-cellular matrix (collagen I,
osteocalcin) and in situ hybridization to discriminate between
human and murine cells were implemented. Bone coloniza-
tion was followed 1, 2, 4 and 6 weeks after implantation.
Results: One week after implantation, the hybrid material
produced new bone which appeared essentially lamellar and
surrounded by areas of woven bone. After 2 weeks, mineral-
ized bone covered with cuboidal-shaped cells ressembling
osteoblasts laying down osteoid was shown. Positive TRAP
activity was found in contact with the material and the bone
formation. Similar observations were reported after 1
month and confirm an active bone resorption-apposition
process inside the ceramic. At 6 weeks, examinations
showed persistence of scarce lamellar bone areas inside the
implants.
Conclusions: The four reliable complementary methods were
successfully implemented to provide new information on the
interactions between cells and calcium-phosphate materials.
Our results on osteogenesis processes in hybrid material
indicated that the investigated calcium-phosphate ceramic
combined with human bone marrow induced bone forma-
tion as early as 1 week after sub-cutaneous implantation.

Then a dynamic cellular process led, in 6 weeks, to the
resorption of the bone formed initially.
DIAGNOSIS O F EXTENSION OF PRIMARY ORAL
C A R C I N O M A BY US, CT SCAN AND R M IMAGING.
Daura Sdez, A.; Martinez Navarro, M.; Paima G6mez de la
Casa, A.; Valiente Aivarez, A. and Bermudo AKino, L.
Hospital Regional "Carlos Haya". Department of Oral and
Maxillofacial Surgery. Mdlaga. Spain.
Introduction: Head and neck carcinoma represents 5% and
2% of all malignancies affecting men and women respec-
tively. Mainly, three imaging thecniques, US, CT Scan and
MR, are used to establish the local and regional extension
of this kind of tumors. We present a comparative study of
them related to the histophatologic final diagnosis.
Patients and method: Sixty six patients with Oral Carcinoma
diagnosed and treated at our Department. We assess epi-
demiology, ethiology and the specific characteristics (sensi-
bility, specificity...) of each imaging technique.
Results: Vecinity spread was best assesed by M R imaging,
althougth CT scan obtained close results. Respecting to
tumoral size R M imaging, compared to histopatholgy, was
the most exact. The cervical lymph nodes metastasis was
assessed by CT scan and M R imaging obtaining similar
results. Ultrasound had less sensibility and specificity than
CT scan and M R imaging but is the only no ionizating thec-
nique, cheaper than the others, with a rapid execution and is
posible to repeat it every the time that yon need.
Conclusions: M R imaging has the best results to detect
vecinity spread, locoregional extent and tumour size, so we
considerate that it is the elective imaging thecnique in the
diagnosis of extension of Oral Carcinoma.
AN A S S E S S M E N T OF THE ACCURACY O F THE
S O F T TISSUE P R O F I L E P R E D I C T I O N DURING
O R T H O G N A T H I C SURGERY, USING
C O M P U T E R I S E D P L A N N I N G SOFTWARE.
Davies, T..M.*, Vasir, N.S., Thuau, H.
Department of OMFS and Orthodontics', Central Middlesex
Hospital NHS Trust, London, UK.
Aims: To evaluate the accuracy of the soft tissue profile
predicted by a computerised diagnostic and planning soft-
ware (OTP by OrthoVision) in orthognathic surgical pro-
cedures.
Method: Pre-orthodontic (TO), pre-surgical (T1) and post-
surgical (T2) lateral cephalograms of 30 patients who had
completed treatment involving orthodontics followed by
bimaxillary surgery were used in the study. Hard and soft
tissue landmarks were digitised using the on-screen facility,
for each cephalogram and for each computer- predicted
image. A customised analysis was used to analyse the differ-
ences between the actual cephalometric landmark measure-
ments and computer-predicted landmark measurements.
Results: These indicated that for some of the soft tissue
landmarks, differences were found between the actual and
computer-predicted profiles. These distances may be attrib-
uted to the inaccuracy of OTP's preprogrammed soft to
hard tissues ratios when predicting the soft tissue response
to orthognathic surgical procedures.
EACMFS Abstracts, HelsinkiCongress 1998 35
Conclusions: The amount and direction of soft tissue
changes differed between the OTP prediction and the actual
cephalometric tracings in patients who had undergone
orthognathic surgery. There are many difficulties in accu-
rately predicting soft tissue changes, not only in response to
orthognathic surgery but also in routine orthodontic move-
ments.
[~ A L L O P L A S T I C T E M P O R O M A N D I B U L A R J O I N T
REPLACEMENT: GRONINGEN T M J TOTAL J O I N T
PROSTHESIS DEVELOPMENT
de Bont, L.G.M. ~1,van Loon, j.pl., Verkerke, B.2
1Department of Oral and ~14axillofacialSurgery, University
Hospital Groningen, The Netherlands; 2Centrefor
Biomedical Technology, University of Groningen, The
Netherlands
Aims: To develop a safe, non-custom-made temporo-
mandibular joint (TMJ) total joint prosthesis for the recon-
struction of completely mutilated TMJs.
Method: The design was based on a kinematic analysis of
the prosthetic as well as the contralateral natural side, on
measurements of the fit to the skull of an adjustable design
consisting of stock parts, on dynamic testing of a rigid
screw-prosthesis fixation for 5 million cycles, on wear tests
of the articulation for 7 million cycles and on animal tests in
sheep, Generally accepted orthopaedic implant materials
were used.
Results: The prosthesis consists of a titanium-ceramic skull
component and mandibular component and an intervening
polyethylene disc. Kinematic analysis resulted in an inferi-
orly located centre of rotation (US Patent Number
5.405.393). Proper fit on the cranial side could be achieved
with less than 10 stock parts. The screw-prosthesis fixation
remained stable until the end of the test. The wear was less
than 0.01 mm per year in-vivo. In animal tests the prosthesis
proved to be stably fixed while the tissue reactions were
mild.
Conclusions: The Groningen TMJ total joint prosthesis rep-
resents the outcome of these analyses. A first series prosthe-
ses is currently available for insertion in patients
TEMPOROMANDIBULAR JOINT
DEGENERATIVE DISEASES: PATHOGENESIS AND
RATIONALE OF SURGICAL MANAGEMENT
de Bont, L.G.M.,
Dept, of Oral and Maxillofacial Surgery, University
Hospital Groningen, The Netherlands
Degenerative joint diseases, e.g. osteoarthritis (OA), result
from an imbalance between, predominantly chondrocyte-
controlled, anabolic and catabolic processes, characterized
by progressive degradation of components of the extracellu-
lar matrix of articular cartilage, together with secondary
inflammatory components. Chondrocytes are surrounded
by numerous peptide factors which modulate cell growth
and differentiation. These factors, proteases, protease
inhibitors, cytokines, growth factors, and arachidonic acid
metabolites, interact in a way that one factor may influence
the production and also the biological effects of others.
They all seem to play an important role in the aetiopatho-
36 Journal of Cranio-Maxillofacial Surgery
genesis of OA. A general feature in these complex and inter-
acting degradative and repair processes in cartilage, bone,
and synovium, is an imbalance of protease versus protease
inhibitor concentrations. Biochemically, OA can be classi-
fied into several phases, based on the grade of degradation
of articular cartilage.
Temporomandibular joint (TMJ) OA and disc displace-
ment seem to be strongly related, but may also represent
mutually independent temporomandibular disorders.
Surgical management of TMJ degenerative diseases should
not simply focus on articular disc displacement but focus on
the repair mechanisms in a synovial joint.
R E D U C T I O N OF EXCESSIVE FRONTAL
BOSSING
J. J. De 34ol Van Otterloo*, E.B. J. Van Mieuwkerk**
* Dept. of Oral & MaxillofaciaI Surgery
** Dept. of E.N. T. & Head and Neck Surgery
Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The
Netherlands
Aims: Excessive pneumatisation of the frontal sinus is a rare
phenomenon with, most of the time, no surgical conse-
quences. However when the pneumatisation leads to an
increasing frontal bossing of the forehead, one has to per-
form a surgical correction.
Method: The different approaches in surgical correction are
discussed.
Conclusions: With proper preparation and clear communi-
cation with the patient, a good result can be expected.
A RETROSPECTIVE STUDY OF 465 ORAL
IMPLANTS INSERTED IN THE SEVERELY
ATROPHIC MAXILLARY JAWS REHABILITATED BY
MEANS OF AUTOLOGOUS BONE GRAFTS.
De Santis ]9., Dolci 34., D'Agostino A., Fior A., Bertossi D.,
and Nocini P.F.
Oral & Maxillofacial Surgery Division
Chairman: Prof. P.F Nocini
University of Verona, I T A L Y
In a clinical study of dental implants inserted at the
Maxillofacial Department of Verona, which was carried
out from 1993, pre-prosthetic rehabilitation of severely
atrophic edentulous jaws were obtained by means of differ-
ent bone regenerative techniques. This retrospective analy-
sis includes the bone graft survival, the absence of any
surgical, vascular or neurologic complication and soft tissue
infections. A whole evaluation has been completed by bone
tissue histological assay. Referring to the implant survival,
we rely on the well known success criteria described by
Albrektsson T. and co-workers in a previous study on dental
implants (Albrektsson T., Dahl E., Enbom L., et al.:
Osseointegrated oral implants. J. Periodontol, 1988).
Including criteria for the present investigation are: severe or
extreme alveolar atrophy, bone grafted upper maxilla or
mandible, major pre-prosthetic surgery, root form implants,
implant-supported prosthetic rehabilitation.
A total of 465 implants were inserted consecutively in
the grafted jaw bones from 1993 up to 1998. Of the whole
implants that have been placed, 172 implants have been
inserted at the mandible and 240 at the upper jaw respec-
tively. The mean follow-up is 42 months for endosseous
implants and 31 months (_+11 S.D.) for dental prosthesis.
The upper maxilla grafted cases show an implant success
rate of 91.8 % (293 implants and 24 failures), while
mandible grafted cases show an implant survival of 94.7 %
(172 implants and 9 failures).
We found the less successful method is the inlay bone,
grafted into a Le Fort I osteotomy and a downtilting of the
upper maxilla, as we achieved a 79.3 % (53 implants and 11
failures). Anyway such lower figures are comparable to Li's
clinical experience (82.0 %) and slightly lower than
Krekmanov L. (86.6 %). The best percentage is obtainable
when bone regeneration is performed via autologous free-
revascularized bone grafts, (100 % of implant survival)
followed by the free autologous bone grafts.
MANDIBULAR DISTRACTION IN
TEMPOROMANDIBULAR J O I N T ANKYLOSIS
Dean, A. * Alamillos, FJ., Ardvalo, R, Rodas J.
Department of Oral and Maxillofacial Surgery, University
Hospital Reina Sofia, Cdrdoba. Spain.
Aims: Bone formation by distraction osteogenesis has
become an accepted method for correction of congenital
and acquired deformities of the mandible. Uni- or bilateral
mandibular hypoplasia and ankylosis may be the result of
early traumatic or inflammatory disease in the temporo-
mandibular joint. The purpose of this paper is to show the
technique employed and the results achieved in the treat-
ment of unilateral mandibular hypoplasia and TMJ anky-
losis by distraction osteogenesis.
Method: Three patients with mandibular hypoplasia and
ankylosis have been treated using distraction osteogene-
sis. Gap arthroplasty of the TMJ was performed simulta-
neously in two of them. Mandibular distraction began
the fifth postoperative day. The mandibles were expanded
1 mm per day until the pogonion was in the midline and
facial symmetry was achieved. Postdistraction consolida-
tion process lasted 5-6 weeks. Agressive physiotherapy
was instituted immediately after the surgical procedure.
Results: The average duration of distraction was 22 days.
Average duration of consolidation was 5 weeks. The bone
was elongated as desired. Oral opening and facial simmetry
were good and stable in the time (mean postoperative period
= 12 months; range 10-19 months).
Conclusions: Osteodistraction may be an effective method
for reconstruction of deficient mandibles in temporo-
mandibular joint ankylosis and opens new perspectives for
interceptive therapy.
[~ LATERAL ORBITECTOMY FOR CORRECTION
OF ENDOCRINE OPHTHALMOPATHY
A.Dederichs*, J.-C. Blecher, H.-P.. Howaldt,
Giessen, Germany
Grave's disease is associated with various symptoms. We are
presenting a surgical method to treat endocrine orbitopathy,
which is characterized in resection of the lower and lateral
wall of the orbit through a subciliar incision.

We overview 22 patients who underwent surgery within
the last 4 years.
The protrusion was reduced 4.6 mm in mean value. The
surgical intervention regulary lead to an improvement of
functional symptoms of endocrine orbitopathy like corneal
exposure or lid irregularities. There was also acute improve-
ment of visus just short after surgical intervention.
Futhermore it is possible to correct the esthetic appear-
ance of the patients who often suffer from psychologic
impairments associated with Grave's disease.
It can be stated that this method leads to good functional
and esthetic results and is easy and save to perform.
A PRELIMINARY REPORT ON THE USE OF
O S T E O D I S T R A C T I O N IN T.M.J. ANKYLOSIS
( F O L L O W I N G THE MC CARTHY-MC C O R M I C K
TECHNIQUE).
J. Defrancq*, F. Noorman v.d. Dussen, B. Vanassche, H.
Vercruysse
Eeuwfeestkliniek-Klina Antwerp, Belgium.
The use of osteodistraction osteogenesis for the treatment of
temporomandibular joint ankylosis is described. Daya is 15
year old girl. She is an adopted child from India since early
childhood (3 years) and known since that time to have had an
extremely reduced mouth opening. The aetiology is unknown
but may be linked to a battered child phenomenon. Her diag-
nosis was extreme fibrous ankylosis of the left T.M.J.
Our initial treatment plan for the ankylosed T.M.J. was
resection and costochondral grafting. After we became
familiar with the work of Mc Carty (NY) and Suzanne Mc
Cormick who advocate the technique of osteodistraction
for those patients we decided to try their proposed method.
The technique used was as follows:
1. Preauricular incision. Amputation of ankylotic condylar
head, in conjunction with the coronoid process.
2. Submandibular incision. Identification of the mandibu-
lar angle up to the amputation area.
3. Osteotomy started, but not completed.
4. Well planned placement of the external flxator and com-
pletion of the osteotomy.
5. Closure procedure.
Further follow up management:
1. No activation for 1 week.
2. Subsequent daily activation at a rate of 1 mm a day (by
the parents) until the distraction is completed as planned.
3. Stabilisation period of four weeks followed by removal
of the appliance.
During all this time, mouth opening exercises were encour-
aged and bacitracin ointment applied to the punch wounds.
At the end of treatment, a durable mouth opening of 35
mm was obtained and facial symmetry and normal chin
projection were restored.
Since then, two more patients have been successfully
treated with this protocol.
Ph RECONSTRUCTION OF THE ANTERIOR ARCH O F
THE MANDIBLE : IS THERE REALLY A GOOD F L A P ?
EACMFS - Abstracts, Helsinki Congress 1998 37
Testelin S. 1., Delcampe p.2, Bonan C. 1, Gigon S. ~, Peron
.1.3/1.2, Devauchelle B. 1
Departments of Oral and Maxillofacial Surgery, University
Hospital, IAmiens and 2Rouen, France
Aims : Mandible reconstruction has become a well-estab-
lished technique. But the anterior segment reconstruction
stay a difficult planing and the results are sometimes disap-
pointing. This retrospective study of 32 patients has
allowed us to compare anterior segment reconstructions
with three types of bone flaps : iliac crest, fibula and
scapula.
Method : All patients were primary reconstructions for can-
cer. Preoperative studies included cephalogram in the three
planes, tomodensitometry and 3D reconstruction with occa-
sional help of stereo lithographic models. In other cases we
used Kirschner pin to prepare bone shape. The choice of
donor site was determined by the bone and soft tissue
defects and the familiarity of the surgeon with one of the
flaps.
Results : The aesthetic results were compared regarding
bone and soft tissue defects, and then dental
rehabilitation.
Conclusions : If the bone defect is carefully examined the
choice of the bone transplant is adjusted to the mandibule.
The soft tissue defects are not so easy to evaluate before sur-
gical procedure. This can lead to scapula flap for short (10
cm) bone defect or to double flap for massive soft tissue
defects.
RESULTS O F T H E O S T E O S Y N T H E S I S OF
CONDYLAR NECK FRACTURES
Delcampe p.l*, Testelin S. 2, Braticevic Al.,Gbaguidi C2,
Devauchelle B. 2, Peron J.M. 1.
Departments of Oral and Maxillofacial Surgery, University
Hospital, 1Rouen and :Amiens, France
Aims : In a retrospective study we compared two surgical
extraoral procedures : the condylar neck miniplates
osteosynthesis via transfacial approach and the traction
screw osteosynthesis via sub and retro mandibular
approach.
Method : The level of the fracture was ascertained by frontal
tomodensitometry. 60 fractures were fixed (30 for each pro-
cedure) and then early jaw mobilisation was achieved in the
same manner as for the functional treatment.
Results : The duration of the procedure, the early stability,
and the nerve complications were investigated. Also the
functional results regarding the mastication and the occlu-
sion were investigated.
Conclusions • Traction screw osteosynthesis is a safe and
easy approach but can lead to poor reduction and osteosyn-
thesis if the fracture is close to the head. In opposite, trans-
facial approach needs dissection of the upper facial nerve
branches but allows osteosynthesis of the subcapsular
fractures.
38 Journal of Cranio-Maxillofacial Surgery
[~ BRIDGING LOWER JAW DEFECTS: A
C O M P A R I S O N O F TWO RECONSTRUCTION PLATE
SYSTEMS
Deni~ R. 1*, Werkmeister,R. 2 Bublitz, R J, Joog U 2, Weingtn't,D.1:
1) Department of Oral Maxillo and Facial Plastic Surgery,
Katharmenhospital Stuttgart, Germany. 2) Department of
Cranio Maxillofacial Surgery, University of Miinster,
Germany
Aim: To compare two different AO-reconstruction plate sys-
tems, T H O R P and U N I L O C K ( Synthes, Umkirch
Germany ), when bridging lower jaw defects.
Method: The clinical study comprised 78 patients who had
undergone segmental resection of the mandible because of
carcinoma of the oral cavity. Forty one of the 78 patients
were treated with the T H O R P system and 37 received a
U N I L O C K plate. The U N I L O C K group was analyzed
prospectively and the T H O R P group retrospectively. The
following parameters were evaluated: instability of
plate/screw, fracture of plate, premature removal,
skin/mucosa perforation, infection, functional status and
aesthetics.The mean observation time in the T H O R P group
was 30 months, in the U N I L O C K group 12 months.
Result: In the T H O R P group there were 5 cases of plate
fracture and 2 cases of loosening of screws, so that the
plates had to be removed prematurely. In the U N I L O C K
group we observed 2 cases of plate fracture. Fourteen
patients of the T H O R P group had soft tissue infection. In
none of these cases did the plate have to be removed. There
were only 5 patients with soft tissue infections in the
U N I L O C K group. Concerning the other parameters evalu-
ated, similar results were found in both groups.
Conclusion: The study suggests a higher reliability of the
U N I L O C K system in bridging lower jaw defects. This could
be due to the much shorter observation time in the
U N I L O C K group.
The preliminary result of our study justifies further
observation and critical evaluation of the U N I L O C K
reconstruction plate system.
The U N I L O C K plate belongs to the AO 2,4 plate sys-
tem and the already existing equipment can be used.The
T H O R P system requires additional equipment.
Considering all this the future might show whether the
U N I L O C K system should be preferred to the THORP sys-
tem when bridging lower jaw defects.
LASER ASSISTED TREATMENT OF
P E R I I M P L A N T BONY DEFECTS
Deppe H*, Horeh 1=1,Hiermer T, Lebeit G, Milatovic 1),
WiUamowski U, Hailer D,
Dpt. of Oral and Maxillofacial Surgery University of
Technology, Munich, Germany
Lasers may be useful in uncovering submerged implants or in
removing contaminants from 'ailing' implants. The purposes
of this study were to record temperature changes at the bone-
titanium implant interface when using a C02-1aser-scanning
system (Swiftlase®) to decontaminate exposed dental
implants. Furthermore, the effects of laser irradiation on the
surface properties of plasma-sprayed titanium implants and
its potential to sterilize those surfaces after contamination
with spores of Bacillus subtilis have been examined in vitro.
Depending on the parameters chosen, melting, loss of
porosity and other surface alterations can be seen.
Otherwise, no alterations and excellent sterilization was
found even at low power setting in cw-mode.
The aim of a study on 6 beagle-dogs was to determine whether
new bone formation can occur on previously contaminated dental
implants. 10 dental implants were inserted in each mandible.
Implants and bony defects resulting from gross plaque accumula-
tion were treated either conventionally by airpowder-abrasive or
by laser-irradiation. Corresponding histological examination of 4-
month sections demonstrated, in many areas, newly formed
lamellar bone, significantly more often in the laser-treated group,
especially when treated with submerged membranes in addition.
These results support the hypothesis that plaque-induced
peri-implant defects can be successfully treated by laser
assisted implant decontamination without damaging the
surrounding tissues.
MANDIBULAR L E N G T H E N I N G VIA INTRAORAL
P R E P R O G R A M M E D T O O T H B O R N E DISTRACTION
OSTEOGENESIS
Dessner, S., Razdolsky, Y.,
Oral Surgeon, Arlington Heights, Illinois, USA
Orthodontist, Buffalo Grove, Illinois, USA
Aims: Demonstration of surgical experience with intraoral
and hybrid osteodistractors for mandibular lengthening.
Method: Clinical slides, diagrammatics and oral description
illustrate surgucal techniques used for outpatient mandibu-
lar lengthening
under local anesthesia and I.V. sedation. Evaluation of pre-
and post-operative cephalometric analysis will be presented.
Results: Mandibular arch lengthening of 10-13 mm was
accomplished. Orthodontic adjustments following surgery
resulted in routine
Conclusions: Intraoral preprogrammed
F E M O R A L P E R I O S T E A L FREE F L A P AND
MAXILLOFACIAL SURGERY
B. Devauchelle*, B. Lengele, B. Laurent, C. Gbaguidi, S. Testelin
It would be advantageous, lastly to raise interest in the phys-
iological capacity of the free flap. So we have to transplant
not only anatomical units but the specific properties of the
different tissues of the body used. Thereby we will repro-
duce on the mesoscopic scale the same effect of treatment
on the microscopic scale.
That is the intention of the use of the periosteal femoral flap,
first described by the French surgeons (Masquelet and Martin).
To try to fill the congenital or non-bony defect and try to
reverse the inexorable destruction by bone necrosis are both
indications for this productive flap which could be called a
"prefabricating" flap.
A b o u t 15 flaps in the maxillofacial field are illustrated.
THE GIANT FACIAL SKIN TUMOUR:
THERAPEUTIC MANAGEMENT IN 10 CASES
Bonan* C., Delaporte T.H., Testelin S., Nderagakura F.,
Devaucheile B.
Dept. of Maxillofacial Surgery, CHU Nord, Amiens, France

By giant malignant skin tumour of the face (melanoma.
epithelioma, sarcoma...), the authors mean lesions covering
more than three aesthetic units of the face and sometimes
more than 100 cm2.
Several of those historical tumours are unfortunately no
longer accessible to curative treatment. Some others, when
the general status of the patient allows, are a matter of com-
plete removal and use of an epithesis with a resulting rather
poor aesthetic result.
Some others finally, with a good prognosis are com-
pletely removed and the reconstruction used the most
sophisticated techniques (multiple microsurgical flaps, suc-
cessive expansion procedures) as a way of achieving an
acceptable functional and aesthetic rehabilitation.
These successful surgical procedures should give encour-
agement to sufferers with some monstrous diseases, hope-
fully rare in west Europe (about ten cases in ten years) and
more often after inadequate treatment for years.
L I M I T S O F VASCULAR MICROSURGERY AT A
SECOND OPERATION
S. Testelin L C Bonan, E Wolf F. Taha, L.C Sun,
B. Devauchelle
The indications for secondary reconstruction (after
radionecrosis [41 cases], gunshot wound or serious facial
trauma [30 cases], sequellae of transmandibular buccopha-
ryngectomy [15 cases], failure of primary reconstruction
[15 cases]) with microsurgical procedures must only be per-
formed with precise knowledge of the vascular recipient
site.
The neck area is obviously favoured, but previous opera-
tions or radiotherapy may have modified the soft tissues and
skin, decreased the possibilities of vascular anastomosis,
and impaired the vascular recipient sites.
The irradiated, sclerosed, many times previously oper-
ated neck becomes the most important and decisive factor
in the indication for operation.
Even if the technical microvascular anastomosis rules
have been clearly laid down by G U E L I N C K X and Co (PRS
1984), the first operation is still the most important and best
choice of success.
Finally that 100 microanastomosis at second hand allow
the authors to establish those rules which become indispens-
able to obtain decreased failure rate and the vascular acces-
sible map at disposal.
In previously operated sites, recourse to a very difficult
procedure such as vascular by pass of a "captive" free flap is
therefore limited.
F I L M GRAFT O F P E R I O S T E U M AS A
TREATMENT F O R L I P AND PALATE CLEFTS
B. Devauchelle*, S. Testelin, C. Bonan, S. Garson, M. Mori
The use of a tibial periosteal graft for closure of complete
palate and lip clefts allows not only respect for the principles
of conservative surgery of the palatal mucosa, but also
restoration of a really efficient alveolar wall without growth
interference and projection of the asymmetric and retro-
posed nasal alae.
This technique described by Professor Michel Stricker
allows early surgical closure at the age of 5 months, a single
EACMFS Abstracts, Helsinki Congress 1998 39
operation for a complete closure of the cleft. The details of
the procedure in one case are illustrated.
Q=~ ANALYSIS O F SURGICAL INTERVENTION IN
60 CASES O F F R E E - F L A P C O M P R O M I S E IN HEAD
AND NECK RECONSTRUCTION.
Devine JC % Brown JS, Vaughan ED, Magennis JP
Regional Maxillofacial Unit, Aintree Hospitals Trust,
Liverpool, UK.
The success rate of microvascular free tissue transfer has
been reported to be between 90 and 98% in recent reports.
The need to return to theatre to attempt to salvage a com-
promised flap can overstretch available resources and com-
promise the recovery time for the patient. We have analysed
those cases that required surgical intervention for flap sal-
vage in an attempt to highlight those factors which may be
important in case selection and surgical technique.
Four hundred and fifty cases have undergone oro-facial
reconstruction using free tissue transfer at the Regional
Maxillofacial Unit, Walton Hospital , Liverpool, between
1992 and1997. The majority of these cases were immediate
reconstructions following ablative surgery for Head and
Neck Malignancy. Surgical intervention in the immediate
and early post-operative period was required in 60 (13.3 %)
cases, in response to clinical signs of potential or evident
compromise of the free flap. We retrospectively reviewed
these cases in an effort to identify and quantify causes of
free flap compromise in our series of patients and the subse-
quent management and outcome of free flap salvage. A
detailed account of our findings will be presented.
SUBJECTIVE I M P R E S S I O N S OF PATIENTS
ABOUT THE QUALITY OF L I F E AFTER SURGERY
F O L L O W E D BY R A D I O T H E R A P Y O F THE TONGUE
AND F L O O R O F M O U T H CANCER
Dimitr~]evie, M.*, Konstantinovic, ES.#
*Clinicfor ORL and Maxillofacial Surgery, Faculty of
Medicine, Clinic center of Serbia #Clinic for Maxillofacial
Surgery, Faculty of Stomatology; University of Belgrade,
Belgrade, Yugoslavia
Aim: To determine which of the following factors: size of
the post-excisional defect, site of the defect and type of
reconstruction have most influence on the quality of life
of patients after tongue and floor of mouth cancer
treatment.
Method: A total of 60 patients, who had been evaluated at
least 6 months after surgery followed by radiotherapy (60
Gy in 30 fractions), were selected. According to the size of
the post-excisional defect, patients were divided into 2
groups: 1) defect less than 5 cm (35); 2) defect more than 5
cm (25). Based on the site of the defect, patients were also
divided into 2 groups: 1) anterior tongue and/or floor of the
mouth (30); 2) lateral tongue and/or floor of the mouth (25)
and tongue base (5), According to the type of reconstruc-
tion, patients were divided into 3 groups: partly recon-
structed (18); reconstructed with locally available tissue -
local flaps (27); and with pectoralis major myocutaneous
P M M C flaps (15). Subjective impressions about the follow-
ing were studied: overall we/l-being, food intake, speech
40 Journal of Cranio-MaxillofacialSurgery
intelligibility, dryness of the mouth, and willingness to
undergo surgery and radiotherapy again.
Results: According to the size of post-excisional defect, a
significantly lesser number of patients could use solid food
in an average diet. There were no significant differences
between 2 groups based on the site of the defect.
According to the type of reconstruction, a significantly
greater number of patients was reconstructed with
PMMC; had minimal social activities, evaluated their
cosmesis as poor, frequently had food trapping during the
meal and considered their speech to be more or less dis-
turbed.
Conclusions: According to results of this study, type of
reconstruction followed by size of post-excisional defect
seemed to be the most influential factors on quality of life
of patients after tongue and floor of the mouth cancer treat-
ment. Site of the defect has no influence.
R E P L A C E M E N T O F ALVEOLAR JAW DEFECTS
BY B I O C O M P O S I T E MATERIALS
*Drobishev A., Voiozin A., Agapov V., Asnina S., Beloserov
M., Mustafaev M., Baker Abu Kefah.
Medical Stomatological Institute, Department of Oral and
Maxillo-Facial Surger): Moscow. Russia.
AIMS: Experimental testing and clinical application of
biocomposite materials produced by Polystom manufac-
tures for replacement of jaw defects.
METHODS: Hystological and pathohystological investi-
gation of bone tissues in experiment on animals. Clinical
studies were performed on 75 patients with postoperative
jaw defects after removal of tumors and tumor-like
processes. The bone defects were filled by the collagen and
hydroxilappatite preparations hydroxyapol, collapol KP or
collapol KP-3.
RESULTS: The indications were developed for various prepa-
ration use depending on defect size and patient age. Follow-up
results were observed up to 3 years. High efficiency of this
treatment was obtained in out patients practice.
CONCLUSION: The tested preparations of hydroxilap-
patite with collagen are indicated for replacement of alveo-
lar jaw defects.
THE E L I M I N A T I O N O F MANDIBULAR
SEGMENTAL DEFECTS
Drobot Car.,Karayan A., Nabiev E
Department of Face and Neck Plastic Surgery Central
Research Institute of Stomatology, Moscow, Russia
Aims: Mandibular reconstruction after segmental resection
of benign tumours.
Method: For mandibular reconstruction after segmental
resection of benign tumours, a combination of demineral-
ized bone matrix and titanium-mesh-system have been
used.
Results: From 1993 to 1998 in 8 reconstruction cases the bone
matrix was longer than 4 cm. We observed complications in 3
cases. Postoperative infection was observed only in two of
them. Fracture of the titanium implant was observed in one
case, 8 to 10 months after the operation. The condition of the
other five patients revealed certain functional results.
Conclusions: The results of the research have demonstrated
the high osteogenetic possibilities of demineralizated bone
matrix.
THE TREATMENT O F A LOWER LIP
HAEMANGIOMA
Prof. Dr. Dr Rainer B Drommer
Heidelberg. Germany
A four year old girl presented to our clinic with a cherry-
sized haemangioma in the left vermilion border of the lower
lip The original birth defect was a large filled haemangioma
which had been initially treated with interferon. Laser-ther-
apy was contra-indicated. The treatment plan decided on
involved combining a surgical procedure and the applica-
tion of fibrin-glue. The techniques used and results
obtained are documented in the following video.
EXPERIENCE WITH VARIOUS F O R M S O F FACE
LIFTING
Prof. Dr. Dr. Rainer 11. Drommer
Heidelberg, Germany
There are many ways of performing a face lifting operation.
These concern on the one hand placement of the skin-inci-
sion, where different incision-lines - pre-auricular, temporal
and retro-auricular - can be chosen. On the other hand, dif-
ferent fascial layers can be chosen, using the subcutaneous,
sub-fascial and subperiostial layers. We report on our long
term experiences with face lifting, and demonstrate chosen
guidelines for the different operative techniques, with their
respective pro- and contra-indications. The age of the
patients ranges from forty to seventy five years. All were oper-
atively treated in our clinic over the past years.
MAXILLOFACIAL I N J U R I E S (MFI) AND
POLYTRAUMA: HEAD INJURY(HI) CRITERIA AND
T I M I N G O F CRANIOFACIAL SURGERY
Dyer, P. E* Cannell, H., Patei, H.
Department of Oral & Maxillofacial Surgery, The Royal
London Hospital, Whitechapel, London. E1 UK.
Aim: To assess clinical measm'ements of HI in patients with
craniofacial trauma with the aim of establishing a protocol
for timing of M F I interventions.
Method: HI criteria suggested by Derdyn et al, (1990) of
significance for timing interventions for repair of MFI, were
an intracranial pressure (ICP) of > 15, low Glasgow Coma
Scale (GCS) values and/or evidence of cerebral injuries
from CT. These criteria were tested by a prospective case
controlled study of 155 M F I patients with polytrauma. One
group (n=50) underwent invasive neurosurgical procedures
in addition to treatment for MFI. The control group (n=42)
with HI received treatment for M F I alone.
Results: Objective evidence of HI was common to test and
control groups. Mortality rates within 24 hours were similar

at 20%-23%. GCS scores at accident scenes <8 for test and
control groups were 56% and 36% respectively but scores >_
12 were significantly different at 16% and 45%. Probability
of survival, (Ps) > 50% was 46% for the test group and 63%
in the control group. ICP values were available for 34 cases
in the test group for periods up to 6 days and persistently
unstable values delayed definitive surgery for M F I in 8
cases. Repair of lacerations, tracheostomies and naso-eth-
moidal haemorrhage control were the main urgent surgical
procedures for MFI. For urgent HI, bolts for monitoring
ICP were placed at a mean time from admission of 7.7
hours and evacuation of extra- or sub- dural haemorrhages
was at a mean time of 4.5 hours from admission. Definitive
early interventions for open reduction and fixation for M F I
was performed in 5 cases but was considered clinically feasi-
ble in at least another 12 craniofacial cases.
Conclusion: In the cohorts tested, urgent M F I interventions
and in a few cases definitive repair did not affect outcome
for HI patients adversely.
PLASTIC REPAIR OF PHARYNGO-CUTANEOUS
C O M M U N I C A T I O N S BY MYOCUTANEOUS F L A P S
Dzolev A., Ristic J.., Dedic S., llic M. P.,* Kiralj A.,
Hrabovski A.
Institute of Surgery, Clinic of Maxillofacial Surgery,
University of Novi Sad, Novi Sad, Yugoslavia
Aim: To investigate the possibility of plastic repair of
pharyngo-cutaneous communications by peduncular or free
myocutaneous flaps.
Methods: 236 reconstructions of large intraoperative/post-
operative defects in the head and neck were obtained
between 1987-1997. Large pharyngo-cutaneous communi-
cations were created in 39 patients: intraoperatively - after
excision of an oropharyngeal tumor; postoperatively - by
dehiscence of a primarily closed wound due to infection; by
postirradiation necrosis. Plastic repair of fistulae was per-
formed using the pectoralis maior and latissimus dorsi
myocutaneous flaps. Immediate reconstruction (after
tumour excision) was performed in 22 patients and post-
poned reconstructions, performed a few weeks after the first
operation, in 17.
Results: Plasty of pharyngo-cutaneous communications,
using myocutaneous pedunculated or free flaps, was done in
39 cases: by pectoralis maior pedunculated flap in 32
patients (82 %); by latissimus dorsi free flap in 7 patients.
Complication in terms of partial necrosis of flap occurred
in 4 patients and complete necrosis in 2 patients.
Conclusions: Utilization of the pectoralis maior peduncu-
lated and latissimus dorsi free myocutaneous flap gives very
acceptable results in plastic repair of pharyngo-cutaneous
fistulae.
SAGITTAL AND VERTICAL FRONTAL DENTO-
ALVEOLAR MANDIBULAR DEVELOPMENT IN
YOUNG EUGNATHIC PATIENTS
Ehmer A*, Z611ner B, Smolka K, Ehmer U, Joos U
Cranio-Maxillofacial Surgery, University of Muenster,
Germany
EACMFS - Abstracts, Helsinki Congress 1998 41
Aims: The purpose of this retrospective longitudinal study
was to establish a set of cephalometric sex-dependent stan-
dard values for sagittal and vertical growth of the frontal
dento-alveolar mandibles in young eugnathic patients.
Method: The subjects were 77 (36 male, 41 female) white
patients with an Angle Class I (eugnathic patients) from the
Bolton Brush Growth Study Cleveland, Ohio. Lateral
cephalometric radiographs at the age of 9, 12, 15 and 18
years were digitized in a computer-assisted way to deter-
mine the development of the lingual and the labial bone
extension of the frontal dento-alveolar mandible.
Results: The sagittal dento-alveolar bony extension of the
frontal mandible at the lower incisor apex level decreased
from a mean of 11,4 mm at the age of 9 years to 10,3 mm at
the age of 18 years in men ranging from 6,4 mm to 14,1 mm
at the age of 18 years and from a mean of 13,3 mm to 10,6
mm in women ranging from 6,7 mm to 16,2 mm at the age
of 18 years. In detail: On average, the sagittal bone exten-
sion of the labial dento-alveolar mandible was 5,6 mm at
the age of 9 years in men and 6 mm in women. The lingual
bony extension with 5,4 mm in men and 5 mm in women
showed a similar distribution. In both groups the sagittal
bony extension decreased gradually from 9 to 18 years of
age. The vertical bone extension of the frontal mandible at
the level of the lower incisors increased permanently.
Conclusions: The standards values might be a keystone for
optimal timing of the insertion of dental implants in the
frontal mandible and proved to be helpful for orthodontic
treatment.
~h KERATOCYSTS O F THE MAXILLARY SINUS
Eichhorn, W., Gehrke, G.*, Knauer, O.
Department of Maxillofacial surgery, Kreiskliniken
Balingen, Germany
Nordwestdeutsche Kieferklinilc, UniversitiitHamburg,
Germany
The keratocyst or primordial cyst is a odontogenic cyst
occuring most commonly in the third molar region. Its
agressive nature often causes extensive destruction before
attention is drawn to the presence of the cyst by swelling or
pain. Especially in adolescents the differentiation between a
keratocyst and a follicular cyst may be difficult. In five cases
only the recurrence of the cyst was diagnosed as a
keratocyst.
In the period of 20 years 26 operations on the maxillary
sinus of 19 patients have been performed. The operative
procedure consisted of a cystectomy and, if necessary,
removal of the surrounding structures. The histopatholigic
specimen have been classified according the W H O criteria
(Pindborg etal., 1971).
The results of the retrospective study show that over 50
percent of the patients have been in the age of 11-20 in the
time of first diagnosis. 90 percent of the recurrence have
been observed in the first five years after operation. The
recurrence rate was 54 percent.
The recurrence may occur from remnants of the
epithelium of the cyst or from satellite cysts. Extensive
operative procedures are limited by the young age of the
patients to avoid mutilations. The use of K a r n o y solu-
tion seems to be difficult due to the proximity to the
infraorbital nerve. The chosen operative precedure refer-
ring to the high recurrence rate found seems not to be
satisfying but all recurrences could be treated
successfully.
42 Journal of Cranio-Maxillofacial Surgery
INFLUENCE OF PREOPERATIVE P E R F U S I O N
WASH OUT O F F L A P S ON THE WOUND H E A L I N G
Eichhorn, W., Gehrke*, G., Knauer, O.
Department of Maxillofacial surgery, Kreiskliniken
Balingen, Germany *Nordwestdeutsche Kieferklinik,
University of Hamburg, Germany
After 6 hours of primary ischemia myocutaneous flaps of
pigs suffer from necrosis of 30-60 percent. The aim of the
following study is to investigate the possible enhancement of
tolerance to ischemia by preoperative perfusion washout in
an experimental study on pigs.
20 myocutaneous flaps underwent normothermic perfu-
sion washout with lactated Ringer's or Euro-Collins or
University of Wisconsin (UW) solution before the onset of
6 hours primary ischemia.
Flap survival was assessed on the 10th postoperative day.
While 14 percent of the flaps perfused wtih lactated
Ringer's solution survived , survival rate of the Euro-
Collins group was 23 percent. Perfusion washout with U W
showed a survival rate of 89 percent. Histopathologic inves-
tigations revealed the muscle to be most sensitive to
ischemia.
D MIXTURE OF s-CAPROLACTONE-LACTIDE
C O P O L Y M E R AND T R I C A L C I U M P H O S P H A T E . A
H I S T O L O G I C A L AND I M M U N O H I S T O C H E M I C A L
STUDY O F TISSUE REACTIONS.
Ekholm* Maria, Hietanen Jarkko, Lindqvist Christian,
Rautavuori Jorma, Santavirta Seppo, Salo Antero, Seppiilii
Jukka, Suuronen Riitta.
Department of Surgery, Helsinki University Central
Hospital, Helsinki, Finland
Aims: To assess tissue reactions to a mixture of tricalcium
phosphate (TCP) and e-caprolactone-lactide copolymer
P(s-CL/DL-LA) histologically and immunohistochemically,
and to compare bone healing at the sites of implantation
versus that at control sites. Resorption time and intensity of
inflammatiory reaction were also evaluated.
Method: The material was placed in the dermis and in
mandibular bone defects in 13 rabbits. Follow-up times
were: 2, 3, 7, 8, 12, 15 and 18 weeks.
Results: We found that the mixture caused a mild inflamma-
tory reaction when placed in bone and severe inflammation
when placed in the dermis. Formation of osteoid was less in
the defects where the material had been implanted than in
defects in which it had not. No highly fluorescent layer of
tenascin or fibronectin was found surrounding the implant
area.
Conclusions: The mixture was excellent to handle and very
easy to place into bone defects. The results are promising
and have led us to continue development of the mixture.
O ADVANCES IN MAXII,LOFACIAL TRAUMA SURGERY
Edward Ellis II1,
Professor of Oral and Maxillofacial Surgery, University of
Texas Southwestern Medical Center, Dallas, Texas, USA
Over the past one hundred years, major achievements have
been made in care for victims of maxillofacial trauma.
Today, such injuries adversely affect the quality of life less
frequently than they once did owing to countless advances
that have been made by countless numbers of individuals
from diverse disciplinary backgrounds. Collectively, these
advancements have provided great improvements in the pri-
mary and secondary correction of traumatic maxillofacial
deformities.
Many of the major achievements that have occurred are
not specific to the maxillofacial specialties. Discoveries and
factors involved in the metabolic response to trauma, heal-
ing of traumatic injuries, shock, nutrition, anesthesiology,
bacteriology, imaging, educational courses in trauma life
support, etc., while extremely important to the topic of
trauma, are more pertinent to the patient as a whole than to
the maxillofacial area in particular. These advances will not
be discussed. Instead, this talk will focus on the historical
development of current surgical procedures/techniques that
have improved treatment results for patients who have sus-
tained maxillofacial injuries.
The following topics in the surgical treatment of the
maxillofacial trauma patient are so monumental, that they
deserve mention as true advances. Each will be discussed in
light of what they have done for the care of injured
patients.
I. Use of the Dental Occlusion as a Guide to Fracture
Reduction
I. External Skeletal Fixation
III. Open Reduction
IV Craniofacial Exposure
V. The Realization that Facial Bones Could Be Used as
Free Grafts
VI Internal Wire Fixation
VII. Primary Bone Grafting
VII. Plate and Screw Fixation
IX. Internal Orbital Reconstruction
X. Re-Suspension of Facial Soft Tissues
Z Y G O M A FRACTURE REPAIR W I T H
BIODEGRADABLE FIXATION DEVICES - CLINICAL
CONSIDERATIONS
G.Enislidis1., S.Pichorner 1, F.Lambert1, G.Lagogiannis1,
N.Fock 1, F.Kainberger2, R.Ewersl
1University-Clinic for Oral and Maxillofacial Surgery, AKH
Vienna, Austria
2University-Clinic for Radiology, AKH Vienna, Austria
AIMS - The evaluation of a new, commercially-available
osteosynthesis system for the repair of zygomatic fractures
was the aim of this study. M E T H O D S - In a prospective
study, a total of 63 patients with unilateral zygomatic frac-
tures was treated between July 1996 and December 1997.
Open fracture repair was performed using the Lactosorb
osteosynthesis system. This material is made of a
biodegradable P L L A / P G A copolymer, which retains 70% of
its initial strength for 6 to 8 weeks and is known for its excel-
lent biotolerance, being in clinical use since 1984 in the form
of a resorbable ligation clip. The intraoperative handling of
1.5mm panels and 2.0ram plates and of the corresponding
screw sytems was found to be of adequate ease for senior
oral and maxillofacial surgeons as well as for trainees.
RESULTS - In the 18 month follow-up period, none of the
patients showed any material-related complications, as

described for other biodegradable osteosynthesis devices.
Sequelae included four ectropic eyelids, three cases of intra-
oral wound dehiscence, two cases of dysaesthesia, and one
case of enophthalmos. CONCLUSIONS - The Lactosorb
osteosynthesis system provides a practicable method for
successful open reduction and fixation of zygomatic frac-
tures. Long-term observation and operative re-entry will be
needed to document the immaculate biodegradation prop-
erties of this material.
BIOMECHANICAL TESTING OF RESORBABLE
SCREWS FOR SAGITTAL SPLIT MANDIBULAR
OSTEOTOMIES
D Sarver*, B Pietvzak, BL Eppley
Indiana University
Indianapolis, Indiana USA
This study determined the suitability of resorbable screws
for fixation of sagittal split osteotomies by in vitro biome-
chanical strength testing. 2.5ram screws composed of a
P L L A - P G A copolymer (LactoSorb) were placed in an L-
hole pattern in overlapping sawbone blocks typical of sagit-
tal split mandibular surgery. In an in vitro model at 22
degrees C, the test specimens were statically loaded until
failure occurred. On a new set of test specimens, dynamic
testing was done in an in vitro water bath at 37 degrees C
through cyclical loading until failure occurred. In static
testing, the screws sustained an average peak load of 131 kg
(5.2 standard deviation) with 5.5% strain at yield. In
dynamic testing, the screws tolerated a 45 kg loading for an
average of 340,675 cycles (22.783 standard deviation).
These tests indicate that P L L A - P G A 2.5ram screws can tol-
erate the postoperative masticatory demands of the unre-
strained sagittal split osteotomy for up to 8 weeks after
surgery.
RESECTION O F A M A L I G N A N T H I S T I O C Y T O M A
DURING M.R.I. SCANNING GUIDANCE
M. Erbe *, S.C. Girod, R. Steinmeier, F. W. Neukam
Department of Oral and Cranio-Maxillofacial Surgery,
Friedrich-Alexander- UniverstitgitErlangen-Niirnberg,
Gliiekstrasse I1, 91054 Erlangen, Germany
Malignant histiozytomas are a rare mesenchymal tumors
which are characterized by subcutaneous location, rapid
invasive growth and ill defined margins. In addition to the
histological diagnosis the assessment of the tumor extension
is important and can be determined well by M.R.I. imaging.
We report the case of a 62-year-old patient with a malig-
nant histiozytoma of the left parietal skull and the neck.
The tumor masses in the neck which extended to the skull
base and the prevertebral muscles were removed in the M R
scanner using a modified radical neck dissection including
the skin. Intraoperatively M R imaging was performed to
determine the complete removal of the tumor tissue
(Magnetom open, 1.2 Tesla, Siemens). The margins were
controlled histopathologically and correleated with the M R
findings. When tumor free resection was established using
these two different diagnostic modalities, reconstruction of
the defect was performed using a pedicled myocutanous
pectoralis major flap.
EACMFS - Abstracts, Helsinki Congress 1998 43
In conclusion intraoperative imaging in the open M R
proved very helpful in determining the complete resection of
a malignant histiozytoma.
N E U R I N O M A O F THE PTERYGOID F O S S A
Girod* S.C., Erbe M., Paulus IV..,Neukam F. W.
Department of Oral and Cranio-Maxillofacial Surgery,
Friedrich-Alexander- Universtitgit Erlangen-Niirnberg,
Gliickstrasse 11, 91054 Erlangen, Germany
Neurinomas are rare tumors which can also occur at the
skull base. The preoperative diagnosis is limited as neither
the clinical symptoms nor the results of radiological investi-
gations, eg CT or MR, can usually establish the exact dig-
nity of the tumors.
We report the case of a 36-year-old female patient who
presented with a neurinoma of the pterygoid fossa and no
clinical symptoms. The patient had a neurinoma in the cheek
several years previously and the tumor in the pterygiod fossa
was detected in a follow-up MR. Due to the location of the
tumor a diagnostic biopsy could not be performed.
In solitary neurinomas the surgical resection is the treat-
ment of choice. Surgery was performed via a hemitemporal
and submandibular access with temporary splitting of the
mandibula and the zygoma. The facial nerve was carefully
dissected and preserved. Postoperatively the patient had a
temporary incomplete facial palsy which resolved rapidly.
Furthermore she had hypothermia of the inferior aveolar
nerve which was monitored using the PATH test.
Due to the location the exact diagnosis of tumors in the
pterygoid fossa is difficult and can usually only be estab-
lished intraoperatively. Solitary neurinomas need to be
included in the differential diagnosis of tumors in this area
as their removal can cause permanent nerve damage about
which the patient needs to be informed prior to surgery.
T M J SURGICAL MANAGEMENT OUTCOME:
OPEN J O I N T PROCEDURES AT INTERNAL
DERANGEMENT AND DEGENERATIVE J O I N T
DISEASE
Lars 0 Eriksson,
Department of Oral and Maxillofacial Surgery, University
Hospital of Lund, Sweden
Internal derangement and degenerative joint disease are fre-
quent findings in patients with persistent joint pain and dys-
function. According to the AAOMS Parameters of care-95,
temporomandibular joint surgery is indicated at these con-
ditions only when non-surgical therapy has been ineffective
and when pain and/or dysfunction is moderate to severe in
nature. Surgery is not indicated for preventive reasons.
Discectomy without the use of implants was until 1960
the most commonly reported procedure for surgical treat-
ment of the painful TMJ. However, the postoperative results
have been questioned as signs of adhesions and degenerative
changes have been found in clinical and radiographic exam-
inations. During the eighties interpositional alloplastic
implants became popular in spite of insufficient scientific
support. Later severe postoperative destructive changes
were reported and the use of alloplastic materials as a disc
substitute was abandoned. Autogenous disc substitutes like
44 Journal of Cranio-MaxillofacialSurgery
cartilage and temporal muscle have also been used with
varying results.
During the last decade improved diagnostic radiographic
and M R I techniques of the TMJ have resulted in an
increased interest for surgical repositioning of displaced
discs. However, although clinical results have been encour-
aging in several cases, more seldom a normalized morphol-
ogy has been found. This observation has led to a
questioning of the relationship of disc position to pain and
mandibular dysfunction.
The presentation will discuss the above mentioned surgi-
cal techniques in the light of recent scientific findings.
G = ~ D O S E DEPENDENT S T I M U L A T I O N AND
R E D U C T I O N OF T U M O R CELL GROWTH IN VITRO
BY ACTIVATION AND I N H I B I T I O N O F NCC (NON-
SELECTIVE CATION CHANNELS)
Ervens, J.*, Wolff, K.-D., Hoffmeister, B.
Department of Maxillofacial Plastic Surgery, Medical
Center Benjamin Franklin, Free University Berlin, Berlin,
Germany
AIMS:
Intracellular Ca 2+ plays a fundamental role as a regulator of
many enzymes and as an effector for hormones and growth
factors which control a wide variety of cellular processes. In
the recent past, evidence has been accumulated that Ca 2+
homeostasis and Ca2+-regulated events are important in
malignant transformation and cell proliferation. Therefore,
we studied the effects of activation and inhibition of NCC
on tumor cell growth.
METHOD:
We used the human epithelial tumor cell line, KB, and
assessed the tumor proliferative capacity by the human
tumor stem-cell assay and determination of colony number.
RESULTS:
Inhibition of N C C by econazole and 5-amino-[4-(4-
chlorobenzoyl)-3,5-dichlorobenzyl]-1,2,3,-triazole-4-car-
box-amide (L 651582) significantly reduced tumor cell
growth. Econazole decreased tumor cell growth with an
ECs0 of 3 moll1 and a maximal effectiveness at approxi-
mately 30 mol/1. Econazole at a maximally effective concen-
tration induced an inhibition of tumor cell growth by about
80%. L 651582 reduced tumor cell growth with an ECs0 of
300 moll1 and a maximal effectiveness at 3 moll1. At con-
centrations up to 3 mol/1, the inhibition of tumor cell
growth was nearly complete. Activation of NCC by cyclop-
iazonic acid and thapsigargin significantly enhanced tumor
cell growth. At concentrations below 300 nmol/1, cyclopia-
zonic acid lead to a significant stimulation of tumor cell
growth with a maximum at 1 nmol/1. At a maximally effec-
tive concentration, the cyclopiazonic acid-induced stimula-
tion of tumor cell growth amounted to approximately 70%.
At concentrations below 30 nmol/1, thapsigargin signifi-
cantly enhanced tumor cell growth with a maximum at 100
pmol/1. At a maximally effective concentration, the stimula-
tion of tumor cell growth by thapsigargin amounted to
85%.
CONCLUSIONS:
Inhibition of NCC by econazole and L 651582 significantly
reduced tumor cell growth of the human epithelial tumor
cell line, KB, whereas activation of NCC by cyclopiazonic
acid and thapsigargin enhanced tumor cell growth. These
data indicate the participation of NCC in the regulation of
proliferation of KB cells.
FOUR SCREWS 1NTERMAXILLARY FIXATION:
OUR EXPERIENCE
Escuder 0 . * Gimeno J, Pericot J., Piulachs P. Escutia E.
Department of OMFS, University Hospital of Bellvitge.
L'Hospitalet del Llobregat, CATALONIA.
Aims: To evaluate our experience with the fast method of
intermaxillary fixation with four screws.
Method: Our fast and safe method of intermaxillary fixation
has been used in over 250 patients from 1987 on in our
Department. The method consists of placing two screws in the
maxilla and two in the mandible. Fixation is accomplished by
placing wires -2 or 4- from maxillary screws to mandibular
screws. The basic requirement to use this fixation is to have an
occlusion stable enough to be mantained with less fixation
points than the classical intermaxillary fixation with Erich
archs-or similar. The selected patients include those with frac-
tures affecting tooth occlusion, as well as patients requiring
intra and/or postoperative intermaxillary fixation because of
any surgery (oncological, orthognathic, etc.)
Results: With our selected patients, we almost had no com-
plications. No force is applied to the teeth. Mucosal lesions
occur less than with classical fixation. Oral hygiene and peri-
odontal care are much better accomplished than with other
methods. Furthermore this method reduces surgical time by
over half an hour. Comfort for the patient is higher.
Another additional advantage is the minimal risk of acci-
dental injury to the surgeon (mainly inadvertent finger
puncture). The only negative result in comparison with
other methods is the possibility of root lesion (less than
1%), until now, only one case required endodontic treat-
ment. Removal of the fixation is routinely performed in two
stages: the wires first and the screws 7-15 days latter. This is
again much easier and comfortable for both the patient and
the surgeon. We have increased the selected patients as our
experience has grown.
Conclusions: Our method of four screws intermaxillary fixa-
tion is appreciated because of its ease and speed of applica-
tion. Also for the safety for both the patient and the
surgeon. Its incidence of complications is virtually non-exis-
tent if performed by a minimally experienced surgeon.
[~ H I S T O L O G I C A L BEHAVIOUR O F SOLVENT-
DEHYDRATED H U M A N COSTAL CARTILAGE
(SDHCC) IN VIVO: (An experimental study in rabbits)
Esen E. 1, Usubiitiin A. 2, Giray CB. 3
1.Faculty of Dentistry, Dept. of Oral Surgery ~ukurova
University, Adana, Turkey.
2.Faculty of Medicine, Dept. of Pathology, Hacettepe
University, Ankara, Turkey.
3.Faculty of Dentistry, Dept, of Oral Surgery, Hacettepe
University, Ankara, Turkey.
Aims: The value of solvent dehydrated human costal carti-
lage (SDHCC) is well known in our specialty. The use of

SDHCC for facial contour defects ,TMJ reconstruction and
in ENT surgery is highly valued. The interesting point is the
question does a revitalization process occur after SDHCC is
implanted? In the cases in which we have used SDHCC, it
was well tolerated and integrated with human tissue for long
follow up periods. But in order to find out the cellular via-
bility, we needed detailed histopathological experimental
studies concerning this process. The aim of this study to
evaluate the histological features regarding cellular viability
of SDHCC in vital structures.
Method: SDHCC grafts were placed in surgically-created
defects in the mandibular bone of 12 New Zealand white
rabbits. Control defects were also prepared in bone to com-
pare the cellular changes. Simultaneously larger pieces of
cartilage were implanted under the dorsal skin of rabbits in
the scapular region to determine the changes in the sur-
rounding soft tissues. Animals were sacrificed at
1,2,4,6,8,10,12 weeks. The mandibular body containing the
cartilage transplant and control defect was resected for
histopathological examination. Subcutaneously placed car-
tilage was also excised together with the surrounding tissue.
Specimens were decalcified, stained with haematoxilin-eosin
and examined under light microscopy. A piece of SDHCC
was also examined with transmission electron microscopy to
evaluate the cellular composition of the graft after the sol-
vent dehydration process
Results: We observed pyknotic nuclei in the condrocytes in
the graft prior to insertion and in the specimens taken in the
early weeks. But they are not viable. In the early weeks,
mixed inflammation around the graft, and in the latter
weeks fibrosis and the partial destruction of the cartilage
tissue by macrophages were observed. The control defects
healed within 4-6 weeks.
Conclusion: In SDHCC grafts implanted into the bone cavi-
ties, we did not observe any revitalization process in respect
of condrocytes. The cellular remnants of the graft were
totally pyknotic, even in the latter weeks. Slow degradation
and destruction of the graft can be helpful as a framework
until the original tissue regenerates in the defect. But since
we have used SDHCC as a xenograft for rabbits, the resorp-
tion process occurs more rapidly than in humans.
Furthermore as an advantage, there is no risk of viral trans-
mission to the host from the SDHCC grafts such as occurs
with cryopreservation or lyophilisation graft systems.
G=~ BR#,NEMARK IMPLANTS IN IRRADIATED
VERSUS NONIRRADIATED MANDIBLE AFTER
ONCOLOGY SURGERY
Esser, E. 1 and Wagner, W..2
~Department of Maxillo-Facial Surgery, Stiidtische Kliniken
Osnabriick, Germany
:Department of Clinical Radiotherapy, Paracelsus
Strahlenklinik, Osnabriick, Germany
Aims: Representation of risks associated with implants in
the irradiated mandible
Methods: From 1988 till 1995 145 Brgmemark fixtures (34
patients) were inserted in the irradiated mandible (60 Gy,
linear accelerator 6 MV, split course technique, conven-
tional fractionation) after radical oncologic surgery. In a
retrospective analysis, perioperative complications as well as
clinical development including periimplant bone loss were
compared with a control group of 28 patients with 130
implants in the nonirradiated mandible.
EACMFS Abstracts, HelsinkiCongress 1998 45
Results: The implant-related prosthetic rehabilitation of the
mandible with radiotherapy up to 60 Gy entailed a higher
primary incidence of complications (2.9 % osteoradionecro-
sis, 8.8 % soft tissue necrosis, 5.5 % lack of osseointegration,
4 . 1 % loss of osseointegration). However, 15 months after
insertion, a significant implant loss or a higher rate of peri-
implant bone loss were not detectable. The cumulative 5
years success rate according to Kaplan-Meier for implants
in the irradiated mandible was 93.8 % or 97.6 % respectively
in the nonirradiated mandible.
Conclusions: The insertion of implants in the irradiated
mandible up to a limit of 60 Gy should not to be principally
considered contraindicated. However, a higher incidence of
complications for the insertion period and the loading pro-
cedure is to be expected. Prophylactic HBO treatment is not
recommended. Such therapies should be reserved to cases
with corresponding complications
C R A N I O P L A S T I E S W I T H INDIVIDUALLY
PREFABRICATED TITANIUM I M P L A N T S
H Eufinged*, M Wehm6ller2, M Schoiz3, L Heuser 4, E
Machtens I
1Dept. of Oral & Maxillofacial SurgelT, 3Dept. of
Neurosurgery and 4Inst. of Radiology & Nuclear Medicine at
the University-Hospital 'Knappschafts-Krankenhaus'; :Inst.
of Production Systems & Processing Techniques,
Ruhr-University, Bochum, Germany
Reconstruction of craniofacial bone defects by intraopera-
tire modelling of autogenous or alloplastic materials may
fail to create harmonious contours with long-term stability.
In contrast, computer aided design and manufacturing
(CAD/CAM)-techniques may be used for the preoperative
geometric modelling of the implant, out of titanium, based
on computed tomography (CT)-data. Helical CT-data is
used to create a computer-based 3D model of the defect
region, which serves as the basis for a free-form surfaces
design of the implant's shape, position and thickness;
thereby the use of individual model fabrication is aban-
doned. Special construction elements, e.g. plates for fixa-
tion with microscrews, holes for drainage or complex
implant margins such as the supraorbital rim can be
included in the design and can be fabricated with the
implant. The data required for this geometric modelling are
derived from the structures neighbouring the defect, model-
ling tools and programs developed for industrial
C A D / C A M are used. The precise and individual fit of the
implant results from generating its margins by the borders
of the defect with a precision of up to 0.25 mm, whereas its
surface is generated by the geometry of the non-affected
neighbouring bone contours. Afterwards, the geometric
data run a numerically controlled milling machine to fabri-
cate the individual titanium implant with a constant thick-
ness of 1.5 mm. So far more than 50 patients with
posttraumatic, postsurgical or congenital defects have been
reconstructed in various Central-European hospitals. Some
of the defects have had a diameter of up to 18 cm, many
had been operated on previously without success.
Reconstructions using this new method have been success-
ful in all but one case, producing supremely aesthetic results
due to the precise and individually pre-determined techni-
cal processing chain. Surgical insertion and fixation is only
the simple final step in this procedure with a distinctly
reduced duration of operation and thus decreased stress on
the patient. It is expected that these individually prefabri-
46 Journal of Cranio-Maxillofacial Surgery

cated titanium implants will claim their position within the University Clinicfor Oral and Maxillofacial Surgery,
spectrum of reconstructive techniques of cranioplasty, University of Vienna
especially in cases with large and complex craniofacial Waehringer Guerte118-20, 1090 Vienna, Austria
defects.
Originally the hydroxyapatile material Algipora has been
developed as bone substitute material with the condition
[~ THE C O M P R O M I S E D MAXILLA of an interconnecting porosity and enough stability to
hold the given augmentation height. The material has
R. Ewers, F. Watzinger, S. G6ssweiner been primarily developed as osteoconductive substitute
material and has proved very well in the clinical use. Until
University Clinicfor Oral and Maxillofacial Surgery, now the preparation has alwas been used in connection
University of Vienna with spongy transplants in a mixture between 1:1 until 5:1.
Waehringer Guerte118-20, 1090 Vienna, Austria Primarily one assumes that a mixture ratio of l:1 would be
necessary. But the clinical results have shown that the
According to Cawood et al. (1994) we classify the severely admixture of 1/5 bone material is not enough. In the last
atrophied maxilla due to different augmentation methods in time one has abandoned spongy transplants and uses only
classes more than 8 mm, 4 - 8 ram, less than 4 mm and below spongy material which has been won in bone collector.
2 mm. If we have more than 8 mm we prefer to perform The recarmination of 402 patients showed a low ratio of
micro-invasive bone lifting without controlling our bone infections which could all be controlled without the loss of
the material, excellent results in the field of the augmenta-
lifting by sinuscope surgery and applying 13 mm long
tions, especially in connection with implants, and only a
implants. Between 4 and 8 mm bone height we apply a sinus-
few complications. In the clinical use is has been shown
lift with the sinus graft and one stage implant application.
that the Algipore material does not only heal very well in
Do we have less than 4 mm bone we do have to perform a
the sense of conductivity but that it is grown around slowly
two stage implant procedure half a year after the sinus graft
by bone. Within 12 to 24 months the material is completely
in order to have sufficient stability for the implants. As
dissolved and by a large part replaced by new built bone.
grafting materials we use to apply a mixture of phycogene
(Donath 1997). The porous material is resorbed after a cer-
hydroxyapatite (Algipore®) in a ratio 5:1 mixed with autoge-
tain time so that it is nearly equivalent to the remodelling
nous bone taken from the chin or the ascending ramus.
of the natural bone.
According to Haessler (1997) we now use Algipore® mixed
In animal experimental studies Algipore is now tested as
only with few portions of the collected bone from milled
canter material for BMP materials. On one side Algipore
bone in the canine fossa so that we have a ratio less than 5:l.
shows nearly a good protein bonding ability as collagen. So
All these procedures require that the alveolar ridge is
Algipore has a much better protein bonding ability that all
wider than 5 ram. If the alveolar ridge is less than 5 mm we
other hydroxyapatite material that have been used until now
perform, in addition to this, a monocortical bone block
because of its interconnecting microporosity and its stechlo-
transplant from the chin, both ascending ramus and in
metric structure and its chemism (Terhayden 1997).
severe cases we use pelvic bone block grafts.
Moreover, the animal experiment shows under the use of
Great severe atrophied maxilla with less than 2 mm bone do
Algipore and rhOR1 (BMPT) that algipore has shown an
show discrepancy in the sagittal and transversal direction with
extensive formation of new built bone due to the combina-
a pseudoprogenic surgical situation and a very small maxilla
tion with this bone inductive protein especially around the
compared to the enlarged mandible due to the atrophy. In these
smaller granules.
cases we perform either the original Le-Fort-I-osteotomy
The clinical use of the hydroxyapatite Algipore, won out
designed by Bellor we use our modification of the Horseshoe
of calcium incrusting algae in combination with autolo-
Le-Fort-I-osteotomy (Ewers and H~rle 1980). We will report
gous spongy bone, has shown a excellent osteoinductive.
about 23 Le-Fort-I- and Horseshoe-osteotomies (Watzinger
Due to the interconnective microporosity, the stechlometric
and Ewers 1996) with dental implant application and a survey
grouping and the chamism Algipore is an ideal carrier
on up to 6 years after implantation supported prosthetics. Our
material for the recombinant-human osteoninductive pro-
statistic show that there is no difference between one and two
tains that are to be used in the future as it has already
stage procedures and the Horseshoe Le-Fort-I-osteotomy
shown in the animal experiment. There is a cause for hope
group and we will discuss the good outcome of these proce-
that also the clinical use will prove these good animal
dures as well as the complications we have seen and managed.
experimental results.
In few cases we have also performed monocortical block
transplant augmentation in addition to the Horseshoe Le-
Fort-I-osteotomy in order to widen the alveolar ridge in
addition to enlarging the alveolar height. These most
[~ ADVANCES IN INTERACTIVE I M A G I N G
extreme cases also show good results.
Due to these different procedures we are able to treat R. Ewers*, Mr. Truppe, F. Watzinger, W. Millesi
patients with very severe atrophied maxilla and the patients
have the possibility to wear prosthesis fixed dentures with
minor complications which all had been able to manage to University clinicfor Oral and Maxillofacial Surgery,
an excellent outcome and comfort for the patients with their
University of Vienna, Waehringer Guerte118-20, 1090
compromised maxilla.
Vienna, Austria

Following recent technical developments in computer-aided

Q=~ ALGIPORE: CARRIER MATERIAL FOR BONE surgery, the feasibility of computed navigation assistance in
MORPHOGENIC PROTEIN neurosurgery as well as in head and neck surgery has been
demonstrated for a wide variety of indications. The princi-
R. Ewers, Ch. Sehopper, Sonja Gossweiner, Else Spassova, ple of intraoperative image guidance is to enable the sur-
K. Wild geon to define a procedural task, depict it on-screen in

relation to the patient's imaging data, so that the informa-
tion on individual anatomy and pathology and on the sur-
gical access to treatment can be at hand during the
intervention. The Virtual Patient operation system is the
first of its kind to enable a transnational network constella-
tion. First, all imaging modalities are set in relation to each
other by image fusion for an interative on-screen planning.
The depiction of the surgical access path, anatomical land-
marks and target structures as overlay graphics on radio-
logic or on still video images of the patient is followed by
the transferral of data to the patient in the registration pro-
cedure. During surgery, the planning graphics are superim-
posed orthotopically on the live video images in real-time.
The surgeon simultaneously views the operation site and
the graphical planning scheme, which is shown on the
micromonitors of this head-up display. In a lesions. In 8 of 9 patients with PCO extramandibular scinti-
telepresence/teleconsultation setting, the composite images
- live video and overlay planning graphics - can be seen in
all communication centres simultaneously. This technique
will allow to establish national and international standards
of medicine and of surgical procedures especially. In the
future, telecommunications will become a major issue in
the standardisation of global health care. Potential benefits
of intraoperative teleconsultation for patient care as well as
the impact on economy, education and training of surgeons
will have to be evaluated in the course of international
projects.
THE R A D I O L O G I C A L P R E D I C T I O N OF THE
I N F E R I O R ALVEOLAR NERVE WITH H I G H
RESOLUTION COMPUTED TOMOGRAPHY
Eyrich GK*, Niibler-Moritz M, Carls F, Sailer HF.
Department of Maxillofacial Surgery, University Hospital
Ziirich
Aims: Surgical removal of an impacted mandibular third
molar may result in damage to the inferior alveolar nerve.
Precise preoperative radiographic examination enables the
surgeon to adjust operative strategies according to anatomi-
cal structures. However, coronal or axial computed tomog-
raphy does not always lead to sufficient preoperative
imaging. The purpose of this prospective study was to com-
pare different imaging planes.
Method: Three different imaging planes were used in 23
patients with 35 impacted lower third molars and projection
of the roots onto the mandibular canal. In 16 patients imag-
ing planes were also planned in the tooth axis.
Results: Oblique imaging were found to be superior to coro-
nal and axial planes and resulted in more precise anatomical
diagnosing, less number of scanning planes, and reduction
of cataratogenic dose to the lens.
Conclusions: If plane film radiographs present diagnostic
signs of anatomical vicinity, then an oblique imaging plane
with high resolution computed tomography is
recommended
A S S O C I A T I O N OF PRIMARY CHRONIC
O S T E O M Y E L I T I S W I T H THE SYNOVITIS, ACNE,
PUSTOLOSIS, HYPEROSTOSIS, O S T E I T I S (SAPHO)
SYNDROME
Eyrich GK*, Harder C, Sailer HF, Langenegger T,
Michel BA;
EACMFS -Abstracts, Helsinki Congress 1998 47
Departments of Maxillofacial Surgery and Rheumatology,
University Hospital Ziirich
Aims: Diffuse sclerosing osteomyelitis has been suggested to
be the mandibular localization of the SAPHO-syndrome.
This prospective cohort study evaluates a hypothetic associ-
ation of the SAPHO-syndrome and PCO.
Method: 12 patients with diffuse sclerosis of the mandible were
examined for proposed symptoms of a SAPHO-syndrome.
RESULTS:
9 patients were found to have primary chronic osteomyelitis,
8 of these patients presented a SAPHO-syndrome. Seven of
9 patients with PCO presented or reported historical skin
graphic enhacement was detected. The serum concentra-
tions of IgA, IgM and IgG were elevated in 5 patients. A
dysimmunoglobulinemia was observed in 8 patients (includ-
ing changes in relative distribution of subclasses in 7
patients).
Elevated anticardiolipin levels were found in 5 of 9
patients and elevated levels of antinuclear antibodies in 8 of
9 patients. The frequency of A2-Allele was 78% (7 of 9) in
patients with PCO. Serologic testing reveals B 19 parvovirus
to be the most frequent infectious viral agent (67%, 6 of 9).
Conclusions: Results in this series support the hypothesis of
an association of primary chronic osteomyelitis and
SAPHO, hence, we suggest that hereditary and autoimmune
factors may play a role in the pathogenesis.
A NEW M E T H O D F O R THE ASSESSMENT OF
RESULTS AFTER LE CLERC O P E R A T I O N
Eyrich, G. K.*, Warnke, T., Carls, F. R., Sailer, H. E
Department of Maxillofacial Surgery, University Hospital,
Zurich, Switzerland
Aims: The Le Clerc operation for the reduction of the ante-
rior movement in the temporomandibular joint in patients
with frequent luxation of mandibular condyle gives good
results in most patients. However, whenever problems such
as recurrence of luxation arise, diagnosis of the exact cause
for the failure of this procedure is quite difficult. This study
has been performed in order to evaluate a new method of
imaging for this purpose.
Method: Twelve patients underwent axial computed tomog-
raphy (CT) scans of the zygomatic arch with maximal
mouth opening after Le Clerc operation, one of them com-
plaining about occasional luxation of the mandibular
condyle and another patient about pain during chewing.
The CT slices were obtained by an SR 7000 computed
tomograph (Philips Medical Systems, Best, The
Netherlands). The axial volume scan was taken with 50 mA,
100 kV, 1.5 mm table increment and 1 s per rotation. 15
rotations were performed in each patient. Curved sagittal
reconstructions of the axial CT slices following precisely the
course of the zygomatic arch were obtained using den-
talscan software (GYROVIEW, ISG Technologies, Toronto,
Canada). Furthermore a three-dimensional image of the
zygomatic arch was computed from the same set of data. In
comparison to a conventional CT scan, the radiation dose
was reduced by 90 percent.
Results: The three-dimensional CT image gave in all cases
an overview of the postoperative anatomical situation, even
the infracture in the anterior part of the zygomatic arch
could easily be visualized. Due to the short scanning time
48 Journal of Cranio-MaxillofacialSurgery
(15 s for the whole examination) there was no motion arti-
fact in any examination. The curved sagittal reconstructions
allowed for a more detailled analysis of the new position of
the zygomatic arch. In the patient with luxation (opera
singer), resorption of the augmented eminentia articularis
was seen on the curved sagittal CT reconstructions. The case
with pain during chewing showed incomplete healing. Six
months later, there was no further pain, and the repeated
CT examination showed bony consolidation.
Conclusions: The volume CT is a reliable and fast method to
assess the resulting new anatomical situation after Le Clerc
operation. As the radiation dose is reduced by 90 % in com-
parison to conventional CT scans, the examination can be
repeated for documentation of the long-term outcome.
[h EFFECTIVNESS O F LASER-THERAPY TREATING
ORAL LEUKOPLAKIA AND OTHER M U C O S A L
LESIONS
Eyrieh GK* Niibler-Moritz M, Sailer HF.
Department of Maxillofacial Surgery, UniversityHospital Ziirich
Aims: Cryotherapy, surgical excision and corticosteroid
medication have been recommended as treatment concepts
of oral leukoplakia. However, incurability and recurrence is
known as a frequent complication. Previous reports
promised good results with laser ablation of leukoplakia.
This prospective study evaluates the efficiency of laserabla-
tion in treatment of oral leukoplakia.
Method: 60 patients with oral leukoplakia were treated with
either a CO2-1aser or a Erbium-YAG-laser and followed for
at least 6 months.
Results: Postoperative findings in our series of patients presented
a total cure rate of 60% and improvement in 30% of patients.
Conclusions: Therefor, we concluded that laser-ablation is a
efficient tool in the treatment of oral leukoplakia. In addi-
tion, PDT (photodynamic-therapy) and laserablation in
other mucosal lesions will be discussed.
FASCIOCUTANEOUS RADIAL FOREARM FREE
FLAP. AN EXPERIENCE O F ONE SURGEON
l~zsids, A.
Dept. of Oral and Maxillofacial Surger); John Radcliffe
Hospital, Oxford, England
A series of 18 consecutive radial forearm flaps were raised
by one surgeon over a period of 19 months for reconstruc-
tion of ablative surgery in the maxillofacial region. A num-
ber of methods were used from primary closure to meshed
skin graft to cover the defect.
Apart from the evaluation of subjective complaints a
detailed study was undertaken to assess and quantify donor
site morbidity; sensation of the forearm and hand in the distri-
bution of radial, ulnar and median nerves; range of move-
ments of the hand, wrist and forearm; grip and pinch strength;
fine movement co-ordination. Tourniquet time was used to
measure time needed for the harvesting of the fasciocutenous
flap and was correlated with the experience of the surgeon.
Our study clearly shows the advantages of flap harvest-
ing by the same surgeon resulting in a considerable reduc-
tion in operating time and a marked decline in
complications.
~7 PHOTODYNAMIC THERAPY (PDT) FOR THE
TREATMENT OF ORAL DISEASE.
Kathleen F.M. Fan.
National Medical Laser Centre & Department of
MaxiIlofacial Surgery, University College London Hospitals,
England."
Photodynamic therapy (PDT) involves the activation of a
previously administered photosensitiser by an appropriate
wavelength of non-thermal light. This reaction in the pres-
ence of tissue oxygen produces cytotoxic species capable of
causing tissue necrosis. PDT is a simple non invasive treat-
ment that can be easily applied to surface lesions. The
advantages of PDT over conventional modalities for oral
cancer and precancer are excellent healing with no cumula-
tive toxicity enabling repeated treatments.
The clinical evaluation of 3 photosensitisers will be dis-
cussed: Photofrin®, aminolaevulinic acid (ALA) and meta
tetrahydroxphenyl chlorin (mTHPC, Foscan®).
Photofrin® was found to be promising in patients with dys-
plasia and early oral cancers but the prolonged cutaneous
photosensitivity makes it less attractive. A L A is associated
with only 24 hours skin sensitivity but was only effective for
epithelial lesions, mTHPC was observed to be a very potent
photosensitiser requiring much lower light doses to produce
a deeper PDT effect. However, minimal scarring may be the
price to pay for the deeper necrosis required to eradicate
more advanced lesions. It is possible to select a photosensi-
tiser and light dose based on the required depth of damage.
A L A is suitable for oral dysplasia, whilst mTHPC or
Photofrin® is an option for patients with early oral cancers
and field cancerization.
CORRELATION BETWEEN INDICATORS OF
NICOTINE AND A L C O H O L ABUSE AND
TRAUMATOLOGIAL PATIENT GROUP IN
MAXILLOFACIAL SURGERY
Fangmann, R.*, Mischkowski, R.A., Harm, B., Harm, K.,
Kiespel; B., lffland, R., Stember, 34.
Department of Oral and Maxillofacial Surgery, University of
Cologne
Aims: To estimate the percentage of traumatological
patients who tested positive for specific indicators of nico-
tine and alcohol abuse.
Study Design: Prospective controlled.
Method: The study includes 105 patients who had sus-
tained a maxillofacial fracture. The time between
t r a u m a and admission was limited to 12 hours. Nicotine
abuse was assessed using a urine cotinine/urine creati-
nine quotient. As indicators for alcohol abuse we
obtained the serum values of ethanol, 9-gt, cdt,
methanol, acetone and isopropanole. We subdivide the
patients into three groups: 1. M a n d i b u l a r f r a c t u r e s , 2.
Zygomatic and orbital floor fractures, 3. Complex mid-
facial fractures.
Results: The alcoho indicators were positive in 56% of the
patients in group 1, in 42 % of group 2 and in 38 % of group
3. 60% of all patients also tested positive for nicotine
indicators.
Conclusion: The study shows that alcohol and tobacco
consumption may be important causal factors in the

majority of accidents resulting in maxillofacial fractures.
These factors should be emphasized in history taking and
may play an important role in the assessment of the treat-
ment costs.
POSTOPERATIVE C O M P L I C A T I O N S IN
S Q U A M O U S CELL CARCINOMA O F THE M O U T H
A N D OROPHARYNX, A PROSPECTIVE STUDY
*Farag I, McGurk M.
Department of Oral & Maxillofacial Surgery, UMDS, Guy's
Hospital, London, UK
Introduction: Over half the patients with cancer of the
mouth and oropharynx have advanced disease at presenta-
tion and surgery is associated with high morbidity. This
study evaluates the incidence and character of the complica-
tions encountered following surgery by a single surgeon for
oral and oropharynx cancers.
The Stu@ Design: In the period Oct 1992 - Dec 1997, 232
patients with head and neck tumours were seen at Guy's and St
Thomas' Hospital Trust head and neck unit of which 152 had
squamous cell carcinoma of the mouth and oropharynx. Of
these cases 95 patients received surgery (either for primaries or
salvage) for 98 turnours. Full data on complications were avail-
able in 68 cases. Data were collected prospectively and for the
purpose of analysis, complications and surNcal procedures
were divided into three grades (serious, intermediate, minor:
major, intermediate, minor respectively). The end points cho-
sen for the study were occurrence of serious complications and
operative death. The following variables were individually
tested to determine the effect on the end points: age, sex, stage,
grade of surgery, blood loss, duration of operation, perfor-
mance status and history of smoking and alcohol intake.
Results: In the present series 68 patients underwent 100
operative procedures and 120 complications were encoun-
tered. The commonest complications were related to
wound healing and respiratory problems. The factors that
predicted for serious complications were younger age,
blood loss and duration of operation, which were attrib-
uted to magnitude of procedure. This in turn correlated
with stage of disease. An operative death occurred in 4
patients (6%) of cases treated or in 4:100 operative proce-
dures for cancer. No death occurred after either an inter-
mediate or minor procedure and the risk for major
operations was 10%. No independent variable predicted
for death but there was a trend associated with increased
performance status.
Conclusion: Complications are still an ever-present reality
that significantly increase morbidity. Serious complications
occur more frequently in patients having a major surgical
procedure, The risk of operative death is 10% in patients
having major procedures.
73 P L A S T I C O P E R A T I O N S O N H E A D A N D NECK
TUMOURS
A(ferov ES., Fedontenko C.P., RotobeIskya L.E.
Cancer Research Centre RAMS, Moscow, Russia 115478,
Moscow, Kashirskoye shosse, 24
At present, primary and postponed plasty recommended for
patients with head and neck tumours leaves many questions
EACMFS Abstracts, Helsinki Congress 1998 49
undecided. Some authors are against p r i m a r y plasty in
removal of m a l i g n a n t tumours or disagree with it post-
radiotherapy. But others r e c o m m e n d p r i m a r y plasty
after destructive operations. F r o m 754 plastic opera-
tions performed for upper respiratory and digestive
tracts tumours d e p a r t m e n t in Cancer Research Centre
R A M S from 1980 to 1997 p r i m a r y plasty was per-
formed in 71%, p o s t p o n e d plasty - in 29%. In 55.6% of
cases we used musculocutaneous flaps. A m o n g them, in
49.6% - musculocutaneous transplants including large
musculus thoracis c o m p o n e n t were used. Musculofat
flaps were used in 12%. In other cases free cutaneous
flaps and mucous m e m b r a n e transplants have been
used.
Data analysis demonstrated the need for primary plasty
in defects of the oral cavity, tongue, cheek, melanoma and
skin cancer. The selection of flaps depends on the size of the
defect, localization and other factors. After a course of rad-
ical radiotherapy, in removal of the oral cavity cancer we
recommend the use of musculocutaneous grafts with axis
vessel anastomosis.
After operations with pharyngoesophago - or laryngos-
tomy formation we need posypone plasty. The favourable
selection of a transplant for defect replacement helps avoid
post-operative complications and is successful after the
plasty has been performed.
R E C O N S T R U C T I O N OF M A N D I B U L A R DEFECTS
AFTER FRACTURES BY THE L E N G T H E N I N G OF
B O N E REGENERATE
S.N.Fedotov,
The Department of Oral and Maxillofacial Surgery
Arkhangelsk State Medical Academy, Russia
Aim: The purpose of the report is to show the possibility of
new method of removing the mandibular long-ranged
defects by the distruction osteosis.
Materials and Method: We observed 23 patients with
mandibular post-traumatic defects, size of defects varing
from 10 to 130 ram. For all patients we used a new tech-
nique of fragment fixation by means of extra-mouth
compression-distraction apparatus designed at our clinic.
Depending of the defect's size and localization we per-
formed monolocal, bilocal and polylocal osteosynthesis.
Distraction was performing for 1-2, 5-4, 5 months, but
the speed of fragments distraction varied but it was not
more than 1 mm a day, but in some patients it was inter-
mittent. Then the apparatus performed the retention
function.
Results: We received rather satisfactory anatomical and
functional results.
LOWER LIP R E C O N S T R U C T I O N - A MODIFIED
METHOD
rehdr, A.
Department of Dentistry and Oral Surgery of Albert
Szent-Gy6rgyi Medical UniversitN Szeged, Hungary
Aims: To present a new modification of the Bernard plasty
after lower lip resection.
50 Journal of Cranio-MaxillofacialSurgery
Method: The central guide to the facial muscles around
the mouth is the modiolus. The buccinator and the orbic-
ularis oris muscles form a continuous sheet passing
around the face horizontally from the right to the left
pterygomandibular raphe. It is of great importance to pre-
serve the modiolus as much as possible by the incisions
used for mobilizing the neighbouring tissues for recon-
struction.
Result: In the past 5 years, 22 patients have been operated
on using our new modified method. No postoperative
wound breakdown was experienced. The function and cos-
metic appearances of the lower lip were satisfactory in our
cases.
Conclusion: To obtain a good functional and cosmetic result
after lower lip repair, the modiolus has to be preserved as
intact as possible.
SURGICAL EXPERIENCE W I T H THE
ORTHOSYSTEM, A NEW PALATAL I M P L A N T FOR
ORTHODONTIC ANCHORAGE
Feifel, H. l, Wehrbein, 1t. 2, Jiinicke, S. 1, Riediger, D. 1
1Dept. of Oral Maxillofacial and Plastic Facial Surgery,
2Dept. of Orthodontics, University of Technology, Aachen,
Germany
Aim: A new endosseous orthodontic implant system for
palatal anchorage of orthodontic devices, the Orthosystem,
is presented.
Material and methods: The Orthosystem (Straumann,
Waldenburg, Switzerland) consists of a transmucosal fix-
ture with a clamping cap fixed by an occlusal screw. All
parts are made of pure titanium. The screw shaped
endosseous part has a diameter of 3.3 mm and varying
lengths of 4 and 6 mm. Under local anaesthesia, the palatal
mucosa is removed in the midiine at the level of the premo-
lars with a mucosa punch. The fixture is inserted at an angle
of 60i to the occlusal plane. Bone supply in this region pre-
dominantly allows the use of 6 mm implants. More distal
implants have to be placed with a length of 4 ram. For heal-
ing, an abutment is fixed to the transmucosal neck for 3
months. Thereafter orthodontic tooth movements are car-
ried out against the implant/transpalatal arch-supported
anchorage teeth.
Results: According to this precedure, 18 patients have suc-
cessfully completed implant based orthodontic treatment.
Seventeen patients received 1 implant each, in one case 2 fix-
tures were placed midsagittally one behind another. One
implant was lost. Reimplantation in a more distal position
was successful 3 months later. Until now 14, implants have
been removed with a bone cuff and assessed histologically
after generation of undecalcified sawn sections. Surgical
technique, fixation of the orthodontic device and histology
are demonstrated by case reports.
Conclusions: Palatal implants are indicated if maximum
anchorage for orthodontic treatment is required. This can
be the case if the sole desmodontal anchorage is insufficient
or loss of stability of the anchoring teeth is present. Implant
based orthodontic treatment makes compliance-dependent
anchorage aids such as headgear and class 2 elastics dispen-
sible. Surgery takes less than 15 rain and has proved to be a
safe procedure, since complications are rare and the implant
failure rate is low.
G = ~ AN IMAGE BASED APPROACH TO DESIGN
AND MANUFACTURE O F BIOMATERIAL
S C A F F O L D S FOR MAX1LLOFACIAL
RECONSTRUCTION
Feinberg, S.IL *, Hollister, S.J., Levy, R.A., Chu, T.M. and
Halloran, d. W.
Departments of Oral & Maxillofacial Surgery,
Bioengineering and Material, Sciences & Engineering,
University of Michigan, Ann Arbor, ML USA
Aim: To present an image-centred engineering and solid-free
form fabrication manufacturing approach to construction
of anatomic-specific biomaterial scaffolds with a defined
internal architecture for use in maxillofacial reconstruction.
Method: Several defects were selected from computed tomo-
graphic films, A defect image was made on a computer termi-
nal to a specific external shape. Internal pore geometry was
created utilizing a specific software package. The external
shape and internal architectural image were than combined to
form a scaffold. The scaffold image was than extracted to cre-
ate a .stl data file that was used to instruct the solid-free form
machine to manufacture a scaffold with a specific external
and internal architecture for the defect to be reconstructed.
Results: Examples of this approach will be demonstrated by
illustration of a manufactured orbital floor, mandibular
defect and a ramus/condyle unit of the mandible that might
be useful in TMJ reconstruction.
Conclusions: We have been successful in the use of image-cen-
tred engineering and solid-free form manufacturing tech-
niques to fabricate scaffolds with site-specific external and
internal architecture. This work is the first step in the develop-
ment of an "instructive" scaffold that could be used for the tis-
sue engineering and reconstruction of maxillofacial defects.
[~ SUBMANDIBULAR TUMOR CAUSED BY ECTOPIC
THYROIDAL TISSUE: REPORT OF A CASE.
Feller, K.-U*," Mavros, A.; Eckelt, U.;
Department of Maxillo-Facial Surgery / University of
Dresden / Fetscherstrafle 74 1D-01307 Dresden / Germany
It is well known that the preponderant number of abnormal
located thyroidal tissue can be detected as remnants any-
where along the course taken by the developing thyroid
gland during ist craniocaudal descent. The embryonic path
in the midline of the throat renders the thyroglossal duct.
Here we outline a case of a 75 year old female patient with
an initially unsymptomatic lateralized submandibular mass
which gradually had increased within a period of one year to
a striking bulky tumor presenting when admitted. Recently
before she had been treated as an inpatient due to a patho-
logic fracture of the pubic bone. The findings of the preoper-
atively administered radiologic examination (CT scan, MRI,
Ultrasonography) gave us the suspicion of a malignoma
deriving from the submandibular gland. However, the exci-
sional biopsy and the following histological examination dis-
closed a benign tumor containing thyroidal tissue.
Lateral from the thyroglossal duct sited ectopic thyroids are
extremely rare (especially when found lateral to the great vessels
close to the submandibular region). These topographic variation
can not be explained by current embryological knowledge.

Reviewing the literature lateral sited thyroidal tissue may
be found as metastasis of a high differenciated papillary car-
cinoma, tissue transfered in previous operations on the thy-
roid gland or as a presumable relic of the ultimobrachial
body.
This leads to the conclusion that tumors in the sub-
mandibular triangle can amongst others give rise to the the
above mentioned differential diagnosis.
EXPERIMENTAL AND CLINICAL RESEARCH ON
T H E STABILITY OF T H E COMBINATION
M I C R O - M I N I P L A T E A P P L I E D TO FRACTURES O F
THE LOWER JAW
Feller, K.-U* Schimming, R., Eckelt, U.
Department of Oral and Maxillofacial Surgery,
University of Dresden, Fetscherstr. 74, D-01307 Dresden,
Germany
Aims: Stabilisation of fractures in the interforaminal region
with two miniplates is a standard procedure in maxillo-facial
surgery. The purpose of this study was to achieve whether
the combination of one micro- and one miniplate does afford
sufficient stability in this region were space limitations make
the miniaturization of osteosynthetic material desirable.
Method: In the experimental part we analyzed which pres-
sure resistance is obtainable from a plastic model of the
mandible which was stabilized through osteosynthesis by
either one micro- and one miniplate or by the combination
of two miniplates. Meanwhile 42 patients with fractures of
the mandible have been treated with the combination of one
micro- and one miniplate in the interforaminal region since
1995. Impressions were taken after fracture treatment and
before removal of the plates and the plaster models were
compared.
Results: The average limit of resistance until fracturing of
the experimental ostesynthetic plate system was 470 N for
two miniplates and 267 N for the mini-/microplate combina-
tion. Comparing these values with values for stress resis-
tance following surgical treatment of fractures of the lower
jaw one could theoretically assume a practice stability in the
interforaminal region. The clinical investigation showed
that only one fracture of a microplate occurred in a patient
who had an accident after fracture treatment again. The
comparison of the plaster models showed that no evident
dislocations have taken place.
Conclusions: This study shows that the combination of micro-
and miniplate osteosynthesis for treating fractures of the
mandible in the interforaminal region is a sufficient procedure.
[~ T M J "ANCHORED DISC P H E N O M E N O N " (ADP):
CLINICAL AND M R I DIAGNOSIS AND TREATMENT
IN 24 PATIENTS. A PROSPECTIVE STUDY.
Fernfindez Sanromdn J.
Department of OMFS, Povisa Medical Centre. Vigo, Spain.
Aims: To analyzed the clinical and M R I characteristics of
24 patients diagnosed of a TMJ anchored disc phenomenon
(fixed disc) and the outcome of two different treatments:
nonsurgical treatment (passive motion, bite appliance and
nonsteroidal antiinfiammatory drugs) and arthroscopy.
EACMFS - Abstracts, Helsinki Congress 1998 51
Method: 24 patients with sudden-onset, persistent limited
mouth opening and with M R I signs considered as fixed
discs were studied. All these patients received nonsurgical
treatment. After unsuccessful conservative treatment
arthroscopy with sodium hyaluronate infnssion was per-
formed in 15 joints. Follow-up ranged from 9 to 36 months
(mean: 20.2 months).
Visual analog scales were used for self-evaluation of
pain, maximal mouth opening -MMO-, lateral -LM- of the
jaw and presence of joint noises were recorded both pre and
postoperatively.
Results: The preop-MRI examination revealed a normal disc
position in 10 joints and an anteriorly displaced disc in 11
cases. All the discs were fixed to the glenoid fossa preventing
an anterior translation of the condylar head. Most of the discs
had a normal biconcave morphology, but in some cases myx-
oid degeneration, biconvex or biplanar morhologies were
noted. After conservative treatment only 2 patients improved,
all the other patients showed a severe decreased in the M M O
(mean 24.2 + 2.2 rams), LM (4.2 1.3 rams) and a high pain
level (9.2 2.6 scale). Only 15 patients were operated on. After
arthroscopy MMO (40.4 3.4 rams) and LM (7.8 1.5 rams)
increased significantly. Also a significant reduction in pain (1.5
1.8 scale) was noted. Only one patient suffered a recurrence of
the closed lock during the study. Arthoscopy findings include
the presence of adherences and some kind of synovitis.
Conclusions: Arthoscopy provides good clinical results in
patients with sudden-onset closed locks diagnosed with
M R I of fixed discs.
Vh M I D L I N E G L O S S O T O M Y AS THE APPROACH
USED IN A CASE OF R H A B D O M Y O M A OF THE
BASE O F THE TONGUE
Fevndndez-Alba, J.*; Cuesta, Mr.; Aeero, J.; Concejo, C.;
Ochandiano, S.
Servicio de Cirugia Maxilofacial, Hospital General
Universitario Gregorio Maragon, Madrid, Spain
Aims: To present a case with a rhabdomyoma of the base of the
tongue. This is a rare benign neoplasm of the skeletal muscle,
most frequently located in cardiac muscle and often associated
with tuberose sclerosis. Of all extracardiac tumours, the prevail-
ing location is in head and neck (95%), affecting pharynx, oral
cavity (floor of the mouth, soft palate and base of the tongue)
and larynx. The treatment of choice is surgical excision.
M & Methods: We present a clinical case of rhabdomyoma
of the base of the tongue, in a 56 year old male, which
causes asphyxiation episodes in the supine position. On
oropharyngeal examination a tumour was noted at the base
of the right tongue. The M R I reveals a great mass that occu-
pies all the right lingual base, crossing the midline, which
obliterated 90% of the oropharyngeal airway. The biopsy
specimen was diagnosed as a rhabdomyoma. A cerebral
M R I and neurological study was performed, that elimi-
nated a tuberose sclerosis. Using a midline glossotomy
approach, we were able to remove the tumour.
Results: The midline glossotomy permitted suitable tumoral
excision and presented no special difficulty. The symptoma-
tology presented by the patient disappeared completely. In
the first year review, both clinically and radiologically, he
was found free of disease.
Conclusion: In benign tumours of the base of the tongue,
approaching through a midline glossotomy should always
be considered, since it is an easy, rapid and less traumatic
method that presents few associated sequellae.
52 Journal of Cranio-Maxillofacial Surgery
MAJOR MAXILLAR DEFICIENCIES : WHICH
TECHNIQUE TO USE FOR IMPLANT
REHABILITATION?
*Ferri J., Peuvrel G., Solyom E.
Service de Stomatologie et Chirurgie Maxillo-Faciale.
CHR U 5903 7 LILLE cedex FRANCE.
Prosthetic implant rehabilitation in cases with major maxil-
lary deficiencies is always a difficult challenge. Despite a
great number of procedures described to repair the bony
defect, few presentations have been made to classify these
techniques according to the maxillary defect.
Our aim is to present our surgical approach according to
the maxillary defect :
Minor vertical atrophy should be treated by a sinus graft-
ing procedure. Implants should be inserted six months later.
Vertical atrophy with sagittal discrepancy should be
treated by leFort 1 osteotomy with grafting. According to
Sailer's procedure, implant insertion grafting and
osteotomy, are performed in a one step surgical procedure.
Maxillary arch amputations should be treated by free
flap. Our choice lies with the fibula flap. Implants to be
inserted 4 months later.
ORAL LICHEN PLANUS AND ORAL CANCER - IS
THERE A LINK TO HEPATITIS C IN A U.K.
POPULATION?
Irving, W., Fisher, S.E., Crowe, M.,
Department of Immunology, Maxillofacial Unit and
Department of Microbiology, University Hospital~Queen's
Medical Centre, Nottingham, England.
Background: Oral lichen planus and oral cancer have been
shown to have possible links to hepatitis C.
Aim: To determine whether this link is present in a U.K.
population.
Method: A consecutive series of 25 patients with oral lichen
planus was tested serologically for evidence of carriage of
the hepatitis C virus. A series of 25 oral cancer patients is
currently undergoing testing.
Results: No patient with oral lichen planus tested positive,
although raised liver function tests were observed, It is con-
sidered that the latter results were related to other factors
e.g. alcohol intake. The series of oral cancer patients is yet
to be completed.
Conclusions: This study, to date, does not support evidence
that hepatitis C is important in the pathogenesis of either
oral lichen planus or squamous cell carcinoma in a U.K.
population.
NUTRITIONAL FACTORS AS A PROGNOSTIC
INDEX 1N ORAL CANCER
*Fisher, S.E.
Maxillofacial Unit, UniversityHospital~Queen'sMedical Centre,
30 The Ropewalk, Nottingham, NG1 5DW, England.
Background: Nutritional factors, especially serum albumin
levels, have been identified as independent prognostic fac-
tors in some cancers, notably colorectal and breast.
Aims: To determine the prognostic significance of nutri-
tional factors in oral cancer.
Method: All patients presenting to the maxillofacial unit
with histologically proven squamous cell carcinoma of the
oral cavity and considered curable by surgical resection were
included in the study. Each had preoperative levels of serum
albumin,a full blood count, ferritin, B12, and folate deter-
mined.
Analysis: 70 patients have data available for analysis using
the Cox Proportional Hazards Model. Alternative models
are being used to evaluate their potential in medical statisti-
cal analysis.
Results: This project is scheduled for completion in July
1998.
Q=~ C L I N I C A L E X P E R I E N C E W I T H
E X T R A C O R P O R E A L SHOCKWAVE
L I T H O T R I P S Y F O R T R E A T M E N T OF SALIVARY
GLAND STONES
Fokas, KI*, Eckardt, A. l, Aleyt, J.1, Gratz, K.F.2
1 Department of Oral and MaxilloJacial Surgery,
2 Department of Nuclear Medicine, Hannover Medical
School, Hannover/Germany
Aims: Surgery was the standard therapy for salivary gland
stones for decades. In recent years this concept has changed
due to the introduction of extracorporeal shock-wave
lithotripsy as conservative approach. The Minilith-SL-l*
was especially designed for the treatment of salivary gland
stones.
Method: Salivary gland stones are routinely diagnosed by
their clinical symptoms and radiological techniques. To
assess salivary gland function, 99m TC scintigraphy is per-
formed. Treatment is performed on an outpatient basis, in a
fractionated manner for usually one session per month.
Treatment duration is 45 minutes and does not require
anaesthesia or sedation. From January 1995 to January
1998 a total of 37 patients aged 14 to 68 years (mean age 43
years) were treated at our institution. Salivary gland calculi
were located in the parotid gland (13 patients) and in the
submandibular gland (24 patients).
Results: For the parotid gland the success rate was 62.5 % for
complete disappearance of calculi and in 25 % adequate stone
disintegration. The success rate for the submandibular gland
was 40 % and 20 % respectively. All patients had complete
symptomatic relief. Treatment consisted of a mean of 2.1 ses-
sions for the parotid gland and 2.5 for the submandibular gland.
Conclusion: Extracorporeal shock-wave lithotripsy is a safe
and non-invasive treatment approach with promising
results. It allows organ preservation and regeneration of
salivary gland function. Severe side effects have not been
reported.
[~ PERMANENT D I P L O P I A FOLLOWING ORBITAL
FLOOR FRACTURES SURGICALLY CORRECTED
W I T H AN ANTRAL PACKING
Folkestad, L., M.D.* Westin, T., M.D., Ph.D.,
Dept of ORL, Sahlgrens Universityhospital, G6teborg, Sweden.
Aim:To establish the frequency of long-term sequelae fol-
lowing surgery for orbital floor fractures.

Method: The incidence of long-term sequelae among 107
patients treated for an orbital fracture was established
through studies of the patients' records and questionnaires
sent to each patient (response-rate 77%).
Results: 83% of the cases had some type of permanent
sequelae. The overall frequency of diplopia was 17%, but
within the group of patients whose fracture was stabilized
by an antral pack - i.e. an insufflation catheter or a gauze
tampon in the maxillary sinus - diplopia was present in
36%.
Conclusion: Using an antral pack to stabilize an orbital
floor fracture seems to be an inadequate repositioning
method where the risk of developing permanent diplopia is
high. The access to biocompatible materials such as porous
polyethylene enables the surgeon to perform an exact surgi-
cal correction and fixation of these fractures.
[~ A NEW M O D E L TO STUDY MICROVASCULAR
A N A S T O M O S I S IN P R E D A M A G E D A R T E R I E S .
Reinhard E. Friedrich * and Kai Piambeek
Department of Oral and Maxillofacial Surgery, Eppendorf
University Hospital, University of Hamburg, Germany
Aims: To develop a model of repeated vascular injury with
endothelial denudation and certain phases of recovery. The
model should be suitable to study the patency rates of anas-
tomoses in damaged common carotid arteries in a training
model of microvascular surgery.
Methods: Under general anesthesia with xylazine
(Rompun TM) and ketamine (KetanesV M) the left common
carotid arteries of female Wistar rats were inflated with air
(00.2 ml, room temperature). After completion of the ves-
sel's damage, sealing of the leakage with a suture (I0-0,
Deknatel), and starting of reflow, an autografl of four mm
length was harvested, turned 180oo , and reinserted into the
artery. The flow through the vessels was investigated by
micro-Doppler ultrasound (20 MHz, penetration depth: 0.8
ram, sixty seconds after air pressure damage and thirty min-
utes after insertion of the autografl). The number of ani-
mals in this group was twenty. Autografts were fashioned in
a further twenty common carotid arteries but left undam-
aged. A further twelve arteries were dilated, but no auto-
grafts were inserted. The vessels were harvested after
perfuse fixation with 4% formaldehyde after one day, seven
days, one month and six months. The specimens were evalu-
ated by light microscopy in longitudinal sections of four
mm slides embedded in paraffin. In addition, cross sections
were taken from arteries treated by this method.
Results: In no instance did dilatation lead to occlusion of
the vessel as judged by micro-Doppler ultrasound. In the
group with autografls that were not dilated no vessel was
occluded after flow had restarted. In this group, therefore,
all arteries were patent after perfusion. In the group in
which dilatation preceded the insertion one vessel was found
to be occluded at necropsy after six months.
Conclusions: This model is recommended for the study of
vascular healing after microvaseular anastomoses. The air
insufflation as the sole damage is not sufficient enough to
cause thrombosis. In addition, the air insufflated to the ves-
sel segment does not cause a higher rate of thrombosis in
subsequently performed microvascular autografts. This
model seems to cause vascular damage comparable to find-
ings in the clinical setting, where rinsing or mechanical
dilatation of the vessel segments prior to the anastomosis
EACMFS- Abstracts, Helsinki Congress 1998 53
can cause severe endothelial damage. (Supported by a grant
of the Deutsche Forschungsgemeinschaft, DFG-project no.
FR 1035li-2).
IMPLANT-RETAINED TITANIUM
SUPERSTRUCTURES F O R T H E F I X A T I O N O F
DEFECT P R O S T H E S E S AND E P I T H E S E S
* ProfD,:Dr.CU.Fritzemeier, Dr.Dr. Reksten A., ZTMD. L.C
Kruchen,
Dfisseldorf Germany
The fixation possibilities for oral defect and facial prosthe-
ses are complex and a main theme throughout the history
of orofacial prosthetics. In the past, mostly wires, strings,
adhesives or spectacle frames were used for retention.
Today, stable fixtures can be performed using natural teeth
and/or osseointegrated implants in combination with
advanced prosthodontics. A further problem is the link
between the implant and the superstructure especially in
combined defects of the maxilla and parts of the face. In
such cases titanium has proved itself with its excellent phys-
ical, biological and electrochemical properties. Meanwhile
there is no doubt about the advantages of titanium's place
in dentistry. Therefore, titanium is also used for oromaxillo-
facial prosthetics. As implantology has shown, electro-
chemical reactions in combination with body fluids and
different metals may cause extensive damage to the super-
structures and the adjacent soft tissue. This is also true for
artificial skeletal replacements in the skull, retained by
endossous implants. Today, several different titanium preci-
sion components facilitate the use of this metal in anaplas-
tology and it is well known that all common attachments
such as telescopic crowns, bar-clip systems or magnetic
retention devices can be manufactured out of titanium.
After the evaluation of 94 patients who had undergone oro-
facial defect prosthetic treatment over the past ten years, we
are now able to distinguish, which anchorage possibilities
are best suited to our purposes. The review of clinical cases
will demonstrate the many possibilities of titanium tech-
nology and will show, that titanium is the metal of choice in
the field of oromaxillofacial prosthetics.
EXPERIENCES WITH DISCECTOMY - LONG
T E R M RESULTS
Fr6schl, Th., DeMwes, C v. Kiigelgen, C, Fleiner, B.
Department of Oral and Maxillofacial Surgery,
Christian-Albrechts- University, Kid, Germany
Aim: Long-term results after discectomy regarding func-
tion, complications and patient's subjective judgment are
evaluated.
Methods: From 1988 until 1997, 107 discectomies were car-
ried out in 80 patients. Discectomy was indicated by the pres-
ence of severe functional impairment or pain. Anterior disc
displacement without reduction was found in 65%. Forty five
patients with a total of 54 disceetomies could be investigated
12 to 96 months postoperatively, by manual function analysis,
x-ray, magnetic resonance imaging and subjective assessment.
Results: In 89%, functional improvement was achieved with
complete absence of complaints. Although 54 temporo-
mandibular joints showed radiological alterations of the
54 Journal of Cranio-MaxillofacialSurgery
condyle of different grades, no consequences were observed
if appropriate occlusal rehabilitation had been provided.
Conclusion: Following a correct indication, discectomy is
liable to improve both functional impairment and painful
displacement of the disc with or without reduction.
Postoperative physiotherapy and occlusal rehabilitation
seem to be of considerable clinical relevance.
INDICATIONS FOR MARGINAL OR SEGMENTAL
MANDIBULECTOMY USING THE LEVEL O F THE
MANDIBULAR CANAL CRITERION FOR T
CLASSIFICATION OF MANDIBULAR CARCINOMAS
Fujibayashi Takashi 1), Kanda Shigenobu 2) and Ohashi
Yasushi 3)
1) Dokkyo University School of Medicine Dept. of Oral &
Maxillofacial Surgery, Tochigi, Japan
2) Kyushu University School of Dentistry, 3) Niigata
University School of Dentistry
Purpose: T N M classification of malignant tumours has
been agreed by the UICC. The Japan Society for Oral
Tumours (JSOT) had a workshop on T classification of
mandibular carcinomas and our previous study showed the
level of mandibular canal (LMC) criterion can be consid-
ered the most correct one for T classification. The present
study was made to certify the indications for marginal or
segmental mandibulectomy.
Methods: A retrospective study, comprising 11 87 cases of
mandibular carcinomas collected from 24 clinical institu-
tions in Japan was performed. Each case collected was
reclassified according to LMC criteria. Radiographic find-
ings of bone invasion were also classified in terms of both
level and type. The result of treatment was analyzed accord-
ing to T classification by L M C criteria and bone invasion
type.
Results: By analyzing mode of mandibulectomy as the treat-
ment method of the primary site, L M C criteria proved to be
a good guide for the choice of mandiblectomy. Marginal
mandiblectomy is the treatment of choice for T2. T3 size
tumours with pressure-type bone invasion, on the other
hand, segmental mandiblectomy is recommended for all T4
tumours, and T2 and T3 size tumours showing a moth-eaten
type bone invasion when classified by L M C criteria.
Conclusions:The level of the mandibular canal (LMC) crite-
ria is considered the most accurate T classification and can
be useful as a guide to treatment choice, i.e. marginal or seg-
mental mandiblectomy in combination with radiographic
bone invasion type.
ROLE O F H O S T CELLULAR I M M U N E SYSTEM
ON PULMONARY
METASTASES F R O M C O L O N ADENOCARC1NOMA
26 IN BALB/C M I C E
Fujishiro, H.*, Nukata, j.l>, Kato, L 1~, Ohmae, M. z~,
Sakuda, M. z~
Department of OMFS, Matusaka City Hospital, Mie,
Japan, l~Second
Department of OMFS, Faculty of Dentistry, Osaka
University, Osaka, Japan
Aims: To evaluate the role of natural killer (NK) cells and
cytotoxicic T lymphocytes (CTL) in the control of artificial
lung metastases of Colon adenocarcinoma 26 (Colon 26)
in BALB/c mice.
Methods: CTLs were activated by 2 subcutaneous inocula-
tions of Colon 26 treated with M M C (MMC Colon 26)
once a week. IL-2 was administered i.p. daily for 3 days to
activate N K cells.
The number of pulmonary metastases 14 days after i.v.
injection of Colon 26 cells and the rate of radioactivity
accumulated in the lungs 24 hours after i.v. injection of
[51Cr] Colon 26 were examined in mice administered rIL-2
for 3 days before i.v. injection of Colon 26 (Group I); mice
administered rIL-2 daily for 3 days after i.v. injection of
Colon 26 (Group 2); mice administered rIL-2 daily for 3
days on Days 5 to 7 after i.v. injection of Colon 26 (Group
3) and mice subcutaneously inoculated with M M C Colon
26 on Days 7 and 14 prior to i.v. injection of Colon 26
(Group 4).
Results: The number of pulmonary metastases was
decreased in Group 1 and 2, which had shown enhanced
N K activity within 24 hours after injection of Colon 26 and
Group 4, which had shown enhanced CTLs activity but
there was no significant difference between Group 3 and the
Control group despite of N K activity of Group 3 peaked on.
Day 8 after injection of Colon 26. Furthermore it was lower
in Group 1 than Group 2 which had shown lower N K activ-
ity within 24 hours after injection of Colon 26 than Group
1. The rate of radioactivity accumulated in lungs 24 hours
after i.v. injection of [5~Cr ]Colon 26 decreased in Group 1
and 2 but not in Group 4; it decreased more in Group 1 than
in Group 2.
Conclusion: These results suggest that NK-mediated inhibi-
tion of experimental metastases may be due mainly to an
increased destruction of circulating tumor cells before their
extravasation and that CTL-mediated cytotoxicity may inhibit
metastases by suppressing the growth of tumor in the lungs.
Ph EVALUATION O F THERAPY FOR MALIGNANT
T U M O R S O F ORAL CAVITY BY P O S I T R O N
E M I S S I O N TOMOGRAPHY(PET)
Funaki, K.*, Sekiyama, S., Sugiyama, E
The Second Department of Oral and 3/Iaxillofacial Surgery,
School of Dentistry, Iwate Medical University, Morioka,
Japan
Aims: To investigate the property of glucose demand in the
tumor cell, the change of its uptake of 2-deoxy-2-flu-
oro[18F]-D-glucose (18FDG) which is a short-lived
positron emission was applied to the evaluation on effi-
ciency of concomitant chemoradiotherapy and study of
prognosis for malignant tumors of oral cavity.
Method: We performed dynamic scans by 18FDG-PET and
evaluated the differential uptake ratio (DUR) after the
injection of 18FDG. Dynamic scans are taken after therapy
for time activity curve, and results are calculated as follows:
D U R =(MBq/ml X PET count X Pt.Weight) / injected
RI Activity
PET count=(Pixel count / Pixel volume) X Calibration
factor
PET scanning was performed in 21 patients who received
cannulation and intra-arterial BMP therapy (bleomycin or
peplomycin + methotrexate + cisplatin) from April 1993 to
December 1997. The primary tumors were on tongue in 7

cases, mandibular gum in 7 cases, maxillary sinus in 2 cases,
oral mucosa in 2 cases, floor of mouth in 1 case, maxillary
gum in 1 case, oropharynx in 1 case. They were all cases of
squamous cell carcinoma.
Results: 12 cases were evaluted as complete respons (DUR=
2.63 +0.56 (mean+S.D.)). 9 cases were evaluted as partial
respons (DUR= 3.73+0.89). 11 cases were evaluted as Ao
and Do without 3 operative cases (DUR= 2.53+0.48). 7
cases were evaluated as Ac and Dc (DUR= 3.63+0.96).
Conclusions: It is obvious that the uptake of 18FDG was the
useful index of activity of tumor. And it was suggested that
the evaluation of the efficiency of oral cancer therapy,
detective recurrent tumor and detective residual tumor by
18FDG-PET has practical possibility.
VERTICAL ALVEOLAR DISTRACTION USING A
NEW INTRAORAL DISTRACTOR
*Alexander Gaggl, Heribert Rainer
Clinical Department Surgery -University of Graz,
Auenbruggerplatz 2 - A/8020 Graz - Austria
Head of SIS-Systems - Bahnhofstrasse 22/1, A/9020
Klagenfurt
Vertical alveolar destraction was first described by Chin and
Toth in 1996. This method seems to be an easier alternative
procedure for augmentation of the alveolar ridge. This
paper presents our first experiences with the new intraoral
SIS-Distraction device for vertical alveolar distraction.
Surgical handling and the first clinical results of treatment
of the edontulous alveolar ridge, and alveolar defects after
traumatic tooth loss, are demonstrated. The indications for
using this new surgical technique in comparison with aug-
mentation techniques, such as Guided Bone Regeneration
and microvascular fibula transplantation are discussed. The
results achieved demonstrate that distraction of the alveolar
ridge with the help of the SIS-Device provides good results
in extremely atrophic jaws by using a simple operative tech-
nique. Duration of the operation is less than in other com-
patible surgical procedures and simultaneous implantation
is possible.
LONG-TERM MORPHO-FUNCTIONAL
EVALUATION OF SURGICALLY TREATED
CONDYLAR FRACTURES.
S. Galioto, A.B. Gianni, G. Salvato, N. Mannucci and
R. Brusati
University of Milan. Maxillofacial Surgery Department,
S. Paolo Hospital
Aims: Surgical treatment of condylar fractures is generally
reserved for adults with displacement of the condyle out
of the fossa, but different opinions exist concerning fixa-
tion methods. In particular, use of rigid fixation allows an
early functional rehabilitation but potentially increases
risks of condylar resorption due to extreme difficulty in
obtaining the correct adaptation of the fractured borders.
For these reasons, Raveh et al. (1989) proposed to reduce
condylar fractures with displacement out of the fossa with-
out any intraosseous fixation in order to enable a correct
postoperative functional adaptation of the condyle to the
fossa.
EACMFS Abstracts, Helsinki Congress 1998 55
Materials and Methods: Within a period of 1-3 years (mean fol-
low-up 24.4 months) after open reduction (using the method
described by Raveh et al. (1989)), we re-examined 10 patients (7
males and 3 females; mean age 25.7 years) with monolateral iso-
lated condylar fracture. In three patients semi-rigid fixation (two
or four holes microplates) was performed due to the high insta-
bility of the condylar segment. Each patient followed post-oper-
ative physiotherapy according to Delaire (1973) with guiding
elastics and contralateral occlusal plate for a period of 70-90
days. The following data were recorded: maximal mouth open-
ing (MMO), lateral deviation in MMO, contralateral and pro-
trusive movements, incidence of articular noises and/or pains.
Morphological alterations of articular skeletal components
were evaluated with OPT (open and closed mouth position).
Results: The average mouth opening was 42 mm. (range 30-
51mm.) with lateral deviation in 80% of the cases (range 2-4
mm.); contralateral movement was the most affected with a
mean loss of 53% in comparison to the other side. No
patients referred articular pain or discomfort. Morphological
analysis showed good recovery of skeletal articular anatomy
in 70% of the patients and only minimal condylar remodel-
ling and decrease of condylar height in the remaining 30%
Conclusions: Although the number of patients is too small
for definitive conclusions, this protocol seems to obtain a
good recovery of mandibular function and at the same
avoids the unfavourable morphological results reported with
rigid fixation (Iizuka etal., 1991).
[~ D I A G N O S I S AND TREATMENT O F D E R M O I D
CYSTS IN THE F L O O R O F THE M O U T H
G"-Consuegra, L.*, Junquera, L., Llorente, S., Ferreras, J.
Department of OMFS. Martin, M. Department of
Pathology. Central Hospital of Asturias, Asturias, Spain.
Aim: Dermoid cyst, epidermoid cyst and teratoma are gen-
erally considered rare findings in the floor of the mouth. We
describe the clinical presentation, diagnosis, localization,
surgical approaches and histopathological findings accord-
ing to our experience.
Method: From 1986 to 1996, at the Central Hospital of
Asturias, ten patients with cysts in the floor of the mouth
were identified. This work reviews our experience and the
previous literature.
Results: The patients ranged in age from 6 to 67 (mean: 33yrs),
with an equal distribution between males and females.
Clinically, the cysts were slow growing and painless in six
cases, four patients had pain on mastication or swallowing.
Most of them were located in the midline (seven). Just in three
cases were the cysts placed laterally. A n extraoral approach
was used in six cases, three were removed intraorally and both
incisions were required in one case. Histologically, six were epi-
dermoid cysts and four dermoid cysts.
TREATMENT O F HAEMANGIOMA AND BENIGN
TUMOURS
Lajos Gaspar DDS, PhD.,
Budapest, Hungary
In cases having laser surgery to remove haemangiomas,
benign tumours and vascular lesions, the haemostatic effect
of the laser beam markedly manifests itself. The removal of
56 Journal of Cranio-MaxillofacialSurgery
these usually highly vascular configurations often presents a
difficult task for the surgeon. The application of the CO s,
Argon, N d YAG and Combi
(CO~+NdYAG) lasers has brought about a new operative
technical approach. In this patient population, the majority
of the advantages of the laser beam can be fully utilized.
Our experience with the removal of haemangiomas
and benign tumours is favorable from various points of
view. Immediate coagulation of intraoperative bleeding is
highly beneficial and postoperative complaints are mini-
mal (pain, oedema, difficulty in swallowing etc.). As a
rule, no sutures are needed after the operation, in cases
without complications, the re-epithelialization of the
wound surface covered by coagulated proteins is expected
in 4 weeks. Following laser surgery performed on an out-
patient basis under local anaesthesia, scarring is minimal
and patients are usually capable of working on the first
postoperative day.
The experience obtained with the removal of 6128 oral
lesions (precancerosus states, benign tumours, malignant
tumours, others). Our own experience concerning the
advantages and disadvantages ot using the different surgical
lasers in the treatment of haemangiomas and benign
tumours of oral cavity and face is described. The present
paper summarizes our 10 year experience.
T H E USE O F THREE-DIMENSIONAL, ANIMATED,
C O M P U T E R G R A P H I C S AND A NEW SURGICAL
TECHNIQUE TO IMPROVE THE ACCURACY O F
DISTRACTION O S T E O G E N E S I S O F THE
MANDIBLE.
Gateno, Jaime; Teichgraeber, John.
Departments of OMFS and Pediatric Surgery. University of
Texas Health Science Center- Houston.
The purpose of this paper is to present a protocol, which
involves a pre-treatment surgical plan and a surgical tech-
nique for distraction osteogenesis of the mandible. The pre-
dictions are determined from three-dimensional animated
computer graphics using a commercially available software
package called 3D-Studio Max (Autodesk). The protocol
has been used in six patients: three males and three females
who range in age from three to eight years. The distraction
was bilateral in four cases and unilateral in two cases. The
postoperative follow-up period ranges from six to 18
months.
The pre-treatment surgical plan involves constructing a
computerized three-dimensional model of the facial skele-
ton using data from a 3D CT Scan. A "virtual" distractor is
applied to the model and the distraction process is simu-
lated moving the mandible into its desired position. Once
this position has been established, the amount of linear
distraction and angular changes are measured by the ani-
mation software. The simulated distraction process also
assists in designing osteotomies, choosing the type of dis-
tractor (uniplanar vs multiplanar) and establishing the ori-
entation and position of the distractor. The surgical
technique is designed to apply the distractor precisely as
determined by the pre-surgical plan. The author uses a mul-
tiplanar device. The distractor is pre-bent so that upon
installation, the arms of the distractor parallel the body
and ascending ramus of the mandible. Using life-size (1:1)
templates of the mandible and distractor, a template for the
position of the distractor is created. The author has
designed a multiplanar drill-guide that can be pre-bent like
the distractor to facilitate precise positioning of the distrac-
tor though a Risdon incision.
One advantage of this protocol is that it allows the
authors to assess the different outcomes for different types
of distractors and osteotomies, It also allows for precise for-
mulation of a distraction plan which take into consideration
the type an location of the distractor, as well as the distrac-
tion sequence. The disadvantage of this protocol is that it
requires an external incision, and is not 100% accurate.
Clinical judgment therefore remains necessary to modify the
distraction plan. Despite this limitations, actual results have
been close to the predicted values.
NOD/SCID MICE AS A M O D E L TO STUDY
M I N I M A L RESIDUAL DISEASE IN BONE M A R R O W
O F PATIENTS W I T H S Q U A M O U S CELL
CARCINOMAS IN THE HEAD AND NECK (SCCHN).
Gath H.JI., Fichtner 11., Heissler El., Jehle MI., Hell W.,
PanteLK~, Bier j1.
Virehow Klinikum und M D C der Humboldt Universitiit,
Augustenburgerplatz, 13353 Berlin, Germany,2Institut fiir
Immunologie der LMU, Goethestrafie 31, 80336 Miinehen
Aim: Detect minimal residual disease in patients with head
and neck cancer.
Method: Cytokeratin (CK) specific monoclonal antibodies
(mAbs) as a marker for epithelial cells made it possible to
detect single disseminated carcinoma cells in mesenchymal
organs such as bone marrow (BM). The applied immunocy-
tochemical assay using the mAb A45-B/B3 is able to identify
tumor cells in BM.
Results: In 16 (28.1%) out of 57 patients with SCCHN cells
in BM were identified with a frequency of 1-207 cells/106.
During follow up (3-36 mons.) Kaplan-Meier-analysis
showed a shorter relapse-free survival of patients with CK+
cells in BM compared to those without (p=0.02). To study
patterns of metastases each BM sample were injected subcu-
tanously in 2-10 immundeficient NOD/SCID mice. Half of
the mice were killed after 4-6 weeks and tissue samples were
taken for analyses. Blood from the tail vein was taken and
the presence of human cells was determined by PCR utiliz-
ing an alpha-satellite D N A probe derived from the human
chromosome 17. The second group was observed during
their life span (8-10 months) and tumor transplants were
measured. 11 BM samples were transplanted and in 8/11 ani-
mals nodes were palpable in the neck region with a size of 4-
5 mm in diameter. In animals analyzed by PCR we were able
to detect cells in blood, BM, liver, lung, spleen and brain.
Conclusions: NODISCID mice are a promising model to
study minimal residual disease in head and neck cancer
patients.
RESULTS OF BONE GRAFTING O F THE
ALVEOLAR CLEFT
B. Gattinger*, J. Obwegeser,
Department of OMFS, AKh-Linz, Austria
Aims: Secondary bone grafting of the alveolar cleft is a
common procedure for reconstructing the alveolar process;
however there is some controversy about the time to do the
operation.

The comparison of the results of bone grafting before
and after eruption of the canine should bring some clarifi-
cation in this matter.
Method: Fifty nine bone graftings were evaluated. Thirty six
graftings were performed before the eruption of the canine
and 18 cases after the canine was fully erupted. In all
patients autogenous cancellous bone from the iliac crest was
transplanted. The evaluation of the height of the alveolar
process was made using the semiquantitative method pub-
lished by Abyholm with 4 types of interdental bone
formation.
Results: The group which was operated on before the eruption of
the canine showed the following classification: 29 cases type I,
5 cases type II and 2 cases type III. The patients operated on
after the full eruption were classified as follows: 8 cases type I,
5 cases type II and 1 case type III. In all type III classifi-
cations an oronasal fistula was closed simultaneously.
Conclusions: In summary, the method of secondary bone
grafting turned out to be a very safe procedure with a slight
benefit in favour of those cases which are operated on
before the eruption of the canine.
The simultaneously closed oronasal fistulae change the
outcome for the worse. Therefore it is recommended that the
fistulae be closed in an independent procedure, at least 3
month before the bone grafting.
[~ HEREDITARY HAEMORRHAGIC TELANGIECTASIA
(RENDU-OSLER-WEBER DISEASE), REPORT OF A
CASE IN WHICH ORAL LESIONS HAVE BEEN
MANAGED WITH CO2 LASER THERAPY.
Uribarrri* A, Velasco V, Arnabat J, Espaga A J, Gay-Escoda C
Master of Oral Surgery and Implantology. Faculty of
dentistry, University of Barcelona,. Barcelona. Spain.
We report a case of hereditary haemorrhagic telangiectasia
or Rendu-Osler-Weber disease. This is an uncommon inher-
ited disorder characterized by the presence of multiple
angiomatous telangiectasias in associatiopn with haemor-
rhagic diathesis. The disease is considered a primary
prupura secondary to a vascular alteration since blood
coagulation is not impaired.
A 58-year-old woman suffered from persistent bleeding
of the oral mucosa accompanied by painful ulcers in the
palate which impided normal feeding. Treatment by conven-
tional surgery was excluded and the patient was assessed at
our unit of laser therapy for the possibility of being treated
by means of this technique.
CO2 laser (Sharplan type) was applied (10W pulses) at
15-day intervals for a total of six sessions over a period of 3
months. During the course of treatment, remnat teeth were
removed. Once oral lesions have been treated and all extrac-
tions completed, a total prosthesis was implanted.
After a follow-up period of one year, no recurrence of
oral bleeding episodes have been documented, total prosthe-
sis is well tolerated and food intake has largely impared.
@=~ U P P E R L I P FRENECTOMY: C O M P A R I S O N OF
F R E N E C T O M I E S USING ER:YAG AND CO2 LASER.
Velasco V*, Uribarrri A, Arnabat J, Espa~a A, Berini L,
Gay-Escoda C.
Master of Oral Surgery and Implantology. Faculty of
Dentistry. University of Barcelona. Barcelona. Spain.
EACMFS - Abstracts, Helsinki Congress 1998 57
Aims: To evaluate clinical differences in upper lip frenec-
tomies using Er:YAG and CO2 lasers.
Method: Er:YAG laser (key-laser), CO2 laser (Sharplan
1020). 25 frenectomies with CO2 laser and 25 frenectomies
with Er:YAG laser were compared.
Results: Significative differences in healing time were
observed. Group treated with Er:YAG laser healed much
faster.
Conclusions: The minimal thermal effect of Er:YAG lasers
produces less heating of surrounding tissues, and healing
progresses much faster.
COMPUTER ASSISTED SURGERY OF THE ORBIT
Gellrich, N.-C.*, Schramm, A., Buitrago-Tdllez, C., Lauer,
G., Schmelzeisen, R.
Department of OMFS, Department of Diagnostic
Radiology, Albert-Ludwigs University Freiburg, Freiburg i.
B~, Germany
Subject: Reconstruction of post traumatic orbital and peri-
orbital deformities still mean a surgical challenge. The pre-
dictive and intraoperative advantage concerning
postsurgical outcome by using modern navigation systems is
investigated in 4 (peri-)orbital posttraumatic defects and an
optic nerve decompression at the optic canal.
Method: Spiral computed tomography data of patients were
acquired with Siemens Somatom Phis4 and transferred to
STN-Navigation-System (Leibinger/ Zeiss). Periorbital
bony and soft tissue contours, orbital contents, angles and
distances were measured preoperatively on the workstation
in a multiplanar view. The surgical approach was marked
and the reconstruction was virtually designed.
Intraoperatively contours of preoperative planning were
navigated by the surgeon using the STN workstation
together with infrared cameras.
Results: In four cases of orbital reconstruction (enophthal-
mus correction, malar bone augmentation) surgical steps
could be performed precisely as preoperatively planned on
the workstation. Autologous bone could be harvested and
moulded to the demands of the surgeon to cover or aug-
ment defects of the orbit and periorbital region. In post-
traumatic optic nerve decompression at the optic canal the
surgical route could be exactly planned and the surgeon
could be securely guided to the region of interest i.e. the lat-
eral wall of the sphenoid sinus.
Conclusions:Using the STN-Navigation-System orbital
reconstructions can be facilitated due to preoperative
planning on the workstation with 2D and 3D measure-
ment of orbital contents, bony and soft tissue structures
and later intraoperative control by computer assisted
surgery. Even in optic nerve decompression this system
was highly applicable as a diagnostic, planning and sur-
gical tool, so that transethmoidal optic nerve decom-
pression proved to be a straight forward and safe
procedure.
SURGICAL APPROACH IN THE S O F T TISSUES
T U M O R S O F THE C E P H A L I C EXTREMITY
*Dr Georgescu A., Dr. Ivan 0., Dr. Maior C., Dr. Onoe R.
University of Medicine Plastic Surgery Clinic, Cluj Napoca,
Romania
58 Journal of Cranio-Maxillofacial Surgery
Identified in an early stage because of their superficial local-
ization, the soft tissues tumors of cephalic extremity benefit
from a radical curative surgical treatment. In covering the
postexcisional defects the pedicled or free flaps have got the
supremacy.
Material and methods
The study discusses a number of 50 cases operated between
1993-1997. The ethiology was: carcinoma- 45 cases; mes-
enchimal tumors - 5 cases. The tumors localisation was;
hairy skin (15 cases); frontal region (10 cases); palpebral
region (8 cases); nasal region (7 cases); cheek region (5
cases); others sites (5 cases).
The first surgical step was a rigorous surgical excision
with oncological security limits followed by defects with
skin grafts or flaps. The split skin graft has been used when
a complete oncological excision has not been sure or in
elderly patients with an associated diseases (4 cases).
The flaps represent the first option in 46 cases as follow:
1. -locals flaps (30 cases) from which
-25 axial paterns flaps- forehead (5 cases); supra-
trochlear (8 cases); cheek flap (12 cases);
-5 randomized flaps - rotational, translated
2. - regional flaps (10 cases) - temporal islands flaps (5
cases); platissma muscle cutaneous flap (2 cases); del-
topectoral flap (3 cases)
3. -distance flaps randomized migrated flaps (1 case);
free flaps (5 cases).
Results
The evolution was favorable in the majority of cases with
only 6 recidives requiring a second intervention. In 4 cases
there was a partial or complete ischemic flap necrosis.
Conclusions
The correct surgical excision of the tumors in oncological
security limits represent the base of the treatment. In covering
the postexcisional defect the local flaps represent the first
choice of theirs important advantages: color, softness, thick-
ness, comfortable position. When the local resources are sur-
passed the free flaps represent a valuable solution.
RHINOPLASTY
*Dr Georgescu A., Dr. Ivan 0., Dr. Maior C., Dr. Onoe R.
University of Medicine Plastic Surgery Clinic, Cluj Napoca,
Romania
Congenital or acquired nasal displasia represent a complex
pathology which require a carefully approach considering
the important role of the nose in patient's mental harmony.
The paper present same aspect related to the reconstruc-
tive and aesthetic nose surgery and its results.
Material and methods
In the Plastic Surgery Clinic of Cluj Napoca have been
operated about 500 cases in the last 5 years in equal propor-
tion posttraumatic or congenital displasia.
The method used was -closed rhinoplasty in 450 cases
(90%) and open rhinoplasty in
50 cases (10%) especially in complexe malformations (ex.
cleft lip and nose).
In the 10 cases has been used a silastic prosthesis with
only two local reject.
In approximately 100 cases (20%) a preoperative result's
establish method has been used: computer assisting meth-
ods or correction on the patient's photo.
Results
The results have been appreciated in collaboration with the
patient.
There was: -very good results (375 cases 75%)
good results (75 cases- 15%)
-satisfactory results (40 cases - 8%)
unsatisfactory results (10 cases - 2%)
20 cases required a second intervention:
-Multistage operation (complex malfor-
mation 13 cases)
Demand by the patient (4 cases)
Of necessity (accident-3 cases).
Conclusion
An adequate preoperator dialogue represents the rhino-
plasty successful key establishing a balance between desires
and possibilities, followed by a correct operative strategy.
HYDROXYAPATITE CEMENT RECONSTRUCTION
IN CRANIOFACIAL DEFECTS.
Gerbino, G. *, Ramieri, G., Berrone, S., Beneeh, A.
Division of Maxillo-Facial Surgery, University of Turin,
Turin, Italy
Aims: To report 7 cases of reconstruction of craniofacial
defects with the use of hydroxyapatite cement paste
(Bonesource, Howmedica Leibinger, Inc., Dallas, TX, USA).
Method: Hydroxyapatite cement paste was used in 2 cases in
defects requiring cranioplasty in the frontal region, in 3 cases
in partial-thickness cranial contour defects and in 2 cases as
an augmentation material to prevent temporal hollowing
after temporalis muscle flap preparation. Six months of clini-
cal and radiological follow-up was undertaken for all patients.
Results: Bonesource implants showed excellent biocompati-
bility and volume maintenance by clinical evaluation.
Postoperative recovery was uneventful, save for a seroma
that was successfully aspirated.
Conclusions: Hydroxyapatite cement paste provides good
results in cranioplasties and as contouring material in the
frontal and supraorbital region. Since experimental data indi-
cate that Bonesource has the potential for complete replace-
ment by native bone over time and it is easy to sculpt, we
believe that it is suitable for selected craniofacial procedures.
Further studies are needed to evaluate the material in larger
series of cases and the long-term outcome of volume
maintenance.
RECONSTRUCTION OF MANDIBULAR DEFECTS
USING NONVASCULARIZED BONE TRANSPLANTS
AND TITANIUM MINI RECONSTRUCTION PLATES
- A MULTI-CENTER STUDY.
Gerlach, K.Lfl*, Kaupe, M. 2, Eekelt, U.s, latrou, j.5, Pape,
1t-1). 4, Stoelinga, P.J. W 6.
Departments of OMFS Magdeburg 1, Erlangen 2, Dresden ~,
Cologne4, Germany, Athens, Greece 5, Arnhem, Netherland 6.
Aims: This study evaluates the clinical results for the
reconstruction of discontinuity and hemimandibular
defects of the mandible using free iliac bone transplants
and two parallel running titanium mini reconstruction
plates.

Methods: Included were 73 mandibular defects treated in 5
different departments. After extraoral (n=46) or combined
intra/extraoral approach(n=28) iliac crest grafts with a
length ranging from 14 mm to 150 mm (mean 73 m m ) and
an average height of 22ram were used for defect reconstruc-
tions. In each case fixation was performed with two parallel
running mini-reconstruction plates.
Results: Of 73 bone grafts 60 with an average length of
65 mm (20 to 145 ram) had an undisturbed healing of the
transplants. A loss of height of 5 mm was noticed in 7
cases, whereas the others had only a diminution of height
of only 2 mm during the follow up period between 1 and 5
years. 2 transplants failed totally, 11 cases had a remark-
able resorption (partial loss) but only 6 of them required a
further bone grafting to bridge a pseudarthrosis. The
length of these defects ranged between 40 and 140 mm
(mean 85 ram). The reason for this complications, however,
was due to an insufficient coverage of the soft tissue with
resulting intraoral dehiscences followed by infections ( n=
9).
Conclusions: The results demonstrated a sufficient trans-
plant stabilisation guaranteed by the used fixation devices.
Its particular advantages are the modest dimension and the
low modulus of elasticity which enables on the one side the
transfer of physiological stimuli to the transplants during
the rebuilding process and on the other hand does not hin-
der the revascularisation of the transplants and facilitates
the closure of the covering soft tissue. Necessary conditions
are a sufficient surrounding soft tissue. The results seem to
be better for the treatment of discontinuity defects than for
free ending hemimandibular cases.
STUDY OF PROMINENT EARS CORRECTION IN
CHILDREN
Gevorkian K.S.
Department of surgery Yerevan State Medical University,
Yerevan Armenia
Aims: To determine the comparative efficiencies of three
groups for corrective surgery.
Methods: Children with prominent ears at age 6-8 years (N
10), 9-11 (N 18) and older than 11 years (N 12), who
underwent a corrective surgery. We are using Musturd's,
Barsky's and Converse's techniques of prominent ears
plastic.
Results: The age at which a patient should undergo a plastic
surgery has been debated for a long period of time.
Compared the observation groups we find out that the best
results in postoperative period (1-10 years) had been
achieved in the II and III groups.
Conclusions: The most suitable age for plastic operations to
correct prominent ears is therefore the 9 - 11 years and chil-
dren with prominent ears should undergo a corrective
surgery at this age to avoid psychological sequel.
NEUROSENSORY DISTURBANCE OF THE
INFERIOR ALVEOLAR AND MENTAL NERVES
AFTER G E N I O P L A S T Y ALONE OR IN
COMBINATION W I T H SAGITTAL SPLIT
MANDIBULAR R A M U S O S T E O T O M Y (SSMO).
A.B. Gianni" O. D'Orto, F.Biglioli, A. Bozzetti and R. Brusati
EACMFS Abstracts, Helsinki Congress 1998 59
University of Milan, Department of Maxillo-Facial Surgery;
San Paolo University Hospital, Milan, Italy.
Aims: The purpose of our protocol is to study neurosen-
sory disturbances associated with genioplasty, SSMO,
and with both procedures in combined. Many authors
assessed the incidence and degree of neurosensory distur-
bances of the inferior alveolar nerve after orthognatic
surgery but results are frequently difficult to interpret
and compare due to a lack of standardization of
methods.
Materials and Methods: Fifty patients (twenty-four males
and twenty-six females) were tested with qualitative (touch
sensation, sharp/blunt test, cold sensation and hot sensa-
tion) and quantitative (localization test, two point static
and dinamic test) methods at least one year after orthog-
natic surgery. The patients were included in the following
groups: 10 patients (controls) in group 1; 12 patients
(genioplasty alone or in association with maxillary
osteotomy or vertical mandibular ramus osteotomy) in
group 2; 10 patients (SSMO alone) in group 3; 18 patients
(SSMO with concomitant genioplasty). On both sides we
tested four areas: the middle of the synphysis (cutaneous
and mucosal side); 2 cm laterally to the middle of the syn-
physis (inside, outside), 3 cm laterally to the middle of the
synphysis approximately at the level of mental foramen
(inside and outside) and vermilium. Tests were always per-
formed by the same operator. We also asked all patients to
indicate if the neurosensory tests were subjectively dis-
abling.
Results: None of the patients showed persistent anesthesia
in the tested areas according to the qualitative tests. In
group 2 the quantitative neurosensorial tests showed normal
or slight hypoesthesia (16.6%) in all the tested areas; in
group 3, 30 % of the patients showed minimal quantitative
neurosensory disturbances, while the incidence of objective
neurosensory deficits increased (38.8%) in patients who had
undergone a concomitant genioplasty (Group 4). Among
the tested areas, vermilium and mouth commisure resulted
the most affected ones in all groups.
Conclusions: In conclusion the combination of genioplasty
and SSMO seems to be more detrimental for the lip sensibil-
ity than genioplasty or SSMO performed alone. In spite of
that, neurosensory deficit was never considered disabling by
subjective patient evaluation.
[ ~ A R T H R O S C O P I C DISC SUTURING
PROCEDURE TECHNIQUE FOR DISC
DISPLACEMENT
GiI-Diez JL.*, Rodriguez-Campo FJ., Goizueta-Adame C.,
Mu~oz-Guerra M., Sastre £, Diaz-Gonzdlez F£
Department of MaxilloJizcial Surgery. University Hospital
La Princesa, Madrid, Spain.
A wide variety of surgical techniques have been per-
formed in the treatment of intraarticular temporo-
mandibular disorders. Disc repositioning surgery is one
of them. The use of this technique in disc displacement
with reduction ( D D R ) or without reduction ( D D N R ) is
controversial. For some authors, the disc repositioning
may not be necessary for therapeutic success, because
there are an improvement in signs and symptoms even
though disc position remained unchanged. For others,
60 Journal of Cranio-Maxillofacial Surgery
the disc repositioning must be a goal of the treatment
because it seems to exist a significative correlation
between disc position and the severity of degenerative
changes in the temporomandibular joint (T.M.J.). With
open surgery and arthroscopic surgery, different proce-
dures have been performed to disc reposition.
Arthroscopic surgery is a high difficult technique with low
rate of complications. We have performed arthroscopic
treatment over the last ten years for correction of internal
derangement of the T.M.J. and we began to perform an
arthroscopic procedure for disc reposition four months
ago. This procedure is based on techniques described by
Israel and Mc Cain.
We show this procedure whereby the disc is reposi-
tioned and fixed arthroscopically (anterior release, disc
suturing and cauterization of redundant posterior syn-
ovium). A wide study is currently being made in our
Department with this technique, the success of disc reposi-
tioning and clinical improvement will be shown in the
nearly future.
DIFFERENT AUTOGRAFT M O D E L IN
MAXILLARY RECONSTRUCTION
Giray, C.B.1, Safak T.2
1. Faculty of Dentistry, Dept. of Oral Surgery Hacettepe
University, Ankara, Turkey.
2. Faculty of Medicine, Dept. of Plastic and Reconstructive
Surgery, Hacettepe University, Ankara, Turkey.
Aim: The use of human cadaveric bone allograft in the
reconstruction of skeletal defects has a long history in
surgery. Practically, there is no limit in size, shape, quan-
tity, and optimum reconstruction model for the defect.
From this point of view, in a patient suffering from malig-
nant melanoma of the left maxillary gingiva, the excised
maxillary segment was used in the same patient for maxil-
lary reconstruction as an autograft following a solvent-
dehydrated bone-preservation process SDBP
(Tutoplast®).
Method: In the first stage, hemimaxillectomy and left
radical neck dissection were performed. The excised
maxillary segment was cleaned of gingiva and
periostium. All the teeth in the maxilla were extracted.
Then the unique bone segment was sent for SDBP pro-
cessing which took 6 weeks after the surgical removal. In
the second stage, the processed and sterilized maxillary
bone was vascularized under the forearm skin and an
osteocutaneus prefabricated forearm flap was harvested
and transferred to the original site after two months. The
bony component of the prefabricated forearm was fixed
to the remaining maxilla with titanium microplates, fol-
lowing the microsurgical anastomosis to the temporal
artery. After 5 months, a partial removable denture was
fabricated to establish functional improvement in the
patient.
Result: Clinical and radiological examination at 2.5 years
revealed survival of the soft and bony tissue without any
complication.
Conclusion: By using this method of reconstruction in
appropriate cases we do not need to sacrifice and dis-
card n o r m a l bony tissue and there is no d o n o r site mor-
bidity. Moreover, the h a r m o n y of the graft in its
original place is naturally perfect, with a short opera-
tion time involved.
R A D I O L O G I C A L FEATURES O F O S T E O G E N I C
SARCOMA: A C O M - PARATIVE STUDY O F
DIFFERENT R A D I O G R A P H I C MODALITIES.
N. Givol*, A. Buchner, S. Taicher, L Kaffe,
School of Dental Medicine, Tel Aviv University, Tel Aviv,
Israel
Aims: To evaluate the clinical and radiological features of
osteogenic sarcoma of the jaws and the efficiancy of various
radiographic modalities to depict those radiological fea-
tures.
Material and Methods: A search of the English literature
resulted in 57 cases of osteogenic sarcoma of the jaws with
adequate radiographs or radiological reports and 9 addi-
tional new cases. A total of 66 cases were studied and criti-
cally evaluated with emphasis on the radiological features
presented in the various radiographic modalities.
Results: The mean age of the patients was 36 years and the
median age 31.5 years. There were no differences in gender
distribution. A ratio of 1:1.6 between the maxilla and the
mandible was found. Lesions had diffuse borders in 78%
and poorly defined in 22%. The density was judged as radi-
olucent in 29.3%, radiopaque in 29.3% and mixed in 41.4%.
Widening of the periodontal ligament space (PDL) was
detected in 14 of the 47 lesions located in dentulous areas
(28%). Structural changes in the mandibular canal were
detected in 34% of the mandibular lesions. Periosteal reac-
tion was observed in 48% and soft tissue involvement in 33%
of the lesions.
Conclusions: Widening of the PDL space was best demon-
strated in cases where periapical radiographs were available.
Structural changes in the mandibular canal were demon-
strated mainly with panoramic radiographs. Periosteal reac-
tion was best demonstrated by occlusal radiographs and soft
tissue involvement by CT scans. Proper radiological exami-
nation using intraoral periapical and occlusal radiographs
and panoramic radiographs, and recognition of the radio-
logical features of osteogenic sarcoma, can lead to an earlier
diagnosis of the tumor by the practicing clinician.
[~ F I L L I N G POSTOPERATIVE BONE CAVITIES
W I T H PAW 1 GLASS CERAMICS
D. Gogalniceanu,Eugenia Popescu,C.Mihai, Cristina Apetrei
UM.F IASI-ROMANIA
The authours present their clinical experience in filling
medium and large bone cavities with PAW 1 glass ceramics
in 22 patients admitted in the Clinic of Oro Maxillo Facial
Surgery in Iasi,Romfinia between 1994 and 1998.Ten
patients had periapical cysts, six had residual cysts and two
were with keratocyst.The medium sized cavities were filled
only with vitroceramics and the large ones with a mixture of
vitroceramics and fresh autogenous medullospongious
material taken from the hip bone.
PAW 1 glass ceramics is a very good bone substitute
produced by PONETI SRL Company in
Bucharest,Romfinia,sold at a convenient price in the form of
radioopaque microgranules.It is nonabsorbable, biocompati-
ble, biointegrable and osteoinductive.
After for years since its setting the synthetic material is
still present in the cavity.Among the gramlles one can see
bone traces not copletely formed.

Postoperative course was good.No complications have
been seen in any of the cases.
THE USE OF DACRON M E S H IN
RECONSTRUCTIVE M A X I L L O FACIAL SURGERY
D. Gogalniceanu,Carmen Vieoi,Eugenia Popescu, Maria
Voroneanu,C.Mihai
UM, F IASI-ROMANIA
The materials used in reconstructive maxillo facial surgery
have been a much debated subject.As far as we know there is
no ideal material in this respect.
Since 1994,in the Clinic of Oro Maxillo Facial Surgery in
Iasi,we have chosen DACRON mesh of a tubular shape,a
material which has been used only in vascular surgery so far.
DACRON(polyetilen tetraphtalat)is a biocompatible
material with solid and longlasting characteristics.It is non-
absorbable, well tolerated and is well accepted by the body, it
has chemical and physical stability and does not induce for-
eign body reactions or cancer.It can 0be sterilized in auto-
claves;it has variable thickness,it is elastic and easy to be
handled,modelled,adapted and anchored to the host
bed.The conjunctive tissue penetrates it fixing it to the tissue
elements surrounding it.It is also radiotransparent.
We have used fragments of DACRON, adjusted to our
necessities,in 12 patients between 5 and 45 years of age, to
reconstruct the orbital floor in fractures with loss of sub-
stance.We have also used it as a material for neoarticular
interposition in 5 patients between 8 and 23 years of age in
temporo-mandibular joint ankilosis.
Our good results recommends DACRON texture to be
used as a reconstructive material and in interposition in
maxillo facial surgery.
A L L O P L A S T I C MATERIALS IN T E M P O R A L
FOSSA RECONTOURING
Gdmez F*, de Pedro M, Pdrez MC, Sdnehez-Gutierrez J,
Sdnchez-Cudllar A, Borddn J, Berguer A.
Department of Oral & Maxillofacial Surgery. University
"Hospital Clinieo San Carlos", Madrid, Spain.
Aims: To evaluate alloplastic reconstruction secondary to
the harvesting of the fasciomuscular temporal flap, and
compare the results with those cases without reconstruc-
tion.
Method: Twenty-nine (29) consecutive cases (29 flaps) were
evaluated (1991-1997 period). Fifteen (15) with no recon-
struction (control) and 12 underwent alloplastic reconstruc-
tion, 8 with methylmethacrylate (MM) and 4 with
polytetrafluoroethylene (PTFE) sheets. A temporal flap was
used after maxyllectomy in 82.8% of cases, (73.3% for
malignant disease). We evaluated the incidence of sero-
haematoma, infection, hospitalization time, and aesthetic
results (periodical revision and phone inquiry). Surgical
technique was the manual modeling and nylon sutures (for
the PTFE), and warm modelling and apposition without
fixation(for MM)
Results: No statistical differences were found in the inci-
dence of haematomas and infection, not hospitalization
time. A good aesthetic and functional result with 100% sat-
isfaction (PTFE) and 50% for M M was found. Two compli-
EACMFS- Abstracts, Helsinki Congress 1998 61
cations led to removal of the material in one case with
P T F E (12 months) and one M M (13 days).
Conclusions: In this study, no significant differences in mor-
bidity between P T F E - M M use and patients without recon-
struction were seen. No definite conclusions can be drawn in
relation to the material used. P T F E results must be analyzed
with care due to the small sample. Subjective patient evalua-
tion is better with P T F E due to its smooth features, offering
a simple surgical technique, although it is an expensive
method.
7h IMPROVING NASOLABIAL AESTHETICS IN
LEFORT I O S T E O T O M Y
Gonzalez-Lagunas, Javier, Hueto J.A., Raspail, (7., H. V. Vail
d'Hebrdn
Department Maxillofaeial Surgery, Barcelona, Spain
Lefort I osteotomy is a well defined technique for correction of
deformities of the middle third of the face. A concern for sur-
geons performing the osteotomy is avoiding some of the sec-
ondary changes that appear in the paranasal and nasolabial
area, including an ill-defined nasolabial angle. Several tech-
niques have been devised to avoid that situation including a
sub-spinal osteotomy, the allar cinch suture, a V-Y closure of
the labial mucosa or bone remodelling of the piriform
apertures.
We present the results of a simple technique that consists
in the fixation of the collumelar subcutaneous tissues to the
posterior aspect of the anterior nasal spine or to the nasal
septum, as proposed by Bloomqnist et. al.
Twenty patients submitted to a Lefort I osteotomy have
been selected and divided in two groups. Group 1 include
patients where a V-Y closure of the mucosa was performed.
Group 2 includes patients where a subnasal suspension of
the collumela was done. Profile photographs of all patients
will be digtalized, superimposed and compared in relation
to the nasolabial angle.
[h TONGUE CARCINOMA: C O N C L U S I O N S F R O M A
COHORT STUDY W I T H THREE YEARS OF
MINIMUM FOLLOW-UP
Diaz Gonzalez, F*., Naval, L., Rodriguez Campo, F.,
Munoz, 3/1., Padron, A., Sastre, J., Hevrera, J., Gil-Diez, J.,
Rubio, P.
Autonoma University, Hospital de la Princesa, Madrid, Spain.
ALMS:
1. To estimate the acummulate rate of local, regional and
distant metastases relapses.
2. To calculate the crude global and subgroups survival rates
of the cohorts.
3. To determine the predicted value of affected margins
and cervical involvement on tumour relapses and
survival.
METHODS:
A total of 87 patients had movil tongue Ca. The mean age
was 58 years. 66% were men. 54% were early stage (I and II
stage) tumor. 78% had a clinical NO stage. All patients
62 Journal of Cranio-Maxillofacial Surgery
received a local resection and in 70% a cervical dissection
(38% of them were bilateral simultany). In addition 41% of
patients received postsurgical Rx. Statistical analyses:
descriptive statistics of clinical characteristics of the cohort.
Accumulate probability of the recurrences and crude esti-
mation for the global survival and by subgroups of initial
risk.
RESULTS:
80% of the surgical margins were free of tumor. The overall
rate of recurrences was 37% in three years: 13% local
relapses. 14% cervical relapses, 7% lococervical relapses and
3% distance metastases.
The local recurrence rates with free margins were 5% vs.
35% with affected margins.(X2=3.80; p=0,05).
The overall number of patients alive and free of tumor at
the end of follow-up was 48 (55%). Among those patients
with free margins, 63% survived three or more years against
19% with affected margins.
CONCLUSIONS:
The three years probability of survival is significantly higher
in patients with free surgical margins in the primary tumor.
One third (34%) of the patients with NO were actually
PN+ or had recurrence during follow-up.
Only 3% of the patients had contralateral or bilateral
PN+.
CARBON DIOXIDE LASER EVAPORATION OF
LEUKOPLAKIA OF THE LIP
P.J.J. Goorls* J..L.N. Roodenburg**, A. Vermey** J.M.
Nauta**
*Department of Oral Maxillofacial Surgery, Ignatius
Hospital Breda Molengracht 21, 4818 CK Breda, The
Netherlands
Tel." 076-5258111 Fax." 076-5200819
*Department of Surgery~Head and Neck Surgery University
Hospital Groningen Oostersinge159, 9713 EZ Groningen,
The Netherlands
Tel." 050-3612561 Fax: 050-3611136
Aims Retrospective evaluation of the treatment results of
CO2 laser evaporation for leukoplakia of the lowver lip in
27 cases.
Method The data included 23 patients who presented with a
leuko plakia of the lip during the period 1978-1986 at the
Depart ment of Oral and Maxillofacial Surgery of the
University Hospital of Groningen, The Netherlands. There
were 4 patients who developed a 2nd leukoplakia of the lip
resulting in 27 cases of leukoplakia.
The lesions were treated using a CO2 laser with an opera
tion microscope and micromanipulater.
Results Short term evaluation showed a complete epithelial-
isation at 4 weeks after CO2 evaporation. There is minimal
scar formation and subsequently no interference with nor-
mal lip function. During long term evaluation 4 recurrences
(14,8%) were diagnosed after CO2 treatment: the recur-
rences developed between 5 and 31 months and were again
treated by CO2 laser.
No squamous cell carcinoma did develop in the CO2
treated area.
Conclusions Selective removal of affected epithelium with
minimal damage to surrounding tissue is possible using
CO2 laser evaporation, followed by excellent wound healing
and good functional result. Treatment can be performed
under local anesthaesia on an outpatient basis. The rate of
recurrence is low compared with the rate of recurrence after
surgical excision, which varies between 10 and 35%.
CO2 laser evaporation therefore is a reliable treatment
modality for leukoplakia of the lip.
EFFECTS OF rhBMP-2 AND OSTEOPROMOTIVE
MEMBRANES ON EXPERIMENTAL BONE
GRAFTING
Gordh M ~ , Alberius P, Lindberg L, Johnell O, Linde A.
Department of Oral Surger); University Hospital MAS,
Malta6, Sweden.
AIMS:
One problem when using autogeneic bone for onlay grafting
is to predict its extent of incorporation and volumetric per-
sistence. The purpose of this study was to explore whether
improved graft volumetric maintenance is achieved by an
effective bone osteoinductive protein (rh-BMP-2) and
whether a combination of rhBMP-2 and osteopromotive
membranes is advantageous in this respect.
METHOD:
Unicortico-cancellous bone grafts were positioned below
the temporal muscle bilaterally in 48 adult Lewis rats. The
recipient bone was ground, and the grafted area was ran-
domly treated according to one of 8 different protocols. Two
doses of rhBMP-2 (4mg/80ml or 32mg/80ml) in a collage-
nous carrier (Helistat,) were tested, with or without cover-
ing with expanded polytetrafluoroethylene (e-PTFE)
membranes. As controls, membrane and carrier, alone or in
combination, and onlay alone, were used. The results were
evaluated after 4 and 20 weeks by routine histology and
immunohistochemical labelling for various bone and carti-
lage matrix proteins.
RESULTS:
After 4 weeks, all BMP-treated grafts showed complete
integration, while, for controls, only the membrane-only
group attained full incorporation during the period inves-
tigated. The combined treatment of high-dose rh-BMP-2
and a membrane demonstrated, compared with the
remaining groups treated with BMP, pronounced bone
formation and less graft resorption, resulting in main-
tained or increased graft size. This finding was already
observed after 4 weeks and the result remained at 20
weeks. Control groups showed less success in graft size
persistance.
CONCLUSIONS:
It was concluded that a combination of high-dose rhBMP-
2 and membrane had a synergistic effect, leading to a rapid,
complete graft incorporation and size maintenance.The
biological activity of the protein may, when used without
membrane placement, cause undesirable bone resorptive
effects.
Dr Monica Gordh, DMD,
Department of Oral Surgery, University Hospital MAS,
Malm6, Sweden.
040/333109; 040/322044;
FAX 040/322046; 040/336205;

OUR EXPERIENCE W I T H TWO DIFFERENT
SYSTEMS O F BIODEGRADABLE I M P L A N T S IN
CRANIOFACIAL SURGERY AND MAXILLOFACIAL
TRAUMATOLOGY
Griitz K. W.*, Oechslin C.K., Haers P.E., lUi O.E. °, Sailer
H.F.
Department of Cranio-Maxillofacial Surgery, °Department
of Pediatric Surgery, University Hospital Zurich,
Switzerland
Introduction: Metallic osteosynthesis material in maxillo-
facial traumatology has the disadvantage that it has to be
removed after the fractures have consolidated, which often
requires general anaesthesia. Titanium plates have been
introduced to bypass this need for secondary intervention.
However, due to corrosion, titanium particles have been
found in scar tissue covering these plates and in regional
lymph nodes, if plates remain in situ for life, they cause
artefacts in CT-imaging and especially MRI-examination
is not possible. In pediatric craniofacial surgery on grow-
ing skulls, metallic implants which are not removed can
with time be situated within and even under the skull, thus
causing defects in the dura. Two different systems have
been used voer the last ten years in our department. Our
experience with these systems is analysed and presented.
Material: Clinical and radiological data concerning all
patients treated with biodegradable osteosynthesis material
since 1988 were analysed with emphasis on following para-
meters: design of the material, handling of the material,
postoperative complications, and skeletal stability. The sys-
tems involved in this study were polylactid and polydixanon
headless screws and woven bands in pediatric craniofacial
surgery (twelve patients with a follow-up ranging between 10
years and 4 years) and miniplates and screws made of poly-
lactic acid-plolygiycolic acid (Lactosorb®) in craniofacial
surgery and maxillofacial traumatology (seventeen patients
with a follow-up ranging between 18 months and 6 months).
Results: Results with both systems mentioned will be
reported in detail. From these data the requirements for an
ideal system will be determined.
MID-FACE FRACTURES
Grecchi F.; Cirincione M.; Noveili G.; Fevrazzi D.; Roghi M.
Department of Maxillo Facial Surgery Niguarda "Cdt
Granda" Hospital - Milan - Italy
AIMS
Mid-face fractures which involve the naso-fronto-orbital
complex may extend deeply towards the anterior skull base
and towards the latero facial regions.
The aim of this study is to define our treatment timing
and experience.
M E T H O D S AND MATERIALS
Our Hospital treated 220 mid-face fractures from 1982 to
1997. We termed "high risk" fractures those associated with
active (persistent or recurring) cerebrospinal fluid fistulae,
those with meningitis or with extensive osteodural lesions of
the anterior skull base. All patients with "high risk" fractures
underwent skull base surgical repair and rnaxillo-facial recon-
struction at the same time, mainly between the % and the 30,~
day.
EACMFS Abstracts, Helsinki Congress 1998 63
A second group of patients received only neurosurgical
treatment; in some cases (most fistulae spontaneously stop)
no surgical repair was required.
The third group was treated only by the maxillo facial
surgeon within the first week or as an emergency, due to the
presence of open fractures or extensive skin lacerations.
When necessary, simultaneous management of anterior
basal skull fractures (ABSFs) and concomitant maxillo-
mandibular fractures was performed.
RESULTS
In aU cases the use of rigid fixation lead to a stable and
definitive result. Main complications concerned bulbar
damage and movements, vision, tear ducts and occlusion.
Coordination with neurosurgeons allowed simultaneous
management of cranio-facial lesions.
BIOCYTAL AS AN I M P L A N T A T I O N MATERIAL IN
SURGERY O F JAWS
Grechukha A, * Chudakov 0
The Clinical Centre of Jaw-Face and Plastic Surgery
The Minsk Medical College. Minsk, Belarus.
Aims. There has been examined the possibility to use the
hyaloid-crystal biocytal as an implementation material for
filling the defects of the face skeleton bones, as well as its
effects on the process of bone regeneration, There have been
elaborated the indications and contra-indications for appli-
cation of biocytal in the jaw-bone surgery. Methods, Under
experimental conditions, there has been studied the influence
of biocytal on the process of healing of alveolus of the
pulled out teeth, and of the formed bone defects by conduct-
ing series of experiments on mongrel dogs and rabbits of the
species "Shinshilla". Results. There has been described the
process of osteointegration within the system of "bone
implant", as well as the influence of biocytal on the process
of regeneration of jaw-bone. There have been presented the
indications and contra-indications concerning the use of the
hyaloid-crystal biocytal in the clinical practice of the max-
illo-facial surgery, and there have been worked out the meth-
ods of surgery implantation of biocytal in the maxillo-facial
surgery. Conclusions. On the basis of the experimental, tox-
ico-hygienic, physical-and-chemical data, one can come to
the conclusion, that biocytal is, in its nature, one of the per-
fect, biologically active implantants. The elaborated indica-
tions and contra-indications concerning the use of biocytal,
as well as the methods of operative technology on its appli-
cation, provide the jaw-face surgeons with an opportunity to
speed up the process of healing of the bone wounds, reduc-
ing thereby the possibility of complications during the
process of bone regeneration. For the first time there have
been elaborated the methods of surgery implantation of bio-
cytal for filling of the defects of the face skeleton bones.
THE TREATMENT O F ARTERIAL
H E M A N G I O M A S IN MAXILLO-FACIAL REGION.
*GHshin A., Agapov E, Matveev A., Rumianzev D.,
Gokoeva A.
Medical Stomatological Institute, Department of Oral and
Maxillo-Facial Surgery. Moscow. Russia.
64 Journal of Cranio-Maxillofacial Surgery
AIM: To develop a complex approach to radical surgical
treatment arterial hemangiomas of maxillo-facial region
based on the study of their blood supply pattern.
METHOD: The investigation of blood supply in heman-
giomas was performed. Selective and superselective angiog-
raphy has shown the main sources of blood inflow into
extensive arterial tumor were all brachiocephal vessels.
RESULTS: The temporary occlusion of carotis externa
artery was not efficient for decreasing the blood supply into
hemangiomas of maxillo-facial area due to fast restoration
of blood flow. For terminating the blood inflow into these
tumors the embolization of afferent vessels was performed.
That permitted the minimization of bleeding during the
operation. This technique was successfully used in treat-
ment of 42 patients.
CONCLUSION: The complex approach is recommended
for treatment of maxillo-facial area arterial hemangiomas
which includes the angiography and embolization of affer-
ent vessels with following operative excision of the tumor.
SKELETAL STABILITY FOLLOWING
DISTRACTION OSTEOGENESIS OF THE
MANDIBLE W I T H TRANSORALLY APPLIED
DISTRACTION DEVICES
Gropp, 1t. ,1, Wangerin, K. l, Pasello, 17.1,Ewers, R. 2, Fleiner,
B. s, Hammer, B.4,
Hardt, N. s, Hoffmeister, B. 6, Triaca, A.. 7 Zeilhofev, 1t.- F.s
1Dpt. of Plastic & Maxillofacial Surgery, Marienhospital
Stuttgart, Germany
2Dpt. of OMFS, University Vienna, SDpt. of OMFS,
University Kiel, 4Dpt. of OMFS, Kantonsspital Basel, 5Dpt.
of OMFS, Kantonsspital Luzern, 6Dpt. of OMFS, Free
University Berlin, ZPrivate Practice, Ziirich, 8Dpt. of
OMFS, Technische Universitgit Miinchen
Mandibular distraction osteogenesis with transorally
applied, submerged devices allow for generation of new
bone without undesired scar formation. In cooperation with
Medicon Instruments, Tuttlingen, distractors for horizontal
and vertical lengthening of the mandible were developed
and have been in clinical use since 1994. Patients treated in
the years 1994 through 1997 were included in a retrospective
study to evaluate skeletal stability, complications, impair-
ment of neurosensory function and patients' acceptance. 23
patients (age 4 to 50 years) treated in eight institutions were
followed. In 18 patients, diagnosis was unilateral (7 pts.) or
bilateral (11 pts.) craniofacial mikrosomia. Distraction was
achieved using a horizontal device at 16 distraction sites and a
vertical device at 20 distraction sites. The average length of
distraction was 14,5 mm (7,5 to 25 mm).The mean follow-up
period was 11,3 months (5 to 44 months). Skeletal stability
was measured using superpositional tracings of frontal and
lateral cephalograms.Neurosensory function was measured
by two-point discrimination and sharp/blunt testing. Patients'
level of acceptance was judged by questionnaire. Adequate
cephalograms for superpositional tracings were obtained in
16 patients. The average loss of mandibular length was 4,7
mm (2 to 14 mm). Of 4 patients with severe relapse, 3 patients
had received unilateral distraction of the ascending ramus.
Complications included minor infections in 2 patients and
purulent bilateral infection requiring early distractor removal
in 1 patient. All patients revealed osseous union at time of
hardware removal. 12 patients suffered from temporary dis-
comfort during distraction, 1 patient had significant pain
resulting in early termination of the distraction. Incomplete
unilateral loss of mental nerve function was found in 3
patients. 2 adolescent patients stated that they would not rec-
ommend the procedure to others. It is concluded that the pre-
sented treatment modality seems to offer a viable treatment
alternative. Possible refinements of treatment planning and
measures to reduce relapse will be discussed.
RECONSTRUCTION OF MIDFACIAL AND
MAXILLARY DEFECTS
Gruber, B.*, Iizuka Z
Department of Cranio-Maxillofacial Surgery, University
Hospital of Bern, Switzerland
Aims: To evaluate different types of reconstruction in
patients undergoing midfacial resection including partial or
complete alveolar ridge loss following trauma and tumor
surgery.
Method: 45 patients who underwent sequential reconstruc-
tions of the midface during 1988 and 1994, were included in
the retrospective evaluation. Follow-up periods ranged from
18 months to 8 years (mean 6.2 years). Data was collected
regarding flap survival; complication rates; restoration of
palatal competence; the ability to feed orally, and speech
intelligibility; maxillary dental rehabilitation; and aesthetic
results. 23 patients had defects that resulted from ablative
oncologic surgery and 22 had severe midfacial trauma.
Results: 15 patients had free-flap reconstruction, all flaps
survived except one. Osseous pedicled temporalis flap con-
sisting of vascularized cranial bone (n=9) showed the high-
est complication rate (89%o, n=8) leading to loss of the bone
or of the entire flaps. Aesthetic and functional results were
rated good or excellent in 91% and 78% of the patients,
respectively. 70% of the patients in which bony buttress was
reconstructed with non-vascularized or vascularized bone
recieved dental rehabilitation. 74% of these patients received
osseointegrated implants into a bone flap. On the other
hand, dental reconstruction was performed in only 33% of
the patients, in which the defects were covered using soft tis-
sue transfer without bony reconstruction.
Conclusions: There are many methods for midfacial recon-
struction depending on the clinical situation of the each
patient. However, for sufficient dental rehabilitation recon-
struction of the bony buttress of the midface and the alveo-
lar ridge is necessary. Pedicled temporalis flap consisting of
vascularized cranial bone seems to have only limited indica-
tion in such cases as described here.
Q=~ IS MINIPLATING ACCEPTABLE IN
FRACTURE DISLOCATIONS OF THE CONDYLE IN
CHILDREN ?
Gundlach, K.K.H.*, Henkel, K.-O.,
Department of Maxillofacial Surgery,
UniversitgitsklinikumRostock, Rostock, Germany
Aims: To find out whether miniplating will help to achieve
better results than
traditional conservative treatment in cases of fracture dislo-
cations of the
condyle in children.
Method: Two series of animal experiments were started with
5 juvenile minipigs each.

In all minipigs the condyles were cut off unilaterally,
removed and replaced
immediately. In 5 cases the fragment was fixed by means of
a miniplate, in the
other 5 no osteosynthesis was performed.
The animals were examined either 20, 40, 60, 120 or 240
days postoperatively by
means of radiography and histology.
Results: All condyles were deprived of their blood supply.
Vertical bone loss was
less in the osteosynthesis group. Asymmetries were more
severe in the
control group (when compared with the contralateral side).
Conclusions: Osteosynthesis of fracture dislocations of the
condyle in children older then
8 years of age should be considered more often.
THE SYNTHES ® 1.5 AND 2.0 S E L F - D R I L L I N G
SCREW - INDICATION IN MAXILLOFACIAL
SURGERY
Guntermann, J.*, Gellrich, N.C., Schramm, A., Gutwaid, R.,
Schmelzeisen, R.
Department of OMFS, Albert-Ludwigs University Freiburg,
Freiburg i. Br., Germany
Subject: With the development of osteosyntheses different
types of plates and screws have been designed, which princi-
pally tended to become smaller and more simple to handle.
The new conicly shaped Synthes. self-drilling screw (1.5 and
2.0 mm diameter) looks like a simple wood-screw. We tried
to evaluate different indications in the maxillofacial field for
the clinical use of this new screw type.
Method: We tested either different indications in respect
of regional differences as well as different application-
forms of the screw in the facial skeleton, i.e. with or with-
out plates. Furthermore the handling of the screw was
judged upon concerning ease of insertion, retention and
torque.
Results: Clinical experience with 110 screws shows good
results concerning ease of insertion, torque and particularly
the variety of indications, ranging from fixation of
mandibular and midface fractures, anchoring of distractors
in the ascending ramus, fixation of canthal ligament or cal-
varian split grafts in reconstructive procedures. The star-
drive insertion results in excellent axial position of the screw
to the screw-driver.
Conclusions:In our opinion simple handling and convincing
clinical application will result in broad acceptance of the
new self-drilling screw, maybe it will even replace the self-
taping mini-screws.
@=~ A CLINICAL STUDY ON OROANTRAL
FISTULA
Giiven, 0.*
Department of OMFS, School of Dentistry, University of
Ankara, Ankara, Turkey
Aims: This survey is based on 98 patients with an oroantral
fistula (OAF) during the period 1983-1997. The conven-
tional techniques and the use of allografts (tutoplast, dura-
mater) in closure of O A F will be discussed.
EACMFS - Abstracts, Helsinki Congress 1998 65
Method: The factors considered were sex, age, cause of the
OAF, incidence, and mode of the treatment.
Results: The highest incidence of O A F was found after
extraction of the second premolar (28.57 %) (P<0.001).
The majority of the cases (90.82 %) were treated by the
buccal advancement flap (BAF) technique. In 10 out of
98 O A F cases allografts were used for closure of the OAF.
In most of the cases, Rehrmann's B A F technique was used
while the flap did not include periostium in allograft
cases.
Conclusions: All the cases in this study treated by BAF
healed uneventfully and none of them needed vestibulo-
plasty. BAF is a conventional, simple and well tolerated
technique for the patients.
T H E TREATMENT OF T R I G E M I N A L NERVE 2yD
BRANCH DAMAGE IN CASE O F MAXILLARY SINUS
INFLAMMATORY CHANGES
Vesta Guzevi~ien6, Gintautas Sabalys DMS
Department of Maxillofacial and Oral Surgery Kaunas
Medical Academy, Kaunas, Lithuania
The trigeminal nerve second branch neuralgia and inflam-
mation of upper dental neural plexus usually (in 66,2% of
all cases,) develops due to immune changes at maxillary
sinus.
In order to improve the treatment results of these dis-
eases it is necessary to perform local therapeutic procedures
on the maxillary sinus mucous membrane. The sinus is irri-
gated with antiseptic solutions, glucocorticoids, proteolytic
enzymes, therefore antimicrobial agents are injected
according to the indications. These procedures are per-
formed by puncturing the maxillary sinus repeatedly
through the lateral wall of nasal cavity. This procedure is
uncomfortable for the patient and traumatic for the mucous
membrane and the bony wall of the sinus. To avoid these
negative features we proposed the artificial maxillary sinus
fistula.
The fistula consists of cones shaped holllow cylinder 1,7
cm in length with inner and outer screw threads and a screw,
preventing the maxillary sinus from communication with
oral cavity. The fistula is inserted by surgical approach
through maxillary alveolar process at the molar area into
the lateral sinus wall.
Except the cure of maxillary sinus, we have treated the
trigeminal nerve 2,~ branch neuralgia and upper dental
neural plexus inflammation using histamine liberators, anti-
histamine and calcium medications, ascorbic acid, carba-
masepine. There were 120 patients having trigeminal nerve
neuralgia of allergic origin and 30 patients with upper den-
tal plexus inflammation treated at the Department of
Maxillofacial and Oral Surgery of Kaunas Academic
Clinics. Age 40 - 70 years.
Clinical manifestation of the second trigeminal nerve
branch allergic injury and the inflammation of the upper
dental neural plexus ceased more rapidly, when the
mucous membrane of the maxillary sinus was treated
using our method comparing to the patients without such
treatment,
Application of artificial maxillary sinus fistula prevents
the patient from psychoemotional stresses, that occur in
case of repeatedly performed punctures of the maxillary
sinus through the nasal cavity. Mucous membrane of the
nasal cavity and the bony wall are not injured.
66 Journal of Cranio-Maxillofacial Surgery
[h I M P L A N T TREATMENT IN SEVERELY
RESORBED EDENTULOUS MAXILLAE W I T H O U T
BONE GRAFTING: SURGICAL TECHNIQUE
Gynther GW*, Mattsson T, Bitting E, Hulterstr6m M,
K6ndell P-A, Fredholm U, Bolin A, Moberg L-E.
Departments of Oral & Maxillofacial Surgery, Oral
Radiology & Prosthodontics, Visby Hospital, Huddinge
University Hospital, Uppsala University Hospital,
Karolinska Institute, Sweden
ALMS:
To describe the surgical technique for implant treatment in
severely resorbed edentulous maxillae without any alveolar
reconstruction prior to or combined with implant place-
ment.
Material & methods:
Fifteen patients with severely resorbed edentulous maxillae
were treated with osseointegrated implants and fixed dental
prostheses. All patients were initially considered for treat-
ment with bone grafting due to lack of sufficient bone vol-
ume for conventional treatment. Preoperative radiographic
examinations showed that the height of the alveolar crest
was, on average, 7.4 mm at the 4 mm width level (Class V-VI
according to Cawood & Howell 1988). By fenestration of
the maxillary sinus and uncovering the nasal floor, the max-
illary bone could be visualized and utilized maximally for
installation of implants. By angulation of the implant and
permitting 2-5 uncovered fixture threads on the palatal
aspect, implants of optimal length could be installed.
Eighty-six implants were installed (4-6 implants in every
patient).
Results:
One implant was lost during the observation period (range
36-54 months, mean 45 months), giving a success rate of
99%. All patients had stable fixed prostheses at the end of
the observation time. No major bone resorption (= mm)
was observed.
CONCLUSIONS:
It is concluded that this surgical technique may be considered
as an alternative to bone grafting in patients with severely
resorbed edentulous maxillae. However, further prospective
comparative studies are necessary for full evaluation.
G=~ DENTAL IMPLANT INSTALLATION
W I T H O U T ANTIBIOTIC PROPHYLAXIS
Gynther GW*, K6ndell P-A, Moberg L-E, Heimdahl A.
Departments of Oral & Maxillofacial Surgery &
Prosthodontics, Visby Hospital, Huddinge University
Hospital, Karolinska Institute, Sweden
AIMS:
The objective of this study was to compare retrospectively
the outcome of dental implant treatment with or without
antibiotic prophylaxis.
MATERIAL & METHODS:
Two groups of patients with edentulous or partially edentu-
lous maxillaes and/or mandibles, were treated using dental
implants (Brfinemark System. ). One group, consisting of
147 patients (790 implants), was given prophylaxis with oral
phenoxymethylpenicillin (pc-V) 1 g 1 hour preoperatively
and 1 g every 8 hours for 10 days postoperatively. The other
group, consisting of 132 patients (664 implants), was not
given any antibiotics pre- or postoperatively.
RESULTS:
There was no significant difference regarding early or late
postoperative infections and implant survival in the non-
prophylaxis group compared well to the pc-V group.
CONCLUSIONS:
It appears that antibiotic prophylaxis for routine dental
implant surgery offers no advantage for the patient.
[h SYNOVIAL INFLAMMATION IN
ARTHROSCOPICALLY OBTAINED BIOPSIES OF
THE TMJ. A P R O P O S E D HISTOLOGICAL GRADING
SYSTEM
Gynther GW*, Dijkgraaf LC, Reinholt FP, Holmlund AB,
Liem RSB, de Bont LGM.
Departments of Oral & Maxillofacial Surgery and
Pathology, Visby Hospital, Huddinge University Hospital,
Karolinska Institute, Sweden and Groningen University
Hospital, The Netherlands
AIMS:
To propose a system for histological grading of synovial
inflammation in the temporo-mandibular joint (TMJ), to
facilitate comparisons between studies from different centres.
METHODS:
The research into TMJ synovial inflammation was reviewed.
RESULTS:
Only a few histological studies have been published regard-
ing synovial inflammation in the TMJ, and various grading
systems have been used Our proposed grading system is
based on semiquantitative evaluation of the following para-
meters: 1. Synovial lining cell layers; 2. Vascularity (number
and/or size of vascular profiles) and 3. Inflammatory cell
infiltrate (commonly lymphocytes).
CONCLUSIONS:
Data indicates that the synovial lining of the TMJ, in some
respects, differs from other joints. The normal variation in
morphology of the synovial lining of the TMJ is quite large,
whereas the variation in pattern of pathological changes
appears to be relatively small (i.e. synovial inflammation is
not of the severity of that of other joints). We expect that
the suggested histological grading system will facilitate that
concensus exists regarding histological definitions and clas-
sifications of synovial inflammation in the TMJ.
MAXILLARY OSTEOTOMIES IN UNILATERAL
CLEFT DEFORMITY APPROACHED BY M I N I M A L
INCISIONS AND STABILISED BY PLATE
OSTEOSYNTHESIS AND SPLINT W I T H O U T IMF.
Haers RE.*, Ge Z.L., Zimmermann A.P., Sailer H.F.
Dept. of Cranio-Maxillofacial Surgery, University Hospital,
Zurich, Switzerland

Introduction: Adequate primary cleft repair and timing
allow for sufficient maxillary growth in 80% of UCLP and
over 90% in BCLP. Clinically relevant maxillary hypoplasia
in the series treated according to the Zurich protocol can
thus be avoided in most cases. In case of underdevelopment
of the midface maxillaryis indicated, aiming for normal
facial convexity, thus correcting the basic stigma of cleft
patients. If midface hypoplasia involves the infraorbital rim,
a Le Fort I I I + I procedure is performed. If not, the skeletal
correction is performed in the Le Fort I level.
Method: This prospective study evaluates the stability
obtained following maxillary osteotomies in 2 or 3 pieces in
18 cases of UCLP. The consecutive operations were carried
out in 10 male and 8 female patients, varying in age between
17 and 21 years. The incision lines were limited to short inci-
sions not extending beyond the first bicuspid. During down-
fracture, the nasal layer was gradually separated from he
palatal soft tissue layer which was kept intact. Maxillary
fragments were stabilised with miniplate osteosynthesis,
bone grafts and reinforced overcorrecting splints without
postoperative rigid intermaxillary fixation. Surgical
advancement, improvement of facial convexity and relapse
were determined by analysis of cephalograms taken preop-
eratively, immediately postoperatively and at the end of the
follow-up period (average 30 months).
Results: The average advancement in A-point was 6.4 ram,
whereas the average advancement of the minor segment was
11.2 mm for the minor segment. Average relapse tendency
after one year was 0.6 mm. In all cases but one, occlusion
remained stable. The stigmatising midface and paranasal
concavity was corrected in all cases. Technical details and
clinical illustrations are presented.
Conclusion: Segmented Le Fort I osteotomies in cleft
patients are versatile procedures with a predictable result.
Apart from diastemas in the cleft area and cleft-related mal-
occlusion such as cross-bite and open-bite, the main indica-
tion for maxillary osteotomies in cleft patients is correction
of the stigmatising midfacial concavity. According to the
Zurich protocol this is done prior to secondary rhinoplasty
and cheiloplasty.
[~N A P P L I C A T I O N O F BIODEGRADABLE SELF-
REINFORCED POLYLACTIDE O S T E O S Y N T H E S I S
IN ORTHOGNATHIC SURGERY
Haers P.E. °, Sailer H.F °.
°Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland
Metallic osteosynthesis material in orthognathic surgery has
the disadvantage that it has to be removed after the
osteotomy has consolidated, which often requires general
anaesthesia. Titanium plates have been introduced to
bypass this need for secondary intervention. However, due
to corrosion, titanium particles have been found in scar tis-
sue covering these plates and in regional lymph nodes. In
earlier studies, self reinforced polylactide devices have
proven to have sufficient strength to bypass the need of
additional support for the fixation of fractures and
mandibular osteotomies.
This video illustrates the application of biodegradable
self-reinforced polylactide plates in orthognathic surgery.
The selection, shortening and bending of a newly developed
1.5 mm system of plates and screws for fixation of Le Fort I
osteotomies as well as a 2.0 and 2.5 system of plates and
screws for fixation of mandibular fragments at the level of
EACMFS - Abstracts, Helsinki Congress 1998 67
sagittal splitting and fixation of the chin fragment following
genioplasty are presented. The plates can be cut and bended
at room temperature without need of a heating device. The
screws are inserted following drilling, pre-tapping and flush-
ing of the corresponding holes in the bone. The material,
the instruments and the surgical procedure are presented.
[~ C A M O U F L A G E O F CLEFT L I P SCARS BY LASER
TREATMENT. A PRELIMINARY REPORT.
Haers RE.*, Sailer H.F., Eyrich Ca.,Oechslin CK., Niibler-
Moritz M.
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland.
Introduction: Scars between the white roll and the nostrils in
unilateral and bilateral cleft lip deformities can remain hyper-
trophic even in adolescents and adults. In some cases the scar
can be accentuated by denivellation of the subcutaneous layers.
Aims: This study investigates if scar correction by laser
treatment improves the aspect of cleft lip scars.
Method: Hypertrophic and/or denivellated scars in twelve
patients aged between 17 and 21 years presenting with uni-
lateral or bilateral cleft lip scars were treated. Four patients
underwent correction using a CO2-1aser with a scan-dura-
tion between 0.2-0.45 seconds and a 0.2 mm focused beam.
Four other cases were treated by means of an ultrapulse
CO2 laser. The laser-settings were as follows: pulse duration
< 1 ms, 3 mm collimated handpiece, average energy density
5-10 J/cm2. Four patients were treated with a YAG laser
delivering pulses of 200 ms with an average energy density
of 5 15 J/cm2. All patients received prophylactic systemic
medication against herpes (Zovirax®) and local treatment
with antibacterial gel (Batramycin®). Hydrating solutions
were applicated during six weeks. En face and profile pic-
tures were taken preoperatively, three and six months post-
operatively in all patients, as well as one year
postoperatively in four patients.
Results: Following an initial period of three months charac-
terised by swelling and erythema, the aspect of the scar area
improved in all patients. All scars appeared to be thinner
and flatter, Correction of denivellation of the subcutaneous
layer could not be obtained completely.
Conclusions: Hypertrophic cleft scars overlying a functional anas-
tomosis of the muscular layer can be improved by laser treatment.
[~ THE EFFECT OF GRADUAL MANDIBULAR
DISTRACTION FOR THE TMJ AND FOR THE
TOOTH GERM IN GROWING DOGS.
Hagino, H.* Sawaki, E, Mizutani, H., Ueda, M.
Department of Oral Surgery Nagoya University School of
Medicine, Nagoya, Japan
Aims; To observe the effect of gradual bone distraction on
the temporomandibular joint and the developing tooth in
the lengthened mandible for the growing dogs.
Method; Nine growing mongrel dogs in deciduous dentitin
were used for this study. An cortcotomy was carefully made,
where a tooth bud of permanent first molar had been con-
firmed radiographically, was made and then the external
distractor (Orthofix M-100)was connected to four pins
installed across the corticotomy site. Ten days later, distrac-
68 Journal of Cranio-Maxillofacial Surgery
tion was started at a rate of 0.75turn per day for 10 consecu-
tive days. At the time of completion of distraction and at 2,
4, 6, 8, 12, 16 weeks after complication of distraction, clini-
cal, radiographic and histrogical evaluation (H-E stain) were
performed to observe the change of tooth buds and TMJ.
Results; D E V E L O P I N G TOOTH ; As distraction began,
the space between the wall of follicle and the crown of the
tooth bud expanded. The open end of growing root show
wavy, but the roots at fractured region show wavy
too.Finally the apexs closed and the buds erupted.
TMJ; Radiographic examination of lateral oblique
transpharynreal projection showed no significant change.
Histologically, no remarkable changes were observed.
Conclusion; Tooth in the lengthened mandible did erupt.
There root sharpes become irregularly, but the tooth did
erupted. The forces of distraction osteogenesis had be
thought to induce TMJ changes at operated and contralat-
eral side. But severe degenerative changes were not observed.
@=~ DOES E N O P H T H A L M O S SURGERY CORRECT
DIPLOPIA ?
Hammer, B, Kaiser, H, Wolfinger, E, Prein, J.
University Hospital Basel, Switzerland
Between January 1990 and December 1996 a total of 48
patients were operated on for enophthalmos, using cranio-
facial techniques and outer table bone grafts.
Thirty six of these patients had a complete pre- and long
term ( minimally 1 year) postop, follow up and documenta-
tion in the Department of Strabology , University Eye
Clinic. Our data allow the following conclusions:
Enophthalmos surgery affects eye motility and binocu-
lar vision in a complex way.
Eye motility and diplopia can be improved in specific sit-
uations, when localized soft tissue incarceration is respon-
sible for the motility disorder.
Shifting of the field of binocular vision into a favourable
position is a second possible mechanism.
In most cases however enopthalmos surgery alone does
not correct double vision, but it is a necessary pre-requisite
for eye-muscle surgery.
The surgical trauma dramatically reduces eye motility in
the postop, p e r i o d , with improvement occurring for up to
12 months.
CALLUS MANIPULATION AS A POSSIBLE
ALTERNATIVE TO MULTIVECTORIAL DISTRACTION
OSTEOGENESIS TWO CASE REPORTS
Ch. Kunz, B. Hammer, J. Prein
University Hospital Basel, Clinic for Reconstructive Surgery,
Basel, Switzerland
We present two patients aged 10 and 12 years who under-
went bilateral linear distraction of the ascending mandibu-
lar ramus using intraoral distraction devices. At the end of
the distraction period, the mandibular angle had flattened,
resulting in a severe open bite. Following a suggestion pub-
lished by Pensler et al (1995), the devices were then immedi-
ately removed and the soft callus manually remodeled into a
mandibular angle, with subsequent maxillo-mandibular
immobilisation for five weeks.
Uneventful consolidation occurred in all four distraction
sites. Callus manipulation could be an elegant solution to
the technically difficult problem of multivectorial distrac-
tion with intraoral devices.
An animal study is planned to answer the following questions:
• Does callus manipulation result in compression of the
inferior alveolar nerve?
• Can consolidation reliably be expected with different
degrees of callus bending?
[~ MANAGEMENT O F O D O N T O G E N I C SINUSITIS
ENCOUNTERED W I T H OROANTRAL
C O M M U N I C A T I O N BY MEANS O F T H E CLOSURE
AND THE L O N G - T E R M A D M I N I S T R A T I O N O F
CLARITHROMYCIN
Hanazawa, E *, Hayashi, E
Division of Oral Surgery Kawatets~ Chiba Hospital, Chiba, Japan
Aims: To evaluate the efficiency of the long-term usage of clar-
ithromycin (CAM) grouped to 14-membered macrolide antibi-
otics for odontogenic sinusitis occurred with oroantral opening.
Subjects: 13 cases of odontogenic sinusitis resulted from the
destruction of the floor of maxillary sinus by chronic infec-
tive lesions in the maxillary posterior teeth. During opera-
tions that were extractions of teeth and curettage of
infective lesions, oroantral communications were developed
and then the immediate closure of the openings were done
by the use of a pedicled buccal fat pad graft. C A M was
administrated for about 1.5- to 2- month postoperatively.
Results: The closed operation was successful in all cases.
The preoperative symptoms of sinusitis such as rhinorrhea
and nasal obstruction completely disappeared.
Furthermore, X-ray findings of maxillary sinusitis were get-
ting better. No side effects of C A M and no recurrence of
sinusitis were present in all cases.
Conclusions: The management of odontogenic sinusitis
would treat the lesions of affected teeth as fast as possible.
When oroantral communications occurred during the treat-
ment the closure of openings should be immediately made
at the time of making the opening. After that C A M might
be administrated for about 2-month postoperatively.
[h SELF-REINFORCED BIOABSORBABLE FIXATION
SYSTEM F O R CRANIOFACIAL SURGERY
H. Happonen .1, T. Pohjonen 1, ,4. Kaikkonen 2 and P. T6rmiilii t
1Institute of Biomaterials, Tampere University of Technology,
P.O. Box 589, FIN-33101 Tampere, Finland," 2Bionx Implants
Ltd., R O. Box 3, FIN-33721 Tampere, Finland.
AlMS
Metallic bone fixation plating systems have used widely in
cranio-maxillofacial surgery. In many caces metallic C M F
fixation devices need to be removed after bone fracture is
healed. Particular in pediatric surgery metallic implants
effect dysmorfia of the growing bone if the implants are not
removed. Polymeric bioabsorbable fixation devices for
cranio-maxillofacial surgery have been developed in the 90's.
However materials in the market have certain draw backs:
They tend to be brittle and need to be heated in order to
contour them in desirable shape. Our aim was to develop a

rigid and ductile fixation plating system, which can be
reshaped in situ without additional heating.
MATERIALS AND M E T H O D S
A m o r p h o u s P ( L / D L ) L A copolymer (Resomer(LR708,
L/DL ratio 70/30, i.v. 6.3 dl/g) was obtained from
Boehringer Ingelheim Pharma KG. The polymer was melt
extruded into cylindrical billets and subsequently self-
reinforced in the solid state by die-drawing techique.
Plates and screws were manufactured from the die drawn
material by compression moulding and machining.
Dimensions of the plates were: Thickness 1.2 ram, width
5.5 mm and length 42 mm. Diameter of the cruciform
head screws were 2.0 mm. Plates and screws were steril-
ized by gamma irradiation. Mechanical properties were
measured using the LLOYD LR30 materials testing
machine. Flexural properties were determined by the
three-point method, following the guidelines of A S T M
D790, tensile properties following the guidelines of
A S T M D638 and shear strength properties following the
guidelines of BS 2782.
RESULTS AND C O N C L U S I O N S
Initial load bearing and strength properties of the plates
and screws are given in table 1.
Table 1. Initial load bearing and strength properties of
self-reinforced bioabsorbable plates and screws.
Implant Bending Shear_Tension___( (MPa)_G (MPa)_F
(N)_( (MPa)_( (MPa)_F (N)__2.0 mm screw 177 6.0 -
139 - -2.0 system plate 168 - 101 108 125 449
When the plates were bent and twisted by glamp at room
temperature (22°C), no visible failures occurred.
Self-reinforced bioabsrbable P(L/DL)LA (70/30) copoly-
mer is very promising material for craniomaxillofacial bone
fixations. It is strong and flexible and because of its high
strength the amount of implanted material is minimum.
Self-reinforced P(L/DL)LA (70/30) copolymer retains its
strength on the initial level for approximately 18 weeks and
thereafter looses its strength steadelyl.
References
Pohjonen, T. and T6rmglfi, E, Self-reinforcing of amorphous
bioabsorbable polymers, 13th European Conference on
Biomaterials, European Society for Biomaterials, G6teborg,
Sweden 4. - 7. September 1997.
STABILITY AFTER THE SAGITTAL SPLIT RAMUS
OSTEOTOMY AND FIXATION W I T H POLY-L-LACTIC
ACID (PLLA) SCREWS: LONG TERM RESULTS
Harada, K.* and Enomoto, S.
Second Department of Oral and Maxillofacial Surgery,
Faculty of Dentistry, Tokyo Medical and Dental University,
Tokyo, Japan
Aims: To examine skeletal stability after surgical correction
of mandibular prognathism using a sagittal split ramus
osteotomy (SSRO) and fixation with poly-L-lactic acid
(PLLA) screws.
Methods: Twenty patients with Class III malocclusion
were treated with bilateral SSRO and mandibular setback.
Ten underwent fixation with titanium screws (group I )
and the other 10 with P L L A screws (group II).
Cephalograms were obtained 2 or 3 days postoperatively,
and 3, 6, 12, and 24 months after the operation. Changes
in the position of upper incisors (U-l), lower incisors (L-
.o EACMFS - Abstracts, Helsinki Congress 1998 69
1), B-point, and pogonion were examined on lateral
cephalograms.
Results: Certain tendencies for overjet and overbite were
noted to have decreased more markedly, and changes in the
position of the skeletal points were greater in group II than
in group I. However, statistical analysis showed no signifi-
cant differences between the two groups.
Conclusions: Our results suggest that fixation of the
bony segments with P L L A screws after SSRO may be a
useful method for treating mandibular prognathism,
However, the relapse tendency was greater in group II
than in group I. Therefore, it might be necessary to
select the most appropriate indications for P L L A screw
fixation.
[~ TONGUE A M Y L O I D O S I S AS AN INITIAL
SYMPTOM OF MULTIPLE MYELOMA
Marinho, R.O.M., Hardee, P.*, Hutchison, I.L.
Department of Oral and Maxillofacial Surgery, The Royal
Hospitals NHS Trust, London, England.
Amyloidosis is a generic term for diseases where there is
extracellular deposition of one of a family of unrelated
pathologic, insoluble fibrillar proteins in organs or tissues.
Primary amyloidosis arises idiopathically or as a complica-
tion of multiple myeloma, a condition characterised by
uncontrolled proliferation of one or more clones of malig-
nant plasma cells. The presenting features of amyloidosis
may be protean, depending on which organ(s) are promi-
nently involved.
A case of an otherwise healthy, 75-year old caucasian
woman referred to the maxillofacial department regarding a
one-year history of an enlarged tongue, lower jaw and bilat-
eral submandibular swellings, is presented. Her main com-
plaints were difficulty in speaking and repeated trauma to
the tongue. Routine haematological and endocrinological
investigations were within normal limits. M R I scanning
showed that the submandibular glands were not enlarged,
but displaced by a grossly enlarged tongue. Biopsy of the
enlarged tongue was positive for amyloidosis and the patient
referred to the clinical immunology department where fur-
ther investigations confirmed the diagnosis of multiple
myeloma as the underlying cause for the amyloidosis. She
underwent chemotherapy treatment, which resulted in par-
tial remission of her myeloma, but no changes in the areas
affected by amyloid. The patient eventually required surgical
reduction of her tongue, as speech difficulty and repeated
tongue trauma were her present and only complaints.
EXPERIENCE OF 53 CASES O F RECTUS
A B D O M I N I S MYOCUTANEOUS F L A P F O R ORAL
AND MAXILLOFACIAL RECONSTRUCTION - ITS
M O D I F I C A T I O N S AND INDICATIONS
Hasegawa, K J, Yamashiro, 3/1.3, Kobayashi, JJ, Miyamoto,
Hfl, MiyasMta, T.2
Department of 10MFS and 2Surgery, Shizuoka City
Hospital, Shizuoka City, SFirst Department of OMFS,
Tokyo Medical and Dental University, Tokyo, Japan
Aims: The rectus abdominis myocutaneous flap can be mod-
ified variously for reconstruction sites. Only one or two
large perforators in the paraumbilical region can easily
70 Journal of Cranio-MaxillofacialSurgery
nourish the large abdominal wall in various directions.
Furthermore, the bulkiness of the flap can be adjusted by
reduction of the rectus abdominis muscle and subcutaneous
fat. The purpose of this paper is to evaluate fifty-three cases
of oral and maxillofacial reconstruction using rectus abdo-
minis myocutaneous flap.
Materials and Methods: Fifty-three patients underwent oral
and maxillofacial reconstruction using rectus abdominis
myocutaneous flap between 1988 and 1997. Of reconstruc-
tion sites, there were 32 cases of tongue (23 subtotal, 5 total,
4 partial glossectomy), 6 perimandibular region, 6 orophar-
ynx, 3 facial contour deficiency, 3 extraoral and intraoral
defects, 2 hard and soft palate and 1 maxilla including cra-
nial base.
Results: Fifty-one flaps were taken completely (success rate:
96%). But two flaps showed total necrosis due to arterial or
venous thrombosis. Six patients developed wound dehis-
cence. But there was no serious complications except one
abdominal herniation. The rectus abdominis myocuta-
neous flap could be modified variously for reconstruction
sites. Of volume reduction of flap, muscle diminished flap
was used in 17 cases and skin thinning was performed in 19
cases.
Conclusion: The rectus abdominis myocutaneous flap
showed very reliable vascularity and low morbidity associ-
ated with its donor site. Various modifications of the rectus
abdominis myocutaneous flap could be performed for
reconstruction sites. It considered that rectus abdominis
myocutaneous flap was one of the most suitable for oral and
maxillofacial reconstruction.
D F O U R CASES REPORT O F PULMONARY
E M B O L I S M OCCURRED BY THE OPERATION FOR
THE ORAL L E S I O N
Hayashi Y*., Hanazawa Y.
Division of Oral Surgery Kawatetsu Chiba Hospital, Chiba,
Japan
Aims: To present four cases of pulmonary embolism follow-
ing or during the oral operation which is rarely a postopera-
tive complication.
Subjects and Results: Four cases were females ranging from
48 to 67 years. Oral lesions were diagnosed as the carci-
noma of the oral floor, the gingival carcinoma of the
mandible, the denture fibroma and the radicular cyst,
respectively. Operations were performed under the general
anesthesia except one. Three were revealed to chest pain,
dyspnea and the decrease of PaO2 postoperatively. One
under the local anesthesia, was shown to chest pain,
hypotension and decreased SaO2 during the operation. All
cases were diagnosed as pulmonary embolism by means of
pulmonary perfusion scintigraphy. Treatment was per-
formed using anticoagulant and thrombolytic agents. These
cases were alive until now, but one died from the lung
metastasis.
Conclusions: Pulmonary embolism results sometimes in
death, because of the difficulty of the early diagnosis. This
disease is suspected to show the clinical symptoms of chest
pain, dyspnea and hypoxia accompanied with hypocapnia
by the blood data. To prevent, it is important to give much
attention to the operative patients, and to diagnose more
quickly and to receive adequate therapy.
CLINICAL EVALUATION O F ARTIFICIAL
DERMIS(TERUDERMIS®) IN ORAL AND
MAXILLOFACIAL R E G I O N
Hayatsu, Y.*, Uchida,R., Mizugaki, Y., Shinozaki, F.
Department of OMFS, Yamaguchi University, School of
Medicine, Ube, Japan
Aims: To indicate the usefulness of applying artificial der-
mis (Terudermis®) in the oral and maxillofacial region.
Terudermis® is composed of two layers : the upper one con-
sists of silicone and the lower fibrillar aterocollagen and
heat-denatured aterocollagen.
Subject: Thirty two subjects were treated with Terudermis®.
They had 34 mucosal or skin defects in the oral and max-
illofacial region. The subjects ranged in age from 1 to 89.
Twenty three patients had malignant tumors, 4 had benign
tumors, 4 had cleft palates and 1 had another case. Wound
beds were bone beds in 18, muscular beds in 10, bone and
muscular beds in 6.
Results: G o o d epithelization of the wound surfaces was
found 26 out of 34 cases. Contraction of the wounds were
smaller in bone beds and larger in muscular beds. Side
effects including infection were not observed in all cases.
Conclusions: The results showed that artificial dermis
(Terudermis®) was useful and safe for defects of the oral
mucosa.
O S T E O T O M Y O F THE LOWER JAW USING THE
WANG-NORDERUD M E T H O D
Hedemark, Dr. Arne* and Drommer, Prof. Dr. Rainer
Trondheim, Norway and Heidelberg, Germany
A description of this operative technique was first published
1953. Even today, particularly in Norway, this technique is
widely used. The disadvantages are the extra- oral incision
required; the longer time (up to eight weeks) of intra- max-
illary fixation necessary. The advantages are the extremely
reduced operation time required; almost no nerve damage;
minimal operative stress for the patient. Indeed, the opera-
tion can often be carried out on an out- patient basis. In our
clinic, we have modified the operation technique by incor-
porating mini-plates for osteosynthesis, and varied the
external incision line so that post operative scarring is ren-
dered cosmetically acceptable. The osteosynthesis allows us,
in conjunction with the osteotomy, to advance the lower jaw.
This last element was not described in the original proce-
dure. This report deals with our experience in Trondheim
and Heidelberg.
THE USE OF DRILL FREE SCREWS IN
MAXILLOFACIAL SURGERY - RESULTS O F A
CLINICAL STUDY
Heidemann, W.*, Gerlach, K.L.
Department of Oral-Maxillofacial Surgery,
Otto-von-Guericke UniversityMagdeburg, Germany

Aims: Drill-Free-Screws(DFS) are characterized by a special
tip, formed like a corkscrew and a narrow cutting flute
which chisels off the bone and acts as a channel for the
removal of bone chips. These qualities enable to insert the
screws directly into the bone without predrilling.
Advantages of DES are the saving of time and the minor
risk to injure nerves and dental roots by avoiding the use of
an electric drill. In preliminary in-vitro tests the holding
power of DFS was between 70% and 104% of the holding
power of selftapping Titanium screws with standard pilot
hole size. Aim of this study was to find out ideal ranges of
application for DFS and to examine the holding power of
D F S in clinical use,
Methods: 1,5ram and 2mm Center Drive DFS were used for
osteosyntheses in orthognathic surgery and traumatology in
a clinical study with 70 patients.
Results: D F S were inserted in the central midface without
any problems; the application of DFS was possible in the
lateral midface and in the region of the anterior mandible;
only in the area of the mandibular angle the insertion gener-
ally failed when using an intraoral approach. Here the screw
tip often slipped off from the surface of the bone making it
impossible to insert the screws. In 2 of 5 cases screw frac-
tures occurred during the insertion of DFS in the mandibular
angle region. Healing was uncomplicated in all cases,
secundary dislocation of bone fragments has not been
observed.
Conclusions: The application of DFS is recommended for
osteosyntheses in the central and lateral midface. An indica-
tion for the use of D F S in the mandible of adult patients is
only given in the interforaminal area.
[B A H I S T O L O G I C A L STUDY O F TISSUE
REACTIONS TO S O L I D POLYORTHOESTER.
Helander Pia*, Ekholm Maria/Lindqvist Christian/
Suuronen Riitta, ~ Hietanen Jarkko, 2 KeUomiiki Minna, 3
;Department of Oral and Maxillofaeial Surgery, Helsinki
University, Helsinki, Finland, Hietanen Jarkko, 2Department
of Oral Pathology, Institute of Dentistry, University of
Helsinki, Helsinki,Finland, 3Institute of Biomaterials,
Tampere University of Technology, Tampere, Finland
The aim of this study was to evaluate the tissue reactions of
solid polyorthoester histologically and immunohistochemi-
cally. Resorption times and affect of two different steriliza-
tion methods (gamma radiation and ethylene oxide) to
resorption were also evaluated. Material was implanted
into the tibia of 24 rabbits. The gammasterilized rods were
placed into the right tibia and the ethyleneoxide sterilized
into the left tibia. One gammasterilized rod was placed
subcutaneously into the right mandibular ramus area of
each rabbit. Follow-up times were from one week to 22
weeks. Histological studies showed that polyorthoester
induces a moderate inflammation in soft tissue and in
bone.At 22 weeks of follow-up inflamation was mild in
soft tissue. The foreing body reaction seemd to be stronger
with ethyleneoxide sterilized implants. Resorption was
faster with gammasterilized rods. Resorption time was
more than 22 weeks in both groups. Immunohistochemical
studies will be also reported.Based on promising results of
this study polyorthoester is a potential material for more
researsh.
EACMFS -Abstracts, Helsinki Congress 1998 71
T E M P O R O M A N D I B U L A R DISORDERS IN
PATIENTS W I T H R H E U M A T I C DISEASES
Helenius M*, Leirisalo-Repo M, Hietanen J, Suuronen R,
Hoffner-Hallikainen D, Helenius I, Lindqvist C
Department of Oral and Maxillofacial Surgery, Departments
of Surgery and Medicine, Helsinki University Central
Hospital, Helsinki, Finland
Aims: Symptoms and clinical features of temporomandibu-
lar joint (TMJ) disorders as well as signs of focal sialoadeni-
tis were studied in patients with various rheumatic disorders.
Methods: 86 patients (mean age 44, 57 females) were stud-
ied. 25 had rheumatoid arthritis (RA, mean duration of dis-
ease 11 yr.), 17 mixed connective tissue disease (MCTD, 11
yr.), 18 spondyloarthropathy (SPA, 15 yr.), and 20 ankylos-
ing spondylitis (AS, 13 yr.). All patients answered a ques-
tionnaire on TMJ disorders and were interviewed;
orthopantomogram (OPTG), and JLA, as well as minor
salivary gland biopsies were also obtained. Erosion (OPTG)
or movement (JLA) in x-rays and symptoms for TMJ disor-
der were scored from 0 (with no erosion, no symptoms) to 4
(condyles totally eroded, most troublesome symptoms).
Results: Symptoms of TMJ disorder (pain, tenderness, diffi-
culty of mouth opening) were reported by 52% of the R A
patients (mean symptom score 1.2), 27% of the MCTD
patients (0.7), 94% of the SPA patients (1.9), and 76% of the
AS patients (1.8) (X2-test, p=0.0009; Kruskal-Wallis,
p--0.03). Focal sialoadenitis was found in 76% of R A
patients, in 94% M C T D patients, in 45% SPA patients, in
50% AS patients (X2-test, p=0.004). In OPTG, the mean
erosion scores were 1.7 for R A patients, 1.3 for M C T D
patients, 2.5 for SPA patients, and 1.6 for AS patients
(p=0.04). In the JLA, the mean scores were 1.3 for R A
patients, 1.4 for M C T D patients, 1.4 for SPA patients, and
1.3 for AS patients (NS). The symptom score for TMJ dis-
orders correlated significantly with erosion in OPTG
(Spearman's correlation, rs=0.45, p=0.0004).
Conclusion: Patients with SPA report significantly more
often and more severe symptoms for TMJ disorders than
RA, M C T D or AS patients. In OPTG, this group showed
also the most severe erosion. Focal sialoadenitis is common
in all patient groups, with highest frequency in MCTD.
LE FORT I OSTEOTOMY: SKELETAL STABILITY
A N D S O F T TISSUE CHANGES IN DIFFERENT
CLEFT TYPES
Heli6vaara, A. % Ranta, R., Hukki, J.
Cleft Center, Department of Plastic Surgery, Helsinki
University Central Hospital, Helsinki, Finland
Aims: To evaluate skeletal stability and soft tissue changes
after orthognathic surgery on different types of cleft.
Method: Sixty-four adult cleft patients (40 U C L E 10 BCLP
and 14 CP) with maxillary hypoplasia underwent a one-piece
Le Fort I osteotomy with bone grafting and miniplate fixa-
tion from 1987-1995. Neither intermaxillary fixation nor
splints were used postoperatively. Skeletal stability and soft
tissue changes were analysed both horizontally and vertically
by cephalograms taken shortly before surgery, immediately
after surgery, at 6 months and at 1 year postoperatively. In
UCLP and BCLP groups bone grafting of the alveolar cleft
had been done in the mixed dentition stage.
72 Journal of Cranio-Maxillofacial Surgery
Results: The mean maxillary horizontal advancement (mea-
sured from point A) varied from 3.9 mm (CP) to 5.0 mm
(BCLP) and the mean maxillary vertical lengthening from
3.6 mm (UCLP) to 6.6 mm (BCLP). Most of the postopera-
tive relapse took place during the first 6 months. One year
postoperatively the mean vertical relapse (point A) was 24%
in all cleft types whereas the mean horizontal relapse varied
from 7% (CP and BCLP) to 20% (UCLP). In the latter
group the relapse improved significantly between 1987 and
1995 (from 37% to 9%, respectively). Horizontal change in
upper lip profile was 60-80% of the skeletal changes in all
cleft types. Vertically the soft tissue changes in the upper lip
were smaller. However, vertical changes increased signifi-
cantly if V-Y plasty was used.
Conclusions: Skeletal stability and the soft tissue changes in
different cleft types were similar except for the greater skele-
tal horizontal relapse in those UCLP patients operated on
before 1994. Vertical soft tissue changes in the upper lip pro-
file can be increased by V-Y plasty.
FULL, SIMULTANEOUS MAXILLO-
MANDIBULAR RECONSTRUCTION WITH B O N E
GRAFTS AND IMPLANTS.
F. Hernandez Alfaro* 3/1.£ Biosca, C. Marti
Department of Oral and Maxillofacial Surgery, Teknon Medical
Centre, & Hospital Generalde Catalu~a, Barcelona, Spain.
We present a case of total maxillo-mandibular atrophy
(grade 6 -Cawood), where a full maxillo-mandibular recon-
struction with bone grafts and implants was performed in
one stage.
The upper jaw was managed by a Le Fort I osteotomy,
and inlay composite bone grafts from the iliac crest. The
grafts were placed on the sinus and nasal floors and secured
with nine screwed implants.
The mandible was reconstructed at the same operation
with onlay composite grafts between the mental nerves and
again secured with six implants.
Follow up of the case including abutment connection
and loading with fixed restorations is presented
Advantages of the method will be discussed.
[~ M A L A R P R O C E S S S T U D Y BY 3D CT IMAGING IN
CASES OF BILATERAL C O R O N O I D P R O C E S S
HYPERPLASIA. A CASE REPORT
Herndndez Montero, S.*, Bada,M.A., Saura, E., Martinez-
Tello,M., Herndndez,£, Herndndez Altemir, F.
Department of Oral and Maxillofacial Surgery. Hospital
Miguel Server. ZARAGOZA (Spain)
Aims: Removal of any zygomatic exostosis must be consid-
ered in cases of bilateral coronoid hyperplasia. 3D (CT)
imaging is useful in planning surgical treatment and must be
used to confirm a malar exostosis and coronoid hyperplasia.
Method: A 21-year-old man with severe limitation of
mandibular opening is presented. He had a history of 4
years of gradually developing limitation of opening and had
been under orthodontic treatment.
Clinical examination, study of the limitation, orthopan-
tomography study and our suspicions were confirmed by
3D CT scanning pre- and postsurgery.
Anaesthesia by nasoendotracheal intubation and an
intraoral approach were used.
Results: Mouth opening was immediately restablished after
surgery. Nevertheless physiotherapy (mechanical exercises)
must be practised by the patient after surgery.
Conclusions: Malar process study by 3D CT imaging must
not be forgotten in cases of coronoid hyperplasia.
COMBINED PROSTHETIC AND SURGICAL
THERAPEUTIC APPROACH IN ORTHOGNATHIC
SURGERY - A CASE REPORT
1)Herzmann, K. */) Schimming, R., 2)Walter, M., 1)Eckelt, U.
1JDepartment of Oral- and Maxillofacial Surgery,
2)Department of Prosthetic Dent&try
University of Dresden, Fetscherstr. 74, D-01307 Dresden,
Germany
Introduction: Orthognathic surgery in young patients is nor-
mally associated with a full set of teeth. In these cases, inter-
maxillary fixation using pre-operatively applied orthodontic
brackets is standard procedure. Older patients are increas-
ingly interested in surgical correction of dysgnathic bite sit-
uations but they do not always have a full set of teeth or
they suffer from tooth malformations or tooth diseases such
as hypodontia or amelogenesis imperfecta. A stable occlu-
sion during and after orthognathic surgery is necessary in
order to avoid recurrence. Our poster presentation will
describe a prosthetic bridge we have developed to avoid such
recurrences.
Method: A plastic faced long term provisional prosthetic
bridge system made of cobalt alloy is placed in the patient's
mouth immediately pre-operatively. The bridge system had
been prepared earlier in the planned post-operative
situation using an articulator transfer system. Intra-opera-
tively intermaxillary fixation is then performed using a spe-
cial hook system invented together with the basic bridge
system. The hooks can be removed later.
Conclusions: In orthognathic surgery on patients with a
reduced number of teeth, the prosthetic appliance described
provides a sufficient post-operative occlusion, a stable post-
operative result is achieved, and the risk of dysgnathic
recurrence is reduced. The patient gets a functional and aes-
thetically sufficient supply while definitive prosthetic reha-
bilitation takes place.
THE VERTICAL DISTRACTION OF THE
ALVEOLAR B O N E
Hidding, J.*, Lazar, F., Z61ler, J.E :
Department of Oral and Maxillofacial Surgery, Cologne
University, Cologne, Germany
Aims: In edentulous parts of the mandible after segmental
resection in tumor surgery or trauma loss instead of bone
transplantation reconstruction by vertical distraction can
be used. In local open bite a teeth bearing bony segment can
be moved vertically.
Method: The vertical distraction technique was carried out
according to the distraction schedule of Ilizarov. After
osteotomy of a cranial part of the alveolous a new devel-
oped vertical distraction-device is inserted. After a stabiza-
tion period of 7 days the callus distraction with a regimen of

2 x 0.5 mrrdday can start. Following a stabilization-period of
2 months the distractor can be removed. In a prospective
pilot study we treated 10 patients.
Results: Within 10-14 days we reached our attempted verti-
cal hight. Four weeks later a beginning mineralisation of
the new bone as well as reunion of the transportet bone in
the alveolar ridge is seen. With this technique bony seg-
ments of the mandible with or without teeth could be dis-
tracted. In all patient the vertical distraction was
successfull.
Conclusion: The advantages of callus distraction in tooth-
less bony gaps are as follows: no donor site morbidity, dis-
traction of vital bone, less resorption comparable to
sandwich osteoplasty, no infection problems, early mineral-
ization of new bone, implantology after 3 months, shorten-
ing of treatment time.
Additionally advantages of distraction of tooth-bearing
segments are: therapy of local open bite, safe blood supply
of the segment, teeth vitality remains intact, no periodontal
problems.
PATENCY AND M O R P H O L O G Y O F T H E CLEFT
L I P AND PALATE (CLP) NOSE
Hierl, Z*, Krb'ger, W., Hemprich, A.
Dept. of Oral and Maxillofacial Plastic Surgery, University
of Leipzig, D-04103 Leipzig, Germany
Aims: In the rehabilitation of CLP patients the most
emphasis has been placed on reconstructing the form and
function of the cleft lip and palate, in a way neglecting
nasal respiration. This study was intended to investigate
nasal morphology and function of CLP patients with
objectve methods.
Methods: 137 patients aged from 5 to 51 ys, average 17.5 ys
(56% M, 44% F) have been examined from 7/96 to 12/97 by
way of active anterior rhinomanometry and acoustic rhi-
nometry. 56% suffered from unilateral cleft lip and palate
(UCLP), 26% from bilateral CLP, and 18% from cleft
palate all having been treated in the same centre with an
identical scheme of operations. Data collected included
nasal air flow at 150 Pa, nasal resistance, position and
diameter of minimal cross-sectional area (min.-area), and
nasal volume before and after decongestion with
oxymetazoline.
Results: Flow, minimal cross-sectional area, and volume
turned out to be significantly lower on the cleft side before
and after decongestion in UCLP patients (without
oxymetazoline: 173 vs. 330 ml/s flow; 0.39 vs. 0.47 cm 2
min.-area; 7.5 vs. 10.4 cm 3 volume; p<0.05). In bilateral
CLP patients measurements for both sides lay in between
the above mentioned figures and no significant difference
was noted between either side (flow 227 ml/s per side; min.-
area 0.45 cm2; 9.8 cm 3volume). Nasal flow and resistance
correlated significantly with minimal cross-sectional area
and volume.
Conclusions: As is known from the literature that the sub-
jective assessment of nasal patency is misleading, objective
methods are necessary for the assessment of nasal function.
Acoustic rhinometry and rhinomanometry are complemen-
tary methods of demonstrating the impairment of nasal
respiration in CLP patients. With exact data, a better
understanding of the complex nasal malformation might
be achieved, which could lead to superior operative
outcome.
EACMFS - Abstracts, Helsinki Congress 1998 73
RECOVERY O F LINGUAL NERVE F U N C T I O N
AFTER IATROGENIC INJURY PRIVATE
Hillerup, S.
Departments of OMFS, Copenhagen County Univ. Hospital
Glostrup and Rigshospitalet Univ. Hospital, Copenhagen,
Denmark
Aims: To describe treatment strategies of a wait and see policy
and microsurgical nerve repair, and the potentials for recovery
of neurosensory and gustatory function in either group.
Method: Of 27 patients, 13 were allocated to observation, 14
to surgery on the basis of neurosensory capacity at least 2
months after injury. Neurosensation was monitored with
tests including featherlight touch, pinprick, sharp/blunt dis-
crimination, heat (45oC), cold (0oC), localization, percep-
tion of direction of touch movement, and two-point
discrimination. The 7 sensory qualities were rated arbitrar-
ily from 0-3. The sense of taste was tested with the stimu-
lants, sweet (saccharose 5%), sour (citric acid 5%), salt
(saline 5%), and bitter (chininhydrochloride 0.5%). Lingual
nerves with no signs of recovery, i.e. sum score <= 2 were
surgically exposed and repaired by direct epineural suturing.
Results: Cases with some remaining neurosensory function
showed a remarkable potential for spontaneous recovery
within the first year. Eleven out of 14 patients with persis-
tent anaesthesia experienced a favourable neurosensory
recovery after nerve suturing, mean 75 percent of scores of
the healthy side of the tongue, range 26-90%. Gustatory
recovery was rare and, even at best, incomplete.
Conclusions: The return of tongue sensibility after lingual nerve
repair in the majority of cases makes the surgical procedure
worthwhile in the face of otherwise irreversible iatrogenic damage.
Fh POSTOPERATIVE MASTICATORY M O T O R
F U N C T I O N IN MONKEYS RECEIVED VERTICAL
MANDIBULAR R A M U S OSTEOTOMY: A
L O N G I T U D I N A L H-REFLEX AND C H E W I N G E M G
STUDY
Hirashima, S., 1 Amano, N., 2 Chang, H.-H., 2 Yi, C. -K.,
and Fukuda, £;
First Dept. of Oral and Maxillofacial Surgery, 1 Dept. of
Oral Neuroscice, Kyushu Dental College, Kitakyushu, Japan;
2 Dept. of Oral and Maxillofacial Surgery, School of
Dentistry, Yonsei University, Seoul, Korea.
We consider that the postoperative relapse of elongated
mandibular ramus would be due to excessive tension of the
masseter-medial pterygoid muscle sling. The purpose of this
study is to compare the effects at different muscle tensions
on the masticatory motor function between monkeys
received intraoral and extraoral vertical mandibular ramus
osteotomies (IVRO and EVRO). The Hoffman (H)-reflex in
masseter muscle and the E M G activity of the right and left
jaw muscles during mastication were recorded before and
after the surgery in 5 adult Japanese monkeys. The monkeys
were divided into 3 groups. In Groups I and II, the right
mandibular rami were cut with IVRO, whereas the left rami
cut with IVRO and EVRO, respectively. After splitting of
the rami, metal splints were cemented to the left lower
molars for the unilateral ramal elongation. The intermaxil-
lary function was applied for 3 weeks. Group III received a
sham operation: The right and left rami were cut with IVRO
74 Journal of Cranio-MaxillofacialSurgery
and EVRO, respectively. No treatment for the ramal elon-
gation was given. In groups II and III, the masseter and
medial pterygoid muscles on the side received EVRO were
detached and remained unsutured. Postoperative E M G
recordings were attempted at an interval of one month for
all animals. Neither the H-wave nor the rhythmic chewing
E M G activity has reappeared in the right and left masseter
muscles of Groups I and III up to 4 months after the opera-
tion. The examination of Group II is now in progress.
CLINICAL AND R A D I O L O G I C A L STUDY
F O L L O W I N G SURGICAL TREATMENT O F
LAG-SCREW O S T E O S Y N T H E S I S IN CASE O F
MANDIBULAR CONDYLAR NECK FRACTURES- A
REVIEW.
Hlawitschka, 3/1., Eckelt U.
Department of Oral and Maxillofacial Surge~
University of Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
PURPOSE:
This study evaluates the intra- and postoperative complica-
tions and failures following open reduction and lag-screw
osteosynthesis of condylar neck fractures and describes the
clinical and radiologic results.
METHOD:
230 patient underwent surgery for displaced or dislocated
condylar neck fractures via a submandibular approach.
The proximal fragments were fixed using a lag screw
designed by Eckelt. Standardized clinical and radiological
examination were performed 6 months and approximately
2 years post-operatively. Clinical factors recorded were
pain, occlusion, range of mandibular movement, demage
of 5th or 7th nerve. Angulation between the mandibular
ramus and the dislocated condyle were measured and com-
pared with the contralateral side preoperatively and at the
last follow-up.
RESULTS:
Limited anatomical shape of the mandibular ramus was
seen intraoperatively in 15 cases (6,5%). In those case an
additional fixation was necessary. Not correct reposition
and fixation of the proximal fragment did occure in 12
cases. Five fractures did exhibit complications requiring
reoperation. The radiographic examination did show excel-
lent positions of the surgically fixed condylar neck fractures
in 93,4%. The postoperative outcome was uneventful in
most patients. However, some patients did have complica-
tions, including unsatisfactory reduction, arthrotic changes
and resorption (3,9%) of the mandibular condyles. Most of
them complication were seen in these patients with postop-
erative redislocation or infection.
CONCLUSIONS:
The results indicate that ideal treatment of condylar neck
fractures is possible using axial anchor screw system in cer-
tain cases. However in some cases complications and diffi-
culties were seen occure probably.
[~ MAGNETIC RESONANCE I M A G I N G (MRI) O F
T E M P O R O M A N D I B U L A R J O I N T FRACTURES
Hlawitschka, M., Eckelt U.
Department of Oral and Maxillofacial Surgery, University
of Dresden, Fetscherstr. 74, D-O1307 Dresden, Germany
Purpose: The purpose of our investigation was to examine
the temporomandibular joint disc following surgical treat-
ment of condylar neck fractures. All fractures were treated
with lag screw osteosynthesis or miniplates. Using M R I
scans the following features were investigated: position and
function of the temporomandibular joint disc.
Method: 36 patients with unilateral (18) and bilateral (18)
condylar neck fractures underwent MRI, eight of them pre-
operative and 28 patients postoperative.
Results: The highest number of disc dysfunctions were
observed in cases of intra-articular fractures, followed by
fractures with luxations and dislocations of the condylar
neck.
Following osteosynthesis procedures only in one case a
medial dislocation of the disc were found. In all other
patients an exact position in the glenoid fossa were
observed.
In addition, pathological changes of the contralateral
temporomandibular disc were found in 8 of 18 patients with
unilateral condylar neck fractures. In 40 of 72 temporo-
mandibular joints investigated during our study no patho-
logical changes of the discs were seen. No clinical
correlation between M R I diagnosis and clinical findings
were found.
Conclusions: M R I is a suitable method for diagnosing inter-
nal derangement of the TMJ following condylar neck frac-
tures.
These findings indicated that the discs removed with the
repostion condyles when a open reduction occurred. On the
other hand an impact on the contralateral no fractured disc
may occur.
3-YEAR F O L L O W - U P AFTER SURGICAL
TREATMENT O F OBSTRUCTIVE SLEEP APNEA
Hardy, 0.1% Conradt, R.2, Hochban, W.1, Heitmann, J.2,
Umstadt, HE.l, Penzei, T.2, Peter, JH.2
Philipps-University Marburg, Klinik for Mund-, Kiefer-,
Gesichtschirurgiel, Schlafmedizinisches Labor2, Marburg,
Germany
Subject: Obstructive sleep apnea (OSA) can successfully be
treated by maxillomandibular osteotomy (MMO) in some
cases. But until now, long-term follow-up results over years
are missing.
Methods: More than 30 patients with (mean fi SD) 44.5 fi
11.8 years and a body-mass-index BMI of 8.3 fi 3.4 kg/m2
underwent MMO. All patients were investigated for two con-
secutive nights by cardiorespiratory polysomnography. Sleep
stages and breathing disorders were visually scored accord-
ing to standard criteria. Polysomnographic controls were
assessed 3 months and every year after surgical treatment.
Results: There were no significant changes in mean BMI
during the investigation period. In the first postoperative
control mean respiratory disturbance index R D I (number of
apneas, hypopneas and arousals during snoring periods per
hour sleep) decreased from 51.4 to 6.4. 3 years postopera-
tively the R D I slightly increased to 9.5. Nevertheless, these
changes during the follow-up were not significant. Persisting
breathing disorders were merely partial upper airway
obstruction. Oxygen saturation significantly increased after
surgery, a significant increase of N R E M 3/4 and decrease of

NREM1 indicated a restoration of physiologic sleep struc-
ture. As for the respiratory parameters, the improvement of
sleep structure proved to be stable 3 years after operation, at
least, no significant changes could be found.
Conclusion: This study demonstrates that surgical therapy
by maxillomandibular advancement issuccessful in a high
percentage of patients selected by cephalometric and
polysomnographic investigation. Furthermore, these results
proved to be fairly stable over a 3-year-period.
H Y P O G L O S S A L NERVE STIMULATION: A NEW
TREATMENT OF OBSTRUCTIVE SLEEP APNEA
Knaaek, L.I*, Hochban, W.2, Heitmann, J., Podszus, T1,
Peter, J.H.1.
Philipps- University Marburg, Schlafmedizinisches Labor:,
Klinik for Mund-, Kiefer-, Gesiehtschirurgie2, Marburg,
Germany
Subject: Obstructive sleep apnea (OSA) is a consequence of
decreasing muscle tone of the upper airway dilating muscles.
Electrical stimulation of the upper airway muscles (f.i.
genioglossus) has been shown to improve inspiratory flow in
patients with OSA. Nevertheless, the breakage of apneas
with percutaneous electrical stimulation is associated with
alpha EEG-arousals and thus disturbing sleep.
Method: In cooperation with Medtronic a pacemaker device
has been developed to stimulate the neuromuscular unit via
the hypoglossal nerve. Prior to application in human the
device had been tested in dogs and showed increased air-
flow. After the first implantation in 1995 the device is con-
siderably improved and meanwhile consists of a fully
implantable system with a pressure transducer implanted
into the sternum, sensing inspiratory efforts, a pulse genera-
tor in the pectoral area, and a U-shaped electrode to the
hypoglossal nerve.
Results: Intraoperative stimulation proved reasonable
tongue protrusion, the intrathoracic pressure sensor worked
perfectly. At the 1 month follow-up in the sleep lab under
polysomnographic control 98% of all inspiratory efforts
were recognized and effective stimulation was obtained dur-
ing both slow wave and REM sleep with a voltage of 2.5-
2.8. This stimulation increased inspiratory flow by
300fil00ml, a significant reduction of apnea-hypopnea-
index was obtained, sleep quality improved. No arousals
due to the stimulation could be observed.
Conclusion: Even if long term follow-up is missing, these results
demonstrate, that neuromuscular stimulation of the hypoglos-
sal nerve may be an appropriate treatment alternative for OSA.
SURGICAL CORRECTION OF CLEFT NOSE
Hochban, W.*
Philipps-University Marburg, Klinik ffir Mund-, Kiefer-,
Gesichtschirurgie, Marburg, Germany
Subject: Surgical correction of the cleft nose requires all
principles of rhinoplasty, but all rhinoplastic procedures
lead to good results only with respect to the cleft anatomy
and its surgical correction. The cleft lip muscles cause the
distortion of the nose, and often proper primary cleft lip
correction results in good nasal shape, even if no nasal pro-
cedures have been performed at that stage.
EACMFS - Abstracts, Helsinki Congress 1998 75
Methods: Adult cleft patients with major nasal deformities
were treated with special respect to the underlying defor-
mity. Beside all steps in rhinoplasty (median and lateral
osteotomies for the bony nasal correction, modelling of the
deviated nasal septum and spine, sculpturing of the upper
lateral and alar cartilages), this additionally means subpe-
riosteal mobilisatiou of the alar base, augmentation of the
hypoplastic cleft maxillary base, and, most important,
restauration of the perioral and perinasal muscles.
Results: Pre- and intraoperative evaluation of 23 cleft
patients with the desire for correction of the nasal deformity
proved more or less incomplete restoration of the cleft lip
muscles in all cases. Part of them also had major skeletal
problems with bony deficiency mainly on the cleft side and
underwent maxillary advancement procedures as a first step
prior to rhinoplasty. The maxillary advancement with better
support to the nasal base improved the situation consider-
ably. Nevertheless, beside the routine rhinoplastic proce-
dures all patients needed re-operation of the cleft lip with
restauration of the gaping perioral/-nasal muscles for good
nasal shape and symmetry also at the one year follow-up.
Conclusion: Rhinoplasty in cleft patients should consider all
cleft restoration principles. In cases with severe nasal defor-
mity one must assume for certain, that there is no proper
restoration of the cleft. For stable results re-operation of the
cleft deformity especially of the cleft lip muscles seems
absolutely essential.
[~ THE COMET ASSAY: A M E T H O D TO EVALUATE
DNA-DAMAGE IN AN EPITHELIAL CELL LINE
AFTER TREATMENT WITH RADIATION AND
TOBACCO SMOKE SOLUTION AND IN HUMAN
BUCCAL MUCOSA
Hofele, C.*, Krueger, H., Tomakidi, P., Muehling, J.
Dept. of Oral and MaxilloJacial Surgery, University of
Heidelberg, INF 400, D-69120 Heidelberg, Germany
AIMS:
To evaluate the induction and the repair of DNA-Damage in
an epithelial cell line caused by radiation and tobacco smoke
solution. Furthermore we were looking for increased levels
of DNA-strand-breaks in lymphocytes and human buccal
mucosa of smokers compared to non-smokers.
METHODS:
Strand breaks in the D N A - a measure for the damaged
D N A - were be detected by the single-cell-gel-elec-
trophoresis (Comet-Assay). Cell line: The epithelial cell
line was of oesophageal origin (TE). The D N A damage
was induced by treatment with radiation or a tobacco
smoke solution. To study the repair of the induced dam-
age the treated cells were stored for two hours at 37°C
without any further damaging influence, i.e. in the
absence of radiation or cigarette smoke solution.
Investigations in humans: Lymphocytes were drawn by
venepuncture and purified by the use of Ficoll-Paque.
Human buccal mucosa was obtained by scraping with a
tooth brush and collecting the cells in phosphate buffered
saline.
RESULTS:
Cell line: Both radiation and tobacco smoke solution induced
DNA strand breaks which showed a reduction in comet size
after the cells were allowed to repair the DNA damage. The
76 Journal of Cranio-MaxillofacialSurgery
reduction in comet size was less distinct in the cells treated
with cigarette smoke solution. Investigations in humans: A
slight increase in basal D N A damage in smoker lymphocytes
compared to non-smokers could be observed. We couldn't see
such an increase in the human buccal mucosa cells.
CONCLUSIONS:
Cell line: We conclude that cells need a longer period of time
to repair induced D N A damage after treatment with ciga-
rette smoke solution compared to the treatment with radia-
tion. Investigations in humans: The basal D N A damage was
too high both in smokers and non-smokers so that no dis-
tinct difference could be seen. For further experiments it
seems likely to purify living, i.e. basal and parabasal cells
from the residual cells.
[~ P O S I T I O N O F DISC AND CONDYLE IN
O R T H O G N A T H I C SURGERY
Hoffmeister* B., MD, DDS, PhD, Marks Ch., Ohnesorge,L, MD
Berlin, Germany
When performing intraoperative fixation of the ascending
ramus we routinely use preoperative and postoperative M R I
of the TMJ to evaluate the condylar position as well as to
determine disc dislocation. In our opinion, only this tech-
nique will be able to give us true information about the soft
tissue structures as well as bone formation.
In a prospective study on 50 patients on whom we oper-
ated with sagittal split osteotomy to achieve mandibular
advancement pre- and postoperative M R I were used for the
evaluation. The evaluation of the MR-images was routinely
performed using the technique developed by Bumann and
co-workers 1997.
In 65%of the cases we examined preoperatively, we
observed anterior positioning of the disc. Postoperativly, in
all of these cases we found a similar position of the disc as
well.
None of these patients claimed to have pain or func-
tional problems with the TMJ.
We wondered about the high amount of anterior disc dis-
location with lengthening of the posterior ligament. Only in
9 cases preoperatively did we observe an anterior dislocation
of the disc with reduction, observed on clinical examination.
These results show clearly that preoperative and post-
operative M R I of the TMJ gives us a valuable informa-
tion about the location of the soft tissue and bony
structures of the TMJ. This technique is a reliable method
of evaluating the quality of our orthognathic surgery
results.
@=~ T H E FLOATING BONE CONCEPT IN
INTRAORAL MANDIBULAR DISTRACTION
Hoffmeister* B., MD, DMD, PhD, Marcks, Ch., Wolff. K.
P., MD, DMD, PhD,
Berlin, Germany
Recently different systems have been developed for the
intraoral Callus Distraction Technique. In our department,
12 adult patients were operated on using different intraoral
callus distraction devices All of the patients had a mandibu-
lar advancement of more than 9mm.
The application of the devices can be performed unilat-
erally as well as bilaterally. Callus distraction was obtained
in all cases.
The patients did not complain about the intraoral
devices The distraction device was fixed intraorally
using monocortical screws and angled-screwdriver
systems.
The distance of distraction was evaluated by panoramic
x-rays as well as the ultrasound technique.
In all of the cases presented the distraction device was
removed 2 to 4 weeks after the end of the distraction. The
ongoing therapy procedure requires orthodontic treatment
by the use of elastics until the bone has consolidated in the
desired position.
Conclusion: The Callus Distraction technique, using the
intraoral approach, is a superior technique in cases of severe
hypoplasia, for correction of malformations of the
mandible both in the ascending ramus as well as in the hori-
zontal ramus.
In this presentation, the application of the technique will
be described. Combined treatment with an orthodontist
immediately after removal of the osteosynthesis device gives
a new dimension to orthodontic correction of 'floating
bone'. Some cases will be discussed demonstrating the excel-
lent outcome of this procedure and the experience gained in
dealing with this concept.
PAINFUL H Y P E R P L A S I A / O S T E O C H O N D R O M A
OF THE MANDIBULAR CONDYLE: REPORT O F
SURGERY IN FIVE PATIENTS
Holmlund, A.*, Gynther G.
Department of Oral and Maxillofacial Surgery,
Karolinska Institute, Huddinge, Sweden.
Aim: To present a preliminary evaluation of a surgical
method for treatment of hyperplasia/osteochondroma of
the mandibular condyle.
Methods: The material comprised 5 patients with hemi-
mandibular asymmetry and clinical and radiographic
features of symptoms/growth of the affected condyle. All
patients had pain in the affected T M J on mandibular
movement. Surgery comprised condylectomy and a verti-
cal ramus osteotomy on the affected side. The condylar
neck was reshaped and positioned underneath the disc.
A vertical or sagittal ramus osteotomy was additionally
performed on the contralateral side in 3 patients. In
order to improve aesthetics a lower border ostectomy of
the ramus was also performed in 2 patients.
Postoperative evaluation included clinical and
radiographic examination.
Results: Four patients have been followed up for 3 years
and the remaining one for 2 years. All patients improved
as regards joint pain, mandibular function and occlu-
sion. So far, no recurrence o f the growth has been
observed.
Conclusion: Compared with arthroplasty with autogenous
costochondral grafts the advantages are as follows: No need
for additional surgery in order to obtain a graft and there-
fore less morbidity for the patient. Shorter operation time. A
local osseous pedicled graft based on the medial pterygoid
muscle instead of a free bone graft. Radiographic evalua-
tion of the graft is easier compared with that for costochon-
dral grafts.

ARTHROSCOPY: T H E T M J SURGICAL
MANAGEMENT OUTCOME
Holmlund, .4. *
Department of Oral and Maxillofacial Surgery, Karolinska
Institute, Huddinge, Sweden.
In the field of orthopaedic surgery, arthroscopic procedures
have more and more replaced open surgery. The same trend
has occurred regarding the TMJ. However, compared with
large joints such as the knee, arthroscopic surgery of the
TMJ is more difficult. Instruments of fine dimensions are
required in order to give access to all areas of the joint.
However, the instruments have often been too small to allow
for effective working. The recent introduction of surgical
lasers such as the Holmium YAG seems to offer a solution
to this problem.
The biological basis for TMJ arthroscopic surgery, being
minimally invasive both to the internal and external joint
structures, is that the TMJ has a considerable potential for
adaptation and repair. Therefore only minor interventions
in the joint tissues may be sufficient to reverse the disease
process and improve function.
Compared with open surgery, arthroscopic surgery has
some advantages. Complications are few if any. Many
arthroscopic procedures can be performed under local
anaesthesia in an outpatient clinic. It is cheaper than open
surgery since it means a shorter hospitalization and little if
any sick leave for the patient.
Various procedures have been presented in the literature
all indicating a good short-term outcome. In my presenta-
tion I shall go through these procedures and evaluate them
critically. I also intend to present some new data from our
own studies.
CRANIOFACIAL R E C O N S T R U C T I O N W I T H A
N E W N O N C E R A M I C HYDROXYAPATITE CEMENT
(HAC)
Horch HH, Zeilhofer HF,, Neff A, Sader R.
Dpt. of Oral and Maxillofacial Surgery, University of
Technology, Munich, Germany
A wide variety of implant materials are currently being used
for facial skeletal augmentation and skull bone reconstruc-
tion. The most commonly used materials are bone, cartilage
and polymeric alloplasts. Each of these implants has signifi-
cant limitations. Autogenous bone grafts have the disadvan-
tages of donor site morbidity, limited quantity, variable
resorption and unpredictable remodeling of the graft.
Alloplasts cause often an inflammatory response, following
an implant movement at the implant-host interface.
Methylmethacrylate implants are also associated with local
tissue necrosis and foreign body giant cell reaction, elicted
by the exothermic polymerization phase at the time of
implantation.
For reconstruction of cranial bone defects hydroxyap-
atite cement has been proved to be an interesting biomater-
ial. The human skeletal and dental structure consists
mainly of calcium phosphate in the form of hydroxyapatite
(HA). Hydroxyapatite cement is a calcium-phosphate-
based material. Synthetic hydroxyapatite is a strong, brittle,
biocompatible ceramic. Its strength makes it useful for aug-
EACMFS - Abstracts, Helsinki Congress 1998 77
menting bone, but hydroxyapatite blocks are not easily
sculpted. Nonceramic hydroxyapatite cement
(BoneSource0 can be mixed with water to form a dense
paste that sets within 15 minutes and isothermically con-
verts in vivo to a microporous hydroxyapatite implant.
Unlike hydroxyapatite blocks, H A C paste can be precisely
molded and contoured to fill osseous defects. Replacement
of the hydroxyapatite cement implants by new bone is pos-
tulated to occur by a combination of osteoconduction and
implant resorption.
H A C was used to reconstruct or seal defects o f the
skull and facial bones in 21 patients. The results demon-
strate wide application possibilities for reconstruction of
bone defects up to 25cm2. U p to now cranial bone
integrity has been achieved in 20 patients. Dissolution of
cement has occured in 1 case and appears to be tech-
nique related. The anatomic contour of the soft tissue
overlying all hydroxyapatite cement implants was well
maintained. There were no infections or structural fail-
ures. The implants were well tolerated. It is beleaved that
H A C will become a standard tool in the management of
cranial and facial bone defects following t r a u m a or
surgery.
T E C H N I Q U E S F O R SIMULTANEOUS
CORRECTION O F NASAL D E F O R M I T I E S
T O G E T H E R W I T H ORTHOGNATHIC SURGERY IN
CLEFT PATIENTS
Hukki, J. *, Heli6vaara, A.
Cleft Center, Division of Plastic Surgery, Helsinki University
Hospital, Helsinki, Finland
AIMS:
To demonstrate various rhinoplasty techniques with carti-
lage or bone grafts used in conjunction with Le Fort I
osteotomy for correction of mid-facial and nasal deformi-
ties in cleft patients.
BACKGROUND:
Many cleft patients require orthognathic surgery for correction
of growth disturbances especially of the maxilla. In addition to
affecting occlusion, maxillary hypoplasia leads to poor facial
aesthetics of the mid-face and the nose. An osteotomy without
rhinoplasty may further aggravate nasa/asymmetry and lead
to an unsatisfactory result and a secondary rhinoplasty.
METHODS:
All patients in the presented series had a Le Fort I
osteotomy together with an open rhinoplasty carried out in
the same procedure. Depending on the case, nasal septal or
auricular cartilage was used either alone or in combination
with calvarial bone grafts
CONCLUSIONS:
Most patients especially in the UCLP group (33140)
required nasal correction in a second operation if the proce-
dure was not carried out in the same procedure together
with osteotomy. The rhinoplasty increased the length of the
operating time by an average of 2.5 hours. The combined
procedure has not increased morbidity nor the length of
hospital stay. Our preference today is to perform an open
rhinoplasty together with Le Fort I osteotomy whenever
indicated. Several clinical examples of cleft patients with
simultaneous rhinoplasty and orthognathic surgery will be
78 Journal of Cranio-MaxillofacialSurgery
shown. Detailed descriptions with drawings of various
rhinoplasty techniques using cartilage grafts with or with-
out bone grafts will be presented.
EXPERIMENTAL C H E M O T H E R A P Y O F H U M A N
S Q U A M O U S CELL CARCINOMA
H E T E R O T R A N S P L A N T E D TO NUDE MICE:
R E S P O N S E O F DOCETAXEL IN DIFFERENT TIME
SCHEDULES
Huttmann, C. 1% Fokas, K. 1, Eckardt, A. 1, Kuske, 3/1.2,
Knebel, J. W.3, Hedrich, H.-J. 4, Haindl, j.s
1Department of Oral and Maxillofacial Surgery,
2Department of Pathology,
3Department of Experimental Pathology,
4Animal Care Unit,
5Department of Nuclear Medicine, Hannover Medical
School, Hannover/ Germany
Aims: To study transplantation of human tumour cells into
immunodeficient mice. This has provided an in-vivo model
for the study of biological behaviour and tumour progres-
sion.
Method: Tumour cells of a recurrent tongue carcinoma
(ZK001) were cultured and subsequently injected subcuta-
neously into several NMRl-mice. Following tumour
growth the tumour was then transplanted into other nude
mice. Histologically the tumour showed the same charac-
teristics as the host. A total of 74 tumours distributed into
3 groups were treated with i.p. injection of Docetaxel
(30mg/kg). Different time schedules were tested: Group 1:
Treatment days 1 and 7, group 11: treatment days 1, 4 and
7 and group 111: treatment days 1,4,7 and 11.34 untreated
tumours served as controls. Tumour volume and body
weight of tumour bearing animals was measured every
four days. 14 days after the last drug injection the animals
were sacrificed. Blood samples from the jugular vein were
taken and serum levels of tumour markers SCC, TPA and
TPS were assessed. Tumours were dissected from the ani-
mals and placed in 4 % formaldehyde for histological
examination.
Results: Treatment was well tolerated by the animals.
Treatment-related deaths occurred in four animals.
Compared with untreated mice, the tumour growth curves
of Docetaxel-treated mice showed a clear growth inhibition
which was independent of the time schedule of drug admin-
istration. Only SCC values correlated well with tumour vol-
ume in mice.
Conclusion: Docetaxel was active in this murine model of
human squamous cell carcinoma. No increased activity in
tumour growth inhibition could be demonstrated in different
time schedules. In the clinical setting, Docetaxel is currently
under investigation in recurrent head and neck cancer at our
institution, in particular with focus on dose intensification.
THE INFLUENCE O F APPLYING REPLACEMENT
THERAPY ON THE SUCCESS O F I M M E D I A T E
POST-EXTRACTION DENTAL I M P L A N T S
Huys L %
Oral Implantology, Hospital Queen Fabiola, Blankenberge,
Belgium
AIMS: Placing any type of implant into an immediately
post-extraction socket was always said to be hazardous,
because clinicians are faced with two major problems: initial
stability of the implant(s) used, and soft tissue ingrowth
during the healing period. Therefore, most clinicians tend to
wait at least twelve weeks before inserting the implants. This
study combines two particular materials, used when per-
forming Replacement Therapy TM to define if one can pro-
duce predictable results and success.
M E T H O D S : Teeth were extracted in 102 patients, between
19 and 71 years old, and a total of 416 ITI single stage tita-
nium screw implants were placed immediately 2-5mm api-
cally into the extraction sockets. Bioplant H T R 40 Synthetic
Bone, the smaller size of these microporous granules, was
used for packing apically in the socket. Primary closure was
done with Vicryl Rapid 2/0 or 3/0 for suturing the flap(s),
and with Vicryl Normal 4/0 around the neck of the
implants. Prosthetic rehabilitation was obtained by place-
ment of ball retained overdentnres and cemented crowns
and bridges.
RESULTS: The 7 year follow-up revealed no allergic
reaction, inflammation swelling or pain. Very important,
was that no soft tissue ingrowth was ever seen. Bioplant
H T R itself seems to act as a membrane. The material ini-
tially forms dense or very dense fibrous tissue under the
gum flap, preventing epithelial and connective tissue
ingrowth around the implant. No implant was lost after
7 years. N o measurable loss of bone height and width
was seen during this follow-up period of 7 years. The
material always produced immediate surplus stabilisa-
tion and helps stop bleeding. Because of its naturally
slight negative charge of -I0mV, the material sticks to the
titanium, stays where it is placed and repels micro-organ-
isms.
CONCLUSIONS: Bioplant H T R Synthetic Bone is an
excellent and simple-to-use graft material, highly suitable to
combine with immediate titanium single stage screw
implants, such as the ITI Straumann implants. Applying
Replacement Therapy TM following the protocol tremen-
dously improves the survival rate of immediate post-extrac-
tion implants. This will become the future in Implant
Dentistry, because it provides every clinician the certainty of
success in a very easy way, and it saves the patient surgery
time and money.
CONDYLAR RESORPTION BEFORE AND AFTER
ORTHOGNATHIC SURGERY
Hwang S.J. *, Haers P..E., Sailer H.F.
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland
Aims: To analyse the incidence of condylar resorption
following orthognathic surgery and determine common
factors in the cases involved. To analyse skeletal stability
in patients with preoperative flattening and other changes
of the condylar form due to orthodontic therapy with
headgear and other functional appliances at an earlier
age.
Method: Cephalograms and orthopantomograms taken pre-
operatively, immediately postoperatively and two years
postoperatively in a group of 452 patients who underwent
orthognathic surgery were analysed retrospectively for signs
of condylar resorption. This was detected in eleven patients
out of 452 (2.4%) without preoperative flattening of the
condyle (Group 1). In ten other patients analysis of

orthopantomograms and cephalograms taken before start-
ing orthodontic therapy at an earlier age, and the radi-
ographs taken before starting preoperative orthodontic
coordination, showed flattening and loss of at least the
vertical dimension of the condyle (Group 2). These data
were compared with radiographs taken preoperatively,
immediately postoperatively and 2 years later with empha-
sis on the posterior facial height and the mandibular plane
angle.
Results: The patients in group 1 showed the characteristics
reported in the literature i.e. female patients, high mandibu-
lar plane angle (51 °), preoperative TMJ disorders.
Group 2 also consisted exclusively of female patients with
high mandibular angle (53 °) and preoperatively existing
TMJ disorders (8110) Condylar resorption and ensuing mal-
occlusion were seen in two cases, whereas occlusion was sta-
ble in the remaining eight cases. However, cephalometric
parameters showed beginning condylar resorption in three
of these.
Conclusions: 1. Although condylar resorption occurs in less
than 3% of all orthognathic cases, the patients involved
should be informed concerning this risk. 2. Analysis of radi-
ographs before and after orthodontic therapy with functional
appliances at an earlier age is mandatory before starting com-
bined treatment in high mandibular angle cases. If condylar
resorption is already present at that stage, the patient should
be informed that the prognosis concerning skeletal stability is
compromised. Yet combined treatment is the only method
available to obtain neuromuscular balance and a functional
occlusion thus correcting overloading of the TMJ.
P R O G N O S I S AFTER M A R S U P I A L I Z A T I O N O F A
DENTIGEROUS CYST IN T H E L O W E R P R E M O L A R
REGION:
Shouichi Miyawaki, Wataru Takioka, Hyomoto Masamitsu,
Katsuhiro Horiuchi, Toshiaki Noshi, Masahito Sugimura.
Nata Medical University, Nata pref Japan
The purpose of this study was to investigate the prognosis of
the lower premolars after marsupialization of a dentigerous
cyst. Fifty-seven pre-adolescents (Mean age: 10.9 years) with
a dentigerous cyst in the lower premolar region were used as
subjects. Almost all subjects' chief complaint was "swelling
of oral mucosa of the lower premolar region". They had
already been treated by marsupialization in our hospital.
Panoramic radiographs and charts from the initial stage to
post-treatment were examined closely in order to measure
the exact size of the cyst, position of the impacted premolar
and maturity of the dental root and to examine the treat-
ment results. Natural eruption occurred in forty-four cases,
mechanically assisted eruption was made possible in seven
cases and extraction was performed in six cases. There were
no significant correlationships between successful eruption
and the size of cyst and the position of the impacted premo-
lar. Premolars with an immature root had a tendency to
erupt more easily and the size (more than 6mm) of space in
which to erupt was an important factor in obtaining a suc-
cessful outcome. The results suggest that the state of the den-
tal root and space for eruption may be important factors in
achieving a good outcome after marsupialization of a
dentigerous cyst in the lower premolar region.
[~ T R A U M A T I S M AND FRACTURE TREATMENT O F
M I D D L E PART O F FACE
EACMFS Abstracts, Helsinki Congress 1998 79
Dumitru Hytsu, Dumitru Scherbatiuk *, Oleg Cojoraru,
Nicolae Kele
The N. Testemitsanu SMFU, Department of Oro-
maxillofacial Surgery, CHISINAU, The Republic of
Moldova.
Aim: The improvement of the fracture treatment of middle
part of the face and the decrease in the post-traumatic com-
plications.
Methods: We had studied 2413 patients who had been
treated from 1992-1997. The fractures of the middle part of
the face constituted 23.11%. When diagnosing the fractures,
the following methods were used: the x-ray studies in differ-
ent views, the computerised tomography, the ortopantho-
mography, the endoscopy and infrared thermography. In the
fracture treatment, orthodontic appliances, osteosynthesis
with wires, and miniplates were used.
Results: According to the type, the fractures were classi-
fied as follows: m a n d i b l u l a r fractures - 76.89%; frac-
tures of the naso-ethmoidal complex - 10.0%; fractures
of the zygomatic bone - 9.71%; fractures of the zygo-
matic-orbito-maxillary complex - 3.4%. Fracture immo-
bilization with o r t h o d o n t i c appliances impedes the
n o r m a l oral cavity hygiene that sometimes results in
development of superinfection. Osteosynthesis with the
wire was an additional injury to the fractured bone;
therefore, we consider that miniplates are best for the
immobilisation o f fractures and because they are less
traumatic.
Conclusions: Computerised tomography is a more informa-
tive method, but at the same time it is rather expensive.
Immobilisation with miniplates permits anatomical realign-
ment and, thus, the eventual function normal. Endoscopy
and infrared thermography can be used for the prophylaxis
of complications.
Prof. Dumitru Scerbatiuk
President of the AOMS of the Republic of Moldova
28, Drumul Viilor str., ap.28, MD2021 Chisinau, Republic
of Moldova
tel: (3732) - 24-84-10, fax: (3732) - 22-33-86
[~ SURGICAL I M P L A N T REHABILITATION OF
PATIENTS AT ADOLESCENT GROWTH STAGES
AFFECTED BY FIBROUS D I S P L A S I A O F THE
U P P E R JAW
Di Paolo Carlo, Panti Fabrizio, Valentini Valentino, De
Ponte Francesco
Maxillo Facial Unit University of Rome "La Sapienza"-
Prof. Giorgio Iannetti
The Fibrous Displasia is a pathological alteration of bone
structures consisting of a substitution of physiologic bone
with fibrous tissue. Clinically it's possible to distinguish two
forms: monostotic and polystotic forms. In the maxillo
facial district the most frequent localization of the mono-
stotic form is the upper jaw. The F.D. is a benign growth
process with a tendency of local recurrence, for that rea-
son, in our department, the selective therapy is the bone
resection of the mass within healthy margins. The goals
of the surgical reconstructive protocol are: surgery within
healthy margins, re-establishment of extra and intra oral
morphology with tissue reconstruction for functional and
aesthetic rehabilitation. When the pathological event
involves patients at adolescent growth stages, many
80 Journal of Cranio-MaxillofacialSurgery
anomalies of facial development can occure. For achiev-
ing the therapeutic goals, in these patients, is necessary to
perform a step by step therapeutical protocol. The
Authors describe this protocol applied on 12 patients at
this stage affected by Fibrous Displasia of the upper max-
illa whose were followed for 2 to more than 10 years in
order to check the long-term success of the therapeutic
planning and surgical implantologic rehabilitation.The
check up criteria consist of clinical and instrumental con-
trol such as: X-rays analysis with orthopantomograpy,
telecranium with two projections, for the first five post-
surgical years, annual C.T. scan to check on eventual dis-
plasia recurrence, the C.T. dental scan for
implant-prosthetic feasibility and functional electrogna-
graphic recording. The long-term follow up have shown
good results in order to avoid an asymmetric develop-
ment of the maxillo facial complex, no recurrences, a
good re-establishment of the stomatognatic functions
chewing, swallowing, phonation and a satisfactory aes-
thetic and morphologic result of the bone-implantologic
reconstruction of maxillary region.
S P L A N C H N O C R A N I U M A N O M A L I E S IN
OSAS PATIENTS
Iannetti G., De Ponte F.S., Bottini D.J.
Maxillo-Facial Unit
"La Sapienza" University of Rome- Italy
Surgical treatment as regards patient age and site of
splanchnocranium anomalies in OSAS patient.
As far as cranio-maxillo-facial region is concerned many
morphostructural abnormalities occur, which could be asso-
ciated with OSAS fealure. They would also be the etiopatho-
genetic factors in the PAS reduction. Every congenital or
acquired event altering the balance between the spheno-eth-
moidal growth and the maxillary development can deter-
mine craniofacial malformations.
A multidisciplinary approach and a close team work
among the specialists involved is important to reach the best
result in treatment of osas patients
The correction of the skeletal anomalies is the most
important rule of the Maxillo-Facial Surgeon in the treat-
ment of this pathology.
The two parameters which determine the choice of treat-
ment are the patient age and the malformation site, due to
the differences in growth of the cranio-facial area.
We analyse two groups of OSAS patients; the first com-
posed by growing patients and the second by adults and in
each group we study the surgical treatment as regards the
site of the maxillo-facial malformation.
In conclusion the Maxillo-Facial Surgery has to restore
the tridimentional position of the facial bone causing
OSAS. In some cases, despite the correct repositioning of
the maxillo-mandibular complex, there are still some
apnea episodes. In these cases , the classification was
probably not correct because a central component ,
responsable for nocturnal apnea, was present in the OSAS
patients.
THE DIAGNOSTIC VALUE O F FNAC IN
METASTATIC LYMPHADENOPATHY IN ORAL
CANCER PATIENTS
Daskalopoulou, D., Rapidis, A.D., latrou, L *, Markidou, S.
Departments of Cytology and Maxillofacial Surgery, Greek
Anticancer Institute, St Savvas Hospital, Athens, Greece
AIMS:
Oral squamous cell carcinoma is the commonest malig-
nant tumour of the oral mucosa comprising more than
95% of oral malignancies. The status of cervical Iymph
nodes at presentation is the most important prognostic
factor for these patients. The presence of metastatic cervi-
cal Iymph nodes in oral cancer patients decrease survival
by more than 50%. Proper management requires accurate
diagnosis of suspected neck metastases. In an attempt to
improve pre-operative diagnosis of cervical Iymph nodes
we used fine needle biopsy to evaluate the presence of
malignancy The aim of the study was twofold: A To eval-
uate the diagnostic accuracy, sensitivity and specificity of
fine needle biopsy in cervical Iymph node enlargements in
oral cancer patients and B To access the method as the ini-
tial investigation of cervical enlargements in patients
without a prior medical history of oro-facial
malignancies.
METHODS:
The cytological results of 607 cases of fine needle biopsies
from cervical Iymph nodes performed over the six years
period 1991-1996 were retrospectively reviewed and
analysed. Definitive histologic diagnosis was established
in 480 out of 607 cases after surgical treatment and histo-
logic diagnoses were compared with pre-operative cytol-
ogy. In 24 cases cytologic sampling was judged
unsatisfactory for diagnosis owing to scanty cellularity of
the smears.
RESULTS:
In the total number of 474 cases comparison between histol-
ogy and cytology revealed nine false negative and two false
positive cytologic results. In another seven cases a difference
in histologic typing of the tumour was found. The overall
diagnostic accuracy of the method was found to 97,9%
whereas the sensitivity and the specificity of the method
were 97% and 98,7% retrospectively
CONCLUSIONS:
We can therefore conclude that fine needle biopsy of sus-
pected neck metastases in oral cancer patients is a highly
accurate, simple, safe and inexpensive method to establish
definitive diagnosis.
PERIPHERAL AND MURAL AMELOBLASTOMA
Ibrahim E. El-Hakim (BDS, MSc, MscD, PhD)* and
Mostafa M. El-Khashab (BChD, MscD, FICD)**
Cairo, Egypt
Peripheral ameloblastoma (PA) is a relatively uncommon
odontogenic turnout that is histologically identical to the
classic intraosseous ameloblastoma, but occurring solely in
the soft tissues covering the tooth-bearing regions of the
jaws. However, the peripheral lesion does not usually
exhibit the invasive and aggressive behaviour of its
intraosseous counterpart. The origin of the PA is thought
to be from one of two sources: extraosseous remnants of the
dental lamina, or the basal cell layer of the oral epithelium

which is believed to have odontogenic potential. In a study
of 116 cases of ameloblastoma, Waldoron and E1-Mofty in
1991 found that 5% were peripheral and in nearly all of the
reported cases of PA, the tumour developed in the soft tis-
sue overlying the alveolar bone.
Intraosseous ameloblastoma conceivably may be derived
from remnants of Hertwig's sheath as well as a potential
complication stemming from the lining epithelium of a
dentigerous cyst or from the rests of odontogenic epithe-
lium in the cyst wall. In an appraisal of ameloblastoma
potential of follicular cysts, Stanely and Diehl in 1965, stud-
ied 641 cases of ameloblastoma of which 108 tumours
(approximately 17%) were definitely associated with an
impacted tooth and/or follicular (dentigerous) cyst. The
purpose of this presentation is to add to the world literature
the first case which presents an unusual association of
peripheral ameloblastoma originating from the basal layer
of oral epithelium and mural ameloblastoma developing
from the epithelium lining of a dentigerous cyst related to
an impacted mandibular canine in a 13-year-old Egyptian
boy.
* Associate Professor of Oral Surgery- Presentor
** Professor of Oral Pathology
Faculty of Dental Medicine, A1-Azhar University Cairo-
Egypt.
Telephone: 4027200
Speaker:
Ibrahim E. El-Hakim
Home Telephone: 202-3690289
5 c m x 5 cm Slide
Oral Presentation
Correspondence:
Dr.Ibrahim El-Hakim
6 E1-Gendy street
Hadayek Helwan 11433
Cairo-Egypt
TREATMENT OF PERSISTENT CEREBROSPINAL
FLUID (CSF) RHINORRHEA BY THE
SUBCRANICALISUBFRONTAL APPROACH
lizuka, Z *, Laiidrach, K., Raveh, J.
Department of Cranio-Maxillofacial Surgery, University
Hospital of Bern, Switzerland
Aim: To evaluate surgical techniques of the subcranial/sub-
frontal approach for treatment of CSF leaks of the anterior
skull base.
Method: This follow-up study includes 34 patients with per-
sistent rhinorrhea who underwent subfrontal exposure of the
skull and dural repair with fascia lata between 1992 and 1996.
The etiology of the fistulas was traumatic or posttraumatic in
28, spontaneous in 4, and postoperative in 2. The patients
with traumatic fistulas were treated operatively after a failue
of the conservative treatment for 2 to 5 weeks (mean 19 days).
The follow-up consisted of sequential controlls after one,
three and 6 months and each year further on. Follow-up
period ranged from 2 to 5 years (mean 3.2 years). There were
10 female and 24 male patients with mean age of 34 years.
Results: The fistulas were located to the orbital roof in 5, the
ethmoidal roof in 13, the sphenoidal roof in 16 patients. In
5 cases, the fistulas located at the cribriform plate. Of the
trauma cases (n:21), 43% (n=9) had fistulas in the sphe-
noidal region with combined fractures in the petrous bone,
33 of 34 patients (97%) the fistulas were successfully closed
EACMFS - Abstracts, Helsinki Congress 1998 81
with the initial procedure. One patient with sponataneous
rhinorrhea who had reccurence 10 months postopratively,
required a second operation. Complications consisted of
transient diplopia in 5 (15%), prexisting anosmia in 6 (18%)
and postoperative in 2 patients (6%). Infections such as
meningitis or chronic sinuitis were observed in none of the
cases.
Conclusions: In regard to the low morbidity and a high suc-
cess rate in sealing fistulas, the subcranial/subfrontal
approach as described is efficient for the management of
CSF rhinorrhea. Fractures of the sphenoidal planes com-
bined with those of the petrous bone are considered to be a
typical fracture pattern resulting in persistant fistulas.
~ = ~ LESS INVASIVE SURGERY F O R S Q U A M O U S
CELL C A R C I N O M A OF T H E ORAL CAVITY AND
T H E OROPHARYNX
K. lkemura* 1), R. Oya 1), S. Nakamura 1) and N. Onari 2)
Dept. of Oral & Maxillofacial Surg 1) and Radiology 2),
University Hospital of Occupational and Environmental
Health, School of Medicine. Kitakyushu City, Japan
PURPOSE:
In order to avoid dysfunction and its negative impact on
QOL, less invasive surgery for carcinoma of the oral cavity
and the oropharynx was conducted at the primary site and
evaluated.
M E T H O D S AND RESULTS:
Less invasive surgery includes the preoperative chemother-
apy with irradiation, the application of the artificial dermis
to the operation wound and the pathological investigation
of surgical margins using a frozen section diagnosis com-
bined with the modified Mohs method.
The patients with T3 and T4 squamous cell carcinoma
or T2 carcinoma, in which surgery may cause functional
impairment, were treated with the preoperative chemora-
diotherapy. The targeted intra-arterial infusion of CBDCA
(carboplatin) and concomitant radiation therapy were
undertaken, and per os administration of 5-FU (UFT®)
was also added during this treatment. Fifteen of the evalu-
able 17 patients showed clinical complete response and the
other two partial response. In these cases, the operated area
was remarkably reduced and when necessary, the resected
area was covered with the artificial dermis, which was the
collagen/silicon bilayer membrane (Teru-dermis ®). Tumor
persistence at surgical margins was histologically examined.
CONCLUSION:
This method preserves the function of patients with
advanced cancer. A long follow-up is necessary to observe
recurrence and survival rate.
O=~ CARCINOMA IN P L E O M O R P H I C A D E N O M A
llic M. P., Ristic J., Dzolev A., Vucokovic N. % Hrabovski
A., Dedie S.,Kiralj A.
Institute of Surgery, Clinic of Maxillofacial Surgery,
University of Novi Sad, Novi Sad, Yugoslavia
* Institute of Pathology, University of Novi Sad, Novi Sad,
Yugoslavia
82 Journal of Cranio-MaxillofacialSurgery
AIMS:
We examined incidence and presentation of carcinoma in
pleomorphic adenoma (CaPA). Also, we studied prognosis
in dependence of carcinomas site in pleomorhic adenoma
(PA) and methods of operative treatment.
METHOD:
In period 1973-92. 634 patients were treated operatively
with tumor of salivary glands. All principles for treatment
salivary gland's tumors were observed. When we had been
obtained the find CaPA with penetration capsule of benign
tumor operative treatment for malignant tumors were per-
formed.
5-years surviving in patients with CaPA were observed.
RESULTS:
In the observed period from totally number of operated
patients 489 had benign tumor with the most frequent
localization in parotid salivary gland (PSG).
Pathohystological examination showed 351 cases of PA. 27
patients had CaPA. The most primary site of CaPA was
PSG (59%), but then submandibular salivary gland
(SmSG) (37%). Primary site of PA is more frequent in PSG
(77%).
From 27 CaPA patients 10 had regional metastasis.
Primary CaPA in SmSG gave more frequent regional metas-
tasis - 5 (50%) then the site in PSG - 5 (31%).
All patients with CaPA had arise from PA. CaPA with-
out infiltration of PA's capsule made regional metastasis in
one case. However, penetration of PA capsule had bad prog-
nosis. Five-years period survived 3 patients with PSG site
and 2 patients with SmSG localization. High percent of
five-years period surviving had patients both of sites - 88%
(PSG) and 80% (SmSG).
CONCLUSIONS:
In our biopsy material percent of CaPA is high. Spreading
of regional metastasis is as world's literature reports.
Metastasis in SmSG have badly prognosis. Regularly opera-
tive treatment of tumor's with primary site in salivary
glands produces of high percent five-years surviving.
27 = 7,7% PA
16 parotis 59%
10 submand 37%
A NEW H U M A N ORAL S Q U A M O U S CELL
CARCINOMA CELL LINE AND P R O D U C T I O N O F
INTERLEUKIN - 6 ( IL - 6 )
Imai, Y.*I, Sasaki, T.1, lwase, H.1, Fujibayashi, T.1,
Akimoto, K.2, Niwa, A.3
Department of OMFS1, Laboratory of Morecular and
Cellular Biology2, Department of Microbiology3, Dokkyo
University School of Medicine, Tochigi, Japan
A i m s : To determine the IL - 6 secretion from a new cell line
derived from oral squamous cell carcinoma.
M e t h o d : Using a new human carcinoma cell line estab-
lished from a tongue cancer, IL - 6 levels were measured by
ELISA in culture supernatant. IL - 6 / IL - 6R m R N A
expression was studied by RT - PCR analysis.
Results : The concentration of IL - 6 in condition media
were 2.4 A_}0.4 ng / ml / 72 h (n : 3). The oral SCC cell line
apparently expressed IL - 6 m R N A ( 295 - bp) and IL - 6R
m R N A (gp 80:251 - b p / g p 130:423 - bp).
C o n c l u s i o n s : R e s u l t s suggests that the I L - 6 , which is pro-
duced by the new cell line derived from oral SCC seems
to act in an autocrine fashion. This new cell line will be
useful for studing the influence of I L - 6 on oral SCC.
EXPERIMENTAL STUDY O F ORGAN AND TISSUE
REACTION TO THE H Y P O D E R M I C I N J E C T I O N O F
POLYACRYLAMID GEL (PAAG)
lourkovsM 0., Osipov G., Vologin A.
Department of Face and Neck Plastic Surgery Central
Research Institute of Stomatology, Moscow, Russia
Aims: To study the reaction of the tissues, haemotological
system and biochemical indices to the hypodermic injection
of PAAG used for contour plastic operations on soft tissues.
M e t h o d : White rats were subjected to 2-ml PAAG spinal
hypodermic injections under sterile conditions. One group
of rats was rendered immunodeficient by cyclophosphan
injection, the other group was later injected with
immunomodulator T-activin in relation to the immunodefi-
ciency.
Results: It was noted that PAAG injection does not essen-
tially influence the haemotological system and biochemical
indices. However, some reduction in the activity of a num-
ber of reactions was observed as well as the development of
leukopoenia in the lymphopoenia background. T-activin
partially normalises these indices. Histological research has
revealed that the tissue reaction to gel is subjected to
changes in the immunodeficiency status, especially at late
stages of the experiment: on days 30 and 60. The injection
of T-activin, to a certain extent, normalizes the tissue reac-
tion to PAAG implantation.
Conclusions: In the status of immunodeficiency the PAAG injec-
tions should be given in relation to immunomodulative therapy.
STUDIES ON MAXILLARY ALVEOLAR ONLAY
AND SINUS INLAY GRAFTING T E C H N I Q U E S F O R
I M P L A N T PLACEMENT IN SEVERELY RESORBED
MAXILLAE.
Sten Isaksson DDS MD PhD
Medical & Dental Health Centre Halmstad Sweden
In situations with significant atrophy of the edentulous
maxilla, advanced loss of alveolar and/or basal bone struc-
ture, endosseous implants may be utilised in combination
with various types of bone grafts.
When bone grafts are placed, with or without immediate
implant installation, the graft and host bed interfaces
should be carefully adjusted for complete contact and
immobilised utilising principles of rigid fixation. Rigid fixa-
tion is essential to successful onlay- or inlay grafting and is
accomplished by placement of either titanium implants or
titanium rigid fixation screws after intimate non-rocking
interfacing of graft with host bone.
Four studies will be presented; onlay-and sinus inlay -
techniques of bone grafting in one- or two stage-procedures
will be discussed for situations when bone grafts may be
used overlying existing residual bone in the edentulous max-
illa.
The first study will evaluate retrospectively a one stage
maxillary sinus augmentation technique with endosseous

implants. Forty-nine patients received 314 BrSnemark
implants, of which 171 implants of various lengths were
placed in the grafted bone and 143 implants in the adjacent
maxillary alveolar process. Five patients also received onlay
grafts to the anterior maxilla. Follow-up time was 3-49
months after abutment connection.
The second study is an osteometric evaluation of 22
patients from the first study and the aim was to determine
whether bone quality influences the integration of implants
and whether such data can be prognostically useful.
The third study is a prospective analysis of a two stage
maxillary sinus augmentation with endosseous implants. It
includes 186 implants, of a total of 290, inserted in grafted
bone in 46 edentulous patients. The follow-up period is
between 2-36 months so far, and the results are preliminary
ones.
The fourth study is a study undertaken to compare
implant angulation and position after one- or two-stage
sinus inlay bone grafting. Twenty patients were selected
retrospectively; ten were operated on with a one-stage
procedure and ten with a two-stage method. Casts
processed for the final bridgework were used for the
assessment.
[~ T H E TREATMENT O F MANDIBULAR
CONDYLAR FRACTURE BY DIRECT APPROACH
TO REACH THE FACIAL NERVE
Osamu Ishihara, Izumi Mataga, Akira Tanaka
Department of OMFS II, School of Dentistry at
Niigata, The Nippon
Dental University, JAPAN
PURPOSE:
The aim of this study is to evaluate the basic surgical proce-
dure for mandibular condylar fractures replaced by direct
approach to reach the facial nerve.
MATERIAL AND M E T H O D S :
For three patients, two with unilateral lower level of condy-
lar fractures with luxation from temporomandibular fossa
and a malunited of low condylar fracture, were treated by
direct approach to reach the facial nerve. For these
patients, we applied mini-plate fixation systemdirectly fol-
lowing replacement of bone fragments. All follow-up peri-
ods are more than one year. Postoperative function and
radiological morphology were assessed.
RESULT:
We could replace bone fragments and fix for three cases
without resection of the lateral pterygoid muscle and
additional approach. In two patients, reversible facial
paralysis of buccal or temporal branch were observed
postoperatively, but completely improvd two to three
months. Although h a e m a t o m a occured early postopera-
tive course at only one patient, it was healed by aspira-
tion and compressed dressing. In all patients, normal
function and guidance o f the jaw were obtained and
replaced condyles were radiologically similar to non-sur-
gical site.
CONCLUSION:
We recognized that this approach which can make a broad
exposure and a wide operative field, is very suitable surgical
procedure for low level of condylar fracture.
EACMFS - Abstracts, Helsinki Congress 1998 83
TONGUE CANCER AND PRECANCEROUS
LESION
Junnosuke Ishii DDS, DMSc
Department of Oral and Maxillofacial Surgery, Kobe
University School of Medicine, Japan
ABSTRACT
The clinical treatment for oral mucosal disease with laser
surgery was carried out on 370 cases, during 1979 and 1997.
They included 68 cases out of 75 malignant tumors were
squamous cell carcinoma in histopathology.
Twenty cases of them were radically treated without
other kind of therapy other than laser surgery. The sites
were on the tongue in16, the gingiva in 2, and in one case
each on the buccal mucosa and the floor of the m o u t h . No
evidence of a recurrence was shown in all but one with
tongue cancer (T1NOM0).
An incidence of secondary lymph node metastasis in the
patients who had laser surgery because of tongue cancer
was reviewed. Therefore the incidence was compared with
those of the patients received interstitial irradiation.
In this review, the most common disease in precancerous
lesions was leukoplakia, although some precancerous
lesions were included in them. Laser surgery for these dis-
eases showed a good control within a definite period of
time. However some cases recurred and changed malig-
nancy. We compared a recurrence rate of leukoplakia with
the patients who were with C02 laser to those who were
treated with Nd-YAG laser.
The results suggest that we should select laser and
method in accordance with a characteristic of the
disease.
[~ D O W N - R E G U L A T I O N O F BCL-2 FAMILY GENE
PRODUCTS BY TREATMENT W I T H CBDCA IN
S Q U A M O U S CARCINOMA CELLS
tltoh, M.*, 1Chiba, H., 1Noutomi, Z, 2Toyota,
H., 2Mizuguchi £
IDepartment of Oral and Maxillofacial Surgery,
2Department of Immunology, Tokyo Medical College, Tokyo,
Japan
Aims: The growth of the cell lines (TMC6T & TMC7T)
from squamous cell carcinoma (SCC) has been shown to be
inhibited by carboplatin (CBDCA) more than 80%, whereas
in one cell line (TMC8T) with inhibition by only 40%. To
understand the differential sensitivity to CBDCA, the level
of Bcl-2 family gene products was measured.
Methods: Cell line were maintained in RPMI-1640 contain-
ing 15% fetal calf serum in the presence of 2 m M L-gluta-
mine, 5_M mercaptoethanol and 100 g/ml of kanamycin at
37_ in humidified air with 5% CO2_. The level of Bcl-2 fam-
ily gene products were determined by Western blotting.
Results: Balance between the apoptosis-preventing gene
(bcl-2, bcl-xL) and the apoptosis-accelerating gene (bax,
bad) has been postulated to be crucial for cell survival. The
cell line TMC8T contained higher level of Bcl-xL than the
sensitive line TMC7T. Moreover, down-regulation of Bcl-
xL was observed in TMC7T treated with 100E g/ml
CBDCA for 48h with almost unaltered level in TMC8T.
The Bcl-2 was also down-modulated by CBDCA, although
the change is not so dramatic as Bcl-xL.
84 Journal of Cranio-Maxillofacial Surgery
Conclusions: CBDCA-mediated inhibition of the cell
growth is accompanied by the down-regulation of Bcl-
xL/Bcl-2. Bcl-xL appears to be critical for survival of cells
in SCC cells.
D FOLLOW-UP OF GERIATRIC PATIENT W I T H
EXTRAMEDULLARY PLASMACYTOMA OF THE
SUBMANDIBULAR REGION
lwata, M., Soga, T.
Department of Oral and Maxillofacial Surgery, Hiroshima
City Hospital, Hiroshima, Japan
Aims: Plasmacytoma is the disease with tumor-like growth
of plasma cell or of their cognate, and often generates in the
bone tissues of the entire body as multiple myeloma. Also,
unusually, it develops in soft tissues as extramedullary plas-
macytoma. Extramedullary plasmacytoma originating in a
submandibular region is reported together with a review of
the literature on this rare disease.
Subject: We present a 93-year-old female of extramedullary
plasmacytoma occurring in the submandibular region.
Results: This tumor was excised and was suspected to be a
plasmacytoma or multiple myeloma on pathological exami-
nation. General examination followed which denied possi-
bility of multiple myeloma. Furthermore, we investigated an
excised specimen on immunohistological examination, and
the PAP technique revealed that the tumor cells produced
kappa light chain and partially Ig-G.
At present, 5 years 5 months postoperatively, there are no
signs of recurrence, and she is still in excellent condition.
Condusious: It is most important to distinguish
extramedullary plasmacytoma from multiple myeloma
because the prognosis of the two entity is quite different.
And we should never forget the fact that extramedullary
plasmacytoma might later change into multiple myeloma.
Therefore, the detection of the tumor producing
immunoglobulin either in the serum or urine is considered
to be valuable in following up this disease.
The geriatric patient with extramedullary plasmacytoma
had no local recurrence or multiple myeloma for 5 years
after surgical operation only.
SURGICAL TREATMENT IN COMPLICATIONS OF
CONSERVATIVE THERAPY OF CONDYLAR
FRACTURES.
Jagielak 31., Piekarczyk J., Soltan 3/1., Wielogrrski J.
H Clinic of OMFS, Institute of Dentistry, Medical
University of Warsaw, Warsaw, Poland
Aims: To define indications for surgical treatment in compli-
cations of conservative therapy of condylar fractures, to
present surgical techniques and disscuss results.
Method: Condylar fractures constitute 20-29 % of all
mandibular fractures. Most of these cases are treated conser-
vatirely. New methods of osteosynthesis allow to extend the
indications for surgical treatment of condylar fractures, espe-
cially in cases of the condyle luxation, major shortening of the
mandibular ramus, bilateral fractures. Such cases, if treated
conservatively (IMF), give high risk of complications. In the
years 1992-97 in the II Maxillo-Facial Surgery Clinic of
Warsaw Medical University, we operated on 13 patients, that
previously had been treated conservatvely (IMF) for condylar
fractures. They were qualified for surgery because of posttrau-
matic face asymetry, limitation in mouth opening and pain. As
surgical treatment we performed sagittal elongating osteotomy
of the mandibular ramus (6 cases) and condylectomy (7 cases).
Results: In all cases the pain disappeared, improved occlu-
sion and face symetry was restored.
Conclusions: First promising results of the surgical treatment
give new possibilites to treat failures of the conservative, and
later orthodontic treatment of the condylar fractures.
EFFECTS OF OSTEOINDUCING PROTEINS IN
EXPERIMENTAL CLEFTS
Jiinicke, S. 1, Park, H.S.2
1Dept. of Cranio-Maxillofacial Surgery, University of
Aachen, Med. School," Germany
2SAMSUNG Medical Center, Seoul, South Korea
Aims: Bone grafting can be considered as the "gold stan-
dard" in the treatment of maxillary clefts. Beside that exper-
imental attempts such as a)GTR, b)CaPO4-ceramics,
however, above all c)osteoinducing proteins have gained in
importance. In an experimental model the rank of these
materials was determined under particular consideration of
bone inducing proteins.
Material/Methods: In 144 rabbits, at the age of 30-60 days a
maxillary cleft was produced surgically and treated with the
above-mentioned methods. Seventeen experimental groups
of 6-9 animals each emerged and one control group (13 ani-
mals). Altogether in 71 animals an average dose of 20+2rag
of osteoinducing protein, exclusively or in combination with
other biomaterials, was applied to the cleft area. The ani-
mals were sacrificed after 168 days. Among others the fol-
lowing histomorphometric and cephalometric parameters
were determined to be essential: bone regeneration in the
cleft area, contact rate of bone and implant(CaPO4-ceram-
ics), maxillary length, deviation angle of maxillary growth
(statistics: Wilcoxon ranksum test).
Results: Under the influence of the osteoinductive protein
there is significantly improved bone regeneration an
increased bone-implant contact in the cleft area. Maxillary
growth in length is improved. The deviation angle of the
maxillary growth is not completely eliminated but is signifi-
cantly improved too. Generally the more favourable values
were observed in experimental groups with osteoinductive
proteins exclusively or in combination with resorbable bio-
materials than with non-resorbable materials.
Conclusions: Osteoinductive proteins show a favorable influ-
ence on bone healing in maxillary clefts and on maxillary
growth. Complete abolition of the negative consequences after
experimental clefting on craniofacial growth does not result.
A PREOPERATIVE CAD-BASED PLANNING
ENVIRONMENT FOR CRANIAL SURGERY
*G. Jans 1, J Vander Sloten 1, R. Gobinl , G. Van tier Perre l,
M. Y. Mommaerts 2
1Division of Biomechanics and Engineering Design,
Katholieke Universiteit Leuven, Belgium
eDivision of Maxillo-Faeial Surgery, Department of Surgery
and Cleft Palate & Craniofacial Anomalies Team, General
Hospital St Jan, Bruges, Belgium

Aim: Accurate pre-surgical planning is a prerequisite for suc-
cessful craniofacial surgery. This CAD-based planning envi-
ronment will provide the surgeon with a means to try
different techniques and get a clear view on the different
alternatives, with feedback on the feasibility of the
operation.
Methods: CT-scans of the patient are taken, and after seg-
mentation and transformation to IGES-format, are intro-
duced into a C A D system. [1] After separation of inside
and outside, a NURBS-surface of the outside of the skull is
generated since the outside is the reference surface used in
the operation room. 3-Point bending tests have been carried
out in order to introduce a database with mechanical prop-
erties of the skull into the program. [2] This enables the
program to give feedback to the surgeon during pre-surgi-
cal planning, e.g. whether a piece will break during
bending.
Results: After classification of surgical techniques into basic
actions, routines for simulation of osteotomy, translation, rota-
tion and bending have been developed The use of CAD pro-
vides the possibility to simulate actions like bending in a way
that resembles the real practice of this manipulation. Bending
is modelled as a change in curvature of a reference line on the
bone segment. Also, the information is used as input for the
mathematical model introducing the mathematical properties.
This enables the system to check whether a piece would break
during bending and advise the surgeon to make notches~ On
the other hand, the use of CAD makes accurate modelling of
the skull in reference to the face difficult due to the specific
properties of the NURBS-surfaces. Therefore, the vicerocra-
nium is visualised using voxel-shading, since this part of the
skull is not manipulated in the software, i.e. it serves as a refer-
ence base. Also, a database with reference distances is intro-
duced into the system. A first clinical case has been simulated
and the operation was successfully carried out accordingly.
Conclusion: The use of a C A D system to simulate surgery
makes it possible to implement manipulation of pieces of
the skull. Osteotomy, rotation, translation and bending can
be simulated in a realistic way.
References
1. J. Vander Sloten et al., Interactive simulation of cranial
surgery in a computer aided design environment, J. Cranio-
Maxillofacial Surgery, 24, 122-129, 1996.
2. G. Jans et al., Bending Properties of Cranial Bone Segments of
New-Born Children, Paper submitted for XIVth Congress of
the European Association of Cranio Maxillofacial Surgery,
Helsinki, 1998.
7h CT-SCAN IN ASSESSING VOLUMES O F BONE
GRAFTS TO T H E HEAVILY RESORBED M A X I L L A
B Johansson.1, A Grepe2, K Wannfors1, P Aberg s,
Dept. of Oral and Maxillofacial Surgery, Danderyds
Hospital, Danderyd, Sweden,
Dept. of Radiology2, Danderyds Hospital, Danderyd,
Sweden, Dept. of..Oral and Maxillofacial Surgery s,
Liinssjukhuset, Ostersund, Sweden.
The aims of this studywas to develop a radiological method
of assessing volumes of bone grafted to the edentulous
maxilla and to report the bone-resorption after 6-months of
healing in two bone-grafting surgical techniques. CT scan
has, in this study, been used to assess the volumes of a / b o n e
grafted to the maxillary sinus (to increase the posterior alve-
olar height) and b/bone grafted to the alveolar process (to
EACMFS - Abstracts, Helsinki Congress 1998 85
increase the alveolar width). The study included 10 patients,
totally edentulous, with a reduced amount of alveolar bone.
The donor site was the iliac crest. All patients were operate-
don using a 2-stage technique, using bilateral sinus-inlay
(SI) and buccal onlay (BO) bone-grafts bilaterally. The SI-
graft was particulated in a bone-mill and was mainly of tra-
becular origin. The BO-graft was harvested as a cortical
block. Radiographic examinations were performed postop-
eratively and after 6 months of healing, immediately before
the insertion of the implants. By CT-scan reformations of 2
mm thickness it was possible to assess the area of each slice
of reformation and to calculate the volume of grafted bone
in each region. The volume of inserted bone differed signifi-
cantly in the two groups, p <0.05. The grade of resorption in
the two groups did not differ significantly after 6 months of
healing, SI-bone-loss=48 %, (22-66 %), BO-bone-loss=53
%, (20-96%), (mean range). The two methods of treatment
showed, regarding bone-resorption after 6-months of heal-
ing, no significant changes intraindividually. This study
introduces a method of assessing bone-volumes, e.g. bone-
grafts, in an edentulous maxilla with a CT-scan technique
and presents the experience of studies of resorption after 6-
months of healing before fixture-installation, in maxillary
edentulous cases. This study was supported by grants from
the Public Dental Service, Stockholm, Sweden.
HYDROXYAPATITE CEMENT (BONESOURCE TM)
IN CRANIO-FACIAL SURGERY
Johnson PA* & Ayliffe PR
Department of Maxillofacial Surgery, Royal Surrey County
Hospital, Cruildford, Surrey, England, UK.
Aims: To determine if the new bone substitute material
BoneSourceTM could be used for reconstructing the cranio-
facial skeleton in a wide variety of clinical applications
Method: This was a clinical study. Patients presenting to the
Maxillofacial department requiring repair of bony defects or
augmentation of the cranio-facial skeleton were selected.
Standard approaches to the defects were employed and the
material was used as a cement or paste. The patients in the sam-
ple were followed up for one year. Where possible biopsies were
obtained at 2 weeks, 2 months and 6 months post operatively.
Results: The study sample contained patients requiring
cranioplasties (n = 8), augmentation of cranial defects (n =
9) frontal sinus obliteration (n = 16) and augmentation of
mid-face defects (n = 6). Complications included overfilling
of the defect (n = 1), under filling the defect (n = 1) misplac-
ing the drain (n = 1). Device related complications were
seroma following a cranioplasty (n =1) (2,6%). No grafts
were explanted due to infection despite intimate contact
with the sinuses in over 50% of cases.
Conclusions: BoneSourceTM is a synthetic bone substitute
that is dimensionally stable after placement into bony
defects of the cranio-facial skeleton. The complication rate
related to the device is low due to the inherent chemical and
synthetic properties of the material. It would appear to be
rapidly replaced by normal bone when examined histologically.
VASCULARISED PARIETAL BONE AND GALEA
IN THE RECONSTRUCTION O F THE DEFECT O F
ZYGOMATIC BONE AND ORBITAL SACCUS
Nebojsa Jovic*
86 Journal of Cranio-MaxillofacialSurgery
Clinicfor Maxillofacial Surgery, Military Medical
Academy, Belgrade, Yugoslavia
War injuries with the defects of bony and soft tissues of the
face cause great problem for satisfactory reconstruction.
In last five years flftin vascularised outer table parietal bone
and galea flaps have been performed for a variety defects of
the face.
In one case we had the combined defect of zygomatic
bone and orbital saccus. In reconstruction we used outer
table of parietal bone for the defect of zygomatic bone and
galea flap for orbital saccus.
Remarkable stability, lack of resorption and a good
esthetic result have led as to favour this method of recon-
struction for the defects like this one.
[~ THE ANTEROLATERAL T H I G H F L A P FOR
LINGUAL R E C O N S T R U C T I O N
Junquera, LM., G"-Consuegra, L., Vicente, JC., Sdnchez, J.,
Fueyo, A.
Departments of OMFS and PS, Central Hospital of
Asturias, University of Oviedo.
Aims: This paper presents the surgical anatomy of the free thigh
flap, and clinical experience in tongue reconstruction. The antero-
lateral thigh flap was first reported by Song et al (1984). At this
moment, there are three variations by which the cutaneous perfo-
rator may arrive in the anterolateral territory of the thigh.
Subject: A 65 year-old male, with a lingual squamous cell
carcinoma of the tongue, was treated initially with radio-
therapy. Two years later, a left hemiglossectomy was per-
formed due to recurrence of his pathology. One year later
glossectomy was done for a new recurrence, and a lingual
reconstruction with a free anterolateral thigh flap. The
dimensions of the flap were 15x8 cm. and the vascular pedi-
cle (descending branch of the lateral circumflex femoral
artery and two veins) had a diameter of 2 mm.
Results: The operative result was satisfactory. The vascular
pedicle are larger, longer and more constant than those of the
inguinal flaps and lower abdominal flaps. The skin quality is
high, and the donor defect can be closed by direct approxima-
tion. The points of surgical importance are: the cutaneous
perforator is very small when it traverses the vastus lateralis
muscle, therefore extra care must be taken not to injure the
vascular pedMe; the fascia lata is a very important
component.
Conclusion: The anterolateral free thigh flap is a good
method for lingual reconstruction.
MORPHOLOGICAL, FUNCTIONAL PROOF OF
T R I G E M I N A L NEURALGIA (TN)
AETIOPATHOGENESIS AND
AETIOPATHOGENETIC TREATMENT
Gintaras, Juod~balys DMS, Gintautas Sabalys, DMS, habil.
Prof
Department of Maxillofacial Surgery, Kaunas Medical
Academy, Kaunas, Lithuania
At Kaunas Academic Clinics, Maxillofacial Surgery
Department approximately 3000 patients with T N have
been treated during a 25 year period. Using histological,
immunohistochemical and electron microscopy methods,
it has been shown that nerve inflammation and degenera-
tion prevails in T N pathogenesis. It was established that
simple or allergic inflammation and dystrophy develops
dependent on the TN etiology. In TN, all structural ele-
ments of the nerve undergo morphological changes. The
morphological state of peripheral branches of the trigemi-
nal nerve reflects the clinical picture of illness which
undergoes changes depending on it's stage and duration.
With an increase in the duration of trigeminal neuralgia,
dystrophy of the nerve fibres gradually progresses,
followed by expansion and coarseness of the connective
tissue. Due to progressive dystrophic process in the distrib-
ution of the trigeminal nerve, there occurs a long lasting
afferent pathological state which determines the formation
of stable pathological foci of excitation of paroxysmal
type in the CNS.
A c c o r d i n g to the findings mentioned above, methods
were suggested for the diagnosis and a e t h i o p a t h o -
genetic treatment for T N of allergic and compressive
origin.
JET CUTTING- A M E T H O D F O R SELECTIVE
SURGICAL PREPARATION O F THE FACIAL NERVE:
AN EXPERIMENTAL STUDY.
Kaduk, W..M.H.*, Pb'hl, A., Stengel, B., Nizze,
H., Gundlach, K.K.H.
Department of OMFS, Rostock University, Rostock,
Germany
Aims: To find out the effect a water jet has on motor nerves
and wether it is a harmless to prepare the facial nerve in the
parotid gland by water jet cutting.
Method: Tissue dissection by means of the water jet tech-
nique has been advocated by several surgeons recently. In
10 Wistar rats we prepared both ischiadic nerves and
exposed only the left nerve to the jet for different times (2,
5, 10 seconds) and varius jet pressures (80, 85 and 90 bar).
After this operation the animals were monitored weekly
for 5 months in order to evaluate the function of the nerve
in comparison to the opposite side. For clinical evaluation
a scale with ten nerve function quality grades was used. 5
month postoperatively the rats were killed and the
ischiadic nerves were studied by light and electron
microscopy.
Results: Clinical evaluation revealed differences of 2.5
grades on our scale of ten marks. The best healing was
found (grade 7) in a rat that had been exposed to the
water jet using 85 bar for 2 seconds. The worst grade
(9.5) were noted in a rat that had been exposed to the jet
using 90 bar for 10 seconds. Histologically, focal axono-
tomy with signs of axon regeneration and increasing
numbers of small myelin fibres were noted, However,
there was no overt correlation to jet pressure and/or time
of exposure.
Conclusions: In this study we found that water jet pres-
sures of 85 bar and exposure times longer than 2 seconds
lead to irreversible damage to the ischiadic nerve.
F u r t h e r studies are necessary in order to find a way to
apply water jet cutting safely. In our opinion it should be
harmless on the m o t o r nerves before being used on
humans.

FACTORS I N F L U E N C I N G T H E SUCCESS RATE
O F COMBINED BONE TRANSPLANT AND
I M P L A N T TREATMENT
Kahnberg, K-E,
Department of Oral and Maxilofacial Surgery, Faculty of
Odontology, G6teborg University, GOteborg, Sweden
A large number of factors may influence the success rate of
bone transplant and implant procedures. Some of thsese
factors are more easily recognized than others.
! The surgical procedure can be performed in different
ways either one-stage or two-stage surgery. The two-
stage procedure is today more commonly used. the type
of bone transplant used may influence the outcome as
well as the healing time of the different surgical proce-
dures. The pure surgical technique is most certainly an
important factor for success.
II. The prosthodontic treatment during healing periods
of both transplant as well as implant surgery may be
one of the most crucial factors where the intermit-
tent functional mechanical chewing pressure of a
denture can end up with fixture losses as well a sloos-
ening of transplant pieces. A careful prosthetic han-
dling of the fixtures after abutment operation is
recommended as well as a temporary acrylic con-
struction during the first 6-12 months. Stabilization
of implants in transplanted bone is a slower process
and demand an extended healing time, Patients with
abnormal chewing forces or bruxism are certainly
risk patients.
IlI. The design and surface structure of the implants have
shown to influence the osseointegration effect in exper-
imental studies. A rough surface has shown to give a
larger bone to implant contact if the surface is neither
too extended nor if there is no roughness at all. A more
and rapid osseointegration should be most welcome
especially in cases demanding bone transplant proce-
dures of different kinds.
[~ PULPAL BLOOD F L O W M E A S U R E M E N T B Y
O P T I C A L R E F L E C T I O N M E T H O D - IN VIVO
TESTING
Kainulainen, E 1 ~ Alaniska, K. 1, Heikkinen, M. 2, Kopola,
H. ~, Oikarinen, K~
Department of Oral and Maxillofacial Surgery, Institute of
Dentistry, : Department of Electrical Engineering, University
of Oulu, Oulu, Finland
Aims: The aim of our study was to find out if it is possible
to measure pulpal blood flow by optical reflection method.
This method could be very usable in dental trauma cases
when following up tooths vitality.
Method: The system is based on light absorption in the pulp
similar to pulse oximetry, but the absorption is measured
from back-scattered instead of transmitted light. The
instrument senses blood flow-induced pulsations in the opti-
cal transmission of tissue and pressure variations in the
pulp. The instrument is composed of a computer, an elec-
tronic signal conditioning part, light transmitters, receiver
parts, and a fiber optic probe. For analyzing the signal from
a tooth, a reference plethysmogram is obtained from the ear
EACMFS - Abstracts, Helsinki Congress 1998 87
by an earprobe. In this study we made several in vivo tests to
compare factors which affect to the signal obtained from the
tooth. Comparative measurements of the probe design, dif-
ferent light sources and substance gels were made.
Results: The best information of the pulpal blood flow was
obtained by using the probe with a focusing micro lense, 560
nm light emitting diode as a light source and a clear sub-
stance gel between the probe and the teeth.
Conclusions: This study shows that it is possible to get reli-
able information of pulpal blood flow by optical reflection
method and could serve as a reliable method to estimate
tooth vitality.
POSTOPERATIVE SEQUELAE AFTER NASO-
O R B I T O - E T H M O I D A L (NOE) TRAUMA
Kalavrezos N.D.,
Department of Cranic)-lvIaxillofacial Surgery, University
Hospital Zurich, Switzerland
Aims: The naso-orbito-ethmoidal (NOE) region plays a
paramount role in the facial expression. Fractures of this
area demand an accurate diagnostic procedure and a pre-
cise therapeutic management, thus avoiding neglected
defects in the fragile periorbital region. A. fracture classi-
fication (5 types) in correlation with the late posttrau-
matic implications is to be established providing the
surgeon with an algorithm of the potential postoperative
sequelae.
Method: 71 patients (age range %78 years) with severe
N O E trauma treated from January 1988 to December 1995
were reviewed prospectively with a minimum follow-up of
18 months. Five types of N O E fractures were defined:
Type I isolated N O E injuries, Type II - N O E and central
midface, Type I I I - N O E central and lateral midface, Type
IV - N O E associated with craniofacial injuries. Type V -
N O E with orbital displacement. The estimated postsurgi-
cal parameters included qualitative and quantitative data
from the long term clinical and radiological evaluation.
Qualitative parameters concerning headache or migraine
and concentration difficulties were graded as non-existent,
low or moderate. The quantitative data included the esti-
mation of posttraumatic telecanthos exo/enophthalmos,
ophthalmic disturbances and weakness or paresis of cra-
nial nerves.
Results: Persistent headache and/or concentration diffi-
culties were mainly noted in fractures type II and IV
(17%). Smell reduction or anosmia reported mainly in
type IV (>75%). Disturbances of the trigeminal and/or
the facial nerve were found in type V (>55% and >28%
respectively). Enophthalmos and/or telecanthos were cor-
related with N O E injuries associated with orbital dis-
placement.
Conclusions: NOE injuries are associated with severe impli-
cations as enophthalmos, telecanthos and disturbances of
cranial nerves. Preoperative definition of the fracture type is
important for an accurate therapeutic planning in the one
stage procedure. Primary reconstruction of bone defects
and repositioning of the canthal ligaments are the surgical
keys for the tree-dimensional NOE reconstruction and the
reduction of postoperative sequelae respectively.
MANDIBULAR ORTHOGNATHIC SURGERY
USING BIODEGRADABLE POLYACTIDE FAXATION
SCREWS
88 Journal of Cranio-Maxillofacial Surgery
Kallela, L *, Laine, P.,Suuronen, R., Lindqvist, C.
Departments of OMFS, Institute of Dentistry, Department
of Surgery, Helsinki University, Helsinki, Finland
A i m s : To study the applicability of biodegradable self-rein-
forced poly-L-lactide (SR-PLLA) screws in the fixation of
bilateral sagittal split osteotomies (BSSO) of the mandible.
M e t h o d : Fifty surgical-orthodontic patients were operated
using BSSO fixed with SR-PLLA screws. No intermaxillary
fixation was used after surgery. Follow-up consisted of clin-
ical, radiological and cephalometric studies. The longest
follow-up times were 5 years.
Results: Bone healing of all osteotomies was uneventful.
Clinically no adverse reactions related to the use of biodegrad-
able screws could be detected. Cephalometric measurements
showed adequate skeletal stability. Transient osteolytic reac-
tions were seen around some of the fixation screws. The drill
channels of the screws were discernible even after 5 years.
C o n c l u s i o n s : BSSOs can be fixed using SR-PLLA screws
without intermaxillary fixation. Clinical and bone healing
after surgery is uneventful and predictable. Second opera-
tion to remove the screws can thus be avoided. The
biodegradable rate of SR-PLLA could be higher.
LAG SCREW FIXATION O F ANTERIOR
MANDIBULAR FRACTURES USING
BIODEGRADABLE POLYLACTIDE SCREWS
KalleIa L SaIo A*, Iizuka T,, Lindqvist C
In the present study lag-screw osteosynthesis of mandibular
anterior fractures was performed using biodegradable SR-
P L L A screws for internal fixation. Eleven patients having a
simple anterior mandibular fracture were operated between
May 1996 and December 1996. All fractures were displaced
and/or instable and there were no facial fractures other than
the mandibular condyle in these patients.
Two 45 mm SR-PLLA lag-screws (Bioscience, Tampere,
Finland) were placed across the fracture line from one buc-
cal cortex to the other. The first screw was placed along the
inferior border of the mandible and the second between the
first screw and apices of the lower anterior teeth.
In this study all operated fractures were consolidated
clinically at six weeks. No signs of infection, adverse wound
healing, swelling, discoloration or discharges were seen dur-
ing the follow-up of at least 6 months. Eight patients (73%)
had a neurosensory deficit in the form of slight hypesthesia
postoperatively in the lower lip and chin region that was not
present before operation. Seven of these patients regained
normal neurosensory function within six months.
Radiologically the reduction of fractures was exact in every
case. No adverse signs were seen around the screw canals.
Based on the findings in this study it can be concluded
that SR-PLLA lag screws can be used successfully in the fix-
ation of anterior mandibular fractures. However, this tech-
nique is very demanding of the surgeon and, hence, cannot
be recommended as a treatment of choice for unexperienced
surgeons.
Fh CASE REPORT O F A LARGE NASOPALATINE
DUCT CYST P R E S E N T I N G W I T H UNUSUAL
SYMPTOMS
Kanakis P.
Department of Stomatology
Red Cross GeneralHospital of Athens, GREECE
AIMS:
Presentation of a large nasopalatine duct cyst featuring
labial swelling after trauma of the upper incisor teeth, with-
out palatal swelling. Consideration on the clinical features
and the therapeutic procedure.
MATERIAL:
Male patient 28 years old presented with a painful swelling
in the region of the maxillary labial frenum. Before 1 year he
suffered trauma of the upper incisor teeth that resulted in
dislocation of the right central and lateral incisor teeth.
There was not palatal swelling. All upper incisor teeth were
vital. Radiological examination revealed the presence of a
well-defined heart-shaped radiolucency of greatest diameter
4, 2 cm. Enucleation of the cyst via labial approach due to
absence of palatal perforation was performed without api-
coeetomy of the upper incisor teeth.
RESULTS:
Two years after treatment the patient is asymptomatic and
the upper incisor teeth remain vital. Osteogenesis in the
bone cavity seems satisfactory.
CONCLUSIONS:
The routine radiological examination is mandatory in order
to prevail a nasopalatine duct cyst before reaching such size.
Proper surgical procedure even through labial approach
may leave the teeth vital. Osteogenesis without bone graft-
ing is impaired, maybe due to the development of the cyst in
a bone canal,
Fh CLINICAL AND H I S T O P A T H O L O G I C A L
OBSERVATION O F W H I T E L E S I O N S O F THE ORAL
M U C O S A - W I T H S P E C I A L REFERENCE TO
LEUKOPLAKIA
Kaneko T., Noutomi T,* Ito M. U, UcMda S, Watanabe 3/1,
Chiba H
Dept. of OMS, Tokyo Medical College, Tokyo, Japan
Since oral leukoplakia may become exacerbated. If its
course and histology show dyskeratosis in some areas of the
lesion, it is considered to be a precancerous lesion.
Recently it has been shown that the switch from normal
to cancerous cell behaviour is mediated by a gene which
controls cell proliferation and differentiation. It has been
reported that the p53 cancer suppressor gene produces
mutations in malignant lesions and causes overexpression of
mutant protein. This makes it a useful marker of malignant
or precancerous lesions.
Clinical and histopathological observations were made
on 42 cases who were selected from among the patients who
presented at the outpatient clinic of our institution in the 36
months period from January 1994 to December 1996 who
were diagnosed as having oral leukoplakia according to the
W H O diagnostic criteria and who underwent biopsy. We
carried out an immunohistological investigation of its kinet-
ics using anti-p53 protein antibody and the proliferated cell
nucleus antigen (PCNA) in leukoplakia to examine its asso-
ciation with clinical findings. The present communication is
a report of the results of our observations.

The patients diagnosed with oral leukoplakia con-
sisted of 26 males and 16 females with a mean age of 58
years (range 17-84). The lesions were located in the gin-
giva in 18 cases, tongue in 12, palate in 8, buccal mucosa
in 2, oral floor in 1 and lip in 1. The clinical and
immunohistological findings in lesions at these sites
were c o m p a r e d and assessed for clinicopathotogical
features.
@=~ A R T H R O S C O P I C ANTERO-LATERAL
C A P S U L A R RELEASE F O R INTERNAL
DERANGEMENT OF THE TEMPOROMANDIBULAR
JOINT; A SURVEY O F 100 CASES
Kaneyama, K. ,,t, Segami, IV.1, Murakami If. 2,
lizuka, 1".2
1Department of OMFS, Kanazawa Medical University,
Ishikawa, Japan
:Department of OMFS, Kyoto University, Graduate School
and Faculty of Medicine, Kyoto, Japan
Aims: The purpose was to evaluate arthroscopic surgery
with antero-lateral capsular release employing Holmium:
YAG laser or electric cautery for internal derangement of
the temporomandibular joint (TMJ).
Materials and Method: One hundred cases (123 joints) with
painful hypomobility of the TMJ were treated arthroscopi-
cally who had resisted to previous non-surgical treatments.
The patients were 6 males and 94 females, with an average
age of 39.6 years (13-69), and had a locking duration of 16.5
months (1-120) on average. Preoperatively, the average
interincisal opening degree was 31.3mm (18-48), with mod-
erate to severe arthralgia in 106 joints. The procedure con-
sisted of antero-lateral capsular release and lateral
eminencia release using Holmium: YAG laser or electric
cautery.
Results: At 9.7 months mean follow-up period, the average
interincisal opening degree was 42.7mm. The arthralgia
recovered to painless in 81 joints, slight in 35 joints.
According to our criteria, the surgical success rate were
95.9%, being excellent in 109 joints, good in 9 joints, and
failure in 5 joints, respectively.
Conclusions: Arthroscopic surgery with antero-lateral cap-
sular release and lateral eminencia release using Holmium:
YAG laser or electric cautery for internal derangement of
the TMJ might be more effective compared to the proce-
dures formerly reported.
FREE L I P O D E R M A L GRAFTS
Irene Karabouta- Voulgaropoulou
Dept. of Oral and Maxillofacial Surgery, Dental School
Aristoteles University of Thessaloniki, Thessaloniki,
Greece
The free lipodermal grafts are used for soft tissues recon-
struction in the wide maxillofacial area. They are considered
as good grafts because of their constancy in vessels, fat and
EACMFS - Abstracts, Helsinki Congress 1998 89
especially in dermis which supports them and is well con-
nected with the surrounding tissues. In this work the use and
application of free lipodermal grafts are presented.
Especially, the indications, the surgical technique, the imme-
diate and postsurgical results out of our patients are dis-
cussed in depth and our experience as well. These grafts are
recommended to be used as immediate reconstruction in
extraoral and / or intraoral defects.
H E M I F A C I A L M I C R O S O M I A - CONVENTIONAL
SURGERY OR DISTRACTION?
Irene Karabouta- Voulgaropoulou
Dept. of Oral and Maxillofacial Surgery, Dental School
Aristoteles University of Thessalonika, Thessalonika,
Greece.
Hemifacial microsomia is a congenital condition which can
be reconstructed surgically. The surgical procedure includes
elongation of the affected part of the mandible by orthog-
nathic surgery and correction of the face by other recon-
structive techniques. Recently a new method has been
applied in such cases, well known as bone distraction, and
the published results are considered successful. In this pre-
sentation the advantages and disadvantages of both meth-
ods are discussed, based on the personal experience of
cases.
DISTRACTION TECHNIQUES A P P L I E D IN THE
LOWER AND M I D D L E THIRD O F THE FACE
Karakasis D*., Dimitrakopoulos L, Lazaridis IV.
The distraction techniques have already proved their value
in the treatment of facial hypoplasia, as well as in the recon-
struction of osseous defects of the mandible. During the
last two years we have used distraction techniques in
selected clinical cases. This paper will present case reports
demonstrating our experience and surgical techniques based
on this relatively new principle, as it has been applied to our
patients. We may conclude stressing the revolutionary
change of our treatment modalities in many of the common
maxillofacial surgical problems.
AESTHETIC AND F U N C T I O N A L
RECONSTRUCTION O F FRONTONASAL-
E T H M O I D - Z Y G O M A X I L L A R Y FRACTURES
*Malchikova L.P., Karpova E.L, *Vissarionov V.A.,
Sakovich EP.,
The Urals State Medical Academy, Ekaterinburg, Russia
The reconstruction of facial and medullar bone fractures
implies the reposition and fixation of facial, nasal, orbital,
zygomatic and maxillary bones, dealing with telecanthus
and enophthalmos, the recovery of nasal respiration, vision
and chewing function.
90 Journal of Cranio-Maxillofacial Surgery
The patients admitted to our clinic were subdivided into 2
groups and 1 subgroup according to J. Raveh's classification
(1992). Group 1 consisted of 18 patients with nasal, frontal, eth-
moid, zygomatic and maxillary fractures, including a subgroup
(la) of 3 patients with the optic nerve impairment in the bony
canal and total loss of vision. Group 2 consisted of 5 patients
with the above fractures of immobile facial bones, dura mater
impairment and marked nasal liquorrhea. Computer tomogra-
phy provided valuable diagnostic information and made it pos-
sible to choose an optimal approach to surgical treatment. The
patients of group 1 underwent fragments reposition and fixa-
tion with mini-plates, telecanthus removal and nasolacrimal
canal creation. Besides fragments reposition and fixation, the
patients of group 2 had their enophthalmos closed with tempo-
ral muscular-fascial flap. We used a bicoronary and hypociliary
accesses providing a simultaneous dissection of excessive skin of
the forehead and eyelids along with the main procedure. This
gave a higher aesthetic effect of our treatment.
THE MUCOCUTANEUS FORM OF BEH~ET'S
DISEASE- A CASE REPORT
Kassan, E.* Reuter, E, Miihler, A.
Department of Oral and Maxillo - Facial Surgery
Bremerhaven, Germany
Department of Dermatology, ZKH Reinkenheide,
Bremerhaven, Germany
Morbus Behcet is a seldom encountered disease in western
Europe, oral aphthosis being a main symptom, Minor
symptoms include genital ulcerations, sterile pustulas, sterile
infections of the eyes and superficial thrombophlebitis as
well as a positive pathergic-phenomenon.
In the presented case the medical history of the 74 year old
male patient revealed recurrent oral aphthosis. At the time of
admission to hospital the clinical examination revealed the
major type of oral aphthosis, situated in the soft palate and
the palatoglossal arch. Furthermore, the skin of the neck and
chest showed about a dozen palpable, infiltrated papules, most
of them with a central sterile pustule. There were no signs of
genital ulceration, thrombophlebitis or involvement of the
eyes.Labaratory findings were unspectacular except for a
raised PSA (27,5 ug/1,normal value 0 - 4 ug/I). Further investi-
gations included bone scintigraphy, contrast radiography of
the colon, oesophago-gastro-duodenoscopy, x-ray of the lung
and ultrasonic investigation of the abdomen, all without fur-
ther pathological results. A neurological evaluation reported a
normal status.The urological examination revealed an
enlarged prostate, the result of the biopsy is still expected.
We started cortisone - medication with 20 mg Decortin
H per day. Under this therapy the symptoms had almost
vanished to date. A close follow - up is planned.
The case presented emphasises the need for a thorough
examination when encountering oral aphthosis, especially if
located in the posterior part of the oral cavity.
CLINICAL EVALUATION OF TNIJ
ARTHROSCOPIC SURGERY INCLUDING USE OF
THE H O L M I U M YAG LASER FOR
T E M P O R O M A N D I B U L A R J O I N T DISORDERS
Kawakami, T., Tsuzuki, M., Fujita, H., Sugimura, M.
Department of OMFS, Nara Medical University, Nara, Japan
Aims: To evaluate the results of arthroscopic surgery (lysis
and lavage) of the upper compartment of the TMJ, which
was a minimally invasive surgical procedure including use of
the Holmium: YAG laser.
Method: Arthroscopic surgery is indicated for the surgical
treatment of TMJ intracapsular disorders that have not
been resolved by properly performed nonsurgical modali-
ties. We used Holmium: YAG laser irradiation passed
through a quartz fibre (Versa Pulse Select 22TM, COHER-
RENT) in order to remove adhesions, lateral ligament
release, and arthroplasty.
Results: The average setting of the Holmium: YAG laser was
approximately 1.0 J. and 10 - 15 pulse/see increments. TMJ
arthroscopic surgery was performed on forty two cases, (fifty
one joints). According to the criteria of the American Society
of Oral and Maxillofacial Surgery, the surgical success rate
was 97. l%. No surgical complications were encountered.
Conclusion: The Holmium:YAG laser was evaluated with
respect to its safety. It is a minimally invasive procedure in
TMJ arthroscopic surgery.
PURULENT SOFT TISSUE INFECTIONS OF THE
HEAD AND NECK. AN INTERDISCIPLINARY STUDY
Keller, (7. O. * 1, Feifel, H l, Jiirgens, D. 2, Riediger, 1).
1Department of Oral, Maxillofacial and Plastic Facial Surgery,
:Department of Otorhinolaryngology and Plastic Head and
Neck Surgery, University of Technology, Aachen, Germany
AIM:
According to earlier investigations on oral and maxillofacial
patients, 88-94% of all soft-tissue infections of the head and
neck area are of odontogenic origin [1-3]. Relevant mecha-
nisms and frequencies of infections in oto-rhinolaryngo-
logic cases were not taken into account. The present study
was to investigate the parameters mentioned, studying
patients of both specialities.
PATIENTS AND METHODS:
2,565 oral and maxillofacial surgery (omfs) patients and 413
otorhinolaryngologic (orl) patients underwent surgical ther-
apy of a purulent soft-tissue infection between Jan. 1992 and
Dec.1996. 177 of the omfs patients (6.9 %) and 354 of the
orl patients (85.7 %) had a deep space abscess. 262 patients
with infiltrates were not included.
RESULTS:
The clinical histories of 92 % and 82 % respectively of omfs
and orl patients having deep space infections could be eval-
uated with regard to cause (48.8 % tonsillogenic, 31.6 %
dentogenic, 12.5 % non-dentogenic, 7.0 % unknown), fre-
quency and localisation of the abscess (peritonsillar 45.2 %,
submandibular 1 0 . 1 % , perimandibular 6.9 %, para-
/retropharyngeal 5.0 %, submental 4.0 %, paramandibular
7.9 %, pterygomandibular 3.6 %, buccal 3.8 %, others
13.5 %). The figures given were differentiated for the single
specialities.
CONCLUSIONS:
Only 6.9 % of omfs patients with purulent soft-tissue infec-
tions (in contrast to 85.7 % of orl patients with purulent
soft-tissue infections) had a deep space infection. The
above-mentioned frequency and causes of soft-tissue infec-
tions in the head and neck area have to be corrected when
an interdisciplinary approach applies. In a combined omfs

and orl case material of patients with deep space infections,
the tonsillogenic causes (49 %) predominate in relation to
the odontogenic causes (32 %). In cases where the cause of
soft-tissue infection is not easily identifiable, the neighbour-
ing discipline needs to be examined.
References
AndrS,A. et al.: Grundlagen der Kieferchirurgie. VEB Volk und
Gesundheit, Berlin (1973); Pape H.-D. et al.: Fortschr Kiefer
Gesichtschir 24:86-88 (1984); 3. Schmelzle R., Schwenzer N.:
Zahn-Mund-Kiefer-Heilkunde, Bd. 1, Thieme, Stuttgart (1981).
S U R P R I S I N G H E A L I N G AND REGENERATION O F
THE MANDIBULAR CONDYLE IN A CASE O F
EOSINOPHILIC GRANULOMA
JK Kellokoski*, P Sainio, MA Lamberg.
Oral and Maxillofacial Department, Kuopio University
Hospital and Department of Oral Pathology, Radiology and
Forensic Odontology, University of Kuopio, Kuopio, Finland.
A case with almost total destruction of the mandibular
condyle and its complete regeneration and remodelling
without any "real" treatment is presented. The differential
diagnosis of this benign but originally suspected of being a
malignant lesion will be discussed.
An otherwise healthy 12-year-old girl was referred to our
clinic because of swelling and tenderness around her right
TMJ. Orthopantomograph, CT and M R I revealed a destruc-
tive process involving the right condyle. Scintigraphy showed
a hot spot in that area but nowhere else in the body. A tenta-
tive diagnosis of malignancy or osteomyelitis was made.
The joint was explored surgically and generously biop-
sied, after which nearly nothing of the joint was left. The
pathology report showed granulation tissue with an intense
infiltration of inflammatory but no malignant cells. The ini-
tial diagnosis of the lesion was osteomyelitis. Later, immuno-
histochemistry confirmed a final diagnosis of eosinophilic
granuloma. The patient received no other treatment but the
biopsy and antibiotics (netilmycin, clindamycin). When
condyle reconstruction with a costo-chondral graft was
planned after 6 weeks, radiographs surprisingly revealed
considerable healing in the TMJ. Therefore, no further oper-
ation was performed. Five months after surgical exploration
the right condyle appeared almost normal on X-ray and the
patient was symptom free.
Eosinophilic granuloma (EG) is a solitary and the least seri-
ous lesion of the Langerhans cell histiocytoses, affecting mainly
older children and young adults. Prognosis is very good for uni-
focal skeletal system disease, but poor for multifocal involve-
ment of tissues other than bone. The treatment of choice is
surgical excision. Though rare, EG should be included in the differ-
ential diagnosis of diffuse osteolytic lesions of the head and neck.
RESULTS OF TRANSCRANIAL AND SUBCRANIAL
M A N A G E M E N T OF I N J U R I E S O F T H E
N A S O E T H M O I D - O R B I T A L R E G I O N ASSOCIATED
W I T H MIDFACIAL FRACTURES
Kessler P., Hardt N.
Klinik fiir Mund-, Kiefer- und Gesichtschirurgie,
Kantonsspital Luzern, Switzerland
EACMFS - Abstracts, Helsinki Congress 1998 91
AIMS:
Injuries of the nasoethmoid-orbital region are in over 90%
of all cases combined with neurocranial or subcranial frac-
tures. Fractures of the skull base run in up to 70% through
the roof of the ethmoidal bone or the lamina cribrosa.
There are alternative surgical approaches for the treatment
of these complex fractures. We want to prove that the tran-
scranial approach has major advantages in comparison with
the subcranial surgical access.
METHOD:
Between 1990 and 1997 50 patients with fractures of the
nasoethmoid-orbital region were treated and followed up in
the Klinik ffir MKG-Chirurgie, Kantonsspital Luzern. 25
patients had suffered combined fractures of the nasoeth-
moidal region and the skull base and were operated on via
a transcranial approach. 25 patients without frontobasal
fractures were managed by subcranial incisions. Clinical
and radiological follow-up were continued for up to four
years.
RESULTS:
There was no case of intracranial and ethmoidal infection
or secondary liquorrhea. Repneumatisation, ventilation and
drainage of the aerated cell system of the ethmoidal bone
even in dislocated, eomminuted ethmoidal bone fractures
could be proven.
CONCLUSIONS:
The transcranial approach allows for sufficient surveil-
lance and treatment of complex fractures of the midface
and anterior skull base. It renders a general view for neuro-
surgical injuries. The primary ethmoidectomy is not
necessary.
RESULTS O F SIMULTANEOUS O S T E O T O M I E S IN
O R T H O G N A T H I C SURGERY
Khachatryan G.E., Badalian K. A. *,
Maxillo-Facial Surgery Department, Mikaelyan Surgical
Institute, Yerevan, Armenia.
Aims: To conduct simultaneous osteotomies in orthognathic
surgery by the method of Delaire.
Methods: 75 patients have undergone operations since 1990
for different forms of anomalies of facial skull. The ethio-
logical factors were anomalies of development, traumas,
sepsises and morpho-functional disorders. There were 20
children, 40 women and 15 men. The main diagnostic
method for defining indications and the choice of methods
of simultaneous restorations of aesthetic and functional
aspects were architectural analysis of the profile
roentgenogram according to Delaire (1988). The diagnostic
method revealed that 78% of our patients demanded com-
bined approach. 128 operations in different combinations
have been performed.
Results: Bimaxillar fixation was for 3-4 weeks. Currently we
are also using rigid fixation. We got both aesthetic and
functional good results. Secondary application of bimaxil-
lar fixation was needed in 2 cases for preventing
dislocation.
Conelnsions: As a result, the method of Delaire (1988) used
by us gives good functional and aesthetic results and pre-
vents development of relapse.
92 Journal of Cranio-MaxillofacialSurgery
EXPERIMENTAL STUDY O F SUBMERGING
T E C H N I Q U E IN AUTOGENOUS SKIN G R A F T I N G
Khomieh S*., MDD, Chudakov O.P.
Minsk, Belarus.
Introduction: The problem of the most favourable condi-
tions for widely used in maxillo-facial and plastic surgery
free autogenous skin graft integration is one of the chal-
lenges in recent scientific research. We studied morpho-
physiologic features of the grafts transplanted under
unusual conditions of submerging under the skin on experi-
mental animals.
Materials and Methods: Histologic structure, epidermis pro-
liferation features of the autogenous skin graft submerged
under the skin during the process of healing were studied
on 51 guinea pigs. Healing graft tissues lxl,5 cm of size
were taken at 3, 7, 14, 20 and 30 day after the transplanta-
tion. Paraffin sections 6 pm thick were dyed with hema-
toxylline-eosine. The mitotic processes count per 2000
epidermis basal cells was done as well as sprout, granular
and cornual layers measurements.
Results: Both necrotic and regeneration changes in the graft
were noted on the 3rd postoperative day. At this period
epithelium was 32,79+2,94 gm thick and had 3 or 4 cellular
layers. Mitotic index (MI) proved to be 4,67%0. On the 7th
day it was 52,95+0,7 gm thick and had 5 or 6 cellular layers.
MI was 14,72%o.On the 14th day postoperatively the epithe-
lium morphologic structure was much better than that in
case of the common methods of transplantation. It was
110,85+0,58 gm thick containing 12 or 13 layers of cells, MI
being 15,98%0. On the 20th and 30th day all the grafts
appeared to be well developed and viable, their epidermis
being 58,6+0,68 or 55,45+0,9 gin thick with 6 cellular lay-
ers. M I at this period equalled to 5,4%0.
Conclusions: Histologic study of the grafts transplanted
using the method of submerging showed high morpho-
physiologic epithelium surface quantitative values. The
transplantation method of submerging significantly
improves healing and viability of the grafts.
IN VIVO FABRICATION O F VASCULARISED
TISSUE S C A F F O L D S F O R TISSUE E N G I N E E R I N G
Miller MJM, Khoo AKM*,RC Thomson, JC Lemon, Gurlek
Ali, Mikos AG
Department of Plastic Surgery, University of Texas MD
Anderson Cancer Center, Institute of Bioengineering and
Biosciences, Rice University, Houston, Texas, USA
Purpose: A major obstacle to controlled generation of vas-
cularised tissues using cell transplantation is the require-
ment for a vascularised scaffolding able to sustain large
numbers of cells in 3 dimensions. We hypothesize that such
a scaffold may be created in vivo using an implanted device
designed to guide growth of a vascularised tissue stroma
whilst preserving multiple channels that are accessible for
cell delivery.
Method: Tissue Fabrication System(TFS): The system con-
sists of two units: an implantable device and an injection
manifold. The implantable device consists of a rectangular
chamber enclosed on 5 sides.The chamber contains a
removable channel assembly made of an array of stainless
steel tubules and porous wafers of poly(lactic-co-glycolic)
acid(PLGA) polymer. The device is implanted in vivo adja-
cent to a source of vascularised tissue. After a period
allowed for tissue ingrowth, the chamber is removed and a
suspension of cells or other bioactive particles is introduced
using the injection manifold. In Vivo Study: Five TFS
devices were implanted in 6 mature domestic sheep adjacent
to the periosteum, dermis, fascia or muscle. After 6-8 weeks
in vivo, the chambers were removed and the needle assem-
blies were injected with a solution of microspheres or cul-
tured autologous bone marrow stromal cells. Specimens
receiving bone marrow cells were left in vivo for another 7
days.
Results: Tissue was present in all chambers placed against
each vascular source. Channels were present in all tissue
specimens. It was possible to fill the channels with bioac-
tive material using the injection manifold. On histological
examination, tissue arising from each vascular source was
seen surrounding each channel void space bringing abun-
dant vascularity within the maximum diffusion distance
required for cell survival within the channels.
Conclusions: An implanted TFS designed as in this study
can create a vascularised tissue scaffolding in vivo from a
variety of sources suitable for delivery of cells and other
bioactive materials possibly allowing controlled generation
of new tissues suitable for transfer as free flaps.
A CLINICAL STUDY ON THE REMOVAL O F
TITANIUM-THREADED E N D O S S E O U S I M P L A N T S
PLACED IN THE P O S T E R I O R MANDIBLE
Dae-Sung Kim, Myung-Rae Kim, Chung Kim
Dept.of Oral Surgery, Ewha Womans University, Seoul,
Korea
Aims : This is to evaluate the prognosis of dental implants
installated in the posterior mandible and to know the possi-
ble related factors leading to failure.
Materials & Methods : 361 implants (121 patients) support-
ing bridges of lower posterior regions were examined for 6
months - 5 years after loading. The clincal data were
reviewed retrospectively and compared by continuity
adjunctive chi-square test and t-test.
Results : Of 361 fixtures, 5.8% were removed in 5 years. No sig-
nificant difference in the removal between male and female.
Higher failure was noted in the age group of riffles than in the
forties; 13.1% vs 3.8% (p<o.ol). The group of ASA II were
significantly high-related with failure than in ASA I. The num-
ber of hnplants are more, the failure appeared higher. Type IV
reveaed failure in 19.7% (13153), 3.3% in Type III and none in
Type II & I. Failure with reference to stage appeared 38.1% at
the time of uncovering, 28.6% at temporary loading phase,
19.0% during healing phase, and14.3% after final prosthesis.
The suspected causes are infection 19%, overloading 19%, but
unidentified 62%.
Conclusions; Bone grafts may not be related with failures,
while bone quality must be related with failure of osseointe-
gration. Half of all failures were non-integration found
before uncovering. Infection and poor primary stability are
considered to be main causes of implant lost.
References
Sehliephake H., et al; Survival Analysis of Endosseous
Implants in Bone Grafts Used for the Treatment of Severe
Alveolar Ridge Atrophy. J OMS 55:1227, 1997

IS THERE A M A G I C F I G U R E C O N C E R N I N G THE
REQUISITE A M O U N T O F MANDIBULAR
R E S E C T I O N IN ORAL CANCER TREATMENT?
Kim, H.*, Winter, W., Ehrenfeld, M.
*Department of OMFS, Yonsei University, Seoul, Korea
Department of OMFS, Ludwig-Maximilians University,
Munich, Germany
Aim: To establish a logical treatment plan for the extent of
mandibular resection without leaving residual disease or
causing needless defects.
Method: A literature review was carefully carried out to
identify essential considerations relating to the diagnosis
and treatment of oral cancer in proximity to or involving
the mandible. Retrospective analysis of the clinical and
radiological considerations, and histological reinvestiga-
tions were successively conducted to verify the details of
clinical and radiological considerations.
Result: The following are considered essential for planning
logical resection. Clinical, radiological and scintigraphic
findings/presence or absence of teeth at tumor site/location
of tumour/sizes of tumour measured both on soft and hard
tissues/sensory deficit of inferior alveolar nerve/lowest
height of mandible at site of tumour.
Conclusion: A protocol to determine the requisite amount of
mandibular resection in oral cancer treatment with respect
to both vertical and horizontal dimensions was provided by
a review of the literature and a retrospective study. It seems
that the protocol is also applicable to a prospective study.
SUBANTRAL AUGMENTATION W I T H
AUTOGENOUS ILIAC BLOCK BONE GRAFT F O R
SIMULTANEOUS I M P L A N T INSTALLATION
Kim KW* Kim MJ**, Yu S J**, Nam IW**, Kim JW**. *
Dept. of OMFS, Collegeof Medicine, Chungbuk National
Univ., Chung]u, Korea. ** Dept. of OMFS, Collegeof
Dentistry, Seoul National Univ., Seoul, Korea
Aims: To develope the method of subantral augmentation
with autogenous iliac block bone graft for simultaneous
implant installation.
Method: When residual alveolar bone height of an edentu-
lous posterior maxilla is less than 5mm, we have used auto-
genous iliac block bone for subantral augmentation. In
some cases showing a skeletal class III relationship,
advancement of the maxilla using a Le Fort I osteotomy
may be considered, when simultaneous implant installation
and sinus lifting with interpositional block bone graft are
performed.
Results: We applied these procedures to 31 sinuses, in 24
patients and 94 screw type implant fixtures were installed.
Also, Le Fort I osteotomy with an interpositional bone graft
in 4 patient and 22 fixtures, were installed simultaneously,
from 1992 to October 1996. The mean follow-up period is 2
years 5months (range, 6 months to 5 years). And only one
fixture among 95 implants installed was removed and another
one fixture was submerged (success rate : 97.9%) and 4 fix-
tures among 22 fixtures, installed simultaneously with the Le
fort I osteotomy, were removed ( success rate : 81.8%) and the
others showed satisfactory results aesthetically and
functionally.
EACMFS -Abstracts, Helsinki Congress 1998 93
Conclusions: According to this study, subantral augmenta-
tion with an autogenous iliac bone graft and simultaneous
implant installation can be used.
COMBINED LE FORT II AND LE FORT I
O S T E O T O M Y F O R C O R R E C T I O N O F MIDFACE
DEFORMITY: T H E RATIONALE AND TECHNIQUE
Kim, M.J.* Kim, S.K., Yi, A.N., Jung, K.Y., Nam. LW.
Department of OMFS, Collegeof Dentistry, Seoul National
University, Seoul, Korea
AIMS:
The Le Fort II osteotomy is a useful method for correction
of midface deformity, particularly for patients with midface
hypoplasia as frequently seen in the Mongolian races. Some
patients, however, require differential movement of the mid-
face and the dentoalveolar complex, combining the Le Fort
II with the Le Fort I osteotomy. This is especially true for
patients with complex deviation of the maxillary occlusal
plane or with asymmetric deformity on the midface. This
presentation describes the rationale, technique and results
of the combined Le Fort II and Le Fort I osteotomy.
METHODS:
Ten patients have been treated in our clinic in various cases of
facial deformity combined with nasomaxillary abnormalities.
The skeletal stability following this osteotomy was evaluated.
RESULTS:
The average relapse rate (12.5%) at 1 year postoperatively
after combined osteotomy was slightly greater than that
after Le Fort II osteotomy (11.5%).
CONCLUSIONS:
By using this methods, we can overcome many disadvan-
tages of Le Fort I or Le Fort II osteotomy as a single modal-
ity and we can observe that the skeletal stability of
combined Le Fort II and Le Fort I osteotomy is adequate
compared to other procedures.
[~ SURVIVAL O F THE E N D O S S E O U S DENTAL
I M P L A N T S PLACED W I T H I N BONE GRAFTS
Myung-Rae Kim, DS Kim, JH Oh, SH Cheong
Ewha University Mokdong Hosp, Seoul, Korea
Aims: This to evaluate the prognosis of osseo-integrated
dental implants placed with or in bone grafts comparing the
survival rate of endosseous implants installated in non-graft
alveolar bones.
Materials & Methods; Of 106 titanium threaded
endosseous implants, 26 fixtures were installated in the
reconstructed mandible or maxilla and 80 fixtures were
placed simultaneously with bone grafts. They were followed
up for over 6 months thru 5 years after temporary loading.
RESULTS;
1) Of 106 endosseous implants placed in/with bone grafts,
98 fixtures (92.5%) were followed as successful in function
after 3 years.
94 Journal of Cranio-Maxillofacial Surgery
2) 96% (25/26) of implants placed in 6 months after recon-
struction of mandible or maxilla with bone grafts were suc-
cessful to support dental prostheses.
3) Of 80 fixtures installed simultaneously with bone grafts,
73 implants (91%) were osseointegrated and supported the
prostheses in 3 years.
4) Delayed implantation in 6-9 months after bone grafts
were successful in 92%, while simultaneous installation
resulted successful in 93%(75/81).
Delayed implantation with autogenous bone grafts are
considered to be most desirable option to raise the osseoin-
tegration rate, and bone substitutes could not be indicated
to support the implant-prostheses.
Conclusion: Titanium threaded implants placed with bone
grafts and installated later into the grafted bone are both
considered to be acceptable option to augment the bony
defects, but delayed implantation resulted higher success in
osseointegration and in function.
References
1. Adell R, Lekholm U; Reconstruction of Severlyresorbed
edentulous maxillae using OI fixtures in immediate
autogenous bone grafts, IIOMI 5:233, 1990
2. Schliephake H, et al; Survival analysis of endosseous implants
in bone grafts used for the treatment of severe alveolar ridge
atrophy, JOM 55:1227, 1997
EPINEUROTOMY AND TUBULIZATION FOR
PAINFUL DYSESTHESIA F O L L O W E D AFTER
I M P L A N T SURGERY; REVIEW OF CASES
Myung-Rae Kim, Won-Ho Lee, DS Kim
Dept.of Oral Surgery, Ewha Womans University, Seoul,
Korea
Aims: This is to review the painful dysesthesia caused by
implant surgeries and to evaluate the effect of epineurotomy
& entubulation with e-PTFE.
Materials & Methods: Three patients who had history of
nerve penetration during the implant installation. Two
IANs had be repaired by epineurotomy and entubulation
with e-PTFE in 18 months after injuries, and one was
undergone within 2 months. They were examined periodi-
cally by clinical neurologic examinations (SLT, MLTD,
2PD, PPN, TD and VAS), electro-physiologic studies
(Sensory Evoked Potential) and thermographs (Digital
Infrared Thermal Images) before and after the micro-neuro-
surgery.
Results: Microscopic examination disclosed neuro-fibroma-
tous changed surrounding regenerated neural bundles. Two
patients waited for over 18 months presents pain-reduced
but dysesthesia persisted, while one patient undergone
microsurgeries within 2 months revealed marked improve-
ment in sesory tests and self assessment.
Conclusion: Epineurotomy & tubulization with e-PTFE
membrane could not be a good option to regain the sensory
recovery of the I A N presenting painful dysesthesia follow-
ing the implant surgeries unless the microsurgical explo-
ration was done within 3 months after trauma.
References
1. KenjiWH; Incidence of nerve injury after implant placement,
JOMS 53:264, 1995
2. MR Kim; Regeneration of the mandibular nerve in e-PTFE
tubes, JOMS 55(8) supp.3, 1997
ZINC- AND VITAMIN A-DEFICIENCY IN
PATIENTS W I T H ORAL PREMALIGNANCIES
Kleier, C.*, Werkmeister, R., Kleinheinz, J., Joos, U.,
Cranio-Maxillofacial Surgery, University of Muenster,
Germany
Aims: The purpose of this study was the evaluation of zinc-
and vitamin A- pathway disturbances in patients with oral
malignancies, as they are important for the regeneration of
the oral mucosa (Hogan 1979, Allen 1982). In deficiencies
hyperkeratoses, a disturbed immunosystem and a higher inci-
dence of oral malignancies have been reported (Wald 1980).
Method: In this study blood samples were taken from 40
patients with oral lichen planus, 40 with oral leukoplakia, 40
with oral squamous cell carcinoma (OSCC) and 40 in a con-
trol group. Besides routine blood analysis serum levels of
zinc (Zn), vitamin A (Vit A) and retinol binding protein
(RBP) were evaluated.
Results: Mean values in lichen ruber planus were Zn 806
gg/1, RBP 5,09 mg/dl and Vit A 672 ng/ml, in leukoplakia
Zn 706 gg/1, RBP 4,12 mg/dl, and Vit A 613 ng/ml and in
OSCC Zn 641 gg/1, RBP 3,68 mg/dl and Vit A 581 ng/ml. In
comparison to the control group patients with lichen ruber
planus showed no statistically significant differences. In
leukoplakia patients there were statistically lower values for
Zn and Vit A compared to the control group (p<0,01).
Patients with oral malignancies showed lower serum levels
for Zn, RBP and Vit A (p<0,01).
Conclusions: In patients with oral premalignancies and Zn-,
RBP- and Vit A-deficiency a substitution of Zn and Vit A
must be considered.
RECONSTRUCTION OF LARGE ANTERIOR
MANDIBULAR DEFECTS AFTER TUMOR
RESECTION USING THE BONE TRANSPORT
TECHNIQUE
*Klein, C., M.D., D.M.D.; Walendzik, H., M.D.
1Department of Maxillofacial Plastic Surgery, University of
Frankfurt, Medical School, Theodor-Stern-Kai 7, D-60590
Frankfurt am Main
The reconstruction of large mandibular defects after
turnout resection or traumatic loss is always a challenge.
Only microsurgical grafting, commonly iliac crest, fibula or
scapula, guarantee the stability of the volume. This major
surgical procedure often needs blood transfusion, the in-
patient course is prolonged. Additionally the patient may
suffer from the donorsite morbidity. An alternative proce-
dure for the reconstruction of bony defects which avoids
these drawbacks is the bone-transport which is based on
Ilizarov's technique for segmental bone movement. In ani-
mal and clinical studies, the applicability in the craniofacial
skeleton has already been demonstrated in principle. Until
now, inadequate devices have prevented the successful use of
this technique. In 1994, we had performed our first clinical
case with the help of a self-constructed device using parts of
two different distractors from hand surgery. Based on this
successful clinical experience, together with the Normed

company (Tuttlingen/Germany) we built a new u-bow which
allows the possibility of simultaneous movement of different
bone segments and to stabilize each of them independently.
We present now our first five patients in whom we used this
new device. All patients had undergone ablative tumour
surgery previously, creating mandibular defects about 4 to 9
cm. Three of the patients suffered from a large symphyseal
defect, two patients had had a lateral mandibular resection.
Using the segmental bone movement, in all patients the bony
defect was closed successfully. The bone transport system and
the surgical technique are shown and the results are discussed
There were no major complications. We believe that the bone-
transport will be an useful alternative for mandibular recon-
struction with micro-surgically reanstomosed bone grafts.
A N E W THREE D I M E N S I O N A L M E T H O D TO
ILLUSTRATE LIP A N D PALATE CLEFTS OF
CHILDREN
O. Knauer, A. Hemprich, W. Eichhorn *
Clinic of Maxillofacial sm~ery, University of Leipzig
Niirnberger Strafie 57, D - 04103 Leipzig
* Department of Maxillofacial surgery, Kreiskliniken
Balingen
Aims Developement of a three dimensional illustration of
lip and palate clefts of children without exposing the patient
to any radiation
Method We developed a new method to in a way. In combi-
nation with impressions of the nasal cavity, intra oral and
face moulages we recieved an exact pathologic reconstruc-
tion of the craniofacial deseases. These three dimensional
reconstructions were exposed a CT-Scan and afterwards the
data were visualized with the help of the advanced software
IDL (Inter Data Language version 4.0). This method gave
us the possibility to plan and prepare the operations more
precise than before at the computer. Our method is based on
the idea of computer-assisted surgery and the avoidance of
any radiation for the patients.
D FIXATION O F MANDIBULARY AND MAXILLARY
FRACTURES W I T H RESORBABLE M E S H E S - IS
THERE E N O U G H STABLILITY?
Knauf U., Bschorer R.
Klinikum Schwerin, Departement of OMFS, Wismarsche
Strafle 397, 19049 Schwerin, Germany
INTRODUCTION:
First experiences with resorbable miniplates were shown by
few authors using the technique only in regions of less stress
and function e.g. fractures of the skull, fractures of the
frontal sinus and fractures of the zygoma.
METHOD:
We treated 20 patients with mandibulary and maxillary frac-
tures and compared the result to 20 patients treated with
titanium miniplates.
RESULTS:
Nevertheless costs of the resorbable plates are high, the
overall treatment costs were low. The additional removal of
plates is avoided. Healing showed complicated in one
EACMFS - Abstracts, Helsinki Congress 1998 95
patient with a comminuted fracture of the maxilla. In this
case a small necrosis of the bone with loss of the teeth was
observed while using the resorbable mesh.
CONCLUSION:
Mayby early revascularysation was delayed due the covering
of the bone surface. All other patients treated with the
resorbable mesh showed no complications and the fixation
proofed to be stable enough for early training functioning.
[h TYPE-II P R O C O L L A G E N C-PEPTIDE
EXPRESSION O F THE H U M A N T M J DISCS
Kondoh, Z * , Kunou, H., **Kikuchi, T., **Fujikawa, K.,
Seto, K.
15grst Department of Oral and Maxillofacial Surgery,
Z~urumi University, Yokohama, Japan. and ** Department
of Orthopedic Surgery, National Defense Medical College,
Tokorozawa, Japan.
Aims: To determine the chondrocytic phenotype of human
TMJ disc cells. We studied to expression of type-II procolla-
gen C-peptide on TMJ discs obtained from fresh cadavers.
Materials and Methods: Twelve grossly normal discs were
obtained from the fresh cadavers. All samples were fixed in
10% buffered formalin, segmented sagittaly, embedded, and
continuously sectioned. The specimens were stained conven-
tionally with H-E stain and observed under microscope. And
as indices of collagen metabolism of the disc cells, the local
distribution of type -II collagen and type-II procollagen C-
peptide (chondrocalcin) were studied immunohistochemically.
Results and Conclusion: Type -II collagen and type-II pro-
collagen C-peptide (chondrocalcin) were distributed pri-
marily on the superior and inferior superficial layers of the
disc. The results indicate that the disc cells has a potential to
express of type II collagen,
R A D I O L O G I C A L DIAGNOSTICS IN UNILATERAL
ENLARGEMENT OF THE SALIVARY GLANDS
Kondrashin S.A.*, Agapov ES., Bykova A.A., Koblikov E
E, Bruslik S. E, Ternovoj S.K.
Moscow, Russia
Purpose: Determination of validity and consequence of dif-
ferent imaging methods in diagnosis of unilateral salivary
gland enlargement.
Materials and Methods: In the years 1990-97, 133 patients
from 18 to 68 yr. (M=46,4"2,8 yr; 96-F, 47-M) with chronic
unilateral salivary gland enlargement were seen. We used
functional digital subtraction sialography (FDSS) in 57
patients, CT (82), standard (83) and colour Doppler (56)
sonography, M R I (10).
Results: Separate use of the imaging methods did not
demonstrate the full volume of the pathological mass.
Complex investigation revealed lymphadenitis in 6 patients,
sialadenitis (2). We found 115 tumours of the parotid (90)
and submandibular (25) salivary glands, 11 cysts (7 and 4).
Sonography, CT and M R I revealed all tumours. Lipomas
only had a symptomatic pattern (9) on sonography and CT-
densitometry (-108,3"7,8"). Mean density of pleomorphic
adenomas was in 2-3 times higher (29,6*4,2 *) than the sur-
rounding parenchyma, mean tumour size was, in the parotid
96 Journal of Cranio-Maxillofacial Surgery
gland, 2.9"0.9cm and 3.6"1.3 cm in the submandibular gland.
On standard sonography, pleomorphic adenomas have an oval
or round form with clear contours and homogenous hypoechoic
structure. 21 benign tumours had an intermediate vascular grade
(+ and ++) and basketlike pattern. Peak systolic velocity was less
50.0 cm/s (M=23 crrds). In salivary glands, mean intratumour
velocity was characteristic for benign tumours. MRI gave the
same results as CT. Sonography and CT localized the mass in the
gland precisely in 130 of 133 (97%) patients.
Conclusion: Sonography is the principal imaging method in
investigation of patients with chronic unilateral salivary
gland enlargement. It shows the structure and character of
the tumour vascularisation. Combined usage of CT and
sonography was practically 100% accurate in tumour
determination.
EVALUATION O F SURGICALLY AND
CONSERVATIVELY TREATED UNILATERAL
CONDYLAR PROCESS FRACTURES: A
PROSPECTIVE CLINICAL STUDY
Konstantinovie, ES.
Clinicfor Maxillofacial Surgery, Faculty of Stomatology,
University of Belgrade, Belgrade, Yugoslavia
Aim: To evaluate 18 surgically (wire osteosynthesis via sub-
mandibular approach) and 20 conservatively treated unilat-
eral condylar process fractures.
Method: The following clinical parameters (maximal mouth
opening, deviation, side to side mandibular movements,
protrusion, deviation during protrusion, condylar head
movements and occlusion) were investigated before and et
least one year after completion of the treatment. Also, com-
plications during treatment were recorded.
Results: In the conservatively treated group, there were no
complications during the healing period. In the surgically
treated patients, 4 had wound infection and/or transitory pare-
sis of the marginal branch of the facial nerve. The attained
results have shown statistically (p< 0.01) significant improve-
ment in both groups after treatment for all investigated para-
meters. However, there were no statistically significant
differences between the surgically and conservatively treated
fractures.
Conclusions: After both types of treatment some abnormali-
ties remained, although significant improvement in function
had been achieved. Thus, based on the results of this study, it
seems that patients with surgical reduction were actually over-
treated.
THE VX2-RABBIT-AUR1CLE-CARCINOMA; A
NEW M O D E L FOR INTRA-ARTERIAL (IA)
E M B O L I S A T I O N OF HEAD AND NECK S Q U A M O U S
CELL CARCINOMA (HNSCC)
Koole R*, Van Es R . £ £ , Franssen 0., Hennink W.E.,
Slootweg P.J.
Department of Oral and Maxillofacial Surgery, Utrecht
University Hospital, PO Box 85500,3508 GA Utrecht, The
Netherlands.
Aim: To establish a new animal model for evaluation of IA
embolisation of HNSCC, with a new type of microspheres
for controlled release of anti-tumour drugs.
Methods: Pilot study in 10 NZW:ICO rabbits.
Transplantation of, in vivo passaged, VX2-cell suspensions
(Benjamin Franklin, Berlin) to the dorsolateral portion of
both auricles. IA embolisation of 7 tumours, via the caudal
auricular artery, with differently sized, enzymatically
degrading, dextran hydrogel microspheres. Evaluation of
tumour take-rate, speed of growth, metastatic behaviour
and distribution of microspheres.
Results: Cell suspensions (5 - 25 x 10Z6 cells) injected in 20
auricles took in 17 (85%) cases. Turnout surface doubling
time was 7.1 + 2.0 (range 4.5 - 9.9) days. Histopathology: the
poorly differentiated carcinoma grows in locally invasive
sheets and nests and is surrounded by large irregular, capil-
lary-like vessels. Metastases develop to cervical nodes and
eventually to the lungs, but not to other organs, in all ani-
mals. Embolisation: particles smaller than 10 um (number
weighted mean) give rise to pulmonary emboli. Particles
larger than 15 um and ligation of multiple non-tumour
branches can create a homogeneous embolisation of the
turnout.
Conclusion: The VX2 rabbit auricle carcinoma is a suitable
HNSCC model for studying IA embolisation techniques: in
particular with respect to the future use of dextran hydrogel
microspheres as a vehicle for the controlled release of differ-
ent anti-tumour drugs.
THE RELIABILITY O F M E A S U R I N G ORBITAL
VOLUME U T I L I S I N G CT-DERIVED DATA AND
"ANALYZE'SOFTWARE
Koppei DA .l, Foy R 2, Logan j3, Ayoub A ~, Hadley D3.
:Canniesburn Hospital, :Glasgow University, 3The Institute
of Neurological Sciences, Glasgow, Scotland.
Introduction: CT scans are mandatory in the surgical plan-
ning of many patients with orbital problems. They allow
quantitative assessment, the use of Analyze software allows
quantitative assessment of this digital data. Analyze uses an
automatic thresholding method for the calculation of
volume.
Aim: The study investigates the reliability of the software in
the calculation of orbital volume with different CT scanning
protocols.
Method: Five dried skulls each had an orbit filled with a sil-
icone impression material and a prosthetic globe to simulate
the orbital contents. Each skull was scanned in a standard
way on an Elscint 2400 Elite scanner. Axial and coronal cuts
were made at different slice widths. The orbital volume was
calculated using the CT derived data and Analyze software.
A gravimetric technique based on water displacement was
used to measure the volume of the simulated orbital con-
tents.
Results: The full results will be presented.
Conclusions: The software programme has a high level of
accuracy in orbital volume calculations and for the purposes
of volume measurement no statistical difference between
axial and coronal cuts was demonstrated. The clinical appli-
cations and relevance of the study will be discussed.
[h THE I M P R O V E M E N T O F M E D I C A L AID AT THE
CRITICAL TRAUMA OF THE HEAD
Korotkih N. * Korzh G., Mutafyan M.,

Department of surgical stomatology and maxillo-facial
surgery, Medical state academy, Voronezh, Russia
Aims: Optimization of the diagnostic and treatment med-
ical aid for the injured with the critical cranio-maxillofacial
trauma (CMT) in conditions an versatile specialized hospi-
tals of large industrial city.
Method: On the basis of the carried out analysis of 200
injuries with CMT are analysed and systematized clinical,
radiology, laboratory et.al, methods of examination under
different variants of damages. The groups of the patients
are determined by conditions depending on gravity degrees
of an intracranial or face trauma, requiring urgently med-
ical aid. Are detected the most significant diagnostic crite-
ria. A structure of experts group, taking part in medical aid
rendering at domination of damaging from positions of
previsible upshots is determined.
Results: The gradation of the injurends on groups depend-
ing on CNT trauma gravity degrees is stated; the usage of
interdisciplinary diagnostic-treatment algorithms has
allowed to determine the rational quantity of the doctors
for adequate specialized medical aid and the sequence of
performing the diagnostic studies and treatment manipula-
tions and surgeon actions. When damaging the bones of
middle area of face in all observing cases were marked
cranio-cerebrum trauma (concussion, bruise).
Cone|usions: Efficiency of treatment and predicted upshots
depend on rational use the diagnostic strategies, objective
evaluation of degrees of gravity of damaging a cerebrum,
oro-maxillofacial area, organs of vision, rumour, well-timed
beginning of specialized treatment. The usage of computer
based decision making models promotes a differentiate
choice of optimum variant of treatment with the expert
quality evaluation of rendering a medical aid.
THE EFFECT O F DIFFERENT S O F T TISSUES ON
BONE R E S O R P T I O N AROUND LOADED
E N D O S S E O U S I M P L A N T S IN PATIENTS AFTER
ORAL T U M O U R SURGERY
* Kovdcs, A., M.D., D.M.D., Klein, C., M.D., D.M.D.
Department of MaxilloJ'acial Plastic Surgery, University of
Frankfurt, Medical School, Theodor-Stern-Kai 7, D-60590
Frankfurt am Main
185 dental implants (Bone-Lock) loaded for at least on year
in 49 patients treated with ablative tumour and reconstruc-
tive surgery in the oral cavity were examined to a certain
peri-implant bone resorption. While 96 implants penetrated
local mucosa and serve as the control group, 27 implants are
associated with split-thickness skin grafts, 9 in mucosal
grafts, 18 in myocutaneous flaps, 30 in jejunal grafts and 5 in
a vastus lateralis and a temporal muscle flap. Restoration
type was similar in all groups (overdentures) except for
implants in jejunal grafts (fixed implant-supported prosthe-
ses). Regular follow-up was done with an observation time
of 3 to 5 years after implant placement. Overall survival rate
of the 89 implants surrounded by transplanted soft tissues
was 94.1%. Bone loss under the different transplanted soft
tissues was similar to or less than under local mucosa. Over
time, only horizontal bone resorption under jejunal grafts
and vertical bone resorption under mucosal grafts showed
higher values. Mean values of all measurements for split-
thickness skin grafts were higher than for local mucosa for
the horiziontal as well as for the vertical resorption pattern.
EACMFS- Abstracts, Helsinki Congress 1998 97
It can be concluded that transplanted tissues foreign to the oral
cavity have no detrimental effect on the bone resorption around
loaded dental implants, and do not endanger their long-term
stability. Of all mentioned transplants, split-thickness skin
grafts are least recommended as peri-implant soft tissues.
CRANIOFACIAL NEUROFIBROMATOSIS
Jiri Kozak., Pavel Voska., Eduard Zverina., Michal Tichy
University Hospital Motol, Prague, Czech Republic
Neurofibromatosis in the craniofacial area
Neurofibromatosis can be classified as an autosomal
dominant congenital disease with complicated
treatment,
This disease has many clinical manifestations and the
craniofacial area is the most dangerous site for it.
The authors present their experiences with surgical treat-
ment of neurofibromatosis.
From 1994 to 199714 patients mostly of adolescent
age, were treated in our department because of this disease.
From this group, 7 patients had intracranial spread of the
neurofibroma. Each of them underwent an extensive surgi-
cal operation which was done in cooperation with a neuro-
surgeon. All operations were accompanied by massive blood
loss, but contrary to different reports from other authors,
recovery was uneventful.
The authors also present some case reports of this disease.
THE ASSESSMENT OF THE PROLIFERATION
REGULATORY ROLE OF INFERIOR ALVEOLAR
NERVE NEUROTRANSMITTERS ON
KERATINOCYTES AND CONNECTIVE TISSUE CELLS
Kozakiewicz M.*
Clinic of Maxillofacial Surgery, Institute of Dentistry,
Medical University of Lodz, Lodz, Poland
AIM:
To attempt to assess the influence of sensory nerve endings
on proliferating activity of oral epithelium and subepithelial
connective tissue.
METHOD:
Eighty inbred Lewis male rats were used in the study. In 40
rats, the inferior alveolar nerve [IAN] was partially resected
within the mandibular canal [group R]. The remaining 40
rats were left intact [group I]. Both groups were divided into
four 10-animal-subgroups. All subgroups' rats were
injected in the gingiva in the mental foramen region with: 1)
0.9% NaC1 [control only for injection effect; subgroups: IS-
intact rats; RS-after I A N resection], 2) Capsaicin [neuro-
transmitters releasing from sensory nerve endings;
subgroups: IC-intact rats; RC-after I A N resection], 3)
Capsaicin vehicle [control for capsaicin effect; subgroups:
IV-intact rats; RV-after I A N resection], 4) Complete
Freund's Adjuvant [produces extremely acute gingivitis
with neurogenic component too; subgroups: IA-intact rats;
RA-after I A N resection]. Six hours after the gingival injec-
tions, colchicin was administered intraperitoneally to arrest
mitosis. After the next two hours, gingiva from the region
of the mental foramina was excised on the vestibular side of
the alveolar ridge. These biopsy specimens were fixed in 4%
98 Journal of Cranio-Maxillofacial Surgery
formaldehyde. Stainings: a) haematoxylin and eosin [evalu-
ation of mitotic index, MI], b) pinacyanol erythrosinate
[evaluation of density of mast cells]. Immunohistochemical
reactions: a) proliferating cell nuclear antigen in epithelium
[PCNA-E] and subepithelial connective tissue [PCNA-CT],
b) neuro-specific enolase [NSE] and S100 protein. Results
were analysed by Student's t-test, differences were regarded
as significant at p<0,05.
RESULTS:
NSE and S100 reactions revealed that resection of IAN
eliminated sensory nerve endings from the region examined.
The main changes were detected in subgroups in the range
of MI: IC [1,26%] versus IV [1,58%] and IA [0,84%] versus
IS [1,75%]; in the range of PCNA-E: IS [96,55%] versus RS
[99,75%] and IC [94,55%] versus RC [98,5%]; in the range of
PCNA-CT: IS [25,52%] versus RS [47,86%].
CONCLUSIONS:
The lack of influence of neurotransmitters released from
IAN evoked increasing proliferation of keratinocytes and a
very significant one of the connective tissue cells. The
effects of the experiments conducted indicate that these
transmitters keep proliferation activity at a constant low
level.
RECONSTRUCTION OF SUBTOTAL. TOTAL AND
EXTENSIVE DEFECTS OF THE LOWER LIP
Krasic D. Buric N*. Visnjic M.
Medicine Faculty - Clinic of Stomatology Oral and
Maxillofacial Surgery Deps, Clinic of Surgery-Plastic
Surgery, Nis, Serbia (Yugoslavia)
Aims: To evaluate the efficacy of reconstruction of lower lip
defects by using various methods of reconstruction.
Method: In the period between 1993-1997 a group of 75
patients with lower lip carcinoma has been treated. In the
patient group defects were as follows: subtotal lip defects
in 60 (80%) pts., total lip defects in 10 (13.3%) pts., and
extensive lip and perioral defects in 5 (6.7%) pts.
Postoperative defects after ablative surgery were recon-
structed in 20 pts. by means of the Karapandzic, Fries and
modified Karapandzic (quadrangular flaps) techniques
respectively. Total defects were reconstructed by means of
quadrangular flaps and the Nakajima technique. Extensive
and perioral defects were reconstructed by means of free
radial forearm and pectoralis major flaps. Postoperatively,
in all patients, we recorded aesthetic and functional
parameters.
Results: A squamous cell carcinoma was identified in all
patients. Marginal necrosis occurred in 7 (9.3%) pts., infec-
tions in 3 (4%). In the group with subtotal defects, recon-
struction with quadrangular flaps showed the best
aesthetic and functional results. In the group with total
defects, the best results were given by method acc. to
Nakajima. In the group with extensive defects free radial
forearm flaps gave good results in comparison with pec-
toralis major flaps.
Conclusions: Despite the great number of various tech-
niques for lip reconstruction it those techniques which
spare the muscle perioral ring and adjacent tissue whenever
is possible should be applied. One stage reconstruction of
extensive defects is possible by using a free radial forearm
flap.
BLOOD LOSS IN ORTHOGNATHIC SURGERY:
HYPOTENSION VERSUS NORMOTENSION
Krekmanov, L1 and Enlund, g 2.
Department Oral MaxilloJbcial Surgery, Department of
Anaesthesiology, Central Hospital, Vgisterds, Sweden
ABSTRACT
Aims: The purpose of this investigation was to evaluate the
need for induced hypotension in orthognathic surgery.
Methods: Blood loss, duration of operation and quality of
the surgical field were measured in 36 patients, assigned to
either hypotension (mean arterial pressure, MAR 50-64 mm
Hg) or normotension (MAP> 65 mm Hg). Hypotension
was achieved by increasing the amount of isoflurane given.
The hypotensive group had significantly less bleeding over
time: mean 0.9 ml/minute (0.6 to 1.2 ml) compared with 1.8
ml/minute (1.3 to 2.4 ml).
Special attention was paid to keeping the periosteum
intact when performing the subperiosteal dissection as well
as re-using the gauze compresses in order to activate local
haemostasis.
Results: The corresponding difference in total blood loss
did not differ significantly between the groups: mean 186
ml (95% CI, 98 ml to 275 rnl)in the hypotension group,
compared with 304 ml (95% CI, 210 ml to 399 ml) in the
normotension group. No patient required blood transfu-
sion. Neither the duration of surgery, nor the quality of
the surgical field were significantly influenced by
hypotension.
Conclusions: The clinical relevance of induced hypotension
in orthognathic surgery had been considered to he doubtful.
The mean reduction of less than 150 ml/surgery in spite of a
limited overall blood loss, from the clinical point of view
was insignificant. The surgical technique might been of
greater importance for the relatively short duration of a
"gentle" operation and a low blood loss than the level of the
blood pressure.
MARSUPIALIZATION OF CYSTIC
AMELOBLASTOMA IN YOUNG PATIENTS
Kriiger, H.E. C. *, Grotepass, F. W.., Van der Westhuijzen,
A.Z, Van Rensburg, L.J.
Department of Muxillofacial and Oral Surgery, and
Department of MaxilloJbcial and Oral Radiology, Faculty of
Dentistry, University of Stellenbosch, Tygerberg, South
Africa.
Introduction Cystic Ameloblastoma expands by either
tumour growth in the cyst wall and/or hydrostatic pressure
from within the cyst cavity.
Method The clinical, radiological and histological data of 9
patients under the age of 18 presenting with cystic
ameloblastoma, were investigated retrospectively. At the
stage biopsies were taken, marsupialization was done.
Follow-up periods ranged from 1 to 4 years.
Results Following marsupialization, clinical and radiologi-
cal reduction of the lesion was noted, and bone remodelling
at a normal anatomical level was observed.
Conclusions :Patients presenting with unicystic amelo-blas-
toma, may benefit from marsupialization if marginal or seg-
mental resection is done at a later stage, restricting
deformity to a minimum in the young developing patient.

Even if radical surgery is envisaged for a multicystic lesion,
initial marsupialization allows time for logistic preparation
and will facilitate the supraperiosteal dissection. Four cases
are presented.
P E R S O N A L EXPERIENCE IN THE TREATMENT
OF ZYGOMATIC-ORBITAL FRACTURES
Wanyura H., Kryst L., Samolczyk-Wanyura D.
Department of Oral and Maxillofacial Surgery, Medical
University of Warsaw
Among the various types of orbital fractures treated in our
clinic, zygomatic-orbital fractures (ZOF) occur in 26% of
cases. The most common sequelae of ZOF are the follow-
ing: depression of cheek and facial asymmetry, restricted
mouth opening, depression of outer corner of eyelid with
static pseudoptosis and suborbital paraesthesia.
For many years we have been using a simple method for
repositioning and fixation of the zygomatic fragment in
ZOF patients.
The bony fragment is repositioned from the lumen of the
maxillary sinus and fixed using a wire ligature through the
side of the orbital rim and supported with a Foley catheter
and balloon which is introduced via the nose into the maxil-
lary sinus. The fluid-filled balloon not only keeps the zygo-
matic fragment in the correct position, but at the same time
effectively stops bleeding and allows for continuous
drainage of the maxillary sinus and also its periodic irriga-
tion with antiseptic.
From observation over many years it appears that our
approach, which is illustrated with examples, is technically
easy and effectively eliminates the consequences of ZOF as
regards morphology, function and aesthetics. Neither early
nor late postoperative complications were found in any of
the 286 patients treated by this methods.
[~ REMOTE RESULTS OF TREATMENT OF
TEMPOROMANDIBULAR J O I N T ANKYLOSIS
WITH USE OF METAL J O I N T COMPONENTS
Krzymanski G.
Department of Maxillofacial Surgery, Military School of
Medicine, Warsaw,POLAND
Temporomandibular joint ankylosis developing in early
childhood is accompanied by significant mandibular
hypoplasia. In such cases, in planing of treatment, not only
mobilization of the mandible should be taken into account,
but also elongation of its hypoplastic parts. Surgical treat-
ment of osseous temporomandibular joint ankylosis with
reconstruction of the condyle with osteocartilaginous trans-
plant from the rib, or introduction of joint prosthesis
requires removal of the whole bone block connecting the
mandibular ramus with cranial base which is associated
with significant technical difficulties and the possibility of
complications. Trying to overcome these difficulties, since
1982 we use in the treatment of osseous ankylosis of the
temporomandibular joint an own method including
mandibular ramus osteotomy below ankylosis, separating of
fragments by the desired distance and supporting them in
this position with a metal element, fixed screws to the angle
of the mandible, which is a part of the artificial joint. Owing
EACMFS - Abstracts, Helsinki Congress 1998 99
to this, in one simple operation we obtain simultaneously
elongation of the ramus and mobilization of the mandible.
This method was applied in treatment of eight patients
achieving good results. The results are presented of many
years of follow up of these patients.
CLINICAL EXPERIENCE OF EXTENSIVE SKULL
RECONSTRUCTIONS USING OSTEOINDUCTIVE
BONE IMPLANTS
Kiiblel; IV. R.*, Bill, J. S., Wiirzler, K., Reuther, J. F.
Department of Cranio-Maxillo-Facial Surgery, University of
Wiirzburg, Wiirzburg, Germany
In general, cranioplasties are performed using either autoge-
nous bone grafts or alloplastic materials. For the recon-
struction of large defects, however, the amount of the
patient's own bone may be insufficient, especially in chil-
dren. Furthermore, the remodelling of autogenous bone is
often unpredictable. On the other hand alloplastic materials
(PMMA, etc.) remain in the defect as foreign bodies and
often tend to become infected. For that reason we prefer
autolyzed, antigen-extracted, allogeneic (AAA) bone from
human donors for extensive cranioplasties. AAA bone has
been shown in our experimental work to induce cartilage in
vitro and new bone formation in vivo.
Since 1990 31 patients received AAA bone cranioplasties
either as completely demineralized bone powder, completely
demineralized pliable bone chips, surface-demineralized
bone chips (in 12 cases from human donor skull caps) or
combinations thereof. In some cases preoperative stereolith-
ography-based planning and contouring of the AAA bone
implants were performed. The patients were followed up
clinically and radiologically for between 4 months and 93
months. In some cases scintigraphy and removal of
osteosynthesis material (incl. biopsies) were performed.
No infection or rejection of any of the AAA bone
implants occured.. X-ray assessments as well as bone scintig-
raphy revealed osseous integration and remodelling of the
AAA bone implants with minimal resorption. However, in 2
cases completely demineralized AAA bone chips showed
partial resorptions which ceased after the implants had been
remodelled. Patients undergoing a re-entry for removal of
miniplates showed bleeding surfaces and osseous integration
of the former implants. With the aid of stereolithographic
models and AAA bone donor skull caps even complex
defects could be satisfactorily reconstructed.
The long-term results emphasize the therapeutic applica-
tion of AAA bone for cranioplasty. It is noteworthy that no
unpredictable resorption or infection were observed.
Supported by grants-in-aid from D F G (Ku 655/2-1, Ku
655/2-2, Ku 655/4-1)
CLASSIFICATION AND TREATMENT OF
SALIVARY GLAND TUMOURS
Kiibler, N. R.*, Reinhart, E., Martin, E, Wiirzler, K.,
Reuthel; J. F.
Department of Cranio-MaxilIo-Facial Surgery, University of
Wiirzburg, Wiirzburg, Germany
Since 1981, 148 patients with salivary gland tumours were
treated in our department. In a follow-up study the
100 Journal of Cranio-Maxillofacial Surgery
histopathology findings as well as the treament were re-
examined.
The location of the tumours was the parotid gland in
52.0%, the submaxillary gland in 7.4%, the sublingual gland
in 2.0%, and the minor salivary glands in 38.5%. Benign
epithelial tumors were found in 48.6% of the cases (36.5%
pleomorphic adenomas, 10.1% Warthin's turnouts [papil-
lary cystadenoma lymphomatosum], 2.0% others) while
malignant epithelial turnouts represented 40.5% (14.2%
adenocystic carcinomas [cylindromas], 10.8% mucoepider-
moid tumours, 8.1% adenocarcinomas, 3.4% malignant
mixed turnouts, 3.4% squamous cell carcinomas, 0.6%
acinic cell carcinomas), non epithelial tumours 4.1%, and
non classified benign tumours 6.8% of the cases. 22% of the
parotid gland tumours, 54.5% of the submaxillary gland
tumours, 66.6% of the sublingual gland tumours and 61.4%
of the minor salivary gland tumors were malignant.
Distribution by sex was dependent on the type of tumour:
Warthin's tumours as well as squamous cell carcinomas
were mainly found in men, while pleomorphic adenomas,
adenocystic carcinomas, and adenocarcinomas were more
frequently observed in women.
Surgical treatment depended on the histology, the loca-
tion and size of the tumours. In 4 cases with malignant
tumours, no surgical therapy was performed for various rea-
sons. Benign as well as malignant tumours of the submaxil-
lary gland and the sublingual gland were excised including
the glands. Tumours of minor salivary glands were widely
excised. Benign tumours of the parotid gland were either
excised (n= 10) or a conservative parotidectomy (n=50) was
performed. In a case with a malignant parotid tumour a
radical parotidectomy with partial or complete resection
and subsequent or secondary reconstruction of the facial
nerve was performed (8 patients), a conservative parotidec-
tomy with preparation of the facial nerve was performed in
8 patients, and tumour excision without nerve preparation
was performed in 1 patient.
D RECONSTRUCTION O F MANDIBULAR DEFECTS
WITH rhBMP-2
Kiibler, N. Rfl , Biebl, S.1, Kiiding, K.1, Wiirzler, K.1, Failer,
Gfl, Sieber, Eft, Kirchner, I".2, Sebald, W.3, Reuther, J. F.1
1Department of Cranio-Maxillo-Facial Surgery, ~Institute of
Biochemistry, University of Wiirzburg, Germany, 2Institute
of Pathology, University of Erlangen, Germany
RhBMP-2 was expressed in E. coli and subsequently rena-
tured to yield the dimeric mature protein. To define the
osteoinductive potential of BMP-2 in reconstructive
surgery, the protein was bound to various carriers and
implanted in mandibular defects in rats.
Critcal size defects with a diameter of 5 mm were created
on both sides of the angle of the mandible in 32 rats. In
groups of 4 animals 3 mg bovine collagen, 30 mg ICBM
(bovine bone matrix), 2.6 mg polydioxanon/polyglactin, 50
mg bioglass, 50 mg syn. HA, 45 mg Algipore), 35 mg Bio-
Oss ) or 50 mg syn. TCP (all same volume) were implanted in
the defects. 10 gg rhBMP-2 was combined with the respec-
tive carriers on the contralateral side (test side). After 4
weeks the animals were sacrificed and the newly formed
bone was measured and radiologically as well as histologi-
cally examined.
None of the control defects (without BMP-2) showed
significant bone formation. The carriers were either
resorbed or encapsulated in fibrous tissue. In contrast, all
samples with BMP-2 showed complete reossification of
the defects. Dependent on the carrier material, different
excesses of newly formed bone (bony outgrowth) were
observed on the buccal side of the angles of the
mandibles. Calculation of the induced new bone revealed
792+367 mmA with ICBM, 312_+162 mmAwith Algipore),
303_+124 mmA with TCP, 253_+47 mmA with HA, 252_+38
mmA with bioglass, 206_+66 mmA with Bio-Oss), 181_+19
mmA with polydioxanon/polyglactin, and 151_+13 mmA
with collagen.
The results show that non of the bone replacement mate-
rials alone was capable of healing the critical size defects.
The addition of BMP-2 to the carrier materials led to com-
plete reossification of the defects within 4 weeks. Therefore
the amount of induced new bone was dependent on the car-
rier materials as well as on their being partially displaced.
In conclusion the study shows that the future therapeutic
application of BMPs in reconstructive surgery of the facial
skeleton needs a defined ratio between the amount of BMP
and the respective carrier material. Furthermore displace-
ment of the BMP-augmented carrier should be avoided in
order not to produce excessive bone formation.
Supported by grants-in-aid from D F G (Ku 655/2-1, Ku
655/2-2, Ku 655/4-1)
CLINICAL A P P L I C A T I O N O F [F18]-2-
FLUORDESOXYGLUCOSE-PET - METABOLIC
I M A G I N G F O R STAGING AND SURVEILLANCE OF
ORAL CANCER
Kunkel M *(tJ, Wahlmann Ua), Griitz KA (1), Benz p(2),
Andreas j(3), Wagner W (°.
~J Department of Maxillofacial Surgery, University of
Mainz (Germany)
r2jP E T in the University of Mainz
~3~Department of Nuclear Medicine, University of Mainz
(Germany)
Aims: Careful investigation of lymph node involvement is
mandatory for the se-lection of the appropriate extent of lym-
phnode dissection in the therapy of oral cancer. However, lack
of sensitivity and specifity of conventional imaging tech-
niques based on morphological criteria claim for additional
methods to improve accuracy of lymph node assessment.
Further problems arise in the follow-up, when scaring, radia-
tion fibrosis and flaps used for reconstruction interfere with
morphological detection of tumor recurrency. Therefore, this
study investigates the contribution of [F~8]-2-
Fluordesoxyglucose (FDG)-PET to tumor manage-ment with
respect to lymphnode staging and detection of recurrency.
Methods: F D G - P E T scans were performed in 35 Patientes
with advanced oral cancer (predominantly T3/T4) prior to
surgery or radio(chemo)therapy. Results of PET were corre-
lated to histological findings after ablative tumor surgery.
Ten Patients were investigated in the follow-up period for
verification of initial clinical suspiction of recurrency or
secondary metastasis. Statistical evaluation included sensi-
tivity, specifity as well as positive and negative predictive
values for lymph-node involvement per neck-side and for
recurrency sites. Results of PET were compared to CT and
M R I Data.
Results: F D G - P E T yielded good sensitivity (81%) and supe-
rior specifity (95%) for initial lymph node assessment result-
ing in excellent positive (89%) and negative (90%) predictive
values. In the staging procedure, PET detected four distant
metastases and two simultaneous tumors which had sub-

stantial effect on therapeutic management. For the detec-
tion of tumor recurrency, sensitivity yielded 90%. In 3 out of
10 patients, PET identified additional sites of recur-rency or
metastasis that could neither be detected clinically nor by
conventional imaging techniques but were confirmed 1 to 3
month later in the follow up.
Conclusions: F D G - P E T is a challenging imaging technique
with the potential to support staging procedures and sur-
veillance of oral cancer. There is first promising evidence,
that detection limits of lymph node metastases and tumor
recurrency may be substantially improved by metabolic
imaging.
PREFABRICATED M U S C L E F L A P W I T H BONY
TISSUE: AN EXPERIMENTAL STUDY O F
HETEROTOPIC O S T E O I N D U C T I O N BY A
COMBINATION O F rhBMP-2, COLLAGEN AND
P O R O U S HYDROXYAPATITE W R A P P E D WITH A
MUSCLE FLAP
Kenji Kusumoto .l, Kazuhisa Bessho 2, Kazuma Fujimura2, Jiro
Akioka 1, Yasunori Okubo ~, Yutaka Ogawa 1, Tadahiko lizuka 2
1) Kansai Medical University, Dept. of Plastic and
Reconstructive Surgery, Moriguchi, 570-8507, Japan; 2)
Kyoto University, Faculty of Medicine, Dept. of Oral and
Maxillofacial Surgery, Kyoto, 606-8507, Japan
Aims: To define the heterotopic osteoinduction by a combi-
nation of rhBMP-2, collagen and porous hydroxyapatite
wrapped with a muscle flap in an experimental study.
Method: A combination of rhBMP-2, collagen and hydrox-
yapatite was wrapped with a rat latissimus dorsi muscle flap.
Three weeks later, the osteoinduction of the implant was
histologically investigated and the circulation in the flap was
estimated by microangiogram.
Results: Trabecular bone at the surface of the hydroxyapatite
block and trabecular bone and bone marrow in the pores
were observed. On the microangiogram, axial vasculature
connected to the thoracodorsal artery was indicated in the
muscle flap shadow. The contrast medium was histologically
observed in blood vessels in bone marrow in the pores.
Conclusions: This study indicated that a combination of
rhBMP-2, collagen and porous hydroxyapatite wrapped
with a muscle flap would produce a meaningful prefabri-
cated flap with bony tissue and be a new "vascularized bone
graft" for skeletal reconstruction on poor condition, which
is scarred, irradiated or infectious, with no sacrifice on the
self-skeleton.
RESULTS AFFER MINIPLATE FA/IINOPLASTY FOR
THE TREATMENT OF RECURRENT TMJ
DISLOCATION
Kuttenberger J, Hardt N,,
Kantonsspital Lucerne, Switzerland
Various techniques have been used for the surgical treatment
of TMJ dislocation.
At the Department of Oral and Maxillofacial Surgery,
Kantonsspital Luzern, miniplate eminoplasty, first
described by Puelacher, has been used since 1994 for the
treatment of recurrent TMJ dislocation, in 12 patients.
EACMFS- Abstracts, Helsinki Congress 1998 101
All patients suffered from recurrent TMJ dislocation
with considerable pain and were not able to reduce their
TMJ luxation by themselves.
Postoperatively, no recurrence of dislocation occurred
and all patients were free of pain. This technique, which is
presented in detail, proved its effectiveness even in patients
with severe oral dyskinesia and long-lasting dislocations.
The advantages of this technically easy and effective pro-
cedure for the treatment of TMJ dislocation are discussed.
THREE ORTHOGNATHIC OPERATIONS ON THE
SAME PATIENT
Tae-Geon Kwon* Sang-Han Lee.
Department of OMFS, College of Dentistry, Kyungpook
National University, Taegu, KOREA.
The patient, who had undergone orthognathic surgery on
three different occasions, was investigated to elucidate the
various factors required for orthognathic surgery of a facial
deformity combined with enamel hypoplasia, and the cause
of severe relapse in this type of the patient.
The 23-year-old female attended our clinic complaining
of malocclusion and facial asymmetry. She was also diag-
nosed as having enamel hypoplasia and there was a lot of
difficulty in presurgical and postsurgical orthodontic treat-
ment. The first surgery was a Lefort I osteotomy with
BSSRO. Four months after the first surgery, Maxillary &
Mandibular anterior segmental osteotomies were per-
formed to adjust bimaxillary protrusion which was the
another complaint of the patient. But 20 months later,
IVRO was performed because of a transverse relapse. After
postsurgical stability was achieved, the patient was referred
to the prosthodontic department.
Difficulty in orthodontic treatment influenced the post-
surgical stability. We too experienced the special relapse ten-
dancy. It is likely that before orthognathic surgery, the
surgeon must confirm the expected post-operative molar
relation before the surgery
Tae-Geon Kwon*, Sang-Han Lee.
Department of OMFS, College of Dentistry, Kyungpook
National
University, Samduck 2-Ga, Jung-Gu, Taegu, 700-421,
KOREA.
BACTERIAL AND CLINICAL F I N D I N G S OF
FALLING DENTAL I M P L A N T S
Laine, P. *, Jousimies -Somer, H., K6n6nen ,E., Tarkka, C.,
Lindqvist, (7.
Department of Oral and Maxillofacial Surgery, Helsinki
University Central Hospital, Anaerobe ReJerence
Laboratory, National Public Health Institute, Helsinki,
Finland
Aims: To investigate bacterial and clinical causes of dental
implant loosening.
Methods: Seventeen patients (mean age 48 years, range 25-
73 years), 12 men and 5 women with a total of 30 failed
dental implants (72/30) were enrolled in the study. All
patients had been treated by O M F surgeons. 11 patients
lost one implant, 8 patients two and one patients three
implants. One patient received radiotherapy (mandible)
102 Journal of Cranio-MaxillofacialSurgery
before implantation. At the time of implantation three
sinus lifting operations were made and twice bone graft
from iliac crest were added on the bone. A panoramic
tomogram was obtained for each patient and oral exami-
nation was undertaken before the extraction of implant(s).
Before extraction patients rinsed their mouths with
chlorhexidine gluconate (2mg/ml), the area around the
implants was dried and isolated. The implant was placed in
V M G A - I I I transport medium. The bone socket was
scooped and the scoop yields placed in V M G A - I I I trans-
port medium. Both screws and scoop yields were cultured
within one hour both on selective and non selective media.
Results: In most cases the only clinical symptom was insta-
bility of the implant or suprastructure. Every other patient
suffered from pain in the region of the mobile implant but
only one fistula was found. Characteristic bone pockets and
radiolucencies between bone and screw were detected in
ortopantomographic examinations. 97 percent of the bacte-
rial cultures were positive. Considerably more bacteria
could be detected in the media of the cultures of screws
compared with those of scoop yields. S. milleriwas the most
often identified aerobe and correspondingly E nucleatum
the most often identified anaerobe.
Conclusion: Clinically the reason for dental implant loosen-
ing during the healing period seems to be insufficient quan-
tity of bone or traumatic technique of operation and
subsequent overloading of the implant. Bacteriologically it
is more effective to culture the screw than the scoop yield of
the bone socket. Microbes around unosseointegrated
implants differ significantly from microbes in parodontitis.
[~ OSSEOINTEGRATED DENTAL I M P L A N T S IN
THE CLEFT MAXILLA W I T H BONEGRAFTED
ALVEOLAR CLEFTS
Laitinen, J.* DDS., Pulkkinen, J., DDS., Ranta, R., Ph D.
Department of Plastic Surgery, Helsinki University Central
Hospital
Aims: The purpose of this study was to evaluate longterm
outcome of osseointegrated implants and dental prostheses
in the bonegrafted cleft maxilla.
Subjects: The follow-up study included 11 consecutive adult
patients (7 females, 4 males).The cleft alveolus was bone-
grafted in eight patients. Seven patients had unilateral cleft
lip and palate ,three had isolated cleft palate and one
patient had a lip and alveolus cleft. Eleven patients had alto-
gether 47 implants in the maxilla ( 36 mod. Brgmemark and
11 mod. Astra),of those 25 in bonegrafts and 22 outside the
grafts. Follow-up time for implants varied from 7 to 86
months (mean 45 months). There were seven single dental
crowns, five removable prostheses and two fixed bridges
supported by implants.
Results: During the follow-up period implants were lost in
only one patient ,who lost four out of five implants. All
eleven patients had prosthetic restorations. No remarkable
differences was found in the survival of the implants situ-
ated in the grafts or outside the grafted area.
Conclusions: Osseointegrated implants can be placed suc-
cessfully in a cleft maxilla where the thickness of bone is
sufficient. In the case of insufficient bone support the region
can be re-grafted. Both fixed crowns and bridges as well as
removable prostheses can be used to restore the dentition. In
older edentulous patients, support of implants is an excellent
choice for stabilizing removable prostheses. Regular follow-
up after implantation and prosthetic restoration is needed.
T H E OSTEO-ODONTO-KERATO-PROSTHESIS
(OOKP) ACCORDING TO STRAMPELL1
Landau, H. *, Hille, K. **,
Department of OMFS*, Department of Ophthalmolgy**,
University Clinic, Homburg (Saar), Germany
Aims: To show and define the role of Cranio-Maxillofacial
Surgery in visual rehabilitation by OOKR
Method: Patients with vascularized corneal scarring
often suffer from a rejection of a corneal graft and con-
secutive permanent corneal blindness. In this case visual
rehabilitation can only be achieved by a keratoprosthesis
(KP). In the literature the risk of rejection of most kinds
of K P is high. The only K P with a rather low risk of
rejection is the biologically-supported (= bone and tooth
mediated) Osteo-Odonto-Kerato-Prosthesis first
described by S T R A M P E L L I in 1964. This procedure
requires the harvesting of an autogenous tooth/alveolus-
segment that is meticulously prepared (OMFS) for the
uptake of an optical P M M A - c y l i n d e r and -in a second
stage- will be transplanted into the eye of the patient
(Ophthalmic surgeon). The bony defect of the alveolus
can be reconstructed by surgical and/or prosthetic
methods.
Results: An OOKP was performed in 3 patients. The follow-
up period now covers 5, 2 _ and 1 _ years without any seri-
ous complications. In all 3 patients a significant
improvement in visual acuity was achieved. From preopera-
tive light perception, the visual acuity rose to 0.5 (10/20), 0.7
(14120) and 0.4 (8/20) respectively. Intraoral rehabilitation
by surgical (bone graft/implant) and/or prosthetic means
did not pose any problems.
Conclusions: The interdisciplinary (Ophthalmic
Surgery/Cranio-Maxillofacial Surgery) treatment of corneal
blindness after unsuccessful corneal grafting gives a high
probability of visual rehabilitation while secondary morbid-
ity due to graft harvesting is low.
CLINICAL AND H I S T O L O G I C A L STUDIES O F
ADENOID CYSTIC CARCINOMAS O F THE
SALIVARY GLANDS:
Langanke, B., Hermann, T.
Clinic of Cranio-Maxillofacial and Plastic Surgery
University of Leipzig (Head. ProfDr.Dr. A. Hemprich)
Aims: To investigate the correlation of the histological type
of adenoid cystic carcinoma with its well recognised ability
to involve nerve sheaths and its effect on subsequent clinical
outcome.
Method: Ninety nine case histories of patients with previ-
ously reported adenoid cystic carcinoma involving the
major and minor salivary glands, treated between 1950 and
1997, were evaluated with reference to sex, age, incidence,
primary site, presenting symptoms, histological pattern,
tumour margin clearance, lymphnode involvement, and
haematogenous metastases to determine prognostic factors
related to survival.
Results: Of 99 previously reported cases of adenoid cystic
carcinoma, 17 cases were reclassified histologically as other
tumours; histology was unavailable in a further 31 patients.
Of the remaining 51 patients ,there was a female prepon-
derence with a painless swelling as the most common pre-

senting sign (73%). Tumours with a solid pattern were
shown to have a high level of inadequate local clearance.
Recurrence was found in 64%, and metastases in 34% of all
patients respectively. The 5 year,10 year,15year and 20 year
survival rates (Kaplan-Meyer) were 75%, 50%, 41% and
30% respectively.
Conclusions: The histological differentiation of the tumour
did not appear to influence its behaviour. The prognosis did
however appear to be dependent on the presence of both
microscopic and macroscopic residual disease which led in
most cases to perineural spread with local recurrence as the
main cause of death.
A M O R P H O L O G I C A L STUDY OF THE THORACIC
DUCT AT T H E JUGULO-SUBCLAVIAN JUNCTION.
Langford, R.J.*, Daudia, A.T., Matins, T.J.
Department of OMFS, Royal Shrewsbury Hospital NHS
Trust, Shrewsbury, England
Department of Anatomy, University of Cambridge.
Department of OMFS, North Staffordshire Hospital, England.
Aims: To examine the anatomical variations of the thoracic
duct at its termination in the left neck.
Method: A cadaveric study using twenty four formalin pre-
served specimens.
Results: Twenty one ducts terminated as a single vessel, two
ducts showed a bifid termination and one duct had three
terminal branches. The precise site of termination was vari-
able. Five thoracic du0cts showed branching and re-anasta-
mosing patterns prior to their termination, irrespective of
the number of terminal branches.
Conclusions: The anatomy of the terminal portion of the
thoracic duct in the left side of the neck is variable. Damage
to the thoracic duct during neck dissection is a serious and
potentially disastrous complication and a thorough know-
ledge of the applied surgical anatomy is essential in the pre-
vention and management of such a complication.
L O N G T E R M R E S O R P T I O N OF ONLAY BONE
GRAFTS COMBINED W I T H SIMULTANEOUS
ENDOSSEOUS IMPLANTS
Lauer G.*, Gelirich, N.-C, Schilli, W., Schmelzeisen R.
Department of Oral and Maxillofacial Surgery, Albert-
Ludwigs- Universitdt, Freiburg, Germany
Aims: In this study the longterm resorption of free onlay bone
grafts combined with the simultaneous insertion of
endosseous implants in the severely atrophic maxilla was
investigated.
Method: In 15 patients the atrophic alveolar process of the
maxilla was reconstructed using a free iliac bone graft which
was primarily fixed by 6 - 8 ITI implants. After an osseoin-
tegration period of 3 - 6 months prosthetic rehabilitation
with distal extensions bridges was performed. The patients
are in a regular recall system. The bone resorption was
assessed during the recall period of up to five years. The loss
of bone height in the peri-implant region was measured in
the orthopantomogramm.
Results: Two of 84 implants were lost. There was a conti-
nous and linear loss in the height of the augmented bone -
3.03 mm in average during the first 36 months. The loss dur-
EACMFS Abstracts, HelsinkiCongress 1998 103
ing the next 24 months was much less resulting in a flattening
out of the resorption curve. Depending on implant position in
the reconstructed maxilla the bone resorption varied. The bone
loss at the more anterior fixtures was less (2.5mm after 36
months) than at the more posterior ones (3.5ram after months).
Conclusions: The reconstruction of the alveolar process of
the maxilla with free cortico-spongeous bone grafts and
simultaneous insertion of implants is a reliable method in
the longterm. In comparison to data in the literature on the
resorption of free cortico-spongeous bone grafts in the
mandible and simultaneous implant insertion there is a pro-
longed resorption period. Alternative methods with less
morbidity at the donor site are discussed.
THE NASOLABIAL ISLAND FLAP SUPERIORLY
OR INFERIORLY BASED FOR INTRAORAL
RECONSTRUCTION
Lazaridis N., Zouloumis L *., Venetis G.
Aristotle University, Thessaloniki, Greece
In oral defects, reconstruction with nasolabial flap is a well
established surgical technique. The disadvantages of this
flap are the necessity for a two stage procedure, the relative
difficult insertion to the mouth of a wide cutaneous pedicle
and also the fact that in most cases of floor of mouth resec-
tion it is required to use bilateral flaps.
The traditional nasolabial flap can be also designed as an
island flap with an entirely subcutaneous pedicle. When the
pivot point is designed just lateral to the angle of the mouth,
the technique can be used to reconstruct intraoral defects
within the reach of the flap such as the adjoining buccal
mucosa, the upper and lower alveoli, upper, and lower buc-
cal sulci, and the floor of the mouth. The flap is brought to
the mouth through a cheek tunnel and sutured to the mar-
gins of the defect. The reconstruction is completed in a sin-
gle stage, while the donor site is closed by first intention
Where the defect is at a distance from the donor site, as
in the anterior floor of the rnouth, an island design is more
preferable than the traditional nasolabial flap because the
longer pedicle permits greater versatility.
ORTHOGNATIC SURGERY AND
S E P T O R H I N O P L A S T Y AS A ONE-STEP
PROCEDURE. WHY?
Lemagtre, A.*, Philippart, P., Hermans, M., Drieot, R., Kok, R.
Private practice, Brussels, Belgium
A 25-year experience of Maxillofacial and Plastic surgery of
the face has shown cases in which there is a need for simul-
taneous nasal as well as orthognathic surgery.
In many instance, after maxillofacial osteotomies, the nose
required no treatment. Moreover, some noses, already dis-
pleasing, have worsened after maxillofacial osteotomies. The
procedure of choice is to wait the stabilization of the
osteotomies before performing the septorhinoplasty. However,
many patients do not wish multiples surgical procedures.
A great experience must allow the surgeon to understand
the outcome of the nose and to adapt the technique of the
septorhinoplasty.
The rhinoplasty might be, according to the case, from the
simple to the most complex.
104 Journal of Cranio-MaxillofacialSurgery
It might go from the augmentation of the dorsum, to the
support and the refinement of the tip, the enlargement of
the nasal valve with spreader grafts, and placing together
the alar bases.
Results obtained in a one-step sm'gery are immediately
more harmonious on the functional point of view as well as
the cosmetic one.
Conclusion: Performing maxillo mandibular osteotomies
combined with a septorhinoplasty during the same surgical
procedure allows directly a more harmonious outcome,
However, this skillful strategy requires a large experience of
the orthognatic surgery and the septorhinoplasty. It also
lengthen the surgical procedure while requiring to change
the intubation from the anesthesiologist,
[~ WOUND C O N D I T I O N I N G W I T H A NEW
DRESSING AFTER RESECTION O F M A L I G N A N T
T U M O U R S O F THE SKIN O F THE FACE AND SCALP
- H Y D R O C O L L O I D S AND ALGINATES
Lenz J..-H.* Henkel K.-O., Saka B., Gundlach K.K.H.
Department of Maxillofacial Surgery, Medical School,
Rostock University, Rostock, Germany
Aims: Surgical resection of malignant tumours of the skin
of the face and scalp including the periosteum often results
in defects that do not allow simultaneous skin transplanta-
tion. Wound conditioning prior to skin grafting can be
achieved by semiocclusive dressings using hydrocolloids and
alginates. We compared this kind of moist wound treatment
with the classical methods of wound conditioning.
Method: Eight patients of our department were treated with the
new dressing following resection of tumours within the galea
aponeurotica including the periosteum. We applied the dressings
after perforation of the tabula extema and particularly observed
development of granulation tissue, wound infections, handling
of dressings and the take of skin grafts after transplantation.
Results: In all cases, we observed rapidly growing granulation
tissue after 18 days on average. In contrast thereto, treatment
using classical methods needed more than 4 weeks for this to
occur. No wound infections were observed when applying
the new dressing. This could remain in place for 5 to 7 days.
Upon removal it caused neither tissue damage nor pain. All
skin transplants had taken without any complication.
Conclusions: Hydrocolloids and alginates are well suited for
wound conditioning before skin transplantation because
they are effective and easy to use.
Jan-Hendrik Lenz, Department of Maxillofacial Surgery,
Medical School, Rostock University, Strempelstral3e 13,
D- 18057 Rostock, Germany
Tel. ++49.381.494.6552; Fax: ++49.381.494.6698
LASER THERAPY VERSUS EXCISION OF
VASCULAR FACIAL LESIONS. A CLINICAL
F O L L O W - U P STUDY.
Lenz J.-H.*, Kaduk W.M.H., Dietrich W..-H.,Hiirtei J.,
Gundlach K.K.H.,
Department of Maxillofacial Surgery, Medical School,
Rostock University, Rostock, Germany
Aims: To determine which method (Nd-YAG-laser; the car-
bon dioxide-laser or a surgical approach) is best for the
treatment of vascular facial lesions such as haemangiomas
and facial port wine stains.
Method: Ninety seven patients with vascular facial lesions
were treated by carbon dioxide-laser or surgical approach
in our department since 1994. Forty two additional vascular
lesions were treated by means of Nd-YAG-laser (560nm).
All patients are on recall and clinical outcome as well as
patient satisfaction were studied.
Results: Postoperative follow-up time for this study was at
least 3 months. Clinical evaluation revealed differences in
wound healing, scarring, skin/mucosa regeneration and aes-
thetic long-term results were dependant upon the different
types of treatment.The Nd-YAG-laser (15 to 20 Watt)
applied with skin refrigeration did not destroy the skin sur-
face or mucosa as does the carbon dioxide-laser. The latter
produces even defects, scarring, scar contraction, hypertro-
phy and atrophy. So does the surgical approach. We found no
significant differences between the carbon dioxide-laser and
the surgical approaches with regard to contraction (14% fol-
lowing CO2-1aser vs. 9% following excision) and atrophy
(28.6% vs. 36.4%) but major differences in scarring (28.6%
vs. 8.4% conspicious scars), hypertrophy (29% vs. 8%) and
skin/mucosa regeneration (29% vs. 63%), Patients were
entirely free from postop, pain in areas of Nd-YAG-irradia-
tion, while some were complaining of a little pain following
carbon dioxide-laser and surgical approaches (29% vs. 27 %).
Conclusions: Based on the results of this study, we prefer the
Nd-YAG-laser for treatment of vascular lesions especially
haemangiomas in maxillofacial surgery. It is superior to
both the carbon dioxide-laser and the surgical approach.
Jan-Hendrik Lenz, Department of Maxillofacial Surgery,
Medical School,
Rostock University, Strempelstral3e 13, D-18057 Rostock,
Germany
Tel. ++49.381.494.6552; Fax: ++49.381.494.6698
M E L A N O M A S OF THE ORBIT.
C L I N I C O P A T H O L O G I C A L ANALYSIS OF 15 CASES.
Liarikos, S. *, Rapidis, A.D., Angelopouios, A.P.,
Roumeliotis, A.
Departments of Ophthalmology and Maxillofacial Surgery,
Greek Anticancer Institute, St. Savvas Hospital and
Department of Oral and Maxillofacial Surgery, University of
Athens, Greece
Aims: Melanomas of the orbit are rare. Orbital melanomas
comprise a heterogeneous group of pigmented tumours
originating from melanocytes of the ophthalmic tissues or
represent distant metastases of melanomas to the orbit,
They can be classified into primary and secondary orbital
melanomas. Primary orbital melanomas are extremely rare.
Secondary orbital melanomas are more often seen and usu-
ally represent massive extrascleral extensions of uveal
melanomas. Their diagnosis is difficult as they show no spe-
cific clinical and radiographic characteristics. Controversy
exists not only regarding the treatment but also over the
patient prognosis.
Methods: The records of 15 patients with massive orbital
melanomas treated during the years 1990 to 1997, were ret-
rospectively reviewed and analysed. Eleven patients were
female and 4 were male. The mean age at the time of diag-
nosis was 65 years. Presenting symptoms included an
orbital mass with exophthalmos, decreased visual acuity,
acute glaucoma crisis, painless unilateral proptosis and
intermittent diplopia. The site of origin of the primary

melanoma was the uveal tract in 9 cases, the conjuctiva in 3
cases, the eyelids in 2 cases and the skin in one case.
Treatment included surgery, radiotherapy, chemotherapy
and immunotherapy.
Results: Twelve of the patients died from distant metastases
and three are alive with no sign of disease. Of the patients
who died the longest survival was 33 months and the mean
survival was 15,9 months.
Conclusions: Our conclusion is that we should work towards
earlier diagnosis so that fewer melanomas will reach such
advanced stages where local tumour control and patients'
prognosis become extremely poor.
EVALUATION O F OCCLUSION AND F U N C T I O N
AFTER LATERAL MANDIBULECTOMY DEFECTS
W I T H P E C T O R A L I S M A J O R MYOCUTANEOUS
F L A P RECONSTRUCTION
Lindeboom, J.A.H* ,, Ackerstaff A.H 5 Kroon, F.H.M. ,,
Balm, A.J.M. 2.
Department of Oro- and Maxillofacial Surgery, Department
of Head and Neck Oncology, Academic Medical Center
Amsterdam, The Netherlands l and The Netherlands Cancer
Institute. Plesmanlaan 121, 1066 CX Amsterdam, The
Netherlands 2.
ALMS:
To analyse dental occlusion and articulation in patients
after ablative surgery for a oropharynxcarcinoma, who
were reconstructed with a myocutaneous pectoralis major
flap without bony reconstruction of the mandibular
defect.
METHOD:
13 patients who were treated for an oropharynxcarcinoma
with ablative surgery, a partial mandibulectomy, radio-
therapy were reconstructed with a myocutaneous pedicle
flap. All patients were analysed with regard to their dental
occlusion, prosthetic rehabilitation and chewing abilities.
RESULTS:
On opening of the mouth there was an evident deviation of the
mandible to the resected side; all patients had a limitation of
laterotrusion. None of the patients were able to eat normally.
The edentulous patients had problems wearing their prosthesis.
CONCLUSION:
Problems in proper prosthetic rehabilitation are mainly due to
a lack of reconstruction of the bony continuity. Although com-
plete restoration of all functions can not be guaranteed, recon-
struction should preferable always include bony restoration.
C R E A T E A REAL HARD PALATE IN CLEFT
PALATE CASES BY USING DISTRACTION
OSTEOGENESIS
Eric J W Lioa, DDS, MS, Kai-Fong Hung, MD, Sophia CN
Chang, MD, Philip KT Chen, MD, C Shing Huang, DDS,
PhD, E Ray Chen, MD
Aims: To evaluate the feasibility of repairing a cleft palate
by using distraction osteogenesis to create a real hard palate,
and avoid having raw surfaces and formation of scar tissues.
EACMFS - Abstracts, Helsinki Congress 1998 105
Method: Four adult cats were the subjects. Each cat had a
surgically simulated unilateral palatal cleft, three months
before distraction. The palatal shelves on the non-cleft side
(not including the alveolar ridge) were osteotomized and
distracted medially toward the other side with a custom-
made distraction device. After the cleft edges have approxi-
mated, the distraction device was left for another 3 months
for maintenance. Then the distraction device was removed,
and musculature repositioning of soft palate and gingivope-
riosteoplasty were performed to join both sides of the bony
palatal shelves into one piece. The cats were sacrificed 3
months later. The results were evaluated grossly, radi-
ographically, and histologically.
Results: The cats had no difficulty in eating during the
experiment. Grossly, the simulated cleft palate was com-
pletely eliminated and well repaired with minimal scar tis-
sue. Radiographically, the palatal shelves joined together
and the cleft was filled by a radiopaque image.
Histologically, the new bone formed by the distraction
osteogenesis was non-lamellar and woven.
Conclusions: By using distraction osteogenesis, a wide cleft
palate can be narrowed or completely eliminated before
palatoplasty. This treatment modality can create soft and
bony tissues needed for a cleft palate repair that is hardly
accomplished by conventional treatment methods.
CO 2LASER A P P L I C A T I O N IN A P I C A L SURGERY
F O R ROOT-FILLED TEETH
Lob H S,
Department of Oral and Maxillofacial Surgery
National University of Singapore, Singapore
Aim : To establish the effectiveness of the CO 2laser in rela-
tion to failed root-filled teeth with apical infection.
Materials: Upper anteriors which were root-filled and api-
cally infected (symptomatic with bone rarefaction) were
selected, including those with recurrent infection, previous
surgery, apicectomy and retrograde amalgam restoration.
Method : Under local anaesthesia, a standard flap was raised
to expose the root apex and adjacent bone. Pulsed CO 2laser
beam (3 watts at 0.1 sec) was delivered via a 90oangled hand-
piece. Vaporization of infected tissues was effected with ster-
ilization of the root apex, bone and amalgam.
Results : Healing occurred within expected periods with no
complications. Infection was controlled with no further
need for apicectomy and bone removal. X-rays showed nor-
mal bone regeneration.
Conclusions : The CO: laser was effective in the elimination of
apical infection of root-filled teeth. Hand instrumentation
was not necessary. It minimized the surgical destruction of
the root and bone and provided a prosthodontic advantage.
INTERACTIVE PRE-SURGICAL P L A N N I N G AND
INTRAOPERATIVE REAL-TIME NAVIGATION F O R
IMPLANTATION
Longerich U, Sailer H.F.
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland
Introduction: For greater surgeon confidence the interactive
pre-surgical planning of implants with computed tomogra-
106 Journal of Cranio-MaxillofacialSurgery
phy (CT) reconstruction arose increasingly. Dental image
software provide submillimetric determination of the dental
fixture within the cross-sectional and/or three-dimensional
CT image data. However, the transfer of the precise image
planning results to the patient works as usual with less accu-
rate mechanical templates. This methodical contradiction
could be solved by using instead an image-controlled proce-
dure during implantation, which provide real-time co-ordi-
nate navigation of the dental handpiece for a high accurate
realisation of a preplanned milling bore.
Material and methods: Ten patients were planned a treatment
of implants in compromised ridges, using cross-sectional and
three-dimensional reconstructed image data by the same sur-
geon. Virtual implants were determined within the recon-
structed CT image data sets in a way, that there was enough
available bone for adequate implantation. A new intelligent
dental handpiece with an integrated sensor was developed,
which allowed tracking in the oral region of the oral patient for
real-time navigation. The sensor assembly was connected to
the image guided surgery software VPS T M (Virtual Patient
System, ARTMA, Austria). At the time of surgery the implant
planning results were carried out by real-time navigation of the
intelligent dental handpiece. Postoperatively the post-surgical
CT data set and the pre-surgical CT data set containing the
implants were correlated. The centre point on the top and on
the bottom of a virtual implant and its corresponding real
implant was measured and the root mean square (rms) devia-
tion in x-, y-, z-axis of these centre points was computed. The
conformity in space positioning between the virtual implant
and the real implant was statistically evaluated.
Results: There was no significant difference in space posi-
tioning between the pre-surgical planned implant and its
surgical realisation. The pre-surgical planning results could
realise with high accuracy in all cases.
Conclusion: The interactive pre-surgical planning and intra-
operative real-time navigation for implantation is best justified
in difficult situations with unusual anatomical topography and
requiring multiple implants. It is useful, especially for patients,
who may not be planned for advanced sm'gical procedures
such as ridge-splitting, onlay grafting or nerve repositioning,
and therefore, the implantologist has to be certain that there is
enough available bone to adequately place an implant.
[~ USING THE DRUG 'WOBENZYM' IN BONE-
GRAFTING OF CONGENITAL ALVEOLAR CLEFTS
IN CHILDREN
Prityko, A, Gonehakov, G, Lopatin, A
Moscow Scientific-Practical
Paediatric Centre for Cranio-Facial Surgery and
Neuropathology, Moscow, Russia
Aims: The dispersal of tissue oedema in the zone of opera-
tion, to decrease pain during the postoperative period,
accelerate bone formation.
Method: using the drug 'WOBENZYM' (MUCOS Pharma,
Germany). This drug was used in 10 children aged between
12 and 15 years, with congenital alveolar clefts. The dose of
'WOBENZYM' is 1 tablet 3 times per day, 30 minutes before
meals, starting 2 days before surgery and continuing 8 days
thereafter. The control group consists of 20 children with
alveolar clefts, in this age group
Results: in 10 children there was no tissue oedema in the
zone of operation, this assisted faster wound healing. Pain
was absent in 6 children and in 4 children it was weak and
did not require analgesics. In the control group the tissues
were oedemarous until the 6th day postoperatively and pain
was present. In the study group, at the 3 months X-ray con-
trol there was final complete healing and living implanted
tissues. In the control group such an effect was only at 6
months after surgery.
Conclusion: we recommend systemic enzymotherapy and
particularly the drug 'WOBENZYM' to prevent tissue
oedema and pain during the postoperative period in chil-
dren with an alveolar cleft and also for stimulation of the
reparatory processes.
F L U O R O Q U I N O L O N E S IN PROPHYLAXIS O F
SUPPURATIVE C O M P L I C A T I O N S IN PAEDIATRIC
CRANIOFACIAL SURGERY
Lopatin A . Prityko A.. l~lokhov O.
Moscow Paediatric Scientific-Practical Centre Jbr
Craniofacial Surgery and Nemvpathology, Moscow, Russia
Aim: to estimate the efficacy and safety of fluoro-
quinolone in the prevention of suppurative complications
in the postoperative period in children, after craniofacial
surgery.
Method: in 54 children (aged 10 to 15) with craniofacial
deformities, bacterial cultures from the surface of the
skin, nasal and oral cavities were obtained, susceptibility
of the cultures were checked using antimicrobial test
discs. In 11 samples (26%), S. aureus and E aerugenosa
were found resistant to the majority of cephalosporins. In
these patients, Ciprobay (Bayer, F R G ) (I3.5 mg/kg) oral
administration for 7-14 days was clinically highly effec-
tive as a prophylaxis against secondary infections. There
was no evidence of any adverse events, including
arthropathy or tendonitis. All patients were checked at
follow-up visits using ultra-sound methods of
arthroscopy.
Results: We did not observe any complications in the follow-
up period. The microbiological response was determined on
50% of our patients
Conclusion: Cyprobay can probably be used in a child above
12 years of age, when bacteria to other antibiotics were cul-
tured.
FUNCTIONAL AND AESTHETIC STATUS IN
PATIENTS RECONSTRUCTED W I T H AN ILIAC
CREST FREE FLAP.
Lopez Atalaya, J. %"Navarro, C.; Perez, JE.; Salmeron, Jl.;
Coneejo, C.; Molina, LF.
Department of Oral and MaxilloJacial Surgery, Hospital
General Universitario "'Gregorio MararTon', Universidad
Complutense de Madrid, Madrid, Spain.
Aim: In this video we show the current status of several
patients who underwent mandibular resections and were
reconstructed with an iliac crest free flap. We will present, in
an objective way, the analysis of the results obtained with
regard to, basically, phonation, swallowing and mastication,
the disabilities caused in the donor area and the adaptation
to their occupational, social and familiar environment.
M & Methods: Mandibular repair has always raised serious
problems, and to obtain a suitable facial harmony and den-
tal-mandibular functional integrity, continues to be a chal-

lenge at present. With the microvascular techniques several
flaps with a bony component incorporated for mandibular
reconstruction have been recommended. We present 4 cases
of two males and two females, two of whom presented with
an ameloblastoma, and other two, cancer or oncologic
sequella. All had a segmental mandibulectomy with subse-
quent reconstruction.
Results: The iliac crest flap possesses ideal anatomical fea-
tures for mandibular reconstruction, and it is the best one
for accepting the osseointegrated implants, which serve for
future dental rehabilitation. It has been criticized by other
authors for the aesthetic and functional shortcoming that
can be created at the donor site. When the technique is
accomplished carefully, the aesthetic deformity and scar
are minimal sequellae and it avoids functional impairment.
Conclusion: This flap is considered ideal for mandibular
reconstruction. It is the best one for accepting osseointe-
grated implants, and unaesthetic scars and functional iim-
pairment can be avoided.
H I S T O P A T H O L O G I C P R O G N O S T I C FACTORS
F O R ELECTIVE NECK DISSECTION 1N EARLY
ORAL CAVITY E P I D E R M O I D CARCINOMA.
Lopez Pizarro VML Ballestin Carcavilla C, De La Cruz
Bertolo J, R e s t o y L o z a n o A,
Oromaxillofacial Surgery. University Hospital "Principe de
Asturias". Alcala de Henares. Madrid. Spain.
AIMS. To define accurate indications for elective neck
dissection in early epidermoid carcinomas of the oral cav-
ity based on pathologic specimen microscopic
examination.
PATIENTS AND METHODS. Retrospective study of 122
patients of epidermoid oral cavity carcinomas treated
between 1975 1990 with follow up of five years mini-
mum. Analysis of the following factors: site of the primary
tumor, T stage, pathological diameter, keratinsation degree,
degree of differentation, nuclear degree, number of mitoses,
pattern of invasion, stromal eosinophilia, pathologic maxi-
mum tumoral thickness,desmoplastic reaction, lympho-
plasmocityc reaction, microvascular invasion, perineural
invasion, bone invasion, muscle invasion. Each factor was
defined initially in four groups ( with the exception of the
four last ones) and after a first step with univariate statisti-
cal analysis related to the presence of positive cervical
pathologic metastases two categories was found useful to
study all the variables together in a second step: multivari-
ate analysis with logistic regression model. The final pur-
pose is to find the least number of factors with usefulness in
the clinical practice. All the specimen were examined by the
same pathologist without any information about the evolu-
tion of the patient.
RESULTS. The independent prognostic factors related to
cervical metastases ordered according with the odds ratio
are: pattern of invasion - defined as pattern expansive
versus others -(12, 984), tumoral thickness i 1- 21 mm ver-
sus 0 - 3 mm (8,116), lymphoplasmocitary reaction -
defined as prominent in continuous ring versus others -
(3,440) and tumoral thickness 4-10 mm versus 0 - 3 mm
(2,849).
CONCLUSIONS. Pattern of invasion, tumoral thickness
and lymphoplasmocitary reaction could be considered in
the management of the elective neck dissection in early oral
cavity epidermoid carcinomas after resection of the primary
tumor.
EACMFS Abstracts, HelsinkiCongress 1998 107
T H E INFLUENCE OF S M O K I N G AND CHRONIC
DISEASE ON VESSELS USED IN CRANIO-
MAXILLOFACIAL FREE F L A P SURGERY
* L o w r y J C 1, S a n d h u S 1 , Stringfellow H ~
1Dept. OMS, Royal Bolton Hospital UK
:Dept. Histopathology, Royal Preston Hospital UK
A number of groups of patients in craniomaxillofacial
surgery have been shown to benefit from free tissue transfer
by microsurgical techniques. One of the largest are those
with oral malignancy and patients in this group frequently
have significant risk factors for atherosclerosis.
Aims: Although atherosclerosis is recognised in the coronary
and larger arteries little is known about the incidence in smaller
vessels and in this context those more commonly used as donor
arteries in free flap reconstruction of the head and neck.
Study design: At autopsy in 40 patients (24 male/16 female:
ages 38-91 with mean of 72.6 y) lcm segments of 75 radial,
thoracodorsal, deep circumflex iliac and deep inferior epi-
gastric arteries were sampled together with a segment of the
anterior descending coronary artery in each case. Transverse
sections were fixed, embedded and stained with H&E and
EVG before histopathological examination. Thickening and
disruption of the intima and media were graded 0-4
(Shibabahara et al 1996) and arterial wall thickness was
measured. 4 main study groups were designated dependent
upon medical and social history as follows: control,
endocrine (incl. diabetes), cardiovascular (CVA, myocardial
infarctioon, angina and hypertension) and social habits
(smoking/alcohol consumption)
Results: The range of changes measured is described and the
implications for surgery discussed. It is suggested that the
radial and deep circumflex iliac arteries are relatively spared
and that in cardiovascular disease alone vessels are affected
by atheroma to a greater extent than in diabetes or cigarette
smokers.
Contact author:
John Lowry FRCS FDSRCS
Consultant Oral & Maxillofacial Surgeon
Royal Bolton Hospital
Minerva Road
Farnworth
BOLTON BL4 0JR
United Kingdom
Tel: +44 1204 390937
Fax:+44 1204 390937
e-mail: johnlowry 1@compuserve.corn
Residence:
50 Ravenswood
BOLTON BL1 5TL
United Kingdom
Tel: +44 1204 848815
Fax: +44 1204 845821
[h SURGICAL TECHNIQUE AND S O N O G R A P H I C
CONTROL O F MODERATE MAXILLARY
EXPANSION (MME)
Ludwig, A., Kirchhoff L., Wiltfang, J., Merten, H.-A.
Department of Oral and Maxillofacial Surgery, University of
G6ttingen, Robert-Koch-Str. 40, D-37075 G6ttingen,
Germany
108 Journalof Cranio-Maxillofacial Surgery
Aims: The surgical assisted maxillary expansion in the sense
of intraoral callus distraction is applied in cases of transver-
sal compression of the maxilla. The occurring gap in the
frontal teeth can only be closed through orthodontic appa-
ratus when bone tissue has developped in the maxillary gap.
Up to now, reossification of the expanded area in the upper
jaw was controlled only by x-ray. A sonographically con-
trolled maxillary expansion technique should be demon-
strated.
Method: In 10 patients with maxillary compression,
parasagittal osteotomy of the upper jaw combined with
incomplete Le-Fort-I-osteotomy was applied. The moderate
maxillary expansion technique (MME) with transversal
expansion and rotation of parts of the maxilla was applied
by one or two hyrax-screws: after one week postoperatively
first activation of the screws, after that two rotations of the
screws each second day. Over a period of 6 months postop-
eratively, with a 7.5 MHz linear scanner and a 3D-worksta-
tion (ViewPoint Company) the parasagittal gap in the
maxilla was regularly demonstrated by B-Scan sonography
and 3D-ultrasonography. Simultanously, the results were
compared with the x-rays.
Results: Using the moderate maxillary expansion tech-
nique in all patients the maxillary compression and the
dysgnathia could be removed. In the follow-up measures
the sonographically detected gaps, demonstrated as hyper-
echoic structure with dorsal signal enhancement,
increased in the period of expansion depending on
amount of the applied transversal expansion. After end-
ing the maxillary expansion the hyperechoic structure
decreased slowly but totally. The comparison of the sono-
graphic demonstrations with the x-rays showed, that 14
days before the bone tissue could be seen on the x-ray, the
gap in the jaw sonographically could not be detected any-
more. At that time, the bone usually is not mineralized
and so it could not be seen on the x-ray. However, the echo
waves were absorbed, so that the maxillary gap could not
be detected anymore.
Conclusions: The moderate maxillary expansion leads to
a sufficient generation of bone tissue in the distraction
area and prevents possible bone defects or loss of teeth
which could be seen after rapid expansion.The applica-
tion of B-Scan and three-dimensional sonography
enabled the control of maxillary expansion and sup-
ported determination of the optimal time for orthodontic
closure of the gap.
D IMPROVED LYMPH NODE DIAGNOSIS IN HEAD
AND NECK BY USING SIGNAL ENHANCED COLOR
DUPLEX SONOGRAPHY - CONSEQUENCES FOR
SURGICAL TREATMENT?
Ludwig, A. 1, Moritz 2, £ D., Voilheim', T., Kirehhoff , L.,
Wiese1, K. G.
1Department of Oral and Maxillofacial Surgery,
2Department of Radiology I, University of Ggttingen,
Robert-Koeh-Str. 40, D-37075 G6ttingen, Germany
Aims: The relevance of signal enhanced color duplex sonog-
raphy is a new method in lymph node diagnosis in head and
neck. It should be shown, that this method can improve
security in lymph node diagnosis and influence the surgical
therapy.
Method: In 22 patients 44 enlarged lymph nodes in head and
neck were firstly demonstrated by conventional color duplex
sonography. Afterwards, 2,5 g in bolus or 4g fractionized of
the signal enhancer LEVOVIST" were injected intra-
venously in a concentration of 300 mg/ml (9ml).
Results: After application of the signal enhancer, in all cases
a great signal enhancement could be achieved. Smallest ves-
sels, which in native color duplex sonography were not
detectable, could then be identified. In 19 cases a lym-
phadenitis, in 23 cases a metastasis and in 2 cases a lym-
phoma was diagnosed. After injection of signal enhancer,
only one enlarged lymphnode was categorized avascular. In
45 % of the lymph nodes, vessels could only be detected
after application of signal enhancer. The surrounding ves-
sels could better be evaluated in 43 of 44 cases. In 36 of 44
cases supplying vessels after injection could be seen. LEVO-
VIST" caused a change of diagnosis in 4 cases of lym-
phadenitis (primarilly categorized as metastasis) and in 5
cases of metastasis (primarilly diagnosed as lymphadenitis).
In 3 of these cases the therapeutic concept had to be
changed.
Conclusions: By additional application of signal enhanced
color duplex sonography in head and neck the security of
lymph node diagnosis is improved. The surgical therapy
respectively the decision for radical neck dissection versus
lymph node dissection of the suprahyoid region should be
determined of the sonographical lymph node staging.
A THE SIGNAL ENHANCED 3D-COLOUR DUPLEX
SONOGRAPHY: A NEW DIAGNOSTIC TOOL FOR
LYMPH NODE DIAGNOSIS IN HEAD AND NECK
Ludwig, A.', Moritz ~, J. D., Vollheim', T., Kirehhoff , L.,
Wiese 1, K. (7.
~Department of Oral and Maxillofacial Surgery, 2Department
of Radiology L University of G6ttingen, Robert-Koch-Str
40, D-37075 G6ttingen, Germany
Aims: Through evaluation of vascularization of lymph
nodes in the conventional color duplex sonography security
of diagnosis in lymph node sonography can be enhanced
slightly. Often, due to small size of the lymph nodes, the
demonstration of the vessel structures is insufficient.
Therefore, it should be proved, in how far the vasculariza-
tion of the lymph nodes could better be evaluated through
application of echo enhancers in combination with 3D-
color duplex sonography.
Method: Through combination of a conventional color
duplex system with a 10 MHz transducer (LOGIG 500 ®,
Kranzbuehler Company) and the 3D-workstation
(ViewPoint Company) with integrated color digitalization
board a three-dimensional demonstration of vasculariza-
tion of lymph nodes is possible. Additionally, intravenously,
LEVOVIST ® (Schering Company) was applied for signal
enhancement. In 15 patients with carcinoma of the
oropharynx the sonographic evaluation of the neck lymph
nodes by color duplex sonography and signal enhanced 3D
color duplex sonography was carried out.
Results: Altogether 19 inflammatory lymph nodes and 8
lymph node metastasis were sonographically be detected. In
all lymph nodes the vascularization could be evaluated more
exactly by use of signal enhanced 3D-colour duplex sonogra-
phy. Inflammatory lymph nodes showed normal hilar vessels.
In lymph node metastasis vessels were detected which sub-
side from the periphery through the lymph node capsules. In
the center of the lymph node metastasis larger avascular
areas but no typical hilar vessels could be found. Through
the application of signal enhanced 3D sonography in 4
lymph nodes a change of the evaluation became necessary.

The pathohistological examination confirmed these
results.
Conclusion: Through the signal enhanced 3D-color duplex
sonography the vascularization of lymph nodes can be
demonstrated and characterized three-dimensionally so that
the differentiation between lymph node metastasis and lym-
phadenitis and therefore the security of diagnosis can fur-
ther be improved.
RECONSTRUCTION OF THE SEVERELY
ATROPHIC M A X I L L A W I T H FREE ILIAC BONE
GRAFTS AND TITANIUM I M P L A N T S IN STAGED
PROCEDURES
Sicfan Lundgren DDS, PhD
Department of Oral & Maxillofacial Surgery, Umed
University, S-90187 Umed, Sweden
The normal pattern of resorption in the maxilla can result
in different end points, and therefore different reconstruc-
tion techniques are required. In patients with Class IV and
V (Cawood & Howell) resorption, with a reversed inter-
maxillary relationship with or without increased vertical
intermaxillary distance, an interpositional graft in conjunc-
tion with a Le Fort 1 osteotomy was performed. In patients
with a more normal intermaxillary relationship but insuffi-
cient bone volume, a bilateral maxillary sinus and nasal
graft was performed. In patients with, additionally a thin
alveolar process or low anterior alveolar height, a sinus and
nasal inlay graft was done in conjunction with a cortico-
cancellous buccal or vertical onlay graft. In the first 39 con-
secutively treated patients, the clinical data will be
presented where the minimal follow up time was 3 years
after the second stage implant surgery. In the patients
treated with nasal and sinus inlay grafts only, 20 of 66
implants were lost after a 3 to 6 year follow up. Two
patients each lost all 6 implants. The corresponding figures
were 18 of 70 implants lost after 3 to 6 years in the patients
reconstructed with a vertical cortico-cancellous block graft
in addition to the inlay graft. Two patients both lost all 7
implants. In the patients with a thin alveolar process, with
or without loss of vertical alveolar height, the patients had
either a buccal onlay graft or a buccal/vertical onlay graft
combination in conjunction with a nasal and sinus inlay
graft. In this group of patients, 3 of 67 implants were lost
after 3 to 4 years follow up. In the interpositional grafted
patients, 4 of 60 implants were lost after 3 to 6 years follow
up. Thirty-five of the initially 39 patients now have fixed
bridges and they all continue to function well. The differ-
ence in implant survival with the different reconstruction
techniques will be discussed. For the evaluation of simulta-
neously or delayed placement of implants in autogenous
iliac bone grafts, a clinical study was conducted where tita-
niuln micro-implants were placed in the graft. The micro-
implants and surrounding bone were retrieved from the
patients with a trephine, and investigated histologically.
From the histological investigation it was concluded that
delayed placement of implants in free autogenous bone
grafts results in a significantly higher degree of implant
integration as compared with the simultaneous placement
of implants, even if the healing time is prolonged for the
simultaneous approach. This is likely to be explained by the
fact that with the delayed approach, the graft is partly
revascularised at implant placement, which results in a
response to the surgical trauma and initiation of a repair
process similar to that in normal bone.
EACMFS Abstracts, Helsinki Congress 1998 109
APPROACH OF TEMPORAL, PTYERIGO-
PALATINE AND PTYERIGO-MANDIBULAR
T U M O R S THROUGH HEMIFACIAL DISSECTION
Lung, T.* Muvesan, O.
Department of OMFS, Faculty of Stomatolog); , Iuliu
Haieganu" Universityof Medicine and Pharmacy, Cluj-
Napoca Romania
Aims: We show the advantages of using a hemifacial dissec-
tion approach in managing tumors of the temporal fossa, of
the pterigo-palatine fossa and of the pterigo-mandibular
space.
Method: For accessing a tumor of the pterigo-mandibular
space, extended to the pterigo-palatine and to the temporal
fossa, we used a specific approach formerly described by
Akiyoshi Hirano and Co.. A large hemifacial flap was cre-
ated using a midline skin incision from the forehead to the
neck, completed along the sternomastoid muscle for expo-
sure of the neck, providing a large hemifacial flap, using a
technique of face degloving, in order to achieve direct access
to the tumor. Palpebral dissection was also performed and
all mimic muscles were included in the flap. Left hemi-
mandible had to be resected, being tumoral involved.
Functional neck dissection was performed in the same
session.
Results: Tumor was completely resected, due to a good visi-
bility, facial nerve was preserved due to the specific
approach, palpebral mobility was obtained immediately
postoperative, sensibility of the face was restored satisfac-
tory due to microneurosurgery.
Conclusions: The technique we used for approaching com-
plex tumors situated close to the skull base does not damage
major anatomical structures involved and the aesthetic prej-
udice is minor compared to the importance of the great
operating field provided and the safe ablation of the whole
tumor through direct access.
BEHAVIOUR OF THREE DIFFERENT MATERIALS
IN THE I M P L A N T TREATMENT OF THE ATROPHIC
MAXILLA: A PRELIMINARY REPORT OF A
PROSPECTIVE STUDY.
Ginseppe Luongo* Franeesco Papa, Luigi Califauo,
Giuseppe Coscia.
Department of Maxillofacial Surgery. School of Medicine
and Surgery. Universityof Naples "'FedericoH", Italy.
Aims: To evaluate the behaviour of three different materials
used for the augmentation of the maxilla before implant
insertion.
Methods: Twenty-four patients with an atrophic maxilla
have been treated with bone augmentation using autologous
bone, bovine bone or hydroxyapatite, in a period of 18
months. In all patients, the implant installation has been
performed in a separate stage, four/six months after the
graft. A TC analysis was performed before grafting and at
the time of implant installation. A histological analysis was
performed at the time of implant installation and abutment
connection.
Results: The results of the evaluation of the radiographic
and histological parameters and of the analysis of the bone
resorption and implants survival will be presented.
110 Journal of Cranio-MaxillofacialSurgery
Conclusions: The promising early results with the use of autol-
ogous bone seems to indicate it as the best material for graft-
ing in the maxilla, according to many studies. The possibility
of using other materials must also be considered in selected
cases.
THE CLINICAL F O L L O W - U P O F THE OSFIX
DENTAL I M P L A N T SYSTEM: P I L O T RESULTS
AFTER ONE YEAR
Luotio, K. *, Kotilainen, R., Ryhiinen, J., Petrelius, U.
University of Kuopio, Finland
Objectives: The aim of this study is to verify the success rate
of the Osfix system.
Methods: The study plan is accepted by the medical board of
ethical committee and by Finnish medical department of gov-
ernment. The Osfix implant is a cylinder implant with an api-
cal screw portion for better primary stability. The implant is
made of grade 2 pure titanium and the implant surface is
mechanically coarsened. The upper part of the implant is pol-
ished. The length of the implant is 13.5 mm and the outer
diameter 3.75 ram. The Osfix implant is primarily designed for
bar retained overdentures in the lower jaw in totally
edentulous patients.
In this study the total number of 58 patients were oper-
ated under i.v.-sedation and local anaesthesia. The num-
ber of implants inserted was 203. All implants were
inserted into the anterior mandible between the mental
foramens. During the operation three implants were
inserted in 29 cases and similarly - four implants in 29
cases. After three monts period the secondary operations
are performed and impressions were sent into the Osfix
laboratory, where the retention bar is produced using pre-
fabricated burn-out components and casted using cobalt
crome alloy. The overdenture was strenghtened with glass
fibres. All of the dentures are designed to have a structure
where the canines are in the line paralel with line between
condyles. Moreover, the retention bar is fabricated to
locate paralel with previous lines to allow seesaw move-
ment and therefore only vertical forces towards the
implants.
Results: During the secondary operation all of the implants
were integrated. After the first year lbllow-up period in the
first annual recall no implants were lost.
Conclusion: The success rate of Osfix implants is 100% after
one year follow-up.
[~ CLINICAL ASPECTS OF PIERRE ROBIN
SYNDROM
LLupan, Valentina Trifan, Iu.Baidaut, Silvia Railean
State Medical and Pharmaceutical University, Kishinev, Moldova
Pierre Robin syndrome is a congenital disease and has a
classic triad of conditions microretrognathia, large tongue
and a U-shaped cleft palate. This triad is termed as a
sequense because the initial malformation (microretrog-
nathia) inhibits the tongue from assuming as natural in
untero position on the floor of the month. For patients with
the Pierre Robin sequence care must be taken on airway
management during the first year of life.
The aim of our study is to determine the managment of
different degrees of airway obstruction.
The 15 children with Pierre Robin syndrom were
observed (9 girls, 6 boys). All the patients were devided
into 3 groups, depending ou the degree of airway
obstruction.
The first group includes 4 childrens with the obvious
microretrognathia, U-shaped cleft palate and the tongue
mobility is maintained. Upper airway obstruction occur
during the sleeping on the back. The parents may feed the
child without any complications.
The second group includes 6 children. These patients
have a pronounced microretrognathia, a wide U-shaped
clet palate and a short frenum and a limited tongue
mobility he airway obstruction occurs during sleep or
when the child is awake on the back. The obstruction is
for a long time and needs a nursing care. The parents may
feed the child in an upright rather than a reclining
position.
The third group includes 5 children with pronouced
microretrognathia, a wide palatal cleft, a low tongue mobil-
ity and a short frenum of third degree. The obstruction
occurs almost permanently, only some lateropositions may
give a short time improvement.
The metods of treatment are devided according to this 3
groups.
I group - the tongue is sutured temporarily for 7 days and
moved anteriorly and down. Lateroposition during sleep, a
cleft palate plate and feeding in semivertical position are
recommended.
II group - temporary tongue suturing with extraoral fix-
ation, tongue frenum surgery, cleft palate plate and feeding
in vertical position.
lII group - a tongue reduction procedure, the tongue is
moved anteriorly and attached to either the mandible or the
lip. Feeding is done through a nosopharyngeal tube and
using a palatal plate.
In all these cases treatment was effective. Only in one case
at a child of 6 years old an obstruction happened after
surgery which disappered after neurologic treatment during
10 days.
Dr. Ion Lupan, M.D.
Shef of oromaxilofacial surgery division,
Republican Hospital for children
Associated Profesor
Department of Pediatric Stomatology
State Medical and Pharmaceutical University
Vasile Alecsandri 2, Kichinev, Moldova 2009
Tel.: 373 2 72 81 44; Fax : 373 2 73 19 63
T E M P O R O M A N D I B U L A R J O I N T SURGICAL
MANAGEMENT AFTER AN UNSUCCESSFUL
SURGICAL OUTCOME
Robert B. Macintosh, D.D.S.,
Dept. of Oral and Maxillofacial Surgery, DMC-Sinai
Hospital Detroit, Michigan, USA
Temporomandibular joint surgery of the last 25 years, albeit
generally well intentioned, has often been misdirected,
undertaken without scientific foundation, and of question-
able benefit, or even detriment, to the patient. This presen-
tation surveys the problems arising subsequent to
meniscoplasty, meniscectomy, condylectomy, and alloplastic
and autogenous joint reconstruction.
Failure of surgery on the temporomandibular joint usu-
ally results in pain, restriction of movement, and imaging
evidence of condylar and/or fossa degeneration. Initial

attempts at recovery or improvement are best directed in a
conservative fashion, with splints, medication, and behav-
iour modification, to avoid additional detriment potentially
afforded by further surgery.
Persistent progression of symptoms, or objective evi-
dence of intractable anatomical disintegration, require sur-
gical efforts for any hope of improvement. The protocols
and rationale for such efforts, most frequently with the
employment of autogenous elements, receives major
emphasis in this presentation.
E3 T H E I N T E R M A X I L L A R Y SCREW:- A D E D I C A T E D
BICORTICAL BONE SCREW FOR THE PROVISION
OF M A X I L L O M A N D I B U L A R F I X A T I O N
Jones DC *, Magennis P.
Regional Maxillofacial Unit, Walton Hospital, Liverpool,
United Kingdom.
The introduction of intra-oral bone plating systems has
meant that prolonged periods of maxillomandibular fixa-
tion ( M M F ) are no longer generally required in the patient
who has fractures of the mandible or maxilla. However
there is often a need for temporary M M F intraoperatively
to assist in the reduction of fractures with the teeth in the
correct occlusion. In addition light elastic traction may be
useful in the postoperative period to correct minor occlusal
discrepancies; for example if there is an associated fracture
of the condyle. Traditionally M M F has been achieved with
arch bars or interdental eyelet wiring. These techniques
have some intrinsic disadvantages in particular the risk of
needle-stick injury. A specially designed bone screw has
been used in this Unit to allow the safe provision of
temporary MMF.
The screws used are 2mm diameter threaded titanium
screws. They have a capstan style head and are inserted
using a hexagonal headed central drive screwdriver. Their
indications, contraindications and methods of placement
will be presented.
D E V E L O P I N G A DATABASE - S O M E EXAMPLES
OF EVOLVED S O L U T I O N S TO C O M P U T E R I S E D
RECORD KEEPING
Magennis P * Mnrphy MT, Rogers SN, Brown JS, Vaughan
ED, Patel M.
Regional Maxillofaeial Unit, Walton Hospital, Liverpool,
United Kingdom.
Data collection and it analysis are important aspects of the
care of all patients. In the management of patients with can-
cer this information is essential. There is no doubt that com-
puters are the most efficient means of collecting data. Many
surgeons become either absorbed with the amount of data it
is possible to collect without considering the best way to
assimilate it, or become disheartened by the prospect of
confronting a hostile piece of software. This inertia encour-
ages prevarication and a dependence on the use of other
peoples information such as that of cancer registries,
pathology departments, or hospital administration.
Since 1993 the maxillofacial unit at Walton Hospital has
been prospectively collecting data on all its cancer patients
EACMFS - Abstracts, Helsinki Congress 1998 111
onto a laptop computer. Information is entered directly by
clinicians (of varying degrees of computer literacy). Using
the constructive criticism of these and the database user
group, a practical and efficient interface has evolved. The
process has not been without teething problems.
The authors will outline the lessons learnt in the process
and will give relevant advice to all clinicians wishing to
undertake the development of a useable database or wishing
to adapt a proprietary programme for ease of use. The pre-
sentation will be illustrated with examples not only from the
oncology database, but also the orthognathic, implant,
trauma and logbook databases developed in Walton.
Further advice and a copy of the latest databases will be
available for download, free of charge, from the Internet.
I M M U N O F L U O R E S C E N C E ANALYSIS O F
HYPOXIA IN S Q U A M O U S CELL CARCINOMA AND
F I B R O S A R C O M A M U R I N E T U M O U R S USING A
PENTAFLUORINATED N I T R O I M I D A Z O L E
C O M P O U N D (EFS).
P. MahyS% H. Reychler,, J. Gueulette,, P. Scalliet, and E
Grdgoire'.
Radiation Oncology and Radiobiology Dept.,, Maxillofacial
Surgery Dept. 2, UCL St-Luc University Hospital, Brussels,
Belgium.
Background : Tumour hypoxia has been known for a long
time to be an important physiological parameter implicated
in tumour resistance to ionizing radiation. It has been
shown, for example, that human tumours with low pre-
treatment oxygen partial pressure exhibited a much higher
rate of local recurrence after radiotherapy than well oxy-
genated tumours. Among various methods used to detect
tissue hypoxia, the use of the pentafluorinated derivative of
nitroimidazole (EF5) appears promising. This compound
which is reduced under hypoxic conditions and hence makes
covalent bonds with intracellular macromolecules, can be
detected by immunofluorescence (IF) using specific anti-
bodies.
Aim : To develop in vivo mouse tumour models for quantita-
tive detection of cellular hypoxia using immunofluorescent
techniques with EF5.
Materials and Methods : A squamous cell carcinoma (SCC
VII) and a sarcoma (NFSA) syngeneic to C3H mice were
used. Different conditions of tissue oxygenation were gener-
ated with the animals breathing under ambient air (21%), or
under 100% or 7% oxygen concentrations. EF5 was injected
i.v., 3h prior to tissue harvesting and fixation in liquid nitro-
gen. Tissues were processed for I F using the Cy-3 fluo-
rochrome conjugated monoclonal antibody ELK-51.
Sections were viewed with a fluorescent microscope at mag-
nifications of 125x and 375x, and digitized. Analysis of the
fluorescence pattern was done using the N I H Image soft-
ware. The area above a threshold value of optical density
was determined.
Results : A different I F pattern was found between the two
murine tumours. Data analysis indicates a wide range of
intra- and intertumour heterogeneity. A trend towards
increasing I F with decreasing O, concentration was
observed. In contrast, I F in adjacent leg muscle was much
lower and did not vary with O_, concentration.
Conclusions : EF5 allows quantitative detection of tumour
hypoxia, using immunofluorescence. Experiments in other
mouse tumours as well as comparison with other methods
112 Journal of Cranio-MaxillofacialSurgery
of hypoxia detection (flow cytometry, Electron
Paramagnetic Resonance, histometry, Eppendorf probe)
are in progress.
R E C O N S T R U C T I O N OF THE ORBITAL REGION.
Malakhovskaya V.L, Osipov G.L
Department of Face-Neck Plastic Sm~ery and Microsurgery.
Central Research Institute of Stomatology, Moscow, Russia.
Aims: This presentation demonstrates our approach to the
choice of reconstructive methods of the orbital region.
Methods: Our experience is based on the surgical treatment
of 28 patients with different kinds of orbital defects. It
embraced 25% of all cases with mid-facial defects after
removal of tumors, trauma and gunshots from 1992 to
1997. 9 patients had periorbital soft tissue defects and 19
patients had large defects that included adjacent regions. To
restore large defects we mainly utilized free feap transfer:
latissimus dorsi, scalpular and radial ones. For peri orbital
soft tissue reconstruction we used transposition of forehead
axial and random flaps, dermal,mucosal and chondral
grafts for eye socket reconstruction.
Results: In our attemps to create the eyelids with tissues of
distant flaps we were not satisfied with the results, because
the reconstructed structure were not similar to the non-
injured ones. In such cases the prosthesis better imitated the
lost anatomical structures. Plastic of lower lid was con-
ducted in cases of intact upper lid. The neighboring regions
gave a lot of satisfactory flaps to reconstruct the defects lim-
ited to the orbital region. The localization of the flaps with
due regard for the anatomical conditions and age changes
do not lead to subsequent deformation.
Conclusions: Applications of proper reconstructive method,
depending on the characteristics of defects, gives a possibil-
ity to achieve more adoptable result.
[~ INNERVATION IN ORAL L I C H E N PLANUS.
Niissalo S. *, Hietanen J., Malmstr6m M., Hukkanen M.,
Polak J., Konttinen E
Institute of Dentistry, Department of Oral Medicine,
Helsinki University, Helsinki, Finland.
Aim: To define the distribution of nerves and their peptide
content in patients with oral lichen planus (OLP), lichenoid
reaction (LR) and mild chronic inflammation (MCI).
Method: Immunoperoxidase staining was used to demonstrate
overall innervation (PGP 9.5) and peptidergic innervation was
visualized with substance-P (SP), calcitonin gene-related pep-
tide (CGRP), vasoactive intestinal polypeptide (VIP) and C-
flanking peptide of neuropeptide Y (CPON) as markers.
Results: Overall nerve fibre density was increased in OLP
(p=0.026) and LR (p=0.029). Local loss and retraction of
nerve fibres were detected in areas with most prominent
lymphocyte infiltrates and in areas of liquefaction degener-
ation of basal epithelial cells. The pattern of innervation, in
relation to inflammatory cell infiltration and tissue struc-
tures, was different in OLP compared with LR. Densities of
neuropeptide-immunoreactive nerves were decreased; a
twenty eight-fold loss of CPON-in sympathetic nerve fibres
was registered in LR (p=0.044) compared with healthy oral
mucosa.
Conclusion: Innervation may contribute to the pathogenesis
of OLP and LR as an intrinsic initiating factor, modulating
and maintaining the cascade of immunological events which
ultimately lead to persistent inflammation in the oral mucosa.
C O M P L I C A T I O N S O F 1LIAC CREST BONE
GRAFT.
Manor* R., Ardekian L., Laufer D.
Department of Oral and Maxillofacial Surgery, Rambam
Medical Centeg Haifa, Israel.
The ilium is a common donor site for cancellous, cortical
,and corticocancellous grafts in maxillofacial surgery.
The surgical technique for harvesting bone graft from the
anterior iliac crest is well documented, and includes the
medial, lateral and crestal approaches, as well as combi-
nations of same. A variety of complications associated
with iliac crest bone harvesting has been reported in the
literature, however, it has not been ascertained which
approach is more advisable. The purpose of this study is
to evaluate retrospectively the morbidity of the anterior
crest's medial plate. 75 patients (45 males and 30 females
with a mean age of 14 years) that underwent iliac crest
bone graft for closure of residual alveolar cleft, were
evaluated for intraoperative and postoperative complica-
tions. 70% of the patients complained of pain during the
first two days postoperatively, and in 9% the pain lasted 1
month. 6.5% had wound hematoma in the donor site,
which was treated conservatively, and 4% of the patients
developed a seroma that lasted 1 month, and was treated
by recurrent aspiration. Paralytic ileus , that lasted 2
days, was observed in 4% of the patients, and a naso-gas-
tric tube was applied to them. Sensory disturbances
occurred in 5% of the patients, but only in 2.5% of them
it lasted for more than 2 months, but no one for more
than a year. None of the patients developed a pathologi-
cal condition of the sacroiliac joint,nor fractures of the
iliac wing, or hernias. Our study shows clearly the medial
approach for harvesting bone graft from the anterior iliac
crest is a safe and good technique with a low rate of
complications.
[~ TRANSORAL APPROACH TO A
PARAPHARYNGEAL SPACE T U M O U R
Marcos 0., * Moreno M., Pineda A., Marzan R.
Dept. of Maxillofacial Surgery (Head: Dr. R. Marzan),
Hospital Ramon y Cajal, Madrid, Spain.
Aims: To define an approach that permits the complete
extirpation of proven tumours of parapharngeal location
with extension to the cranial base, minimizing the aes-
thetic and functional sequelae of other traditional
approaches.
Method: A patient of 19 years old was referred with a pro-
nounced bulge in the left orophangeal wall, of seven months
evolution and which had recently presented a higher rate of
growth. She had no pain nor presented any neurological sign or
palpable nodes. In the CT scan there was a 7x4 cm turnout in the
left parapharyngeal space, with well defined borders and with
possible osseous invasion of the pterygoid plate The biopsy did
not provide any conclusive results but suggested chondrosar-

coma. We decided to approach the tumour transorally through a
vertical incision in the palatoglossal arch, including the previous
biopsy scar, meticulous dissection and finishing with a chisel
osteotomy of the pterygoid plate in order to free the tumour.
Results: The pathological study confirmed the diagnosis of
chondrosarcoma of low grade malignancy, with tumour free
borders. The patient was discharged within 72 h. With nei-
ther deformity nor functional limitation. In the CT scan
done 6 months postoperatively there were no appearances
suggestive of local or regional recurrence.
Conclusions: The transoral palatoglossal approach described
here, in spite of having limited indications due to the complexity
and the impossibility of dissecting certain structures, should be
considered when possible, seeing that it provides excellent
results in regard to postoperative complications and the restdt-
ing sequelae, versus the traditional transmaxillary, transparotid,
transcervical, transmandibular or lateral osteotomy techniques.
?h FACIAL I N F E C T I O N CAUSED BY
MYCOBACTERIUM AVIUM-INTRACELLULARE
Marinho, R.O.M.*, Hutchison, I.L.
Department of Oral and Maxillofacial Surgery, The Royal
London Hospitals" NHS Trust, London, England.
Mycobacterium avium-intracellulare complex (MAC) is the
most common aetiological agent in non-tuberculous
mycobacterial infection. MAC infection is considered to be
an important cause of disseminated disease in immunocom-
promised adults, and localised cervical lymphadenitis in
otherwise healthy children.
A case of an immunocompetent 65-year-old caucasian
woman with cervical and facial swellings caused by this organ-
ism is presented. Although surgery is advocated as the treat-
ment of choice in localised infection, surgical excision was
avoided in this case because of the risk of damaging branches
of the facial nerve and also of producing a poor final cosmetic
result. A satisfactory result was obtained using drug therapy
and final surgical correction of the residual scar at the site of
the original sinuses. Our case suggests that medical treatment
may be effective and in difficult surgical sites should be consid-
ered, with surgery reserved for tidying up procedures.
FREE F L A P RECONSTRUCTIONS IN THE
M A N A G E M E N T O F ORAL AND PHARYNGEAL
CANCER
Markkanen-Leppiinen, M.*, Suominen, E., Lehtonen, H.,
Asko-Seljavaara. S.,
Departments of Plastic Surgery and Otorhinolaryngology,
Helsinki University Hospital, Helsinki, Finland
Aims: To analyse the preoperative and perioperative factors
that influence free flap application outcome, patient mor-
bidity and mortality.
Method: Medical records of 50 consecutive patients receiv-
ing microvascular free flaps between 198%1995 were
reviewed retrospectively. All patients had a malignancy
extending into the oral cavity or pharynx. 50% of the cases
were classified as stage IV malignancies. Free microvascular
flaps were used in the reconstruction of the defect caused by
tumour ablation. 24 radial forearm, 15 jejunum, 8 musculo-
cutaneous latissimus dorsi, 1 osteocutaneous fibula, 1 mus-
EACMFS-Abstracts, Helsinki Congress 1998 113
culocutaneous rectus abdominis and 1 osteomusculocuta-
neous scapula flaps were used in these procedures.
Results: 48 flaps were successful and two flaps (1 fibula and
1 jejunum) were lost. There was 1 death, giving a periopera-
tive 30 day mortality of 2%. The morbidity and mortality
are presented in detail. At the end of the follow up 15
patients were alive. Those alive have lived 4 years on average
after a one stage operation for tumour ablation and vascu-
larized free flap reconstruction. On the other hand the
patients who died lived about 1.5 years.
Conclusions: Oral and pharyngeal cancer patients are com-
monly elderly and have often been heavy drinkers and smok-
ers and are in a poor nutritional condition preoperatively.
However, the success rate in these extensive operations is sur-
prisingly good. Reliable factors predicting the success rate
and the postoperative condition are difficult to find.
BONE S E G M E N T NAVIGATION W I T H T H E SSN
SYSTEM
Marmulla, R.*, Niederdelimann 11., Wagener 1t.
Dept. for Oral and Maxillofacial Surgery, University of
Regensburg, Germany
Aims: Computer-assisted navigation of osteotomized bone
segments according to a preoperative plan without preoper-
ative markers or implants.
Method: The Surgical Segment Navigator (SSN), developed
with the support of Carl Zeiss, Germany, is based on an
infrared three- dimensional localizer such as the Surgical
Tool Navigator (STN) and the Surgical Microscope
Navigator (SMN). The pre- and postoperative position of
bone segments can be taken from a model (orthognathic
surgery) or from a CT workstation. The data for transposi-
tion of bone segments can be imported from the
Craniofacial Surgery Planning System (CSPS) by Leibinger
as well. The surface of the navigated bone segment is used
for correlation between data set and op situs. The surface of
the bone segment is fixed intraoperatively by a template to a
Dynamic Reference Frame with three diode beacons. The
SSN workstation renders the navigated bone segment as
polygon and indicates starting, actual and target positions.
The precision of the SSN system is evaluated by bone
segment navigation on three human cadavers (calvaria,
maxilla, zygoma). The position of reference markers in the
surface of the navigated bone segments in a postoperative
high-resolution CT is compared with the preoperative plan.
The transposition of bone segments is controlled by direct
infrared-measurements of reference points on the denuded
cadavers, as well.
Results: Bone segment navigation by the use of the SSN sys-
tem has been performed with a mean error of 0.7 mm, a
standard deviation of 0.2 mm and a 95% percentile for the
deviation on 1 mm.
Conclusions: The Surgical Segment Navigator (SSN) is the
first system to meet the criteria for high-precision naviga-
tion of three- dimensionally registered rigid bodies in
surgery.
?h CONDYLE RECONSTRUCTION BY S L I D I N G
RAMUS OSTEOTOMY
Martinez-Lage J.L.*, Eslava J.M., Gonzdlez J., Moreno M.,
Marcos O.
114 Journal of Cranio-Maxillofacial Surgery
Dept. of Craniomaxillofacial Surgery (Head" Dr. J.L.
Martinez-Lage ).
Hospital Ram6n y Cajal. Madrid. Spain,
Aims: To describe a condyle reconstruction technique in
order to enhance functional results minimizing sequelae and
avoiding to employ alloplastic materials.
Method: Patient of 30 years of age that consulted refering
swelling in left preauricular area with a decreasing mouth
opening pattern , occlusion deviation to the right and no
pain.Panoramic radiograph and CT scan showed a solid
enlargement (3x3x2,5 cm) of the left mandibular condyle
with no cystic pattern. Surgery was undertaken through a
combined preauricular and submandibular approach. After
condyle extirpation, we performed a sliding ramus
osteotomy previously planned with radiologic findings, tak-
ing into account the inferior alveolar nerve canal, remode-
lated the condyle with a burr, fixated the fragment with two
"U' plates and reattached the pterygoid muscle to the new
condyle , at last we assured the position and range of
motion of the new condyle.
Results: After 48h, the patient was discharged, with open
mouth and a range motion over 30 m m , without any com-
plication. Panoramic radiograph showed the new left
condyle with a very similar appearance and function to the
right one.The pathology study confirmed the diagnosis of
chondroma
Conclusions: The technique described provides an excelent
functional and cosmetic results, avoiding the complication
rate associated with other clasical condyle reconstruction
techniques such as costocondral grafts ~iliac bone grafts or
alloplastic materials.
C R A N I A L BASE S U R G E R Y F O R M A J O R T U M O U R
RESECTION. OUR EXPERIENCE.
Martinez Navarro, M.; Daura Sdez, A.; Montes Jimdnez, J.;
Ya~ez Vilas, J.L and Palma GOmez de la Casa,
A. Hospital Regional "Carlos Haya".
Oral and Maxillofacial Department. Mdlaga. Spain.
Aims: We describe our 2 year experience in cranial base
surgery for the resection or' major tumors, showing the
approaches used and the morbidity and mortality in our
patients.
The statistics of 16 cases was as follows.
Method: The skin approaches were cervicotomy and preau-
ricular in 4, bicoronal in 8, hemycoronal in 2, medial lip-cer-
vicotomy in 2, weber-Fergusson in 1. The osseous approches
were frontal orbital in 3, Frontoorbital + Lefort I in 1,
Fronto-nasal-orbitary in 1, Orbitofrontal-temporal in 3,
O.F.Temporal-malar in 1, cervical parotid in 2 and others
in 5.
Calvarial grafts, pericranial flaps, forearm free flaps,
galeal and Temporal muscle flap among others were used
for reconstruction of the postablative defect and for achiev-
ing a functional separation between the intracranial struc-
tures and the airway. The histopathologic analysis of the
tumors showed the presence of meningiomas, paragan-
gliomas, deep, lobe parotid tumors, chondrosarcoma, neu-
rofibroma, sarcoma, neurileloma, malignant meningioma
and fibrous tissues nodes.
Results: Morbidity was bronchial aspiration in 1, sepsis in 1,
facial nerve palsy in 1 and aesthetic secuelae in 4. Mortality
happened in 2 cases.
Conclusions: Morbidity and aesthetic secuelae were due to
tumor exision not of approach. The rule of Maxillofacial
surgeon should be to permit the access for the neurosurgeon
to remove the tumors without any significant functional or
aesthetic morbidity, so as to remove the extracranial compo-
nent of the tumor.
T H E W I D E USE OF THE CO 2LASER FOR
INTRAORAL LESIONS
Martin-Granizo R. *, Naval L., Costas A, Rodriguez-Campo
F, Mu~oz M., Padrdn A, Diaz FJ.
Department of Oral & Maxillofacial Surgery. University
"Hospital Clinico San Carlos" and "'Hospital de La
Princesa", Madrid, Spain.
Aims: To stress the wide range of use of CO 2laser in intrao-
ral surgery, and demonstrate our experience and the out-
comes.
Method: Retrospective analysis of the clinical records of 120
patients treated during an 8 year period. They were 27
females and 93 males with a median age of 57 years. Lesions
were classified as vascular malformations - 3, benign lesions
- 15, lichen planus - 5, actinic cheilitis of the lip - 22,
mucosal leucoplakias - 28, squamous cell carcinomas (SCC)
- 39, and 8 cutaneous lesions. SCC comprised 31.4% of the
total (11 females and 28 males, median age 60 yrs.).
Seventeen were located in the tongue. SCC staging was as
follows: 53.9% were Tis, 7.7% were T1, 2.5% T2, and 35.9%
T3.
Results: Cutaneous epithelization was completel in 2 to 4
weeks, while mucosa epithelialized in a shorter period. Three
lichen planus patients complained of postoperative pain. Of
22 actinic cheilitis, 3 had bleeding after surgery, and 8 pain,
with 1 recurrence. No infections or SCC recurrences were
recorded. Global rates were 7.5% postoperative bleeding,
10% retractile scars and l 5.8% postsurgical wound pain.
Conclusions: Laser CO 2 appears to be a suitable alternative
to the classic methods, valid for resection of a wide range of
intraoral lesions, have lower rates of bleeding and a greater
surgical accuracy than do the other methods.
[~ A NEW SURGICAL TECHNIQUE FOR EXCISION
OF BUCCAL MUCOSA TUMOURS.
Christos Martis, N. Papadogiorgakis*
Eugenidion Clinic, Athens University, Athens, Greece.
Using this technique, tumours of the buccal mucosa extend-
ing beyond the buccinator muscle plane without or with a
small infiltration of the skin are excised.
Through a cruciate incision of the buccal mucosa some
distance from the lesion and a similar incision on the skin,
but smaller in size, the cheek is sectioned in its entire thick-
ness. The resulting crosslike defect is closed in layers
(mucosa, muscles, skin).
If the defect of mucosa is large, a split thickness skin
graft is used to fill the gap.
The final result was excellent in 20 patients operated on
using this technique.
By this method, we avoid flaps which otherwise would be
necessary, such as frontal, deltopectoral or musculocuta-
neous ones.

RECONSTRUCTION OF ORAL CAVITY USING
MAJOR FLAPS FOLLOWING ABLATIVE SURGERY
FOR ORAL CANCER; TWENTY-YEARS
EXPERIENCE
Mataga, L *, Ishihara, O. and Tanaka, A.
Department of OMFS II, School of Dentistry at Niigata,
The Nippon Dental University, Niigata, Japan
AIMS:
To assess the clinical benefits of primary and delayed recon-
structed surgery, using major flaps such as pedicled or
revascularized cutaneous, musculocutaneous and osteocu-
taneoous flaps for oral and maxillo-facial defects following
oral cancer ablation.
M E T H O D AND PATIENTS:
118 patients reconstruced by major flaps, 89 males and 29
females, 22.2% of total number of 531 patients, average age
of 59.2A_}13.7 years, during 20 years from 1977 to 1997
operated in our department are retrospectively discussed.
Primary sites were 33 tongues,24 lower gums,22 floor of the
mouths, 19 buccal mucosas and others. Of 80 patients were
reconstructed at the same time of cancer ablation. Of 100
patients(84.7%) were squamous cell carcinomas. A total
number of 162 major flaps were 30 D-P flaps,43 pectoral
major musculocutaneous flaps,9 latissimus dorsi musculo-
cutaneous flaps,26 forearm flaps,14 rectus abdominal flaps
and others for the soft tissue reconstruction were used.
Total number of 28 vascularized osteocutaneous flaps,10
iliac,7 scapular and 11 fibular was employed for maxillo-
mandibular bone reconstruction for the patients with wide
bony defects,recurrent cancers and poor recipient condition
such as osteoradionecrosis.
RESULTS AND CONCLUSIONS:
Successful rate of the reconstruction was 93.6% (included
partial necrosis). For postoperative functional rehabilitaion,
dental implant was installed in the grafted bone directly or
residual maxillo-mandibular bone.
CCDSA (CERVICAL C H E M O D E C T O M A S :
DIAGNOSTIC AND SURGICAL ASPECTS)
Matyakin, E., Pokrovsky, A., Dan, E, Duditskaya, T.,
Shubin, A., Nikitayev, N., Mashtakova E., Marina G.
Oncologic Scientific Centre, A. V. Vishnevsky Institute of
Surgery, Moscow, Russia
Aims: To present our experience in the treatment of patients
with cervical chemodectomas.
Method: 151 patients suffered from cervical chemodec-
tomas were treated: 93 - with a carotid body tumour; 45 -
with a vagal body tumour; 13 - atypical chemodectomas.
133 patients underwent operations. Reasons for refusing to
perform surgery in 18 patients were: inoperability of the
tumour, presence of distant metastases and serious con-
comitant diseases. Preoperative examination included
Doppler ultrasonography, colour duplex scanning, tran-
scranial Doppler ultrasonography, spiral Computer
Tomography and angiography. The findings in the above
studies confirm the diagnosis, and evaluation of the condi-
tion of carotid arteries and Circle of Willis and estimation
of the relations between the tumour and surrounding tis-
EACMFS - Abstracts, Helsinki Congress 1998 115
sues. Ultrasound and CT findings were found sufficient to
avoid having to perform angiography. Radical surgery pro-
cedures were performed on 124 cases (93.2%). Resection of
major neck vessels was accomplished in 58 cases (43.6%).
Sixteen of them required internal carotid artery prosthetics.
To minimize the risk of neurological complications, mea-
surement of the retrograde pressure in the common carotid
artery and transcranial Doppler sonography were per-
formed during the operation, in 16 patients. In the postoper-
ative period, 4 patients developed evidence of cerebral
damage.
Conclusions: The above mentioned diagnostic techniques
and approproate surgical planning result in a reduced num-
ber of complications.
D PTEN / MMAC1, A PUTATIVE T U M O R
SUPPRESSOR GENE, ITS ROLE IN
CARCINOGENESIS OF HEAD AND NECK
S Q U A M O U S CELL CARCINOMAS: A M O L E C U L A R
B I O L O G I C A L STUDY
Mavros, A.*, Eckelt U.
Department of Oral- and Maxillofacial Surgery, University
of Dresden, Fetscher str. 74, D-01307 Dresden, Germany
AIM
In order to detect regions of the genome that may harbor
tumor suppressor genes, several allelotyping studies in car-
cinogenesis in head and neck squamous cell carcinomas
(HNSCC) could show loss of heterozygosity (LOH) on
chromosome 3q, 5q, 9p, l l q and 17p. PTEN, a recently
detected tumor suppressor gene located on chromosome
10q23.3, exhibits LOH in a variety of tumors including
glioblastoma multiforme, prostate and endometrial cancer,
and the melanoma. To elucidate the involvement of PTEN
in HNSCC we performed LOH analysis using two
microsatellite loci flanking the PTEN gene on both sides.
METHODS
High molecular weight DNA has been obtained from snap
frozen tumor tissue and normal tissue of 40 patients with com-
parable grades of HNSCC by means of proteinase K in a lysing
butler. After purification and dilution of the DNA stocks screen-
ing of microsatellite repeat D N A polymorphisms was per-
formed by polymerase chain reaction (PCR) using microsatellite
markers (D10S215 and D10S541) for specific regions of chro-
mosome 10q23. Denaturing polyacrylamide gel electrophoresis
was utilized for resolution of the polymorphic bands.
RESULTS
The vast majority of tumors exhibited informative allelic
configuration: 33 (82.5%) were heterozygous for PTEN locus
D10S215 and 37 (92,5%) for locus D10S541. Five patients
(12.5%) showed LOH, 3 in locus D10S215 and 3 in locus
D10S541 (9% each) whereas 1 patient showed LOH in both.
DISCUSSION
The heterogeneity of HNSCC and the assumption that multiple
molecular alterations are responsible for its generation, poses a
challenge for intense research in order to determine markers
that may be of service for clinical prognostic evaluation. These
results suggest that PTEN is not involved in tumorigenesis of
HNSCC in the majority of cases. Further studies of this gene
including complete D N A sequencing have to be conducted in
order to confirm this preliminary data.
116 Journal of Cranio-MaxillofacialSurgery
@=~ THE CLINICAL AND EXPERIMENTAL USE O F
POLY-L-LACTIDE MATERIALS IN
MAXILLOFACIAL SURGERY
McKellar, G.*/ Gogolewski, S.2
IDepartment of Oral and Maxillofacial Surgery, Westmead
Hospital, Sydney, 2Department of Polymers, AO/ASIF
Research Institute, Davos, Switzerland
The surgical correction of craniofacial anomalies typically
requires multiple osteotomies and the need for internal fixa-
tion. Titanium plating systems have been shown to have
some adverse effects on the growth of the craniofacial skele-
ton. (Majola et al 1992).
Since the introduction of polyglycolic acid in 1970 as the
first biodegradable material to be marketed as a suture
(Dixon, Davis and Geck, Inc., Manati, Puerto Rico)
biodegradable materials are becoming realistic alternative
alloplastic implants. This paper reviews the current state of
the art for the use of polymer plates, screws, membranes and
beads in craniofacial surgery with an emphasis on biodegra-
dation, biocompatibility and physical properties of polylac-
tic and polyglycolic acid materials. Our clinical,
radiographic and histological assessment of their use in
experimental animal and human studies over the past 7
years is presented.
A R E V I E W O F TREATMENT O F S E V E R E
MANDIBULAR RETROGNATHIA.
McKelvey, R J M
Maxillofacial Unit, Derbyshire Royal Infirmary
AIMS:
To review the results of the various treatment methods avail-
able in the treatment of severe mandibular retrognathia with
high F M P angles.
To present the benefits of the inverted-L osteotomy in
this condition.
METHOD:
The technical details of the inverted-L osteotomy as applied
to the severely retrognathic mandible are evaluated.
Specific reference is made to five cases where very large for-
ward and rotational movements of the mandible in conjunc-
tion with Le Fort 1 osteotomy and bone grafting are
discussed.
RESULTS:
Two to five year follow-up demonstrating the stability of the
mandible following such large movements is illustrated.
CONCLUSIONS:
The specific benefits of the inverted-L osteotomy, which is a
less commonly used technique, in the treatment of severe
retrognathia with high F M P angles is presented. The indi-
cations, contraindicates and complications for this proce-
dure are discussed.
INTERNAL FIXATION O F ANGLE FRACTURES -
IS T H E R E A B E T T E R WAY?
Peter T Doyle, Andrew Currie, *lain H Mc Vicar,
Maxillofacial Unit, Queen's Medical Centre, Nottingham,
United Kingdom
Aim: To describe an alternative method for treatment of
mandibular angle fractures using miniplate osteosynthesis.
Method: In recent years, fractures of the mandibular angle
have been treated increasingly by miniplate osteosynthesis.
The original technique, described by Champy in 1976, uses
a purely intraoral approach to place the plate and screws
along the line of ideal osteosynthesis on the oblique ridge,
This method has several disadvantages such as access, diffi-
culty in adaptation of the plate, placement of screws in
sound bone and poor lower border fracture reduction.
Wound dehiscence and subsequent infection is not infre-
quent. In this unit, fractures of the mandibular angle have
been treated by placement of a plate on the buccal cortex
only, with screw placement via a transbuccal approach.
Results: The results of fractures treated within the past 2
years will be presented.
Conclusions: We conclude that this method of treatment of
mandibular angle fractures gives more reliable plate adapta-
tion and screw placement, and avoids splaying of the lower
border. It has low morbidity and is a time efficient method
of treating these fractures.
7] F O R E A R M F L A P FOR RECONSTRUCTION
AFTER RESECTION O F THE S O F T PALATE
Meguri, S*., 1 Nakajima, E, 1 Kitajima, 7l.2
1Department of OMFS, Hamamatsu Rosai Hospital,
Hamamatsu, Japan
:Department of OMFX Shimada Municipal Hospital,
Shimada. Japan
Aims: To evaluate forearm flap as a material for reconstruc-
tion of the soft palate resected
Method: Three cases of carcinomas of the soft palate were
operated. One subtotal, one half and one total soft palate was
resected and reconstructed by free forearm flap respectively.
Postoperative oro-nasal function was examined in each case.
Results: Slight hypernasality was found in all cases,
although articulation at speech was normal. Nasal snort
was found only at pronunciation of particular sounds in all
cases. No dysfagia was observed in all cases. As a whole,
QOL concerning oro-nasal function in their daily life was
maintained with in almost normal range.
Conclusions:Forearm flap is considered to be an effective
material in reconstruction after resection of the soft palate
at any size of defect. Some technical hints at surgery also are
to be presented.
[~ T H E P E R F E C T COATING: C O - P R E C I P I T A T I O N
OF R H - B M P - 2 IN A B I O M I M E T I C C A L C I U M
P H O S P H A T E LAYER
Meijer G.*. Koole R., De Bruijn J., Van Blitterswijk C.A.

Dept of Oral Maxillofac Surgery, Utrecht University, The
Netherlands
Biomaterial Research Group, Leiden University, The
Netherlands
Aims: The development of an osteo-inductive coating
Method: Ti6A14V samples (10xl0xl.7 mm) were immersed
in Hank's Balanced Salt Solution (HBSS). During precipita-
tion of the calcium phosphate layer, various concentrations
of rh-BMP-2 were added. Subsequently, samples were
implanted in the backs of 7 weeks old male albino Fischer
rats.
Results: X R M A performed on the precipitated layer (thick-
ness: 5ram) showed the presence of Ca and R After a 4
weeks implantation period, bone formation was detected at
the surface of the biomimetic coating. The highest rh-BMP-
2 concentration present in the coating, revealed the highest
de novo bone formation.
Conclusions: In contrast to the process of plasmaspraying
(10.000~o C) the natural precipitation of calcium phos-
phates occurs at 37~o C. Therefore, proteins such as growth
factors, can be easily added. The formation of ectopic bone
at the surface of samples coated with calcium phosphate
combined with rh-BMP-2 proves its osteoinductivity.
The authors would like to acknowledge the Genetics
Institute Inc. for supplying the rh-BMP-2
BONE TISSUE ENGINEERING : OSTEO-
INDUCTIVE P O T E N T I A L O F CULTURED BONE
MARROW CELLS A N D THEIR EXTRACELLULAR
MATRIX
Meijer G.*. Koole R., De Bru(]n J., Van Blitterswijk C.A.
Dept of Oral Maxillofacial Surgery, Utrecht University, The
Netherlands
Biomaterial Research Group, Leiden University, The
Netherlands
Aims: To examine whether in vitro-formed mineralized
bone-like tissue, together with its bone producing cells,
exhibits osteo-inductive capacities, when implanted in non-
osseous sites, in vivo.
Method: Bone marrow cells were obtained from the femora
of 100-120 gram young adult, male, albino Fischer rats and
seeded onto hydroxyapatite (HA) samples. After 8 days in
vitro culture, the samples were implanted subcutaneously in
the backs of syngeneic rats.
Results: After 8 days of culture and 4 weeks of subcuta-
neous implantation, abundant new bone formation was
seen in the hydroxyapatite samples. Approximately 75% of
the hydroxyapatite surface was covered with this newly
formed bone. Control samples that had been incubated in
culture medium without cells and subsequently subcuta-
neously implanted for 4 weeks did not induce bone
formation.
Conclusions: These results show that cultured bone marrow
cells and their extracellular matrix have osteo-inductive
properties already one week after culture. Therefore, in com-
bination with a biomaterial carrier, an autogenous trans-
plant can be cultured (tissue engineering)
CO 2 LASER RESURFACING FOR CHRONIC LIP
FISSURES
EACMFS - Abstracts, Helsinki Congress 1998 117
Meilor, T.K.*, Combes, J.G.
MaxilloJhcial Unit, Royal Hospital Haslar, Gosport,
Hampshire, UK, PO12 2AA
Chronic lip fissures can be extremely troublesome, causing
discomfort with episodes of splitting and bleeding. Their
prevalence is about 0.25% with a male predominance. They
can occur in both lips but are more common on the lower
lip. The aetiology is obscure but smoking, exposure to sun-
light and cold weather have been proposed as at least con-
tributory factors and there appears to be a hereditary
relationship. A number of topical treatments with antibac-
terial, antifungal, steroid preparations, salicylic acid and
nitrates have all been tried but they do not produce perma-
nent relief. Cryosurgery and surgical excision with and
without Z-plasty have all been used quite effectively.
The advent of carbon dioxide laser resurfacing and selec-
tive photothermolysis has allowed precise selective ablation
of thin layers of tissue with regeneration of the epidermis
and dermis with a denser collagen and an increase in the
amount of elastin. Similarly, pulsed or scanning CO 2laser
resurfacing of actinic change on the lips results in satisfac-
tory healing and regeneration of the vermillion in approxi-
mately 2 weeks. It is known that collagen can shrink by up
to two thirds of its original length with the application of
heat. It was therefore postulated that CO2 laser resurfacing
of lip fissures would result in resolution of the fissure with
an increase in the tensile strength of the lip in this area
thereby reducing the potential for relapse of the fissure.
We will present the technique we have developed for
resurfacing lip fissures using a Sharplan SilkTouch TM carbon
dioxide laser which uses spiral scanning technology. This
continuous wave CO21aser scans a 0.2ram spot in a spiral
pattern at a constant velocity, so that no individual spot
within the scanned pattern is irradiated more than once and
the dwell time on any individual spot is <1 msec.
The aetiology and the results of treatment of 10 cases of
lip fissure with at least 6-month follow-up will be presented.
All the cases to date have resolved satisfactorily with no
recurrence. Generally the crusting that forms following laser
treatment resolves after 14-21 days. The patients were very
pleased with the outcome in this locally debilitating trouble-
some problem.
[~ C I N E G A M M A G R A P H Y AND 3D E M I S S I O N
T O M O S C I N T I G R A P H Y IN EVALUATION O F
M A N D I B U L A R REVASCULARIZED B O N E GRAFT
Meningaud, J.P. "1, Basset. J. E 2 Divaris, M. 1, Ancri, D.,
Bertrand. J. Ch. 1, Guilbert, F 1.
Division of Stomatology and Maxillojacial Surgery, (1) and
Department of Biophysics and Nuclear Medicine (2) J.
Pitie-Salpetriere University Hospital, Paris, France
AIMS
The following reports a study conducted to investigate a
scintigraphic monitoring procedure for bone free flap in
mandibular reconstruction. This procedure is based on one
hand on vascular and bone cinegammagraphy and on the
other hand on vascular and bone 3D tomoscintigraphy.
METHOD
We used a prospective cohort study design. All patients who
underwent free flap mandibular reconstruction from April
118 Journal of Cranio-MaxillofacialSurgery
1993 to December 1997 in the Salpetriere University
Hospital (16 cases) have been evaluated in relation to this
scintigraphic procedure. Vascular and bone scintigraphy
were done within the second week after the surgery during
two consecutive days. All images were read by one author
(J-Y. B.), who was blinded to the skin status of the flap. The
results were compared with the viability of revascularized
bone grafts as evaluated by the skin status and the
Greenberg's classification based on bone radiographs three
months after reconstruction.
RESULTS:
Vascular cinegammagraphy seems to be well related to anas-
tomosis patency. Bone cinegammagraphy gives appreciable
information on the bone viability 3D vascular tomoscintig-
raphy remains difficult to interpret. 3D bone tomoscintigra-
phy gives precise information on the viability of the
different segments of the bone flap.
CONCLUSIONS:
These results suggest that vascular and bone 3D
tomoscintigraphy coupled with dynamic study has an excel-
lent prognosis value in this indication. In case of partial fail-
ure it can give information on the location of the patency
trouble and on the bony fragment who has lost any viability.
I N C O R P O R A T I O N O F THREE TYPES O F BONE
BLOCK I M P L A N T S IN THE FACIAL SKELETON: A
NEW A N I M A L M O D E L
Matthias A. W.Merkx 1, Jaap C. Maltha 2, Hans-Peter M.
Freihofer1, Anne Marie Kuijpers-Jagtman2
Departments of IOraland MaxillofacialSurgery and
:Orthodontics and OralBiology, NIJMEGEN (The Netherlands)
Aim: In a new standardized model for evaluation of bone
healing in relation to a paranasal sinus, the regenerative
response on autogenic cancellous and cortical bone grafts,
and on a commercial available xenogenic resorbable bone
mineral (RBM) (Bio-Oss R, Geistlich-Pharma, Wolhusen,
Switzerland) was compared.
Method: On 15 skeletally mature goats four critical sized full
bone defects were made in the frontal bone. These defects
were filled at random with a cortical bone plug, a cancellous
bone plug, a plug of spongious RBM cut into shape or left
empty. Flurochrome bone markers were injected subcuta-
neously 1 and 5 weeks after transplantation, and one week
before the animals were killed. The animals were killed at 3,
6, 12 and 24 weeks after surgery.
Results: Osseous defects over (para)nasal sinuses filled
with autogenous bone grafts heal similar to critical
sized calvarial defects. Bio-Oss R as a RBM is osteocon-
ductive and guides bone formation at the margins of the
defect. The newly formed bone is only partly in direct
contact with the implant material. R B M does not
induce bridging of the defect. The osteoclasts seen
around non-integrated, degraded and non-functional
RBM R B M 112 and 24 weeks after implantation, are
probably originating from the (para)nasal mucosa under
stimulation by continuous breathing-dependant
mechanical changes.
Conclusions: The animal model used in the present study
appears to be a valuable tool for answering questions on
osseous wound repair in maxillofacial regions in relation to
(para)nasal mucosa.
[h RECONSTRUCTION OF ORBITAL FLOOR
DEFECTS USING A NEW ABSORBABLE PDS SHEET
Merten H.-A. *, Wiltfang £, H6nig £F., Luhr H.G.:
Department of Oral and Maxillofacial Surgery, University of
Gdttingen, Germany
INTRODUCTION:
The commonly used allogenous or xenogenous materials
for orbital floor reconstruction are under discussion due to
the risk of transmitting infections and immunological reac-
tions.
Therefore a synthetic absorbable material (PDS-sheet),
consisting of poly-p-dioxanon - was developed and tested in
a clinical trial.
PATIENTS AND M E T H O D S :
In fourty patients with 44 orbital floor defects (< 15 mm
diameter) the 0.15 mm strong PDS-sheet was applied. The
initial mechanical properties of the PDS-sheet were
sufficient for 15 mm diameter defects.
Every patient was re-evaluated 1 and 4 weeks, 6 and 12
months postoperatively. There were no pathological oph-
thalmological findings such as enophthalmos, diplopia or
impairment of eyeball motility 12 months postoperatively.
In case of re-entry operation for plate removal (38 patients)
8 months postoperatively the PDS-sheets were entirely
resorbed.
RESULTS AND DISCUSSION:
In the clinical trial the synthetic material PDS-sheet
has proved to be effective for orbital floor reconstruc-
tion.
No inflammatory reactions were observed during the
whole observation period.
The 0.15 mm, strong sheet is suitable for 15 mm diameter
defects. The use of poly-p-dioxanon leads to delayed degra-
dation and prolonged mechanical stability within the first
four postoperative weeks. These mechanical features seem
to be sufficient even for the reconstruction of larger defects
of up to 20 mm in diameter.
CLINICAL EXPERIENCE W I T H A NEW CALCIUM-
P H O S P H A T E CEMENT IN CRANIO-
MAXILLOFACIAL SURGERY
M. Merwald*, H. B6hm, H. Pistner, £ Reuther
Department of Oral and Maxillofacial Surgery, University of
Wiirzburg, Germany
Bone deficiencies in the cranium are frequently recon-
structed with Polymethylmethacrylate. Unfortunately this
material induces temperatures above 70°C during polymer-
ization. Furthermore, the high content of remaining
unpolymerized monomer induces cytotoxic side effects. To
avoid these disadvantages we prefer autogenous or allo-
genic materials. It can be technically difficult to reconstruct
bony defects using these rigid materials. To yield an aesthet-
ically satisfying result, a malleable cement for the modelling
of the bone surface and for the filling of defects is highly
desirable.
A stochiometric mixture of 27% dicalcium-phosphate
(DCPA) and 73% tetra-calcium-phosphate (TTCP) with

water, intraoperatively, can be prepared as a paste, that sub-
sequently sets to a structurally stable implant converting to
hydroxyapatite (HA). Primary setting time is about 20 min-
utes. PH during setting ranges between 6.5 and 8.5. Neither
relevant heat curing nor expansion or contraction can be
observed. Compressive strength reaches up to 60 MPa.
Tensile strength is about 8 MPa. After a period of four
hours under physiological conditions this cement is no
longer redissolvable.
This material can be used for augmentatio in non loaded
areas. We implanted this material for reconstruction of defects
caused by tumour, trauma and clefts in ten cases. During the
implantation, fluid control of the operation field is extremly
important. Local postoperative infections in three cases necessi-
tated the removal of the reconstruction. In seven cases the
cement integrated successfully in the implant site.
Postoperatively, a satisfying aesthetic result was observed.
Radiologically the augmentation result was clearly distinct and
stable.
The new calcium-phosphate cement can be regarded as
the first generation of biocompatible mineral implant mate-
rial for skeletal reconstruction. Further applications could
be all non-loaded augmentations like obliteration of
paranasal sinuses, filling of cysts or defects following dental
apectomy as well as fixation of implanted hearing aid elec-
trodes. Isothermic curing reaction and intrinsic osteocon-
ductive characteristics of the hydroxyapatite cement offer
special perspectives for the use as a potential carrier for pay-
loads such as osteogenetic protein preparations or
antibiotics.
EFFECTS O F M I C R O M O V E M E N T S ON THE
O U T C O M E OF MANDIBULAR BONE H E A L I N G
U. Meyer*, B. Kruse-L6sler, H.P. Wiesmann, J. Handschel,
D.H. Szulzcewski, and U. Joos
Cranio- MaxilloJacial Surgery, University of Muenster,
Germany
Aims: The aim of this study was to evaluate the effect of
micromovements on the cellular differentiation of
osteoblasts during bone healing in an experimental animal
model.
Method : A corticotomy was performed in the right
mandible of 24 white female rabbits. The mandible was
subjected to various daily strain micromovements after 4
days of latency. After 14 days animals were sacrified and the
mandible harvested for histological, electron microscopical,
and microanalytical investigations. Non-operated rabbits
served as a control.
Results: Radiographical, histological, and electron micro-
scopical examinations showed movement - related bone
healing. Strain rates of up to 0.2% led to regular bone regen-
eration, whereas higher strain applications (2%-20%) led to
immature bone formation. Scanning electron microscopy
demonstrated differentiated osteoblasts in a bulk bony tis-
sue at low strain magnitudes (<0.2%) with regular calcifica-
tion of the matrix as revealed by EDAX-microanalysis.
Macromovements induced fibroblastic dedifferentiation of
cells to fibrous tissue formation.
Conclusion: Bone regeneration during fracture healing
depends on micromechanical loads. Macromovements in
fracture healing lead to immature bone formation, whereas
micromovements in physiological magnitudes seem to be
desirable.
EACMFS Abstracts, Helsinki Congress 1998 119
AN AUDIT OF MANDIBULAR FRACTURES
TREATED BY M O N O C O R T I C A L OR BICORTICAL
OSTEOSYNTHESIS.
Mezitis, M. *, Skoura, If., Rallis G., Zachariades iV.
Department of OMFS, Accidents Hospital of Athens,
"K.A.T.", Athens, Greece.
Aims: To compare the postoperative results, using different
methods of mandibular osteosynthesis.
Method: From our records in the O M F S department, we
reviewed the mandibular fractures cases operated on
between the years 1985-1997, and analyzed those treated
with bone plating.
Results: During the 12 years of our study, 2890 mandibular
fi'actures were admitted. In 900 of those monocortical or
bicortical osteosynthesis was applied. Our analysis included
all cases of postsurgical complications, i.e. infection, maloc-
clusion malunion, facial nerve palsy and hypoaesthesia of
the inferior alveolar nerve. We have also recorded the type of
surgical approach (extraoral or intraoral), the post treat-
ment functioning of the mandible and any facial aesthetic
problems.
Conclusions: Both methods appear to have advantages and
disadvantages which are analyzed and presented. It is in the
choice of the surgeon to use the type of osteosynthesis most
suitable for each type of fracture.
INTRAOPERATIVE COMPUTER AIDED
NAVIGATION USED FOR SECONDARY
CORRECTION OF POSTTRAUMATIC FRONTO-
ORBITO-ZYGOMATIC DEFORMITIES
W. Millesi*. F Watzinger, A. Wagnel; S. Gossweiner, F.
Wanschitz, M. Rasse, A. Baumann, M. Truppe*, R. Ewers
Clinic of Oral and Maxillofacial Surgery; AKH Vienna,
Waehringer Cmerte118-20, A-1090 Vienna, Austria
Tel.: 01-40400/4259; Fax.. 4253 e-mail. r.ewers@akh-
wien.ac.at
* Artma Biomedical Inc., Vienna, Austria
Untreated or imperfectly reduced midfacial fractures may
result in severe aesthetic deformities and functional distur-
bances. Secondary osteotomies are inevitable to achieve
acceptable aesthetic and functional results. Computer aided
intraoperative navigation offers the possibility of visualizing
structures that are not visible or accessible (without exten-
sive dissection) during surgery. The concept of computer
aided navigation (Virtual Patient System, VPS, Artma) is
based on the fusion of diagnostic imaging data together
with the live intraoperative situation. Magnetic field digitiz-
ers are used to assess the intraoperative position. An inte-
rocclusal splint with extrafacial fiducial markers is fixed to
the patient during diagnostic procedures. The radiopaque
markers on the splint are visible in each imaging modality.
The preoperative planning is best performed on axial and
coronal CT-scans. The desired contours of the upper mid-
face are constructed as graphical overlay structures super-
imposing the displaced bony margins. Intraoperatively, the
position of the segment which had to be reduced was corre-
lated to the forehead sensor and after duplication in associ-
ated with a sensor rigidly attached to the zygomatic
prominence. During surgery, the osteotomized segment was
correlated to a corresponding graphic, and the congruent
120 Journal of Cranio-MaxillofacialSurgery
overlapping indicated the final position. In 9 patients
fronto-orbito-zygomatic osteotomies were performed to
successfully correct posttraumatic deformities (6 female, 3
male, average age 44 years). The aesthetic result was satisfy-
ing in all patients In correcting posttraumatic fronto-orbito-
zygomatic deformities, the application of the VPS led to an
essential improvement. Surgical approaches could be mini-
mized - we were able to avoid a coronal incision in one and
subciliary incisions in two, out of nine patients The reduc-
tion of the zygomatic complex including the infraorbital rim
was exclusively observed on the computer navigation system
In the other patients more severe displacement, enophthal-
mos correction and the need for calvarial bone grafts neces-
sitated coronal and subciliary incisions.
MANDIBULAR CONDYLAR P O S I T I O N A L
A D J U S T M E N T F O R TREATMENT OF
T E M P O R O M A N D I B U L A R J O I N T INTERNAL
DERANGEMENT
Hu Min*, Hong Min, Jilin Zh., Xiaojiang E
Yao Jun Department of Oral Maxillofacial Surgery, General
Hospital of PLA, Beijing 100853, China
AIMS:
To correct joint structural derangement and muscle func-
tion unharmonization in patients with TMJ internal
derangement.
METHOD:
32 patients(18 male, 11 female) with TMJ internal derange-
ment treated by mandibular condylar positional adjusting
surgery. All patients had click and pain of TMJ. Outcome
groups were categorized good, fair, or poor, based on clini-
cal assessment. The preoperative radiological examination
of all patients consisted of panoramic radiograph, CT and
MRI. Reduction or nonreduction of displacement of the
disk was found by CT or M R I in all patients. A sub-
mandibular incision was made for adjusting condylar posi-
tions. The subcondylar vertical osteotomy was carried out
from sigmoidnotch to the angle of the mandible. The distal
segments were moved down about 2-3 millimetre. A maxil-
lary occlusal splint was used for 3-5 weeks after operation.
RESULTS:
Normal postoperative occlusion and satisfactory functional
results were found in the majority of the patients. Results
showed that 25 patients had a good outcome, and 5 patients
had a fair outcome, and 2 patients had a poor outcome.
Patients with reductive disk displacement had 90% in the
good group, 10% in the fair group, and no patients in the
poor group. In patients with nonreductive disk displace-
ment, the success rate decreased to 50% with good results,
16% with fair results and 34% with poor results.
CONCLUSIONS:
Surgical adjustment of condylar position aims at correcting
structure derangement of TMJ and avoiding articular
trauma following internal joint operation.
CLINICAL RESULTS O F SECONDARY BONE
GRAFTING F R O M THE SYMPHYSIS MANDIBLE
Minami If. *, Mori i7., Tsukamoto E, Yamada T., Sakuda
M, Mishima K.,* Sugahara T,*
2nd Departments of OMFS, Faculty of Dentistry, Osaka
University, Osaka,
*lst Departments of OMFS, Faculty of Dentistry, Okayama
University, Okayama, Japan
INTRODUCTION
Bridging an alveolar defect with a bone graft is essential in
the rehabilitation of cleft lip and/or palate patients. Usually
particulate cancellous bone marrow (PCBM) from the iliac
crest has been proven good efficacy as a donor. However
there are some disadvantages. So we have performed autoge-
nous bone grafting from the symphysis mandible (chin bone
grafting: CBG) to narrow alveolar clefts and obtained the
good results.
MATERIAL AND M E T H O D S
We have applied this method to 11 patients. X-ray examina-
tion was performed 1 month, 3 months, 6 months after
operation. Marginal bone level on the teeth adjacent to the
cleft and bonelevel of nasal side that we defined were
examined.
RESULTS
In all patient there is no recurrence of oro-nasal communi-
cation, and bone bridge formation was observed about 3
months after operation. Bone level on the teeth adjacent to
the cleft and nasal side were enough to achieve orthodontic
space closure. There is no significant difference in the case of
PCBM from the iliac crest. A few patients complained a
slight and temporal hypoaesthesia in the mental area. No
palpable contour deficit of the chin, negative pulpal reac-
tion and root injury could not be noticed.
DISCUSSION
In the case of bone grafting into alveolar cleft, PCBM from
the iliac crest is thought to be a good material. However
there are some disadvantages such as new operation wound
where is distant from the main operation field, postopera-
tive pain, temporary disturbance in walking et al. So some
authors reported the results of autogenous bone grafting
from the symphysis mandible. We performed this procedure
to the narrow cleft such as unilateral cleft lip, alveolus
and/or palate, and obtained the good results compared to
the iliac bone. We think the use of autologous chin bone has
following advantages if enough bone is available: same
operation field, the donor site is accessible easily, the post-
operative complaints are minimal compared to the iliac
crest.
PROPHYLAXIS AND TREATMENT O F THE
MANDIBULAR FRACTURE:PYO-INFLAMMATORY
COMPLICATIONS.
G. Mingazov*, A. Suleimanov,
Bashkir State Medical University, Ufa, Russia
Aims: To elaborate an optimum method of the complex
prophylaxis of the mandible with the usage of the
"Bioplant" biological transplant.
Method: 102 patients with mandible fractures have been
treated, the therapy of whom including the dental extrac-
tion from the fracture line followed by the replacement of
the extraction wound with "Bioplant". "Bioplant" (know-
how biotransplant) is serially produced in the Bashkir state
research and production institute of brephotransplants and

biopreparations of the Republic of Bashkortostan
Academy of Sciences.
Results: The cavity replacement of the tooth extracted from
the mandible fracture line combined with the antiinflamma-
tory therapy allowed to reduce the number of the mandible
fracture pyo-inflammatory complications treated with the
aid of the intermandibular stretching up to 7,9% (whereas
in the control group of patients treated by the traditional
method it is 16,3%).
Conclusions: "Bioplant" is one of the most reliable medical
preparations open to general use for the prophylaxis of the
suppurative complications of the mandible fractures and
may be a method of choice for the surgeon.
A NEW SYSTEM F O R MAXILLOFACIAL
DISTRACTION O S T E O G E N E S I S
Triaea A., Minoretti R.*, McGurk M., McDonald F.,
Baumgartner R., Hunenbart S., Merz B.,
Pyramide Klinik am See, Ziirich, Switzerland
+ UMDS Guy's and St. Thomas's Hospital, London, UK
§ Institut Straumann, Waldenburg, Switzerland
AIM: Many recent works in the field of maxillofacial
surgery were concerned with distraction osteogenesis. While
many impressive results were obtained, current designs of
distractors still seem to offer many possibilities of improve-
ment.
It was therefore the aim of the present work, to design
and test a new system for distraction, which combines mini-
mal invasiveness with a good variability in terms of axes to
be distracted and of modes of fixation.
Methods: A system was designed which is based on several
fundamental concepts: First, different axes may be com-
bined in a flexible way to achieve optimal adaptation to the
individual patient. Second, as far as possible all moving
parts are placed inside the oral cavity, out of the soft tissues.
Only the fixation units actually extend into the tissue. Third,
the distraction units are closed such that minimal exposure
of moving parts is achieved. Forth, the fixation to the bone
segments may be achieved by using bone plates or ortho-
dontic appliances on the teeth.
Results: The new system was applied in the first cases to
mandibles in skeletal class II malformations. Indications,
results and stability of patients treated to date are presented.
Fh H O S P I T A L A D M I S S I O N TRENDS IN ORAL AND
MAXILLOFACIAL TRAUMA IN THE FRIULI-
VENEZIA GIULIA R E G I O N BETWEEN 1986-1996: A
STATISTICAL STUDY
*A.Miotti, P.Andrian °, E.Panseri, L.Lattuada °, G.Sclippa °°
Department of Oral and Maxillofacial Surgery, Regional
Trust Hospital, Udine, Italy
°Regional Health Authority, Friuli-Venezia Giulia Region,
Italy
°°Planning Unit, Regional Trust Hospital Udine, Italy
Subject - One way to analyse and audit patterns and stan-
dards of care is to measure clinical workload, and this is an
important part of the work of a national health service.
Few studies of this kind have been reported for the spe-
cialty of oral and maxillofacial surgery and most of them
EACMFS -Abstracts, Helsinki Congress 1998 121
are related to individual departments rather than popula-
tions.
Study Design - The Authors studied the Friuli-Venezia
Giulia Region records of hospital for oral and maxillofacial
trauma inpatients for the years 1986-1996.
The diagnoses from the International Classification of
Diseases (W.H.O. 1977) were used in order to identify all
cases treated in hospital in the Region.
The Authors describe some of their findings, confirming
the importance of measuring clinical workload.
PERIOPERATIVE D R U G P R O P H Y L A X I S O F PAIN
AND S W E L L I N G IN MAXILLOFACIAL SURGERY
Mischkowski, R.A. *, Razzaghi, A., Klesper, B., Fangmann,
R., Z6ller, J.E.,
Department of Oral and Maxillofacial Surgery, University of
Cologne, Germany
Aims: To prove the efficacy of perioperative prophylaxis
with a corticosteroid and a non steroidal anti-inflamrnatory
drug in reducing postoperative pain and swelling.
Study Design: Prospective randomized study.
Method: One hundred and five patients, hospitalized for a
bone-impacted 3rd molar removal in our hospital, were
randomly assigned to three groups: 1. no additional
treatment, 2. perioperative administration of Naproxen
(2 x 500 rag), 3. perioperative administration of
Methylprednisolone (1 x 250 mg iv) in addition to
Naproxen. The postoperative swelling was assessed by
sonographic scans, tape measurements of the cheek and
mouth opening. The degree of pain sensation was recorded
on the Visual Analogue Scale. To estimate the influence of
individual factors, we also assessed the body mass index,
skin type and ethnic origin.
Results: The statistical comparison of the three treatment
groups showed a significant reduction in postoperative
swelling and pain after administration of Naproxen and
Methylprednisolone together. Naproxen alone lowered the
pain without a significant antiphlogistic effect. In two
groups we could demonstrate a positive correlation between
the body mass index and the amount of swelling.
Conclusion: The study shows the efficiency of the periopera-
tive administration of Naproxen and Methylprednisolone in
prevention of swelling and pain in a 3rd molar removal
model. The results are also applicable to other maxillofacial
interventions. Routine use of these drugs could result in a
reduction in postoperative morbidity and hospital stay as
well as in a positive effect on patient compliance and subjec-
tive treatment assessment.
[~ CLINICAL A P P L I C A T I O N O F CRYOPRESERVED
CULTURED ORAL M U C O S A L E P I T H E L I U M FOR
PALATOPLASTY
Mizuno 1t.*, Sawaki E, Hata If., Hibino E, Sumi Y.., Ueda M.,
Department of Oral Surgery, Nagoya University School of
Medicine, Nagoya, Japan
Aim: To prevent a disturbance of maxillary growth after
palatoplasty, we have tried an application of cultured oral
mucosal epithelium (COME) for raw surface after push-
back operation. However, it is impossible to maintain an
122 Journal of Cranio-MaxillofacialSurgery
availability of mucosal cells for long time under cultivation.
To correspond this problem, cryopreserved COME was
applied.
Method: Five cleft palate patients were grafted cryopre-
served cultured oral mucosal epithelium for covering the
raw surfaces of hard palates after push-back operation.
Completed epitheliums were frozen following Hibino's
method and preserved at -196oC for several months in cry-
otubes. The cryopreserved cultured oral mucosal epitheli-
ums were rapidly thawed at 37oC in water bath and
immediately grafted with chitin sheets as carriers.
Results: After one week, the grafted areas underwent re-
epithelialization. There were no clinical differentiation at
wound healing and taking speed compared with non-frozen
cultured oral mucosal epitheliums.
Conclusion: This shows the availability of cryopreserved
COME. Furthermore, we report new treatment schedule of
cleft lip and palate patients taking advantages of cryopre-
served cultured oral mucosal epithelium.
U L T R A S T R U C T U R A L CHARACTERIZATION OF
FIBROUS C H A N G E S IN INTERNAL
D E R A N G E M E N T OF T E M P O R O M A N D I B U L A R
JOINT
Mizutani, H.*, Senga, K., Ueda, M.
Department of Oral Surgery, Nagoya University School of
Medicine, Nagoya, Japan
Aims: To characterize a few types of adhesions in internal
derangement of TMJ ultrastructurally.
Methods: Tissue samples of adhesions were obtained during
arthroscopic surgery from 25 joints of 18 patients with
internal derangement of TMJ. All specimens were exam-
ined with a transmission electron microscope.
Results: Two types of collagen arrangements were observed
ultrastructurally; 1) highly arranged collagen bundles, 2)
randomly arranged collagen bundles. Elastic fibers could
also be seen in some parts of adhesion, consisting of ran-
domly arranged collagen. But there were no elastic fibers in
some adhesion, consisting of only highly arranged collagen.
Conclusions: There might be relationships between the
arrangement of collagen bundle and the exsistence of elastic
fiber. These ultrastructural findings suggested that the
arrangement of the extracellular components might corre-
spond to dysfunction of internal derangement of TMJ.
CAN YOU TREAT I M P L A N T O L O G I C A L
"BORDERLINE" CASES IN THE DENTAL OFFICE?
WAYS TO A M E A N I N G F U L OUTPATIENT THERAPY
Mohr, P.
Private practice Jor oral surgery, Bitburg, Germany
When using implants within your ambulant dental therapy,
difficulties may occur both during the surgical and the
prosthodontical phase.
An unsufficient bone supply in transversal and vertical
dimension, the neighbourhood of important anatomical
structures, a narrow space to adjacent teeth and impacted
teeth such as canines a n d premolars need extended preim-
plantological treatment.
Bone augmentation, sinuslift procedures and specially
dimensioned implants are important therapeutical tools.
Augmentation of the bone can be done with various materi-
als: artificial substitutes, autologous grafts or mixtures. In
the dental office the taking of bone grafts is usually limited
to the oral cavity.
Implants may show an uneventful healing in the bone
and might be a good success from a surgical standpoint, but
still they can show an unfavourable position or inclination
for prosthetic superstructures. Also the interocclusal dis-
tance can be too large or too small. In these cases we use
individual abutments to overcome the problems.
Case reports show our biomechanical therapy concept.
MINIPLATE O S T E O S Y N T H E S I S OF
M A N D I B U L A R S U B C O N D Y L A R FRACTURES BY
M E A N S OF AN INTRAORAL APPROACH
Mokros, S., Erie, A., Heidemann, IV..~, Gerlach, K.L.
Department of Maxillofacial Surgery, Otto-von-Guericke
University, Magdeburg, Germany
Aims: Displaced mandibular subcondylar fractures may be
reduced and fixed with miniplates using an intraoral
approach. The video shows the method of reducing and fix-
ating a mandibular subcondylar fracture under endoscopic
control. Special instruments are required for use of this
technique.
Results: In the first part of the video the operation is
demonstrated on a model of a skull and the required instru-
ments are introduced. The form of the specially constructed
miniplate with changed distances of the holes and the hold-
ing device of the 90 degree angulated electric drilling and
screw-driving unit, which prevents the screw from dropping
off, should be noted.
The second part of the video shows the clinical applica-
tion of the method under endoscopic control. The
sequences of the operative technique, which were previously
seen on the model of the skull, are shown in the clinical case.
Conclusion: The technique demonstrated shows, that fixa-
tion of mandibular subcondylar fractures by miniplates is
possible using an intraoral approach, thus avoiding an
extraoral incision or transcutaneous drilling or screwing.
THE C O M P A R I S O N OF B O N E GRAFTS OF
DIFFERENT EMBRYOLOGICAL ORIGINS U N D E R
B I O M E C H A N I C A L FORCES. AN EXPERIMENTAL
STUDY O N DOGS: A PRELIMINARY REPORT
Moilaoglu, N*., Sarisoy, S., Yueel, E., Erkmen, E., Borkan,
U Department of Oral & Maxillofacial Surgery, Faculty of
Dentistry, Gazi University, Ankara, Turkey
Aims: To assess the success of bone grafts in bone trans-
plantation procedures and to compare bone grafts under
different local environmental factors by considering their
types and embryological origins.
Method: Four beagle dogs were used in this study. Standard
defects were created in the maxilla, mandible, and tibias of
the dogs. The endochondral allografts that were obtained
from these defects were transplanted to the mandible, and
similarly the membranous allografts and autografts to the
maxilla, membranous autografts to the tibia The maxilla,

mandible and tibias of one of the dogs were used as con-
trois. Compression force was applied to the standard seg-
ments that were obtained from the dogs, after three months
Results: Ossification was terminated without any problems
as assessed by gross observation. No evident difference was
observed in the resistance of autografts and allografts and
bone grafts of endochondral and membranous origin to
compression forces. But, the control areas were found to be
slightly more resistant.
Conclusion: It would affect the results to do the transplan-
tation in the identical areas and to extend the study period.
D THE EFFECTS O F FIVE DIFFERENT DENTAL
LOCAL ANAESTHETICS ON P L A S M A P O T A S S I U M
LEVELS IN HEALTHY VOLUNTEERS HAVING
THIRD M O L A R REMOVAL.
Moilaoglu, N*., Yucel, E., Cevik, C
Department of Oral & MaxilloJacial Surgery, Faculty of
Dentistry, Gazi University, Ankara, Turkey
AIM:
The aim of this study was to investigate the effects of five
different types of dental local anaesthetics with or without
vasoconstrictor on plasma potassium levels in healthy vol-
unteers having third molar removal.
METHOD:
Sixty healthy volunteers divided into five different groups
took part and five different dental local anaesthetics with and
without a vasoconstrictor, such as Prilocaine 3%, Lidocaine
2%, Articain HCI 20mg, Articain 40mg, and Mepivacaine,
were used. Blood was taken (5cc) at 5 min. before, and 5, 20
and 120 min. after the injection of dental local anaesthetic
and all the blood samples were analysed in the biomedical
laboratory.
RESULTS:
A significant increase in plasma potassium levels was found
with Prilocaine 3% (p<0.098) and Lidocaine 2% (p<0.015).
There were no significant changes with the other dental
local anaesthetics.
CONCLUSION:
It is concluded that the plasma potassium level is not related
to the vasoconstrictor of the anaesthetics.
Yq THE EFFECTS O F FIVE DIFFERENT DENTAL
L O C A L ANAESTHETICS ON BLOOD GLUCOSE
CONCENTRATION, HEART RATE AND BLOOD
PRESSURE IN HEALTHY VOLUNTEERS HAVING
REMOVAL O F THIRD MOLARS.
Mollaoglu, N*., Cevik, C., Yucel E., Sarisoy, S.
Department of Oral & Maxilloji~cial Surgery, Faculty of
Dentistry, Gazi University, Ankara, Turkey.
Aims: The aim of this study was to investigate the effects of
five different types of dental local anaesthetics, with and
without vasoconstrictor, on blood glucose concentration,
heart rate and blood pressure in healthy volunteers having
third molar removal operations.
EACMFS - Abstracts, Helsinki Congress 1998 123
Method: Sixty healthy volunteers divided into five groups
took part, and five different dental local anaesthetics:
Prilocaine 3%, Lidocaine 2%, Articain HCI 20mg, Articain
40rag, Mepivacaine with a different amount of vasocon-
strictor were used. Blood was taken (5cc) and all the blood
samples were analysed in the biomedical laboratory and
also heart rate and blood pressure were recorded at 5 min.
before, and 5, 20 and 120 rain. after the injection of the
dental local anaesthetic.
Results: No significant changes in blood glucose level, heart
rate or blood pressure with the use of five different local
anaesthetics listed above were found.
Conclusion: It was concluded that the five dental local
anaesthetics, (up to 2cc.), listed above may be used confi-
dently in dental practice in patients with cardiovascular
problem or diabetes.
MANDIBULAR LENGTHENING WITH MD-DOS® -
PRELIMINARY RESULTS
Mommaerts, 3/1.*, Jacobs, W., Abeloos, £, De Clercq, C..
Neyt. L.. Vuylsteke. Ph., Bettens, R.
Division of Maxillo-Facial Surgery. A Z St-Jan. Brugge &
A Z St.-Elisabeth, Herentals, Belgium
Aims: To define morbidity of mandibular distraction with
MD-DOS®.
Study Design: Mandibular distraction was performed in
16 patients (mean age 24.4 y, SD 11) for the following rea-
sons: Angle Class 11. deep bite deformity (11 ), sagging
after non-surgical treatment of subcondylar fractures (2),
sleep apnoea syndrome (2), condylar resorption after orthog-
nathic surgery (1). In 9 patients, the procedure was performed
using local anaesthesia only. In 7 patients, the lower third
molars were removed in the same session. Mean advancement
of lower incisor point was 5,4 mm (SD 1,2) in 10 bilateral
cases that could be analysed cephalometrically. Neurosensory
disturbances (NSD) in the lower lip, cheek and tongue were
checked for. Postoperative discomfort and pain during distraction
were compared with that from mandibular advancement with a
bilateral sagittal split osteotomy (BSSO).
Results: There were no infections. Of 28 lip sides, only one
continued to have NSD 10 weeks postoperatively. One day
postoperatively, 18 lip sides had normal sensation. There
were no NSD's found in the cheek or tongue. Postoperative
pain was, in 14 cases, less than with a BSSO. In 5 cases, pain
during distraction was more than after a BSSO. Two
patients resumed work on the fourth postoperative day.
Conclusions: When MD-DOS is applied, pain should be
carefully monitored. NSD is less pronounced than after a
BSSO. Infection is not to be expected.
{~ TWENTY YEARS OF SKULL DEFECT
RECONSTRUCTION W I T H A L L O P L A S T I C
MATERIALS: A RETROSPECTIVE ANALYSIS AND
THE CURRENT STATE O F THE ART
Moos KF % Koppel DA, McLennan AMS,
Canniesburn Hospital Glasgow Scotland.
Introduction: From ancient to modern times, various allo-
plastic materials have been used to repair skull defects. We
present our experience using several techniques for the
repair of skull defects over the last twenty years.
124 Journal of Cranio-MaxiilofacialSurgery
Method: A retrospective analysis of all our cases was made
and the aetiology of the defect, method of reconstruction
and success rate recorded.
Results: The results of the analysis will be presented but the
presentation will emphasise current techniques. The use of
custom-made titanium and acrylic skull plates will be
described and several modifications will also be presented to
deal with particular problems, especially the cases with large
brain volume deficits, large skull defects and the use of cus-
tom-made prefabricated plates for immediate reconstruc-
tion following tumour resection.
Conclusions: This study demonstrates a variety of reliable skull
reconstruction techniques and their particular indications.
@==~ ACTUALIZATION IN DIAGNOSIS AND
TREATMENT O F CRANIOFACIAL FIBROUS
DYSPLASIA (CFD)
Moreno M. ~, Martinez-Large J.L. , Marcos 0., Pineda A.
Dept. of Craniomaxillofacial Surgery (Head." Dr. JL.
Martinez-Lage ).
Hospital Ram6n y Cajal. Madrid. Spain.
Aims : Review of the clinical evaluation, surgical indication
and ablative/reconstructive techniques performed in cases of
craniofacial fibrous dysplasia (CFD).
Method : We have revised 37 cases of C F D in order to :
-Determine the correct clinical evaluation to classify
the type of F D and to exclude possible associated syn-
dromes.
-Establish the need of treatment and in such case the
timing as well as the extension of the surgical tech-
nique.
-Correlate the grade of activity of the dysplasic bone
and the type of therapeutic technique of first choice.
Results: At the end of the diagnostic study, we must have a
precise definition of the case : wether it is mono-polyostotic
or disseminated, with or without endocrinopathy as well as
the radiologic pattern and a pathology study.
In relation to the possible correlation between the grade
of osseous activity and the type of treatment , we have
observed that in cases in which the fibrous component is
predominant, the extirpation should be radical followed by
inmediate reconstruction ; when the matm'e osseous compo-
nent predominants and the surgery is indicated, we perform
extirpation , remodelation and reimplantation (Technique
described by Martinez-Lage and col.)
Conclusions: Although the experience of our Department
allows us to present very different reconstructive techniques
in C F D cases, we want to emphasize the excellent results in
those that have been treated by extirpation, remodelation
of dysplasic bone and reimplantation, behaving as a free
graft.
D E V E L O P M E N T O F A S I M U L A T I O N SYSTEM
F O R SAGITTAL S P L I T RAMUS O S T E O T O M Y W I T H
3D-CT
Mori If..*, Minami K., Tsukamoto Y., Yamada T., Sakuda
M., Mishima K., Sugahara T.
OMFS II, Faculty of Dentistry, Osaka University
OMFS I, Faculty of Dentistry, Okayama University, Japan
AIM
Three dimensional reconstructed image of computed
tomography (3D-CT) has been applied for diagnosis and
planning of orthognathic surgery. We already developed the
Unified Maxillofacial Measuring System standing on the
coordinate regulated by 3D cephalometric measurement. It
included data from 3D-CT and dental cast in its coordinate.
Usually, 3D-CT gave us many suggestion at a glance, how-
ever, almost of them were qualitative and it will not give fur-
ther quantitative information. In addition, to simulate a
surgical procedure by the computer graphics was still diffi-
cult because of complex osteotomy line. The aim of this
study was to develop a complete simulation system for sagit-
tal split ramus osteotomy (SSRO) and to support the
surgery quantitatively.
MATERIAL AND M E T H O D
CT image was obtained from CT-9200 (Yokokawa medical,
Tokyo), under the condition such as tube voltage; 120Kvp,
tube electrical current; 150mA, FOV; 250ram, slice thick-
ness; 2mm, slice interval; 3ram. Imaging data was sent to the
workstation, Indigo2 IMPACT (Slicon Graphics, U.S.A.).
Our system was constructed and developed with
AVS/Medical Viewer on the workstation. This software real-
ized flexible image processing combining each module on
the network editor.
RESULT
3D-CT image was constructed on the exact coordinate.
This also had data from dental cast. According to max-
illo-mandibular relation, movement of the distal segment
was calculated. The Osteotomy line and splitting surface
was set up based on actual surgery by our idea. Accuracy
of our simulation was with in 0.5mm by the model
examination.
DISCUSSION
Almost simulation systems up to now could not set up their
osteotomy line freely, because of machine and program
capacity. Now, we realized simulation cross to the actual
operation. We will be able to calculate interference between
segments.
LASER PHYSICS AND LASER-TISSUE-
INTERACTIONS
M. Niibler-Moritz, H.F. Sailer
Recently, based on a better understanding of laser-tissue-
interactions the term selective photothermolysis was coined
to described site-specific, thermally mediated injury of chro-
mophoric structures by selectively absorbed pulses of radia-
tion. The selectivity for a specific chromophore - such as
hemoglobin, melanin and water - allows the majority of the
energy absorbed by the target to be retained and reduces
thermal damage to surrounding tissue. Clinical applications
in the field of oral and maxillofacial surgery such as pig-
mented lesion removal, hair removal, tattoo removal and
treamtent of vascular lesions by means of different lasers
(e.g. Alexandrite, Dye, Ruby) as well as new skin resurfacing
techniques using short-pulsed, high peak power, rapidly
scanned, focused beam CO2 lasers are discussed. Special
emphasis is given to physical considerations and potential
interaction mechanisms between laser light and biological
tissues.

ORTHOPAEDIC AND F U N C T I O N A L
CONSERVATIVE TREATMENT OF M O N O - AND BI-
CONDYLAR FRACTURES
Mozzati M., Ferrero R. , Arturi L., Bianchi R.
Turin, Italy
This survey aims at monitoring and evaluating the thera-
peutic results of cases treated conservatively, five years after
the trauma. The authors examined 16 cases of maxillo-
facial trauma with 10 consequent monocondylar intracap-
sular fractures (5 of which were associated with paramedial
fracture of the mandible) and 6 bicondylar intracapsular
fractures (3 of which were associated with paramedial frac-
tures of the mandible). They used a conservative-therapeu-
tic protocol consisting of non-surgical treatment to stabilize
the mandible by a simple acrylic plate, anchored to the
upper dental arch, which alowed firm linkage of the lower
teeth; and therefore of the mandible itself to the upper jaw.
The plate mentioned is inserted in the patient's mouth forty-
eight hours after the accident, and it is kept there perma-
nently for forty days. Patients are monitored by routine
radiological examinations completed by computerised
tomography with tridimentional maxillary reconstrution,
and a kinematic-magnetic resonance after the therapeutic
treatment. Finally, the clinical state of the patient is com-
pleted by a functional gnathological examination. Thirty-six
months on average after this conservative treatment,
patients were satisfied with their treatment, maintaining
good and painless masticatory function, without any tran-
sient weakness of the mandibular branch of the facial nerve.
Of the patients with monocondylar fractures, all regained
wide painless mouth opening (>35mm); only three of them
had a laterodeviation of 4 mm on opening the mouth, asso-
ciated with a bilateral click. In all cases mandibular move-
ments were free. There was no evidence of facial asymmetry
and no pain on palpation of the TMJ. In only one case did
the patient refer to recurrent headaches. Of the patients with
bicondylar fractures, all had a wide painless mouth opening
(>35ram), free mandibular movement, in only one case was
there a laterodeviation of 5mm on opening the mouth, two
cases complained of headaches, two cases had slight articu-
lar pain and one case muscle tiredness while chewing. The
radiological examinations 36 months later, show the frac-
tured part of the condyle, with dislocation of the same later-
ally. By analysis of the kinematic-magnetic resonance, it is
possible, in all cases, to appreciate the normality of the
range of movements of the previously injured TMJ. In no
case is any sign of articular anchylosis detectable. Since the
surgical treatment of intracapsular fractures condylar is
particularly complicated and not devoid of grave complica-
tions, sometimes irreversibly. The authors propose an
orthopaedic and functional conservative treatment which
gives satisfactory functional results with absence of compli-
cations.
AVOIDING P R O B L E M S IN PERCUTANEOUS
DILATATIONAL T R A C H E O S T O M Y (PDT)
Muhammad, J K * Patton, D. Major, E. Mangat, P.
Hope, D. Thomas, D. Jerwood, C
Department of Oral and Maxillofacial Surgery and Intensive
Therapy, Morriston Hospital, Swansea, Wales, United Kingdom
EACMFS - Abstracts, Helsinki Congress 1998 125
Aim: To prevent and minimise problems associated with
PDT through a better understanding of the the complica-
tions that might arise.
Method: Based on a retrospective review of over 400 PDT
procedures, their complications and management.
Results: Laryngeal masks, fibreoptic endoscopy, careful pre-
operative evaluation and clinical experience can minimise
the risks of serious complications associated with PDT.
Conclusions: PDT is not an entirely safe procedure.
Operators need to be aware of the potential complications
associated with the technique and the importance of having
an experienced senior clinician present
D O G -AN E X A M P L E O F AN INTRA - ALVEOLAR
DISTRACTION OF THE M A X I L L A
Heinzpeter Miiller-Sehelken
Wels, Austria
Since the first international meetings on this subject - in
June 1997 in Paris and in September 1997 in Stuttgart - we
all are interested on this new exciting field of bone distrac-
tion. The Russian traumatologist and orthopaedic surgeon
Ilizarov showed clearly this therapy in the extremities.
We present a case of a 15 year old boy with micromaxil-
lism,deep bite and retained second premolars, where we
could stretch the maxilla within the alveolar process, so that
we could bring the retained teeth into the dental arch.
In the literature there are, so far, only reports on animal
studies in dogs, reported by Block, Rachmiel and Yamamoto.
We believe this device will be of interest in the future.
OPERATIVE A R T H R O S C O P Y OF THE
T E M P O R O M A N D I B U L A R JOINT: U S E F U L N E S S OF
ELECTROSURGERY
Mufmz-Guerra, M.*, Rodrlguez-Campo F., Goizueta C., Gil-
Diez JL., Sastre J., Naval L., Diaz FJ.
Department of Maxillofacial Surgery, University Hospital
La Princesa, Madrid, Spain.
Aims: Arthroscopy of the temporomandibular joint
(TMJ) is a minimally invasive surgical method of treating
TMJ dysfunction. A set of operating instruments, includ-
ing bipolar and monopolar cautery tips, has been minia-
turized for operating procedures within this joint.
Posterior retrodiscal scarification may cause constriction
of the posterior attachment and aid in retention of the
repositioned disc. The aim of this study was to analyze the
influence of this technique on the outcome of arthro-
scopic treatment.
Methods: Between January 1995 and July 1996, 40
patients were treated by TMJ arthroscopy (uni- or bilat-
eral) with posterior attachment electrocoagulation, partic-
ularly in the region of the oblique protuberance. The
patients were evaluated for preoperative and postopera-
tive (1, 3 and 6 months) maximal interincisal opening
(MIO) and pain. All of them quantified pain on a visual
analog scale.
Results: Thirty-five of the treated patients reported sucessful
results, with an improvement in joint noises and restoration
126 Journal of Cranio-Maxillofacial Surgery
of jaw function without pain. At the 6 months follow-up,
the increase in MIO was statistically significant (p< 0.05)
and dysfunction scores were reduced.
Conclusions: This study indicate that TMJ arthroscopy with
retrodiscal electrocoagulation is an effective surgical proce-
dure for patients with TMJ internal derangement. This tech-
nique may help hold the disc in its new position.
r7 H O L M I U M - Y A G LASER IN T M J A R T H R O S C O P I C
SURGERY.
Kenlchiro Murakami, DDS, DMSc.
Department of Oral and Maxillofacial Surgery,
Kyoto University (Japan)
Introduction: The application of laser surgery to the
arthroscopy has been primarily attempted in the
Orthopedics, and Carbon dioxide, Nd-YAG and other laser
energy were tested. For the temporomandibular joint (TMJ),
the arthroscopic laser surgery was first clinically utilized with
contact Nd-YAG laser in the mid of 1980's. Thereafter the
use of holmium (Ho)-YAG laser has provided more reliable
and safety procedure for TMJ laser arthroscopic surgery in
all stages of internal derangement and arthrosis. Rationale:
Ho-YAG lasers operate at the 2100 nm wavelength, and its
feature in medical use is the pulsed infrared and short-wave
length laser. As compared with Nd-YAG, Ho-YAG laser has
relative short absorption length in a fluid, therefore the abla-
tion rate can be precisely controlled, and laser produces less
thermal necrosis than that of the previous laser wavelength.
Since the Ho-YAG laser is delivered via fiber-optic cable, the
handling of surgical handpiece is quite convenient for the
operative procedure. Results: Varying amount of surgical
manners such as laser cauterization, debridement, cutting
and release of intraarticular tissues, and synovectomy were
able to be easily performed in a small joint compartment by
one probe under the arthroscopic inspection, being selecting
with laser energy and pulses per second. The disadvantages,
in contrast, were the high-cost equipment, needs of special
training, relative long operating time, and possible inadver-
tent damage to the adjacent issue. Conclusion: At the present
time, a Ho-YAG laser arthroscopic surgery to TMJ disorders
encourages the surgeon to provide a minimally invasive
surgery to the patient.
M O R P H O L O G I C A L AND FUNCTIONAL
REABILITATION USING A SPECIFIC SURGICAL
MANAGEMENT IN ORAL CANCER
Muresan, O. ~, Lung, T.
Department of OMFS, Faculty of Stomatology, Iuliu
Haieganu" University of Medicine and Pharmacy, Cluj-
Napoca Romania
Aims: The unsatisfactory and inconstant results of recon-
structive osteoplasty of the mandible determined us to pre-
serve parts of the mandible, we used as an immediate
support of the soft tissues and as a base for secondary
reconstruction of the mandible.
Method: 14 patients with scuamous cell carcinoma of the
floor of the mouth and of the tongue (most of them T 3or
T~) were selected to undergo a specific management of the
tumor, based on selective osteotomy of the mandible and
immediate reconstruction. The external and inferior part
of the mandible were macroscopically uninvaded by the
tumor. Ablation included vertical splitting of the mandible
through osteotomy. The internal side of the lateral and
frontal mandibular arch was removed with the tumor, as
well as the alveolar crest. In 9 cases median or paramedian
osteotomy was performed to gain access to the tumor.
Results: This technique leaves a good frontal arch of the
mandible as a support for soft tissues and the anterior inser-
tion point for the tongue muscles. It is also a good base for
secondary reconstruction of the mandible and for prosthetic
rehabilitation. The inferior alveolar nerve and artery are
preserved, thus the sensibility of the lower lip is maintained.
Fonation, mastication, and facial simetry are restored.
Conclusions: This management of tumors provides a good sup-
port for the anatomical structures after tumoral ablation and
for secondary and prosthetic reconstruction of the mandible.
Closure of the defect can be made per primam. Time for
surgery is reduced and postoperative monitoring and follow-up
is easier as in reconstruction with flaps. Almost normal func-
tions are present in all patients immediately after surgery.
EXPERIMENTAL AND CLINICAL TESTING OF
O S T E O G E N I C MEMBRANS IN TREATMENT OF
JAW TRAUMATIC INJURES.
Mustafaev M., Chergeshtov Yu., VolozinA.
Medical stomatological Institute, postgraduate oral and
maxillo-facial surgery department. Moscow. Russia.
AIMS: Increasing the treatment effectiveness of jaw bone
fractures by stimulation of osseoregeneration.
METHODS: In experiments on 48 rats and 12 rabbits artificial
marginal defects of mandible were performed. On one half of
them the injured bone area was surrounded by Polystom
osteogenic membrane, which separated the bone surface from.
surrounding tissues. The inserted membranes dissolved during
the period of two to three months. Similar type of operations
were performed on clinical cases of mandible fractures in 18
patients. The healing process was checked by clinical, radiolog-
ical and radiovisiography methods.
RESULTS: The study demonstrated the pronounced stimu-
lation of osseogeneration and shortening the length of
treatment after membrane application as compared with the
control. No complications were observed.
CONCLUSION: The results of experimental and clinical
investigations permit us to recommend the use of tested
method for clinical practice to improve the treatment of
mandibular fractures.
EXPERIENCE OF TREATMENT OF PATIENTS
W I T H COMBINED D E F O R M I T I E S OF THE JAWS
W I T H THE A P P L I C A T I O N O F CARBON-
CONTAINING CERAMICS.
Nabiev F., Karayan A., Drobot (7., Salidganov A.
Department of Face and Neck Plastic Surgery Central
Research Institute of Stomatology, Moscow, Russia
AIMS:
The prevention of relapses of deformities of the upper jaw
and speeding up rehabilitation of patients after osteotomy.

METHOD"
After osteotomy and protrusion, of the upper jaw beyond
the tuberosity of the maxilla, we placed a retentive element
made of carbon-containing ceramic with fixation of the
osteotomized fragments with titanium mini-plates.
RESULTS:
Since 1990, 52 patients with combined deformities of the
jaws have been operated on. The long-term results were
studied clinico-roentgenologically within a period from 1 to
3-5 years.
CONCLUSIONS:
The results of the research have demonstrated the absence
of relapse of deformities, the shortening of the periods of
rehabilitation of the patients and the high bio-compatible
qualities of the carbon-containing ceramic.
SIMULTANEOUS ORTHOGNATHIC SURGERY
AND PRIVATE S E P T O R H I N O P L A S T Y
Nadjmi, N.*, Jackson, L T., Topf J.S., Lash, S.
Institute for Craniofacial and Reconstructive Surgery,
Affiliated with the Providence Hospital, Southfield,
Michigan, USA.
Aims: It is frequent for patients who present for orthog-
nathic surgery to have other facial deformities such as
nasal deformity and hypoplasia of the zygomas. They
may also have functional problems such as airway block-
age. Simultaneous correction of these deformities is pre-
sented.
Method: Careful planning of this surgery is essential
together with comprehensive orthodontic preparation. One
hundred fifty patients underwent bimaxillary osteotomy
procedures. Rhinoplasty and corrective airway surgery car-
ried out in the same procedure. A significant number also
had augmentation of the zygomas. Many had neck liposuc-
tion.
Results: The result of this type of surgery has been most
gratifying, both for surgeon and patient. An analysis of
operating time, hospital stay, and long term result will be
presented. Numerous clinical examples will be shown, and
the complications will be discussed.
Conclusions: Orthognathic and rhinoplastic surgery can be
combined with satisfactory result and few complications.
[~ U S E F U L N E S S O F AUTOGENOUS SECONDARY
ILIAC M A R R O W AND PARTICULATE
C A N C E L L O U S BONE G R A F T I N G IN ALVEOLAR
CLEFT PATIENTS
Nagayama, H. *, Fujisawsa, T.
*Department of Oral and Maxillofacial Surgery, Okayama.
Red Cross General Hospital, Okayama, Japan, Orthodontic
Office, Okayama City, Japan
Aims: Autogenous iliac bone grafting has frequently been
performed, to ill! bone defects in alveolar cleft patients, in
order to obtain improved maxillofacial and external nasal
morphology. However, the age and site for bone grafting, as
well as the method employed, differ slightly depending on
EACMFS Abstracts, HelsinkiCongress 1998 127
the institution. This is presumably because bone grafting is
performed to achieve different objectives. Boyne and Sands
have classified the time for bone grafting into 4 stages: pri-
mary, early secondary, secondary, and late secondary bone
grafting. Eruption of the canine or the tooth neighbouring
the alveolar cleft into the alveolar cleft site might be pro-
moted by grafting autogenous iliac marrow and particulate
cancellous bone from the alveolar cleft site to the anterior
part of the hard palate. This is extremely important for the
improvement of the occlusion, and is one of the major
advantages of autogenous iliac marrow and particulate can-
cellous bone grafting. However, thorough studies should be
carried out to determine whether growth of the maxilla or
tooth eruption is affected by bone grafting in these stages.
Conclusions: It has become possible to promote eruption of
the tooth neighbouring the alveolar cleft into the alveolar
cleft site by grafting autogenous iliac marrow and particu-
late cancellous bone from the alveolar cleft site to the ante-
rior part of the hard palate, in alveolar cleft patients, at
approximately 8 years of age following careful management
from birth. In addition, satisfactory growth has been
achieved with regard to the depth of the maxilla and the
height of the upper face.
CREATION O F AN INTEGRATED L I F E - S I Z E D
SOLID M O D E L INCLUDING VASCULAR
INFORMATION
Yuji Nakanishi*, Tatsuo Nakajima+, Yohko Yoshimura+
*Department of Plastic and Reconstructive Surgery, Ise Keio
Hospital, Keio University, Ise, Mie, Japan
?Department of Plastic and Reconstructive Surgery, Fujita
Health University School of Medicine, Totoake, Japan
The recent development of a computer-aided design and
computer-aided manufacturing system has made it possible
to produce life-sized models of the skeleton, made from laser-
curable resins. We have used these models for the preoperative
simulation of surgical procedures for the last 6 years.
However, the skeletal model alone does not facilitate the
understanding of the spatial relationship between the soft tis-
sues and the bone. Therefore, we developed a model with
both soft tissue and bony components. Using this integrated
model, any defect, displacement, or deformity of facial ele-
ments can be clearly visualized. (Plast. Reconst. Surg.
96:1020, 1996.)
In the case of vascular lesions such as haemangioma,
vascular images can be supplied through a CT angiogram.
Combining these data with our integrated model, we have
developed an advanced integrated model that can identify
vascular information with that of the bones and soft tissue.
In this presentation, the method of creating the new inte-
grated model will be described.
T H E MANAGEMENT O F INVASIVE FIBRO-
O S S E O U S LESIONS OF THE BASE O F SKULL
Dr. Abbas Khodayari Namin ~,
Tehran, Iran
Fibro-osseous lesions are the most common problem in the
oral and maxillofacial region especially the Juvenile active
Fibro-osseous form. The fibro-connective tissues of RD.L.
128 Journal of Cranio-MaxillofacialSurgery
are composed of collagen fibres, Oxytalene fibres &
Mucopolysaccharides, which surround the roots of teeth.
The mesanchymal cells which produces the cementum, alve-
olar bone and fibrous tissues in the oral cavity and jaws are
affected by the pathological changes occurring in the
tumours and these invade other vital anatomical areas such
as sinuses, facial bones and especially the base of skull. As
these lesions are usually painless, the patient presents with
facial asymmetry even if the lesion invades the skull base.
Thorough physical examination, complete laboratory inves-
tigations, X-rays, 3D C.T. scans and biopsies are deemed
necessary for a correct diagnosis and appropriate manage-
ment. The treatment recommended for these invasive lesions
is complete resection and extirpation of the tumour.
Radiation therapy is not indicated in these cases.
* ABBAS KHODAYARI; D.M.D Oral & Maxillofacial
Surgeon
Member Board of Medical Science Faculty
Member of American Association of O.M.ES & College of
O.M.ES
No: 159, 1st floor Dr. Fatemi Ave. Opposite Water Corp
Tehran-Iran.Z.C: 14146 TEL: 0098-21-654960 FAX: 0098-
21-8866344
[~ PALATOPLASTICS AS A "BIOTHERAPEUTIC KEY"
Naumovski, S. *, Vaskov, L, Lansineva, A.
Clinic for Maxillofacial surgery, Faculty of Dentistry,
University of Cyril and Methodius, Skopje, R. of
Macedonia, Oulu Hospital, Finland
The aim of this study is to analyze the PALATOPLASTICS
(seo. Veau Wardil Killner) as a "biotherapeutic key" for
rehabilitating the growth and development orofacial com-
plex, speech development, rhinolalia prevention, hearing
reduction and the possible presence of otitis media.
During the 15 years period (1980-1996), 99 patients with
operated primary and secondary palatum were examined
(33 - BLCP, 33 - ULCP, 33 CP). Orthodontic surveys,
phonological analysis, audio-otology status, otorhinolaryn-
gological examination, lateral telerentgenorama and photo
slides were done with every patient.
The maxilla hypoplasia is present in all the the operated
patients, dominating at BCLR less expressed at UCLR
while at CP it is accompanied with protrusion on the front.
The chance for satisfactory "push back" of the palatum
with this method was a crucial element which was actually
the reason why we preferred this method for palatoplastics.
The analysis of the competent contact of the soft palate
with the back wall of the pharynx, confirmed it as a method
of choice with this kind of intervention. We have discovered
22 cases (22.22%) with incompetent contact of the soft
palate with the back wall of the pharynx. The otology -
audio aspects of the intervention have also been considered.
The competent contact of the soft palate with the back wall
of the pharynx enabled the quality of speech impediments
to be satisfactory normal (54.55%), understandable
(44,40%), and unsatisfactory speech impediments were
found with 5,05%.
T H E E F F E C T OF P H O T O D Y N A M I C T H E R A P Y
(PDT) O N N O R M A L O R A L E P I T H E L I U M A N D
SURROUNDING STRUCTURES.
Nauta, J.M. r~, Witjes, M. 1, Roodenburg, J.L.R. I, Star,
W.M. 2, Nikkels, P.G.J.s, Tomson, S.L. 4' Vermey, A. 1.
Department of Oral and Maxillofacial Surgery I University
Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen,
The Netherlands, Department of Pathology, University
Hospital Groningen, Department of Photodynamic Therapy,
De Danidl de Hoed Cancer Centre, Rotterdam, The
Netherlands and Department of Pathology 4, M.D. Anderson
Cancer Centre, Houston, Texas, USA.
Photodynamic therapy (PDT) is a new cancer treatment
modality with the potential for selective local destruction of
malignant tumours. PDT is based on the systemic adminis-
tration of a photosensitizing drug which may be retained
selectively in tumours relative to the surrounding normal
tissues and can be activated by laser light of the correct
wavelength to produce a selective, local cytotoxic effect.
However, retention of the photosensitizing drug, the
haematoporphyrin derivative (HPD) in tumour tissue, has
been found not to be as selective as hoped for. Therefore, a
proper knowledge of the morphological alterations induced
by PDT not only in the area of the tumour but also of the
adjacent normal mucosa is of importance with respect to
the early and late complications of PDT. Although the oral
cavity is easily accessible for PDT, there are not many
reports dealing with PDT of the oral mucosa. Furthermore,
the effect of PDT on normal oral tissue has received little
attention. The aim of this study was to examine the effect of
PDT on the normal palatal mucosa and surrounding nor-
mal tissues such as bone, the dentition and other maxillofa-
cial structures. PDT-induced changes were examined for
both macroscopic and microscopic alterations. Several com-
binations of different drug doses and excitation light doses
were studied. It was found that changes in the epithelium
and surrounding structures were proportional to both the
drug and light dose. Furthermore, PDT with HPD of nor-
mal tissue was found to produce irreparable damage, among
others, to bone and the dentition. Before PDT can be con-
sidered as a new treatment modality in head and neck
oncology, these side effects have to be carefully considered
and further studies are needed to define optimal drug-light
dose combinations or to study new photosensitizing agents
with more favourable photosensitizing properties.
[~ ANALYSIS O F THE O U T C O M E OF SURGICAL
TREATMENT F O R S Q U A M O U S CELL CARCINOMA
OF THE ORAL CAVITY
Naval L*, Rodriguez F, Dfaz F, , GiiDiez JL, Rubio P,
Muwz M, Martin-Granizo R, Padrdn A, Sastre J,
Maxillofacial Department, Hospital de la Princesa, Madrid,
Spain
Aims : To evaluate the results of more than 15 years, treating
by surgery and postoperative radiotherapy, all the locations
of oral carcinoma.
Method : This is a retrospective study of 279 patients
primarily operated on between 1979 and 1995 with a
minimal follow-up of three years (82% of them for 5
years). Statistical analysis for relapse and survival was
calculated by K a p l a n - M e i e r curves and the log-rank
test.
Results : The study group showed a male preponderance
(78%), 6% were younger than 40 years, 23% had second

malignancies. The most frequent locations were mobile
tongue and floor of the mouth (57%). Advanced stages (III-IV)
were found in 53% of the cases. Neck dissection was done in 73%
of the patients. Regional control for all stages was better for No
patients treated with elective neck dissection. Close or positive
margins of resection (24%o), perineural or extranodal spread of
the tumour were related to a worse prognosis (22%). RT was
given in 50% in cases of positive margins, several affected nod-
ules or extracapsular spread, or E IV tumours. At 3 years 44% of
patients had a relapse : local (39%), homolateral neck (20%),
locoregional (20%),contralateral (6%), distant metastases (13%).
72% were treatable. Survival: the 3 year ultimate real survival was
71% (Stage MI) and 48% (Stage III-IV). For positive margins 5
year real survival was 31%, for negative margins 57%.
Conclusions: For No patients we achieved better neck control
with elective dissection. Margin status is an important prognos-
tic factor. We suggest some changes in our treatment protocol.
F U N C T I O N A L STANDING AND QUALITY OF
LIFE IN PATIENTS RECONSTRUCTED W I T H A TRA-
P E Z I U S O S S E O M Y O C U T A N E O U S FLAP.
Navarro Vila, C.*; Lopez Atalaya, J.; Ferndndez-Alba, J.;
Saimeron, JL; Ochandiano, S.; Barrios, JM.
Department of Oral and Maxillofacial Surgery, Hospital
General Universitario " Gregorio Maralon", Universidad
Complutense de Madrid, Madrid, Spain.
Aim: We present several cases of this flap reconstruction and
we show in an objective way the aesthetics and functional
condition of each one of them. We will analyze the function
of swallowing, phonation and mastication, and we will show
the functional impairments at the donor site, and the adapta-
tion to their occupational, social and familiar environment.
M & Methods: The osseomyocutaneous flap, described by
Demergasso in 1977, allows mandibular bone and oral soft
tissue reconstruction in patients subjected to complex resec-
tions. Our service, has great experience in oromandibular
reconstruction using this flap and has been a worldwide pio-
neer of placing osseointegrated implants for the subsequent
implant-supported dental rehabilitation, which permits the
normal masticatory function. We present 2 cases of middle
aged males who developed a carcinoma of the floor of the
mouth and gum which was reconstructed with this flap.
Results: This flap is criticized by some authors, funda-
mentally because of the sequellae created at the d o n o r
site. However, when the integrity of the acromio-clavicu-
lar joint is maintained, the disability created is minimal,
and the patients are efficient of accomplishing the nor-
mal functions of dressing and cleaning. The aesthetic
shortcoming is acceptable and the mobility of the upper
limb is excellent. The soft tissue reconstruction with the
skin of the shoulder allows good mobility of the tongue.
Conclusion: Mandibular reconstruction with this flap, pro-
vides an excellent result, permitting very good rehabilita-
tion through osseointegrated implants, creating minimal
sequellae in the donor area.
USE O F C02 LASER F O R R E S E C T I O N AND
R E C O N S T R U C T I O N IN L I P M A L I G N A N C I E S
Neder, A.
Private Clinic, Rehovot, Israel
EACMFS Abstracts, Helsinki Congress 1998 129
Aims: To present our experience since 1990, of using the C02
laser for oncological surgery of the tongue and lips.
Methods: The Sharplan 1020 C02 laser beam was used for
resection and reconstruction with local flaps in pre-malig-
nant and malignant conditions of the lips. The advantages
of the C02 laser as compared with a "cold knife" is dis-
cussed.
The ability of the focused C02 laser beam as a cutting
instrument and the defocussed beam as a vaporising instru-
ment is presented and demonstrated in several clinical cases.
Results: Using the C02 lasel, almost bloodless operations
could be performed. No significant damage to the tissues
occurred from the point of view of obtaining a biopsy and
definition of 'healthy borders' of the resection.
Conclusion: It is advisable to use the C02 laser for resection and
reconstruction of tumours in tongue and lips because of the
better control of bleeding, sealing of lymph vessels during oper-
ation on a malignant condition, and better sterile conditions.
A NEW, EFFICIENT B I O M E C H A N I C A L M O D E L
OF THE MANDIBLE BASED ON C O M P U T E R I Z E D
NUMERICAL SIMULATION
Neff A*, Kober C, Zeilhofer HF, Sader R, Deppe H, Kuhn
A, Hoffmann KH, Horch HH,
Dpt. of Oral and Maxillofacial Surgery, University of
Technology, Munich, Germany
Computer based simulation tools are being applied more
and more in medical research.One topic is the simulation of
the elastomechanical properties and processes in complex,
three-dimensional objects such as the human mandible.
Until now, most models were based on the finite element
method (FEM). One disadvantage of this approach is static
nature of these simulation tools, as they cannot mimic the
individual conditions in a living patient. The computation
of inhomogeneity effects such as the varying properties of
cortical and cancellous bone or the individual preference
direction of osseous geometry is feasible only within tight
limits.
A new, computer based biomechanical model of the
mandible is presented, built on a mathematical software
package for numerical analysis of partial differential equa-
tions. This program is not another implementation of the
FEM, but rather a descriptive language for the solution of
equations, which were treated with F E M - Methods. One
advantage is the unambiguous description of inhomoge-
neousness similar to that given through the anisotropy of
human tissue. After the data have been loaded, thecomputa-
tion time is only a few minutes, since the program runs on a
vector computer (CRAY).
Five human mandibles were recorded in 3D-CT stud-
ies. Cortical and spongy bone and the teeth were seg-
mented from the image data set, followed by the
numerical description of the surface geometry and the
spatial triangulation. To capture the elastomechanical
parameters completely, the muscle insertion areas and
their respective force vectors were included in the mathe-
matical mandible model. Thereafter, the individual bio-
mechanical properties of the jaws, such as the effect of a
defined external force impact could be simulated.
Comparing the mathematical simulation to in-vitro stud-
ies, an identical fracture behaviour could be verified in
corresponding object pairs.
The individual mathematical model presented includes
all necessary parameters for the biomechanical descrip-
130 Journal of Cranio-Maxillofacial Surgery
tion of the mandible. Thus, it becomes possible to trans-
fer biomechanical test details from the laboratory into
the computer. It is our goal to shift the traditional biome-
chanical tests, as they have been done in traumatology
and orthopaedic surgery, away from a trial-and-error
experiment into a more deterministic numerical environ-
ment, to find mathematical solutions to clinical prob-
lems, to accelerate this investigative process, and to
optimize the solutions by diligent analysis of all known
parameters.
EVALUATION O F ALVEOLAR CLEFT BY THREE-
DIMENSIONAL COMPUTED TOMOGRAPHY
IMAGES
Negishi, A.*, Takaesu, M., Yoshimasu, H., Amagasa, T.
First Department of Oral and Maxillofacial Surgery, Faculty
of Dentistry,
Tokyo Medical and Dental University, Tokyo, Japan
Aims: Secondary bone grafting into the residual alveolar
cleft in patients with cleft lip and palate has become a well-
established procedure with well-accepted advantages.
Morphology of the cleft prior to the grafting and outcome
of surgery is generally evaluated by intraoral radiographs,
however, the actual cleft and grafted bone is different from
two-dimensional (2D) radiograph images. Three-dimen-
sional computed tomography (3D-CT) images have been
reported to be helpful in understanding the maxillofacial
morphology. The aim of this study is to evaluate if 3D-CT is
more suitable for the evaluation of alveolar cleft before and
after bone grafting than 2D radiographs.
Methods: Sixteen patients with unilateral alveolar cleft were
examined by 3D-CT images. Before bone grafting, mor-
phology and volume of the alveolar cleft were estimated. 6
months after bone grafting, the alveolar bone height and
the extent of augmentation of the alar base of the nose
were examined by 3D-CT in comparison with 2D radi-
ographs.
Results: The 3D-CT images of the morphology were more
comprihensible than the 2D images. It was easy to estimate
how much volume of the bone is necessary to reconstruct
the cleft area. The alveolar bone height after bone grafting
was better visualized in 3D-CT than in 2D images. Only 3D-
CT imaging enabled us to evaluate the augmentation of the
alar base.
Conclusions: The 3D-CT imaging allowed for greater evalu-
ation of the conditon of the alveolar cleft before and after
bone grafting.
M O D E L L I N G OF FIBULA F L A P FOR
MANDIBULAR RECONSTRUCTION
Nerobeyev A., Verbo H.
Department of Face Neck Plastic Surgery Central Research
Institute of Stomatology, Moscow, Russia
Aims: Elaboration of the method of fabricating the osseous
part of a fibula flap according to the shape of the mandible.
Method: In the experiment, average parameters of the
angles for performing wedge osteotomies of the fibula were
calculated as a result of which the form of the mandible is
restored. Osteotomies were performed at the donor site
without damaging the vessels or shortening anoxia time. On
the mental part, 2 osteotomies were performed at the angle
of 451 2 cm. from the middle on both sides. The optimal
form from the angle of the mandible is obtained by cuting
the wedge at an angle of 601.
Results: Seven patients with various defects of the mandible
were operated on at our clinic. The sizes of the defects were not
less 10cm. The concomitant defects of adjacent soft tissues
were successfully replaced with the septocutaneus part of this
flap.
Conclusions: The fibula flap can close defects of the
mandible of various sites and lengths.
SURGICAL ALGORYTHM OF TREATMENT IN
PATIENTS W I T H FACIAL PARALYSIS.
Nerobeyev A.I., Churgaya T..S.M.
Department of Face and Neck Plastic Surgery Central
Research Institute of Stomatology, Moscow, Russia
AIMS:
To restore synchronous, symmetric and involuntary move-
ments in patients with a facial paralysis of different degrees
and extent.
METHOD:
The operation is based on clinical research and treatment of
about 300 patients with facial palsy of various degrees, aeti-
ology and character, ranging in age from 6 to 80 years.
Patients were divided into 2 groups with the nerve damage
at the intra- or extracranial level. Some of these patients
have been treated by dynamic methods, and others by static
methods of surgical correction of the paralysed face. In the
algorythm for the first of these groups the following factors
were taken into account: age, general condition of the
patient, character of accompanyning disturbance, state of
donor's affected area and recipient vessels.The static meth-
ods of correction are used as methods independent of the
surgical treatment of the patient. They were used in quality
corrective measures after neuro- and myoplastic operations.
RESULTS:
Restoring symmetry of a face and symmetric movements
was achieved in 80 % of the patients. The indications for a
defined technique in each specific case are defined.
CONCLUSIONS:
A variety of a clinical pictures of paralyses requires the
development of a surgical algorythm of treatment of the
given pathology. The algorythm is based on the treatment of
300 patients with a facial paralysis, and allows us to achieve
good functional and cosmetic results.
Fh M E T H O D S O F SURGICAL C O R R E C T I O N O F
DIFFERENT EYELID DYSFUNCTIONS.
Nerobeyev A.L, Churgaya T.S.M., Marinicheva L G.
Department of Face and Neck Plastic Surgery Central
Research Institute of Stomatology, Moscow, Russia
Aims: The aims of eyelid reanimation surgery are defined by
the normal lid function.

Method: Our report is based on clinical research and treat-
ment of 40 patients with different changes in the eyelids.
Among them: 32-with a paralyzed eyelid; in 17 of them a
retraction of the upper eyelid; 8 - with partial ptosis of the
upper eyelid. Paralytic lagophthalmos was corrected using
gold weights inserted in the upper eyelid; ear cartilage graft
was used for elongating the levator palpebrae muscle;
medial and lateral canthoplasty, lower lid shortening, sus-
pension by a strip of fascia lata; browpexy were also used.
Partial ptosis of the upper eyelid was corrected using the
method of reinnervating the levator palpebrae muscle by
cross-facial nerve grafts.
Results: The results were exellent in 35 of 40 patients and
good in the other 5.
Conclusions: For full restoration of eyelid function, it is nec-
essary to take into account the ratio of the tone of the orbic-
ularis muscle and levator palpebrae muscle. Therefore for
differing degrees of eyelid dysfunction we used a combina-
tion of techniques; this has give very good functional and
aesthetic results.
RECONSTRUCTION O F THE M A X I L L A IN
PREPARATION F O R I M P L A N T A T I O N O F
OSSEOINTEGRATED I M P L A N T S
F. W. Neukam, M. Erbe, S. Schultze-Mosgau, S. Girod
Department of Oral and Cranio-Maxillofacial Surgery,
Friedrich-Alexander- UniverstitSt Erlangen-Nnrnberg,
Glueckstrasse 11, 91054 Erlangen, Germany
The reconstruction of the maxilla after tumour resection
and radiation is a difficult therapeutic problem. Especially
due to radiation therapy the regeneration potency of the
local tissue, especially the bone is diminished and the soft
tissue may be fibrotic. In cases with large defects where
reconstruction of the bony defects is planned in preparation
for integration of intraosseous implants, reconstruction
with microvascular free flaps seems to be a possibility for
the patient's functional rehabilitation.
From 1/96 to 10/97 7 patients (6 oral squamous cell car-
cinoma and 1 osteosarcoma) who had been treated with
maxillectomy and radiation reconstruction was planned
with microvascular radialis flap, latissimus dorsi flaps and
osteocutaneous fibula transplants, as well as bone transfer
from the iliac crest. In three patients the outer skin of the
cheek had to be reconstructed as well. Preoperative plan-
ning was performed using stereolithographic models to eval-
uate the bony defect and plan the size and shape of the bone
transplant, or bone transplants were integrated. In compar-
ison the free iliac crest transplant showed siginificantly
higher resorption rates (25 to 30 %) than the microvascular
anastomosed bone transplants. In those cases, were free iliac
crest was transplanted, a second augmentation had to be
performed in order to provide enough bone for implanta-
tion of osseointegrated implants.
In conclusion, microvascular bone transplants, example
given the osteocutaneous fibula flap, appears to be
favourable as far as bone resorption is concerned. The prob-
lem here is the shaping of the transplant to provide an ade-
quate position for implantation of osseointegrated implants
and the relatively short pedicle which makes microvascular
anastomosis for the reconstruction of the maxilla more dif-
ficult. In our presentation advantages and disadvantages of
free versus microvascular bone graft for reconstruction of
the maxilla in preparation for integration of osseointegrated
implants will be discussed in further detail.
EACMFS Abstracts, Helsinki Congress 1998 131
LARGE CONDYLAR EXOSTOSES
Neyt, L., De Clercq, C., Abeloos, J., Mommaerts, 34.
Division of Maxillo-Facial Surgery, A Z St-Jan, Belgium
Aims: To describe the clinical picture, the radiographic appear-
ances and the therapeutic options in two cases with very large
condylar exostoses, one of them extending to the lateral nasal wall.
Method: Two adult patients are presented who exhibited
progressive trismus and a laterognathic deformity caused
by a large exostosis. The treatment consisted of condylec-
tomy and removal of the exostosis via a temporal approach
with temporary zygomatic arch displacement, as described
by Obwegeser (1985). In one patient the condyle was recon-
structed by means of the tip of the exosotosis, while in the
other patient the resected condyle was replaced.
Results: The aesthetic and functional results were satisfying.
Long-term follow-up is indicated because of possible
growth of the reconstructed condyle.
Conclusion: The temporal approach provides good access for
removal and reconstruction of condylar masses. Condylar
reconstruction with a part of the exostosis is questionable.
References: Obwegeser, H.L.: Temporal approach to the
TMJ, the orbit, and the retromaxillary-infracranial region.
Head Neck Surg 1985;7:185-199.
[~ ULTRASOUND INVESTIGATION O F EXPANSILE
JAW LESIONS
Ng, S.E*, Marinho, R.O.M., Carter, J.L.B.
Department of Oral and Maxillofacial Surgery, The Royal
London Hospitals N H S Trust, London, England.
Definitive preoperative diagnosis of expansile jaw lesions is
difficult from plain radiographs alone.
Management of such lesions varies depending on their
pathological nature and whether they involve other struc-
tures, including the soft tissues.
In a patient with a large odontogenic keratocyst of the
mandible, soft tissue involvement was revealed by ultra-
sound scanning.
The ultrasound findings in this case and that of a large
mandibular dentigerous cyst will be presented.
Although computed tomography and magnetic resonance
imaging may show soft tissue involvement very well, they are
not generally considered to be the best routine investigations
for a jaw cyst. Besides, computed tomography involves ioniz-
ing radiation and both CT and MRI are very expensive tech-
niques. In this regard, ultrasound imaging has a role to play.
Ultrasound is safe, non-invasive, quick, cheap, and
widely available.
The role of ultrasound imaging will be discussed and
compared with other imaging modalities.
[~ DNA CONTENT (PLOIDY) AND P R O G N O S I S IN
SQUAMOUS CELL CARCINOMA O F THE HEAD
AND NECK
Nikolaeva, T.*, Hudirat , S., A chundov ,A., Alferov , V.,
Uvavov ,A., Dobrynin , Y. N.N.Biokhin
Cancer Research Center, RAMS, Moscow, Russia
132 Journal of Cranio-MaxillofacialSurgery
Aims: To study the cell population pattern (ploidy) and to
evaluate significance of ploidy D N A in the prognosis of the
disease.
Method: One hundred and forty six patients (pts) were
examined, who had primary squamous cell carcinomas of
the head and neck ( 94 larynx and 52 oral cavity cancer).
All pts underwent only surgery a n d / o r with radiotherapy/
chemotherapy. The follow up period was 6 to 103 months.
D N A content was determined in operation specimens of
turnout tissue, using an ICP-22 flow cytometer.
Results: It was shown that diploid and aneuploid cancer
occur at equal rates. The rate of aneuploid tumours
increased with disease progression. There was a preponder-
ance of aneuploid tumours in all histological forms of
growth studied. The rate of recurrence under investigation
was mainly associated with aneuploidy and was 1.5-3 time
more than diploid ones. Five year survival time in aneu-
ploid pts was 4.5%, in diploid ones - 74.2 %. Sixty two pts
with laryngeal cancer ( I-III stage) underwent only surgical
treatment (34 diploid and 28 aneuploid). Five year survival
time in pts with a diploid tumour was 2.5 time better than
in pts with aneuploid ones. The postoperation plus radio-
therapy survival time was better in diploid oropharyngeal
cancer pts (21pts) than in aneuploid (21 pts) ones ( 76.4 %
versus 30.4 %). We emphasize that survival time was worse
in aneuploid oral cavity cancer pts (11.2 %). In aneuploid
laryngeal cancer this index was 43.6 %. Preoperative
chemotherapy has a tendency to increase survival time in
aneuploid cancer pts (71.4 %) versus 51.8% in diploid ones.
Our findings do not allow us to compare the results of
radio- or chemotherapy alone for diploid and aneuploid
head and neck cancer. We believe that the comparative
study of diploid and aneuploid cancer response to different
therapeutic modalities should be continued.
Conclusion: The highly informative value of D N A ploidy in
head and neck carcinomas for prognosis and for working
out the individual approach to further treatment is empha-
sized.
[~ THE STATUS O F T H E DISPLACED CONDYLE IN
SURGERY O F T M J ANKYLOS1S TYPE III
Nitzan DI~, , Bar Ziv j2, Shteyer A 1
1Dept of OMS,
:Dept of Radiology, Hadassah Hospital, Hebrew Univ
Jerusalem, Israel
The traditional surgical treatment of ankylosis type I I | & |V
consisits of total joint resection followed by joint gap
arthroplasty or reconstruction.
The objective of this presentation is to propose an
hypothesis regarding the value of the fractured displaced
condyle in the rehabilitation of mandibular function and
growth in patients with ankylosis type III.
Presented are four patients, 9 to 42 years old, with TMJ
ankylosis type III presenting maximal mouth opening of 15
to 19 mm with minimal lateral and protrusive movements.
Using the guidance of improved CT scan the patients
underwent TMJ surgery which included elimination of the
ankylosis site, leaving the displaced condyle and disc
untouched in their aukward position followed by intensive
physiotherapy.
One to four years after surgery the four patients demon-
strated a maximal mouth opening of 44 to 50 mm as well as
improved contralateral and protrusive movements. The two
younger patients demonstrated improved facial symmetry.
Conclsions: Ankylosis type III takes place between the condy-
lar stump and fossa while the displaced condyle, with the disc
attached, is ankylosed to the medial aspect of the stump.Using
CT for guidance, the ankylosing mass is resected leaving the
condyle and disc untouched in medial aukward position for
normal function and growth. Total joint resection and recon-
struction in ankylosis type III is contraindicated.
Fh T M J A N C H O R E D DISC P H E N O M E N O N (ADP)
SIGN & SYMPTOMS, TREATMENT AND
PATHOGENESIS O F A NEW CLINICAL ENTITY
Nitzan D W
Dept. of Oral and Maxillofacial Surgery, Hadassah
Hospital, Hebrew Univ Jerusalem Israel
The aims of this study are to establish a rationale for a particu-
lar type of sudden and severely restricted mouth opening
caused by the disc anchoring to the fossa, to recommend appro-
priate treatment, and to describe its possible pathogenesis.
Patients & Methods: The clinical characteristics proving the
hypothesis, the proposed pathogenesis, and treatment of the
disorder are based upon data published in the literature and
our clinical experience with the diagnosis and treatment of
this disorder.
Results: A group of patients with severely limited mouth
opening (<25mm) due to highly restricted condylar sliding,
unrelated to internal derangement, has previously been
identified. Arthrocentesis of the joint's upper compartment
re-estalishes normal mouth opening. This disorder proba-
bly develops as a result of the disc adhering to the fossa pre-
venting the condyle from sliding. Intra-articular changes by
joint loading may be associated with intermittent overload-
ing of the joint which initiates hypoxic reperfusion cycle
producing free radicals, which cause a variety of changes,
one of which is degradation of the hyaluronic acid (HA). In
its degraded form, H A loses its potential as protector and
lubricant of the articular surfaces, allowing adherence of
the smooth joint surfaces. Arthrocentesis releases the
adhered surfaces, reestablishing movement. Prevention of
readherence is accomplished by the patient's awareness and
by using a specifically constructed joint unloading interoc-
clusal appliance. Post operative physiotherapy is useful for
the final rehabilitation of the joint and normal muscles
function.
A NEW APPROACH TO FACIAL ASYMMETRY
CAUSED BY T M J ACTIVE CONDYLAR
HYPERPLASIA
Nitzan DW, Brin I, Azaz B
Depts. of Oral & Maxillofacial Surgery and Orthodontic,
Hadassah Hospital, Hebrew Univ Jerusalem Israel
Active Condylar Hyperplasia (ACH) is associated with
facial asymmetry and occlusal diturbances. Its traditional
treatment includes condylectomy and orthognatic surgery in
one or two stage procedure.
The objective of this paper is to prove the hypothesis that
the elimination of the growing site only is followed by a
gradual remodelling, self correcting process of both the
facial and occlusal disturbances, due to normal muscular
orientation.

Eighteen patients with ACH underwent high condylec-
tomy only. Cephalometric radiographs and casts taken
before and at least a year after surgery were used to demon-
strate the variuos levels of spontanious rehabilitation of
facial symmetry and occlusion.
Conclsions: 1.ACH is associated with developing facial
asymmetry and occlusal disturbances. 2. Elimination of the
condyle-the actively growing site, stops mandibular over-
growth. 3. Elimination of the condyle - the actively growing
site, is followed by a gradual, partial or total self correction
of facial asymmetry and occlusal disturbances The process
of face and occlusion remodelling will be discussed.
T M J SURGICAL MANAGEMENT OUTCOMES:
ARTHROCENTESIS
Nitzan DW.
Dept. of OMS, HSDM, Hebrew Univ. Jerusalem, Israel
Arthrocentesis is a simple and efficient procedure that can
be performed under local anaesthesia. It carries no reported
complications.
The method proved efficent for disorders associated with
limited joint motion and especially in severly limited mouth
opening caused by a newly described phenomenon: the
Anchored Disc Phenomenon (ADP). Patients with A D P
experienced an increase in maximal mouth opening (MMO)
from 23.115.2 to 44.212.4, associated with marked reduction
in pain with no recurrence. In other TMJ disorders with
limited MMO, arthrocentesis resulted in improvement of
various levels:
In osteoarthritis M M O increased from 27.616.9 to
39.5a2.Smm (27 pts).
Elimination of locking was noticed in 7 out of 10 pts
with disc displacement with reduction with intermittent
locking. In disc displacemnt without reduction, M M O
increased moderately from 31.917.1 to 36.416.8 (19 pts).
Inconsistent and ambiguous effect has been demonstrated
in disc displacement and with reduction.
The success of arthocentesis, although it does not change
neither the shape of the disc nor its position has given impe-
tus to investigate efforts concerning the mode of action or
arthrocentesis and has led to reconsideration of the patho-
genesis of the various disorders. It has been suggested that
limitation in joint movement might be a result of a b r u p t
intra-articular adherence due to a change in lubrication,
rendering the disc incapable of sliding. We will present a
model of joint lubrication and discuss the effect of its possi-
ble disruption on the joint function.
3D SCANNING OF SURFACES FOR
DETERMINATION O F VOLUME CHANGES IN S O F T
TISSUE
Nkenke E.*, Cioutot L. **, Laboureux X.*% Hiiusler G.**,
Neukam F. W.*
*Department of Oral and Cranio-Maxillofacial Surgery,
Friedrich-Alexander- Universitiit Erlangen-Nurenberg,
Gliiekstr. 11, 91054 Erlangen, Germany
**Chair of Optics, Friedrich-Alexander- UniversitSt
Erlangen-Nurenberg,
Staudtstrasse 7lB2, 91058 Erlangen, Germany
EACMFS Abstracts, HelsinkiCongress 1998 133
Introduction: The development of methods for 3D registra-
tion of surfaces renders possible the volumetric control of
the pre- and postoperative status, e.g. swelling, volumetric
changes in microvascular flaps, control of operative results
by comparison of symmetry, analysis of growth and anthro-
pological serial examinations.
Materials and methodes: The requested object is scanned by
the coded light approach with a precise sinusoidal grey
value display. The construction of the 3D image is achieved
by calculation of the single pixels by means of phase mea-
suring triangulation. The time for measurement takes 320
ms. The precision of measurement is 300 lm.
After a computer-aided matching of pre- and postopera-
tive images the difference in volume can be acquired by a
newly developed interactive procedure.
Sample of application: The volumetric determination is
high-lighted by the pre- and postoperative appearanches of
a patient undergoing third molar removal of the right upper
and lower jaw.
Disseussion: This methode will be a great benefit in plastic
and reconstructive surgery of facial defects. The 3D scan-
ning of the facial surface will allow precise predictions of
shape and volume stability of the reconstructions.
STUDIES ON THE SURVIVAL RATE O F VARIOUS
E N O S S A L I M P L A N T SYSTEMS
Cand. med. Nicole Noack, *Dr. Jiirgen Wilier, Dr. Dr.
Jiirgen Hoffman, Univ.-Prof Dr. Norbert Schwenzer
Department of Oral and Maxillofacial Surgery, University of
Tiibingen, Osianderstr. 2-8, 72076 Tiibingen (Germany)
*Private Practice D~ Jiirgen Willer, Hindenburgstr 43,
72762 Reutlingen (Germany)
Aims: The goal of the study was to evaluate the success of
treatment using osteointegrated implants of the BrSnemark,
Frialit-2 and I M Z systems implants.
Method: In a retrospective catamnesic study on 1739
implants inserted into 739 patients in a period from 1985 to
1997, Kaplan-Meier survival analyses were conducted. In
all cases postoperative checkups at short intervals and
documentation on the course of the treatment were
guaranteed.
For all implant systems the ideal indication was discov-
ered and in addition a multivariant analysis of the factors
significant for the survival rate of an implant was conducted.
Results: In all systems lower-jaw implants were generally
more successful than upper-jaw implants.
The pre-prosthetic loss rate was 1.9%, whereas 4.3% of the
implants were lost after the prothetic treatment. The best
long-term prognosis was for implants in intermediate and
free-end situations and single-crown replacements with I M Z
and Brgmemark implants. In edentulous jaw implants of the
Brfinemark systems gave the best results.
F U N C T I O N A L REHABILITATION O F THE
ATROPHIC JAWS W I T H REVASCULARIZED FREE
FIBULA F L A P AND I M P L A N T S - S U P P O R T E D
PROSTHESIS.
*Nocini, P.F.(1), Gotte, P. (1), Bedogni, A. (1), Chiarini,
L. (2), and De Santis, G. (3).
134 Journal of Cranio-Maxillofaciat Surgery
(1) Institute of Dentistry, Surgery Dpt., Verona University,
Verona, Italy.
(2) Institute of Dentistry, Surgery Dpt., Modena University,
Modena, Italy.
(3) Orthopaedic Division, Surgery Dpt., Modena University,
Modena, Italy.
Extreme alveolar ridge bone resorption represents a big
challenge in jaws reconstruction. Autologous Iliac bone
grafts never secure reliable results neither to the mandible
neither to the upper jaw; this depends on poor vascular sup-
ply at the recipient site in extreme bone atrophies. The use of
free revascularized bone flaps in jaws augmentation ensures
an adequate and indipendent vascular income. Since 1993,
we have tested the free vascularized fibula flap in alveolar
crests augmentation due to class VI atrophy sec. Cawood, to
obtain a fixed, homogeneous, bicortical bone support for
implant rehabilitation. 11 patients were treated (average age
45.5 years old) with free vascularized fibula flaps (5
mandible and 6 maxillary alveolar crest augmentations).
The average fibula's lenght was 11.7 cm. All flaps healed pri-
marily. A vestibuloplasty was performed prior to implants.
60 osteointegrated implants have been placed (28 into the
mandible and 32 into the upper maxilla); only one maxillary
implant was removed during surgery because of low pri-
mary stability. Excellent stability was performed in 59 of 60
implants and 11 overdentures were applied. The masticatory
load ranged from 6 to 33 months ( average 13.4 months). A
very well-tested stability of the implant-supported prosthe-
sis has been pointed out in all treated cases, even after 3
years of functional loading, There wasn't any long term
donor-site morbidity. Extreme alveolar crest atrophy,
including the basal bone, represents, in our experience, a
proper indication to the utilise of free vascularized fibula
flap.
PLLA PIN FOR OSTEOSYNTHETIC TREATMENT
OF C O N D Y L A R NECK FRACTURE IN MINI-PIG
A N D PATIENTS
Noguchi, L *, Sato, Y., Ando, Z, Takahasi, M., Kurokawa,
H., Oota, S., Hasegawa, Y., Tihara, K., Someta, H.,
Takayasu, A.
Department of OMFS, National Defense Medical College,
Saitama, Japan
Aims: Kischner's 18-8 wire-pinning and titanium miniplate
osteosynthesis has been extensively applied to fixate condy-
lar fractures of the mandible in patients undergoing surgical
treatment. However, these metal materials contain defects
which should be removed because the pin causes absorption
in the surrounding bone, perhaps leading to osteoporosis.
Furthermore, there has been much discussion concerning
the systemic accumulation of resolved chemical elements
and the continueing mechanical irritation caused by the
metal.
The aim of this study was to evaluate factors, such as the
degree of strength or absorption of the PLLA pin, which
has been used for fixation of condylar neck fractures of the
mandible, the permanently enhanced mobility of the
mandible and the degree of strong or weak osteosynthesis
triggered by the PLLA pin for fixation of condylar neck
fractures.
Methods: The PLLA pin (NEOFIXfi) was used experimen-
tally for fixation of condylar neck fracture of the mandible
in mini-pigs. A daily routine diet was given without inter-
maxillary fixation after internal fixation. The observation of
the postoperative course and hemobiochemical tests were
carried out. The fixation of the condylar neck fracture of
the mandible after sacrifice at postoperative months 1, 2, 3,
4, and 5 were macroscopically and histologically observed.
Condylar neck fracture in patients repaired using PLLA
pin, intermaxillary fixation and osteosynthesis, were
followed using imaging techiques.
Results: Osteosynthesis was macroscopically obtained by
the first postoperative month, and a layer of collagen fiber
was histologically observed surrounding the PLLA pin at
the first postoperative month in the mini-pig. The collagen
fiber layer was ossified at postoperative month 2. The
implanted PLLA pin was gradually thinned by absorption
following months 3, 4 and 5. Using PLLA pin for condylar
neck fracture resulted in clinically good osteosynthesis and
functional movement of the condyle at postoperative month
4 in patients. No side effects and no infections were
observed in either patients or mini-pigs.
Conclusion: Long term strong osteosynthesis without osteo-
porosis was obtained with the PLLA pin, as well as excellent
strength for fixation of the condylar neck fracture of the
mandible. The PLLA pin has been clinically avairable as an
osteosynthetic treatment of condylar neck fracture in
patients.
A NEW M O D E L FOR REPETITIVE ANALYSIS OF
OSSEOUS PERFUSION
Nolte, D.*, Draenert, K., Raab, S., Thein, E., Messmer, K.,
Ehrenfeld, M.
Department of OMFS, Klinikum Innenstadt, Institute for
Surgical Research, Klinikum Grosshadern at the Ludwig-
Maximilians- University of Munich, Center for Orthopaedic
Research, Munich, Germany
Aim: To repetitively analyze the regional blood flow in bone
over a total period of six weeks, using the fluorescent
microsphere technique
Method: Under i.v. ketamine/xylazine anaesthesia, two two-
way valves were placed subcutaneously into the right and
left carotid arteries of New Zealand rabbits (n=6) to permit
microsphere injection and reference probe sampling for
blood flow calculations, respectively. Using seven different
fluorescently labeled microspheres, measurements of the
regional blood flow in tibial bone were made at day 1, 3, 5,
12, 19, 26 and 33 after valve implantation. Perioperative
antibiotic therapy was administered with 30 mg/kg
Cefotaxim. Body weight, MAR heart rate, and standard
laboratory parameters (Na +, K +, leukocyte count, haemat-
ocrit, haemoglobin, PaO2, creatinin) were analyzed repeti-
tively. Regional tibial blood flow was evaluated both by
fluorescence microscopy (direct method) and by calculation
of regional blood flow from reference probe sampling (indi-
rect method).
Result: At days 1, 3 and 5, marked changes in the regional
blood flow in the tibial bones were observed. At day 7 and at
the following points in time, a steady state was achieved,
indicating the absence of trauma-induced alterations in
microvascular osseous perfusion.
Conclusion: This model allows, for the first time, a mini-
mal invasive measurement of regional blood flow in corti-
cal and/or cancellous bone over an observation period of
six weeks. The model therefore seems suitable for better
understanding of the role of osseous perfusion under con-
ditions of impaired bone healing, as encountered after

radio- and/or chemotherapy, implantation of biomaterials
or transplantation of vascularized/non-vascularized bone.
DELAYED AND I M M E D I A T E RECONSTRUCTION
F O L L O W I N G HEAD AND NECK T U M O R EXCISION
Norkus, T., Janu~'s, G., Agtrauskas, T., Vikgraitis, S.
Kaunas Medical Academy, Kaunas Academic Clinic
AIMS:
To estimate possibilities to cover defects following head and
neck tumor excision by using various reconstructive meth-
ods.
METHOD:
Vascularised bone or osteocutaneous iliac crest graft were
used for the reconstruction of defects following excision of
mandibular tumors in 3 patients. The 4th patient underwent
microvascular transplantation of inversed myocutaneous
latissimus dorsi flap for covering of extensive pharyngos-
toma following radiation and laryngectomy. Wide scalp
defect after removing of neurofibroma was covered by
expanded haired fasciocutaneous flap in the 5th patient.
RESULTS:
Immediate replacement of bone and soft tissues after hemi-
mandibulectomy in osteosarcoma resulted in survival of the
patient for 2 years without any threat in the nearest future.
Delayed mandibular reconstruction has failed in one
patient. Reconstruction of cervical oesophagus with simul-
taneous covering of adjacent neck tissues and replacement
of scalp defect in another patient were successful as well in
both patients.
CONCLUSIONS:
Various methods may be chosen for the covering of head
and neck defects following cancer surgery. Immediate recon-
struction after removing of mandibular osteosarcoma may
result in remote good outcome.
P) GROWTH INHIBITION IN SQUAMOUS CELLS
INDUCED BY 5-FU, CBDCA, OR IFN-a
lNoutomi, T. *, tChiba, H., lltoh, M., 2Takada,
E.,2Mizuguchi J.
~Department of Oral and Maxillofacial Surgery,
2Department of Immunology, Tokyo Medical College, Tokyo,
Japan
Aims: Cell lines from five squamous cell carcinoma (SCC) estab-
lished for elucidating the molecular mechanism have been of
varied sensitivity of to conventional chemotherapeutic drugs
such as 5-FU, carboplatin(CBDCA), and interferon-alpha
(IFN-a).
Methods: Cells were maintained in RPMI-1640 containing
15% fetal calf serum in the presence of 2 mM L-glutamine,
5gM mercaptoethanol and 100gg/ml of kanamycin at 37? in
humidified air with 5% CO 2 . The sensitivity of the tumor
cells to the drugs were determined in terms of both [3H]-
thymidine incorporation and cell cycle analysis using pro-
pidium iodide staining method.
EACMFS -Abstracts, Helsinki Congress 1998 135
Results: More than 80% inhibition by [3H]-thymidine uptake
was obtained in three cell lines to 100gg/ml 5-FU or
CBDCA, in one line (TMCST) with some resistance (50%
inhibition) to both drugs. Interestingly, differential sensitiv-
ity to these drugs were observed in another cell line
(TMC5L). Furthermore, I F N - a addition enhanced the
inhibitory effect of 5-FU by [3H]-thymidine uptake. The
ooperative effect of 5-FU and I F N - a was accompanied by
the increased induction of apoptosis.
Conclusion: Chemotherapeutic drugs such as 5-FU and CBDCA
prevent tumor cell growth at least through the induction of apop-
tosis. Our cell lines would be valuable for analyzing the mecha-
nism leading to apoptosis in squamous carcinoma cell~
P H O T O D Y N A M I C D I A G N O S I S A N D THERAPY
M. Niibler-Moritz, H.F. Sailer, G. Eydch, Ch. Oechslin
Since the beginning of our century, certain dyes have
been known to induce photosensitizing effects. Tumour
treatment is the principle but not the only application
field of p h o t o d y n a m i c diagnosis (PDD) and therapy
(PDT). H e m a t o p o r p h y r i n derivates (HpDs) are the
most commonly used photosensitizers. Within a few
hours after application H p D s are distributed. The basic
characteristic of a photosensitizer is that it remains
inactive until irradiated. H p D s are retained longer by
malignant cells than by surrounding healthy cells and
are detected by fluorescence. After resonant excitation
by laser irradiation, the photosensitizer performs sev-
eral simultaneous or sequential decays which results in
intramolecular transfer reactions. A t the end of these
diverse reaction channels, highly cytotoxic reactants are
released causing an irreversible oxidation of essential
cell structures. Currently, further photosensitive com-
pounds are under investigation concerning their applic-
ability for P D D and PDT. One potential candidate is
5-aminolaevulinic acid (ALA) which itself is not even a
photosensitizer but a precursor of the endogenous syn-
thesis of porphyrins. It can be orally and topically
administered rather than being injected like most of the
porphyrins. First results seem promising, however,
future routine clinical use also depends on further
advancements in laser (e.g. diode lasers) and optical
fibre technology, respectively.
Fh INFLUENCE OF FULL-FACE-TYPE H E L M E T ON
MAXILLOFACIAL I N J U R I E S AT TRAFFIC
ACCIDENT OF MOTORCYCLISTS
Nukata, J. * Kano, E, Michizawa, M., Sakuda, M.
Second Department of OMFS, Faculty of Dent&ttT, Osaka
University, Osaka, Japan
AIMS:
To clarify the characteristics of maxillofacial injuries at
accidents of motorcyclists who have on full-face-type hel-
mets (F-helmets).
METHOD:
A clinicostatistical study was performed in 50 motorcyclists
who had suffered maxillofacial injuries and were treated at
our department in the past 8 years.
136 Journal of Cranio-MaxillofacialSurgery
RESULTS:
Of 50 patients 14 had used F-helmets, 24 jet or half-type
helmets (H-helmets) and 12 no helmet. The most common
fracture site in maxillofacial region was the mandible.
Mandibular fracture at the symphysis or parasymphysis
occurred in 32% of patients who had used F-helmet and
18% of patients who had used H-helmets.
Condylar fractures of the mandible occurred in 27%
of patients who had used F-helmets and 50% of patients
who had used H-helmets. Furthermore, premolar teeth
injuries occurred in 62% of teeth injuries in patients who
had used F-helmets and 18% of teeth injuries in patients
who had used H-helmets. On the other hand, anterior
teeth injuries occurred in 31% in F-helmets and 78% in
H- helmets.
CONCLUSIONS:
Above results indicate that even if F-helmets are used,
the occurrence of maxillofacial fractures and teeth
injuries are considerable. However, F-helmets may pre-
vent condylar fractures of the mandible which cause TMJ
dysfunction.
@=~ THE BIOCONVERTIBLE OSTEOSYNTHESIS
SYSTEM. RESULTS O F A PROSPECTIVE CLINICAL
STUDY ON STABILITY OF BIMAXILLARY
ORTHOGNATHIC SURGERY.
Obwegeser, J. A.*, Gattinger, B.
Department of OMFS, AKh Linz, Linz, Austria
Aims: In 1990, we suggested an osteosynthesis system man-
ufactured from bone tissue, as an alternative to polylactides.
In-vivo and in-vitro experimental work indicated that auto-
claved allogenic cortical bone is excellently suited as an
osteosynthesis material. The general advantage is the avoid-
ance of secondary implant removal and the fact that these
implants have - in contrast to polylactides - osteoconduc-
tive capacity. The purpose of this study was to evaluate the
stability of bimaxillary orthognathic surgery results using
this bioconvertible system in the fixation of osteotomies and
to compare the results with that of metallic devices.
Method: A detailed study protocol was designed in order to
standardise and control the follow up. Sixty four patients -
33 using metallic devices, 31 using the bioconvertible system
- were operated on according to this protocol. Four lateral
cephalometric X-rays were evaluated for each patient and
compared in their two deviation levels. In order to assess the
vertical and sagittal behaviour of the osteotomized seg-
ments, independent of intraoperatively altered structures, a
system of coordinates was drawn up. Statistical examination
of the existing data was carried out by computer on the
"GraphPad Prism" Version 2.01 program.
Results: Both groups showed excellent stability in the anteri-
oposterior plane, but a slight tendency to vertical relapse.
There were no statistically significant differences in relapse.
Conclusion: Bimaxillary orthognathic surgery can be per-
formed using exclusively bioconvertible osteosynthesis
material. Due to good initial stability, postoperative
mandibulo-maxillary fixation is not necessary. The postop-
erative stability is comparable to that of metallic devices.
STUDY OF T E M P O R O M A N D I B U L A R J O I N T
STATUS IN O N C O L O G Y PATIENTS AFTER
MANDIBULECTOMY AND RECONSTRUCTION
WITH A REGIONAL PEDICLED OR FREE
M I C R O S U R G I C A L BONE GRAFT AND
OSSEOINTEGRATED IMPLANT-RETAINED
DENTAL PROSTHESES.
Ochandiano, S.* Cuesta, M., Aeero, J., Concejo, C.,
Fernandez-Alba, J.
Service of Oral and Maxillofacial Surgery. Hospital General
Universitario Gregorio Marag6n. Universidad Complutense.
Madrid. Spain.
Aims: To establish the long term status of the TMJ in
patients who underwent mandibulectomy for oncological
reasons and were reconstructed by a regional pedicled or
free microsurgical bone graft and have at least worn an
implant anchored dental prostheses for one year.
Method: Twelve patients, aged between 17 and 72, who
were operated on for an oral epidermoid carcinoma or
benign neoplasia (ameloblastoma), between 1987 and
1996 and were immediately reconstructed with a regional
pedicled (trapezius osteomyocutaneous) or free microsur-
gical (iliac crest or fibula) bone graft. Two different clini-
cal investigation protocols were used. We studied the
anatomy and different mandibular movements by com-
puterised axiography and dynamic magnetic resonance
imaging.
Results: No patient complained of pain or other symptoms
of severe TMJ derangement. Two patients had some clinical
symptoms, only one clearly related to the surgery. 40% of
the patients presented limitations of different mandibular
movements clinically measured in the interincisal area, in
those patients there is a coincidence between the clinical lim-
itation and the restriction of the condylar mobility proved
by axiography and magnetic resonance imaging. Arthrosis
was seen in a third of the patients, unilateral disc displace-
ment with reduction in two of them and without reduction
in another two patients.
Conclusions: 1. Segmental mandibulectomy added to pedi-
cled bone graft reconstruction and dental rehabilitation
does not cause severe internal TMJ derangement clinical
symptoms.
2. There is a limitation of mandibular mobility in 40% of
the patients that could be explained by surgical alterations
and sequellae.
3. Axiographic path tracings and magnetic resonance imag-
ing findings agree with those described in a non surgical
population.
USE O F INTRAORAL DISTRACTOR FOR
ALVEOLAR RIDGE AUGMENTATION
Oh, H.K.*, Ryu, S. E
Department of Oral and Maxillofacial Surgery, College of
Dentistry, Chonnam National University, Kwangju, South
Korea
The aim of this pilot study was to show the feasibility and
potential advantages of using an intraoral distractor for
alveolar ridge augmentation.
The intraoral distractor was designed to augment the
ridge vertically in the atrophic mandible. After an
osteotomy was performed to allow the edentulous ridge to
be distracted vertically, a distractor device was applied, both

in dogs and in humans, An activating pin was exposed intra-
orally. It was left for 7days before distraction was begun.
The device was activated twice a day at a rate of 2x0.5 ram.
After a 4 week healing period, the device was removed and
implants were inserted. The height gained ranged from 5 to
9 mm. Radiographic and histological examinations were
performed.
The results of this study indicate that the intraoral dis-
tractor may have the potential for use in augmentation of
the atrophic edentulous ridge.
INCREASING T H E W I D T H OF ALVEOLAR
B O N E BY M E A N S OF THE CRESTOSPLIT
PROCEDURE
Kyosti Oikarinen
Department of Oral and Maxillofacial Surgery, Institute of
Dentistry, Universityof Oulu, Oulu, Finland
Aim: To estimate the suitability of the Crestosplit method
for the widening of the narrow alveolar crest.
Methods: Crestosplit (J van Straten, the Netherlands) is a
set of chisels which is usable for minor widening procedures.
The instrument set includes six broad and two round chisels
of various diameters and shapes. Altogether, nine patients
have been treated so far. Patients received 16 two-stage
Astra 3.5 mm implants. Six cases were single implantations.
Two splittings in the edentulous anterior maxilla and one
splitting in an edentulous posterior mandible were per-
formed. The largest splitting performed was in a totally
edentulous maxilla in which 6 implants were installed.
Follow-up time varied from 6 to 14 months.
Results: Chisels caused a predictable split. No membrane was
needed. Two out of six implants in edentulous maxillae did
not osseointegrate. This patient received an overdenture while
other cases were treated with a fixed prosthesis as preferred
before surgery. Neither advanced peri-implant pocket forma-
tion nor alveolar bone loss was observed around the implants.
Conclusions: Crestosplit is a 'biological' and predictable
method of widening an alveolar crest. A precondition is that
spongiosa is separated by two cortical layers and that vertical
height is sufficient for implantation. The preservation of the
periosteum on the lateral cortex is important for blood sup-
ply because the chisels fracture the alveolar crest laterally.
Slight gingival hyperplasia is beneficial for soft tissue
coverage.
[~ T H E CLINICAL EFFECTS O F COMBINATION
THERAPY USING INTRA-ARTERIAL
CARBOPLATIN (CBDCA) I N F U S I O N W I T H
R A D I O T H E R A P Y F O R LOCALLY ADVANCED ORAL
CANCER
Okutomi Z *, lehihara H., Fujitsuka H., Kato E, Sakai Z,
Tatematsu N.
Dept. of Oral and Maxillofacial Surgery, Gifu University,
School of Medicine, Gifu, Japan
Aims: Many cases of advanced oral cancer are treated by
combination therapy of surgery, radiotherapy, and
chemotherapy, but the curative rate of advanced oral cancer
is inferior to the early oral cancer. For improvement of the
EACMFS Abstracts, HelsinkiCongress 1998 137
curative rate of them, we have treated locally-invasive oral
squamous cell carcinomas by a combination of radiother-
apy and intra arterial chemotherapy as initial treatment
since 1993.
Method: We investigated the clinical effects and evaluation
of the combination therapy using intra-arterial CBDCA
infusion and radiation for locally advanced oral cancer in
pre-operative cancer therapy retrospectively. In order to
evaluate the clinical effects of this therapy, a clinical study
was performed in fifteen cases with the oral cancer in our
department. Fifteen patients in our department with oral
squamous cell carcinomas (8 of tongue and floor of mouth,
2 of mandibular gingiva, 3 of maxillary gingiva, and 2 of
buccal mucosa.) were treated with this therapy from March
1993 to March 1997. These patients were treated with intra
arterial chemotherapy which was conducted by inserting a
catheter from the superficial temporal artery for one shot
CBDCA ( daily from 15 to 30rag / body ) administration at
about 2 hours before radiation. The external radiation
using 60 Co was given from 30 to 50 Gy as total dose.
Result: After the initial treatment, one case of 15 patients
(7%) achieved clinical CR and 12 of 15 (80%) got clinical
PR. After the radical surgery, 2 cases of 15 (13%) achieved
pathological CR. Four years over all survival rate was
62.2% (10/15). These results suggest that this therapy may
have an efficacy control of tumor and generally improve of
symptom for locally advanced oral cancer in pre-operative
cancer therapy.
Conclusion: We suspected that this therapy using intra-arte-
rial CBCDA infusion is a useful treatment for locally
advanced oral cancer.
TOTAL G L O S S E C T O M Y FOR ADVANCED AND
RECURRENT CARCINOMAS O F THE ORAL CAVITY
Omura, K. *
Department of Head and Neck Surgery, Chiba Cancer
Cente~ Chiba, Japan
Aim: To review our clinical experience with total glossec-
tomy for advanced and recurrent carcinomas of the oral
cavity.
Patients: Thirty-seven consecutive patients undergoing total
glossectomy for advanced or recurrent carcinoma of the
oral cavity were evaluated. Twenty patients (54%) presented
with stage IV disease and the remaining 17 patients pre-
sented with recurrent or persistent disease after prior treat-
ments. In combination with total glossectomy, total
laryngectomy was performed primarilt in 23 patients (62%)
and secondarily in 1 patient (3%). In patients with the lar-
ynx preserved, ancillary procedures such as laryngeal sus-
pension, laryngoplasty and cricopharyngeal myotomy were
advocated to facilitate postoperative deglutition. Neck dis-
section was carried out bilaterally in 35 patients (94%) and
unilaterally in 2 patients.
Results: For the entire group, disease-specific survival rates
were 52.6% and 43.7% at 2 and 5 years, respectively. Of 20
patients died of disease, 11 patients (55%) were died of dis-
tant metastases. Patients with the larynx preserved had intel-
ligible speech with a mean score of 22.5% of 100 Japanese
vowels and no serous problems in deglutition. The majority
of patients were insured a reasonable quality of life by relief
from constant pain and by enjoying oral alimentation.
Conclusions: Total glossectomy with or without laryngec-
tomy is not only a palliative procedure but also an oncolog-
ically sound procedure for advanced or recurrent carcinoma
138 Journal of Cranio-Maxillofacial Surgery
of the oral cavity. Chemotherapy should be advocated as an
adjunctive modality for microscopic distant metastases.
CHROMATIC ANALYSIS OF
AUTOFLUORESCENCE IN ORAL SQUAMOUS CELL
CARCINOMA
Onizawa, K., Yoshida, H.
Department of OMFS, Institute of Clinical Medicine,
University of Tsukuba, Japan
Aims: Fluorescence photography as a diagnostic method for
oral cancer is based on the phenomenon of orange fluores-
cence in squamous cell carcinoma (SCC). However, similar
autofluorescence is also found in other tissues. This study
was carried out to evaluate whether the color of autofluo-
rescence in SCC is chromatically specific.
Methods: Forty-eight fluorescence photographs on which
orange fluorescence was depicted served as subjects. The
fluorescent sites consisted of 30 SCC, 31 dorsa of the
tongue, 18 dental plaques and 5 benign lesions. Thirty SCCs
were classified into 4 stage I, 9 stage II, 8 stage III and 9
stage IV. The color of fluorescence was measured with a
chroma meter (Minolta CS-100) which expressed color with
Y and chromaticity coordinates x and y. The chromatic data
were compared among different tissues and among SCC
cases.
Results: There were significant differences in x and y values
between SCC and dorsa of the tongue (p<0.01), in Y and y
values between SCC and dental plaques (p<0.05) and in y
value between SCC and benign lesions (p<0.05).
Fluorescence in SCC showed a tendency to shift from
orange to reddish orange color as the stage advanced, and
there was a significant difference in x and y values between
stage I and other cases, and in x value between stage II and
IV cases (p<0.05).
Conclusions: These results suggest that the color of auto-
fluorescence in SCC differs from that of other tissues, and
that the fluorescence shifts from orange to reddish orange
as the tumor progresses.
LASERS IN AESTHETIC FACIAL SURGERY; CO2 -
A N D ERB/YAG LASERS AS AN H E L P F U L
EXCISIONAL AND ABLATIVE INSTRUMENT IN
BLEPHAROPLASTY, FACE LIFT AND EXCISION OF
SKIN TUMORS.
Dr.Dr. A.F. Osterhaus, Dr.Dt: U. Westermann, Dr.Dt: G
Lodde
Lasers in Aesthetic Surgery are certainly now far behind the
experimental stage and well established. There are mainly
two systems beeing of interest for its surgical use. The
Ultrapulse CO2 and Erb/YAG lasers have, due to their
absorbtion in water, a cutting and vaporisation mode. For
superficial skin resurfacing procedures the Erb/YAG lasers
are more precise where as the CO2 - lasers provides the nec-
essary thermal stimulation to the fibroblasts in deep skin
resurfacing. The clinical techniques and results are shown
on ablation of epidermal skin tumors, skin resurfacing pro-
cedures of the facial skin and the combination of a
transconjunctival approach in combination with resurfacing
in lower lid blepharoplasty. The CO2 - laser as an cutting
instrument has important advantages due to the excellent
degree of hemostasis obtained. Blood vessels 0.5mm or
smaller are scaled as the incision or dissection is made.
Lymphatic channels are closed, sensory nerves are sealed.
This results in less pain, less swelling and a shorter "down
time" for the patient. Benefits and techniqes of the CO2 -
lasers in Aesthetic Surgery are demonstrated on upper lid
blepharoplasty, face lift procedures and excision of dermal
and subdermal tumours.
NEW CONCEPTS IN LASER-ASSISTED
TREATMENT OF SCARS; A NEW APPROACH USING
DIFFERENT M E T H O D S AND LASER SYSTEMS
RELATED TO THE MORPHOLOGY OF THE SCARS
A.Osterhans~ U. Westermann, G. Lodde
Institut fiir Kosmetische Chirurgie und Lasermedizin
Osnabriick- Germany
Scars are a medical and occasionally also a great psychoso-
cial problem for patients. Their desire for complete restora-
tion is therefore quite understandable and has always been
the concern of those working in plastic surgery. The combi-
nation of traditional surgical and laser treatment is a new
approach to improve the appearance of superficial scars.
The principle of this concept is the reduction of scar ten-
sion, tissue volume, to minimize vascularisation and finally
the restoration of the natural pigmentation. Hypertrophic
scars need flattening, depressed scars need elevation.
Atrophic scars require improvement in tissue quality.
Therfore the diagnosis of all the different aspects of each
scar is the key for successful treatment. Besides surgery,
cryotherapy, injection of steroids, microdermabrasion and
filling procedures, the advanced laser systems are of great
importance for the pigmentation, vascularity and the sur-
face of scars.
Alexandrite-, VPW Nd/YAG- and Ultrapulse- laser sys-
tems were used in different types of scars or keloids.
Concepts of successful treatment in combination with tradi-
tional surgical procedures are presented.
THE COMPARISON BETWEEN ALLOPLASTIC
BONE CHIPS W I T H AND W I T H O U T FIBRIN GLUE
USED IN MAXILLARY SINUS LIFTING
OPERATIONS.
*Sener B.C., *Saysel M. E, *Ozgen, S., *Tasar F., *Basal N.
* Hacettepe University, Faculty of Dentistry, Department of
Oral Surgery,.
In this study our aim was to investigate the effects of fibrin
glue (Tissel(r), Immuno, Austria) in maxillary sinus lifting
operations combined with allogenic bone chips
(Tutoplast(r), Biodynamics, U.S.A.).
30 patients undergoing sinus lifting operations were
chosen for this study. The operations were performed under
general anesthesia. One of the sinus floor was lifted only
with alloplastic bone graft and the other one with alloplastic
bone graft combined with fibrin glue.
Postoperatively in the 30., 60. and 90. days the patients
were followed up clinically and radiologicaly.
(Orthopanthomagraph and Water's)
Regarding to out results we can conclude that the fibrin

glue could provide a decrease in rejection and further more
it has positive effects on bone healing.
A NEW APPROACH FOR LESIONS OF THE
CLIVUS AND PARAPHARYNGEAL SPACE : THE
P A R T I A L S E G M E N T E D LE F O R T I.
Padrdn, A., Diaz-Gonzalez, F.£, Rubio, P., Naval, L.,
Rodriguez, F.J., Sastre, J., Gil-Diez, J.L., Molina, A., Garcia
de Sola, R.
Department of OMFS, Autonomous University, Madrid,
SPAIN.
Aims: To describe our experience with a new approach to
expose a chordoma of the clivus and left para-pharingeal space.
Method: A 19 year-old woman was diagnosed of a chor-
doma centred in clivus and C1 and that extended to the
nasopharingx and pharingeal space. A partial segmented Le
Fort I osteotomy added to a trans-mandibular approach
were preformed to expose the lesion.
Results: The operative technique is described. Some impor-
tant technical details of the approach are pointed. Some of
the advantages compared to the segmented Le Fort I are
that we gained a better lateral exposure due to the fact that
the lateral-posterior segments were easy to movilize, the
approach was more conservative because the central area of
the maxilla was left in its place, the osteosintesis was easier
too because the anterior area of the maxilla was used as a
fixed reference, the risk of avascular necrosis of the maxilla
was decreased, the transmandibular approach that we
added permited a wider exposure to the superior area of the
clivus. The global outcome was favorable.
Conclusions: We consider that the partial segmented Le Fort
I osteotomy is an approach of choice for large tumors of the
Clivus with superior, inferior and posterior extensions.
CLINICAL AND M O R P H O L O G I C A L
CHARACTERISTIC OF CONGENITAL
DEFORMATIONS OF MAXILLA.
*Panin 3/1., Shipkova Z, Mikhailova V., Topolnitskij O.
Medical Stomatological Institute, Moskow, Russia.
Aims: The aim of the research was to investigate the mor-
phological picture of the bony-tissue of the maxilla with
congenital deformations and it¢ s connection with clinical
manifestations.
Methods : During scientific investigation x-ray examination,
light-microscopy et hystological preparations which were
received during reconstructive operations, were used.
Clinical and morphological picture were studied by us from
38 patients with congenital deformations of maxilla.
Including in that case 12 patients had Cleft Palate.
Results : As a result of investigation was exposed that with
congenital pathology considerable rebuilding of bone sub-
stance was noticed. This rebuilding includes formation of
parts of necrosis in the bone-substance and formation albu-
men masses in the marrow spaces with beginning of osteo-
genesis. Osteogenesis was not complete. The processes of
resorbtion and growing of the bone are going altogether
along the bone. Patients with strong clinical manifestation
of deformation have more marked process of the resorbtion
and growing of the bone.
EACMFS - Abstracts, Helsinki Congress 1998 139
Conclusion : For better bone consolidation it is important
not only to provide stronger compression and to increase
contacting surfaces of fragments, but to obtain theyr close
contact "end to end" with reliable fixation excluding the
fragments mobility and dislocation.
P A R O T I D E C T O M Y : O U R E X P E R I E N C E F R O M 42
C A S E S T U M O R S O F P A R O T I D IN 4 Y E A R S .
Pantelas, G. *, Kitros, G., Malas, S.
Department of OMFS, General Hospital of Nicosia,
Nicosia, Cyprus.
The tumors Of salivary gland concern the 3% of tumors of
head and neck. The tumors of the parotid are more often
than the tumors of the other salivary glands and the esti-
mated incidence ranging between 1 and 3 per 100000 per year.
In our clinic between 1994-97 we operated 42 cases of
parotid tumors, which is important percentage for the popu-
lation of the island. 7 cases were malignant tumors and 35
were benign. In 4 cases was performed total parotidectomy,
in 29 cases was performed superficial parotidectomy and in
9 cases local excision of the tumor. After operation, 11
patients had paresis - paralysis of the facial nerve. This was
temporary in 8 cases, and permanent in 3 cases of the total
parotidectomy in which the facial nerve was resected.
In this presentation we discuss the results in relation with
age, sex, size of mass, type of operation, histological result,
and complication after surgery.
EXPECTATIONS AND PERCEPTIONS
REGARDING T R E A T M E N T : A P R O S P E C T I V E
STUDY UNDERGOING ORTHOGNATHIC S U R G E R Y
Panula, K*, Forsseil,H., Forssell,K.,Blinnikka, L-M., Finne,K.
Department of Oral Diseases, Turku University Central
Hospital,Department of Psychology, University of
Turku,Department of OMFS, Vaasa Central Hospital, Finland
ALMS: To determine patients" motives in seeking surgery, to
identify presurgical symptoms and problems, and to ascer-
tain patients" reaction to surgery, and their satisfaction with
life before and after surgery.
METHOD: 100 consecutive patients, who underwent
orthognathic surgery in two OMF hospital clinics in
Finland between May 1994 and May 1995 were given ques-
tionnaires to answer in privacy, about one month before
surgery and one year after surgery. Questions concerned
expectations and perceptions regarding treatment.Post-sur-
gically Visual Analogue Scales were used, as well,to measure
satisfaction with the results.
RESULTS: Problems relating to occlusion or bite were
rated most significant before surgery, next highest scores
were allotted to TMJ problems and headache.General
appearance, speech and general health; self-esteem and
social interactions were not considered particularly prob-
lematic.Significant improvements were noted after surgery
in relation to all aspects except work performance and
general health. Satisfaction scores were higher after opera-
tion and were related to low numbers of postoperative prob-
lems.31% reported numbness after operation, and these
patients were found to be less satisfied than those not
reporting numbness.
140 Journal of Cranio-Maxillofacial Surgery
CONCLUSIONS: Before surgery,problems relating to func-
tion were most significant, followed by aesthetic concerns
and, to a far lesser extent, social-interaction-type prob-
lems.Functional issues were also considered to be those best
resolved by treatment. The finding that such issues were of
greater significance to patients than aesthetic concerns dif-
fers from findings in most previous studies.
LONG TERM EFFECTS OF ORTHOGNATHIC
TREATMENT ON CRANIO-MANDIBULAR
DYSFUNCTION
Panula, K.*, Finne, If., Somppi, M.
Department of OMFS, Central Hospital, Vaasa;
Finland, OMF Department, Oulu University Hospital, Finland
AIM: To examine prospectively the influence of orthog-
nathic treatment on craniomandibular dysfunctions and
headache.
METHOD: Fifty eight consecutively treated patients (48
women,10 men,mean 33.4 years,range 16-57years) operated
upon between 1993 and 1995 were examined three times:
prior to any orthodontic treatment, 12 months (mean) and
29 months (mean) post-operatively.At every visit a question-
naire was given and a clinical examination performed and
on the basis of this data Helkimo's Anamnestic (Ai) and
Dysfunction (Di) indexes were calculated.
RESULTS: At the first examination Ai showed positive cor-
relation to the age of the patient.A statistically significant
reduction in the Ai from the first examination to the second
was found and this positive change remained stable to the
latest visit.This change mainly came from the older group of
patients (age 30-57 years). Also Di improved statistically sig-
nificantly.The improvement was greater for women,but the
difference might also be due to the small number of men.
Before surgery, altogether 36 patients reported suffering
from headache but at the final examination only 11 had
headache and the frequency of the headache attacks was
reduced markedly, as well.
CONCLUSIONS: It is possible to achieve long- standing
improvement in craniomandibular dysfunctional symp-
toms including headache in a considerable number of
patients by means of orthognathic treatment.Which
patients benefit most remains to be analyzed further in the
future.
THE USE OF THE STERNOCLEIDOMASTOID
MUSCLE FLAP FOR THE RECONSTRUCTION OF
OROFACIAL DEFECTS AFTER CANCER SURGERY
N. Papadogeorgakis % (2. Alexandridis, C. Skouteris, A.P.
Angelopoulos
School of Dentistry, Department of Oral and Maxillofacial
Surgery, University of Athens, Greece.
AIM: To present our experience in the use of the sternoclei-
domastoid muscle as a muscle flap for the reconstruction of
oral defects.
METHOD: This flap was used in seven patients with oral
cancer who underwent intraoral resection and a modified
radical neck dissection. In three cases it was used to recon-
struct the floor of the mouth and in four cases to cover
reconstruction plates.
RESULTS: There was only one case of necrosis of the mus-
cle flap when it was used to cover a reconstruction plate.
CONCLUSION: The use of a sternocleidomastoid muscle
flap produced good results in the reconstruction of oral
defects after cancer surgery.
[~ FIRST EXPERIENCES USING A NEW
DISTRACTION IMPLANT SYSTEM FOR ALVEOLAR
RIDGE AUGMENTATION
*Papageorge, M., D.M.D., M.S. 1, Klein, C., M.D., D.M.D2.;
Kowics, A., M.D., D.M.D. ~, Carchidi, J.E., D.M.D. 1
1Department of Oral and Maxillofacial Surgery, Tufts
University, Dental School, Boston, One Kneeland Street,
Boston, Massachusetts 02111
2Department of Maxillofacial Plastic Surgery, University of
Frankfurt, Medical School, Theodor-Stern-Kai 7, D-60590
Frankfurt am Main
The masticatory rehabilitation of patients is dependent
on the quality and volume of residual jaw bone. Lost of
volume caused by mandibular ridge resection during
ablative tumour surgery or age related atrophies can
cause problems just as isolated alveolar atrophies or sin-
gle tooth losses. Reconstructive plastics with free iliac
bone, extern tabula or sandwich plasties are only a few
examples for the usual surgical treatment modalities.
Doing without bone grafts the alveolar ridge augmenta-
tion by means of distraction osteogenesis could give a
valuate contribution to improve the denture bearing area.
Together with the Department of Oral and Maxillofacial
Surgery, Tufts University, Boston, a new distraction
implant system was developed and was tested in animal
models. The experimental results are explained and first
clinical results using this system are shown. In a first sur-
gical step a segmental osteotomy is performed and one or
two distraction implants are inserted. After gaining the
required height of the mandibular ridge and a sufficient
ossification phase of the new callus the distraction
implants are replaced by the endosseous implants.
Interforaminal areas as well as single tooth segments
could be augmented successfully. Shortcomings of the
system have been mended continuously during this pre-
liminary clinical study. The implant system and the surgi-
cal technique are shown and the results are discussed. We
believe that the implant distraction procedure will be an
useful contribution in the management of masticatory
rehabilitation of patients.
EVALUATION OF THE SOFT TISSUE CHANGE
AFTER SEGMENTAL OSTEOTOMY IN KOREANS
Je-Uk Park.
Dept. of OMFS, Kangnam Medical Centre, Seoul, Korea
AIMS:
To define the soft tissue change after surgery
METHOD:
Using cephalometric and photo(en face/profile) analysis
before and after surgery, the intended and unintended
change of the face is evaluated.

RESULTS:
The thicker the lips, the thinner the results. Nasolabial angle
is much obtused, depending on the degree of the posterior
movement of the upper segment. Philtrum is looking much
lengthened, but it results from the change of the angle of the
philtrum. The labiomental fold is also improved with accen-
tuating labiomental angle. The nose is little widened, but it
is acceptable. And compared to the classical method, nasal
change is negligible.
CONCLUSIONS:
Based on this study, modified segmental osteotomy can be
applied to many Koreans with satisfying results.
Fh THE RESULTS O F HEAD AND NECK
M E L A N O M A TREATMENT
Parsegyan E, Badalian Kh. *, Wagner R., Badalian G.,
Mississyan H.,
Department of Oncology and OCMFS of State Medical
University, Yerevan, Armenia," Research Center of Oncology,
St.Petersburg, Russia
Aims: To define the 5 years survival rate of skin melanoma
of the head and neck region according to Clark's level inva-
sion.
Methods: 614 patients of primary skin melanoma had been
studied, 81(13,2%) localized in the head and neck region.
Aged between 3 and 78 years with peak incidence between
30-59 years. They were completely treated, where the most
majority underwent an operation.
Results: 5 year survival rates according to Clark's level of
vertical invasion were as follows: 16 patients presented
stages I and II and 12 (75%) survived 5 years or more, 21
patients presented stage III of whom 65% - survived 5 years
or more. 16 patients presented stage IV of whom 25% sur-
vived 5 years and 28 patients stage V of whom only 10,7%
survived 5 years or more.
Conclusion: The prognosis of head and neck region is
strictly dependent on tumor vertical invasion.
EARLY G O L D W E I G H T I M P L A N T S F O R
SURGICAL MANAGEMENT O F THE PARALYZED
EYELID.
Pechacek T*., lizuka T.
Cranio-Maxillofacial Surgery Facial Plastic and
Reconstructive Surgery (Head Prof J Raveh ) University
Hospital Bern / Switzerland
Aims: To evaluate the clinical results of the reanimation of
the upper eyelid closure using gold weight implants for
treatment of lagophthalmus following facial nerve damage.
Method: A total of 21 patients, in which commercially pol-
ished gold weights ranging in weight from 1.0g to 1.6g have
been implanted, were clinically examined in an averge fol-
low-up of 4 months (range 2 to 6 month).The operation was
performed under local anaesthesia, and all patients were
dismissed on the same day following implantation.
Results: Postoperative infection leading to early removal of
the implant occurred in 2 cases. On follow-up, a sufficient
eyelid closure and corneal protection were achieved in 19
EACMFS-Abstracts, Helsinki Congress 1998 141
patients (91%). Neither foreign body reaction no extrusion
nor displacement of implants were observed.There was no
corneal damage nor vision reduction.
Conclusion: As the risk of complications directly related to
surgery was extremely low, this simple method is to be recom-
mended for both temporary and persistent facial nerve paralysis.
S T E R E O S C O P I C LITHOGRAPHY: CUSTOMISED
TITANIUM I M P L A N T S IN OROFACIAL
RECONSTRUCTION: A NEW SURGICAL
TECHNIQUE W I T H O U T F L A P COVER
Peckitt N.S.,
Department of OMFS, Doneaster Royal Infirmary,
Doncaster, England
Aims: Tumour ablation surgery involves complex composite
flap techniques, which do not replicate the volume and con-
tour of normal anatomy. "Functional reconstruction"
implies replication of normal volume and contour of both
hard and soft tissues, to produce normal form and function
of the mouth and the jaws.
Method: Stereoscopic lithography and C A D - C A M / C N C
engineering techniques have been utilised to manufacture
giant titanium implants of the maxilla/mandible without
flap cover. Pre-operative overdenture manufacture permits a
single-stage reconstruction.
Results: Excellent aesthetics are possible. Implants are stable
and functioning 19 months post-operation.
Conclusions: Multiple surgical teams are not required.
Reductions in surgery time/trauma/ITU dependency, and
enhanced rehabilitation, have been observed. Cost savings
are circa £17,000-£19,000 per case,
1. Royal Bank of Scotland figures.
RECONSTRUCTION O F THE CONDYLAR
PROCESS W I T H A C O S T O - C H O N D R A L GRAFT IN
M A R M O S E T MONKEYS, CALLITHRIX JACCHUS
Peltomiiki, T.*, Viihiitaio, If., R6nning, O.
Institute of Dentistry, University of Turku, Finland
Aims: To examine growth and adaptation of costochondral
grafts (CCG) in the TMJ, and particularly to determine
whether the amount of cartilage in the graft affects the
growth of the constructed condyle-ramus unit.
Study design: The material consisted of three growing and
three adult marmoset monkeys, Callithrix jacchus. A rib sec-
tion with either a short (1 ram) or long (4 ram) cartilaginous
end and a variable bony part to a total length of 6-7 mm was
grafted to replace the removed left mandibular condyle. The
young animals were operated on at the age of four months and
the adults at the age of 24 months. The anaesthetized animals
were examined by visual observation, recording the weight and
taking antero-posterior radiographs preoperatively, one month
after the operation and bimonthly thereafter.
Results: The animals tolerated the operation well and were
allowed to have a normal diet one week postoperatively.
They gained weight in accordance with available growth
curves. None of the animals showed dental or facial aberra-
tions during the first three postoperative months. Growing
animals with a long cartilaginous portion in the graft gradu-
142 Journal of Cranio-Maxillofacial Surgery
ally developed a dental asymmetry, indicative of overgrowth
of the side of the mandible operated on. Facial and dental
symmetry remained in the growing monkey with a short car-
tilage portion. This was also the case in the adult animals,
irrespective of the amount of cartilage in the graft.
Conclusions: The findings of the present intermediate evalu-
ation can be interpreted as revealing that TMJ function does
not have a major role in the regulation growth of CCGs.
Rather, the growth of C C G seems to be affected by humoral
factors as evidenced by overgrowth occuring concomitant
with the pubertal growth spurt of the marmosets. In addi-
tion, the findings confirm our earlier conclusion that the
amount of cartilage in the rib graft is of importance with
respect to growth of the constructed condyle-ramus unit in
growing animals, whereas this is not the case in non-growing
animals.
BIODEGRADABLE SEMI-RIGID PLATE AND
M I N I S C R E W FIXATION IN EXPERIMENTAL
CRANIOTOMIES: A COMPARATIVE STUDY W I T H
RIGID TITANIUM FIXATION
PeltoniemL H.*, Waris, Z, Tulamo, R-M., Toivonen, T.,
HaUikainen, D., Pohjonen, T., T6rmiilii, P.
Helsinki University, Dpts. of Surgery, Radiology and Clinical
Veterinary Sciences, Helsink# Oulu University Central
Hospital, Dpt. of Plastic Surgery, Oulu; Tampere University
of Technology, Institute of Biomaterials; Tampere, Finland
Aims: To compare a 0.4 mm thick, flexible P L D L A plate
with slowly (SR-PLLA) or rapidly (SR-PGA) degrading
miniscrew fixation with titanium miniplating in the fixation
of frontal bone osteotomies in lambs.
Method: In 20 lambs, 15x18 mm pieces of frontal bone were
removed with a paediatric craniotome and refixed on one
side with a P L D L A plate and 4 SR-PLLA miniscrews
(n=10) or 4 SR-PGA miniscrews (n=10), and on the other
side, with a 4-hole titanium miniplate. After 4,6,12,26,52
andl04 week follow-up periods, X-ray, MRI, histology and
histomorphometry were performed.
Results: Loss of fixation, dislocation, instability, clinical for-
eign body reaction or infection were not observed. Bony
consolidation of the 2.35 mm wide craniotomy lines was
slow and incomplete on both sides, as connective tissue-
filled defects through the bone were observed inl3 of 28
lines at 26-52 weeks. Plate fixation with SR-PLLA minis-
crews and contralateral titanium fixation did not show any
difference in consolidation. The rapidly degrading SR-PGA
miniscrew fixation resulted in slightly less effective consoli-
dation than the contralateral titanium side (p<0.05), but the
bone segment was significantly thicker (p<0.005). In the
fixed bone segments, osteoid formation was more active on
the dural than periosteal side (p<0.05). The SR-PGA minis-
crews had hydrolyzed at 4 weeks and disappeared com-
pletely by 12 weeks, whereas the SR-PLLA screws retained
their holding power for at least 26 weeks and were mostly
degraded at 104 weeks. The P L D L A plate degraded by 52
and disappeared by 104 weeks. Passive translocation of the
titanium plates into the bone tissue and frontal sinus was
seen at 52 andl04 weeks.
Conclusion: Rigid metallic fixation could not secure com-
plete osseous consolidation of a small craniotomy in a
rapidly growing lamb frontal bone, and comparable results
in consolidation could be obtained with semirigid
resorbable fixation with slowly degrading miniscrews, with-
out complications.
ORBITAL FLOOR R E C O N S T R U C T I O N WITH
RESORBABLE L-POLYLACTIDE ACID S H E E T S
Pdrez MC*, Sdnchez-Guti~rrez J, Gdmez F, de Pedro M,
Sdnchez-Cudllar A, Martin-Granizo R, Berguer A.
Department of Oral & Maxillofacial Surgery. University
"'Hospital Cllnico San Carlos", Madrid, Spain.
Aims: To evaluate postraumatic orbital reconstructions with
98% polylactide acid (L-PA) sheets, performed during a 6
year period.
Methods: Forty-five consecutive cases from 1991-1997 (44
patients, 45 reconstructions), were analyzed retrospectively.
There comprised 7 1 % males and 69% females, ranging in
age from 16 to 35 years-old. Defects reconstructed varied
from 1/3 to 2/3 of the orbital floor. 46.7% were blow-out
fractures, and 53.3% orbito-zygomatic ones. Data included
ocular function, material-related complications (infection,
haematoma, extrusion), hospitalization time, diplopia or
enophthalmos recurrence, as well as patient satisfaction.
Surgical technique included a subciliary approach, warm
modelling and floor adaptation, and fixation with tissue
apposition or resorbable suture to a titanium screw. Periodic
reviews at 1, 2 and 6 months were undertaken.
Results: No material-related complications were observed,
with a medium hospitalization time of 2 days. No material
needed to be removed. One case had persistent diplopia due
to a deficient fracture reduction, that required reoperation.
Conclusions: In the present study no morbidity was
observed, with good aesthetic and functional results. L-PA
sheet for medium size orbital floor defects seems to be a
good option with only a simple surgical technique, high bio-
compatibility and slow resorption.
[~ THE LATERAL T R A P E Z I U S FLAP:INDICATIONS
IN RECONSTRUCTIVE SURGERY AFTER ORAL
AND OROPHARYNX O N C O L O G I C A L RESECTIONS
Pericot,£ * Escudel; 0., Monner,A., Garcia-Rozado,A.,
Vert,E., Gimeno,X., Juarez,E., Biosca, M"£
Department OMFS, Bellvitge University
Hospital, Barcelona, Spain
Aims: To evaluate the profit of this myocutaneous and
osteomycutaneous flap,in oncological reconstructions.
Methods: A series of 34 patients treated in our Department
in the last ten years has been revised.All patients had malig-
nant tumours of the oral and oropharynx region (28 epider-
mold carcinoma,2 adenoid cystic c.,and 4 intraosseous
c.).Sex distribution was 27 males and 7 females.The surgical
technique was done according to the Demergasso descrip-
tion,and most flaps were elevated in continuity with the
neck dissection.In 15 cases, different parts of the mandibu-
lar body or the hemimandible, were reconstructed with an
osteomyocutaneous lateral trapezius flap.
Results: As major complications we have observed: 4 cases
of total necrosis.Other minor complications were: 2 oro-cer-
vical fistulas and 3 wound dehiscences.We attained a good
quality reconstruction in all patients,except in the flap
necrosis cases.
Conclusions: The lateral trapezius flap provides a thin and large
skin paddle for the oral and oropharynx resected tissues,and
good bone tissue for jaw substitution,that enables the use of
dental implants.The vicinity of the donnor site is another

advantatge of the flap.The main disadvantatges are: shoulder
dysfunction when the spinal nerve is not preserved,and the dif-
ficulty in fixing the spine of the scapula to the mandibular arch
form,together with the settlement of the skin paddle.
@=~ REAPPRAISAL OF THE PARAMEDIAN
F O R E H E A D FLAP A N D ITS MODIFICATIONS FOR
CLOSING NASAL DEFECTS.
Pfeifer G.,
Hamburg, Deutschland
Introduction: The paramedian forehead flap offers different
designs for closure of nasal defects. Depending on the local-
isation, extension and depth of the defects, following alter-
native flap designs can be selected: the complete forehead
flap including the cutaneous layer, the subcutaneous flap
without skin paddle, and the forehead island flap. If nasal
osseous or cartilaginous structures are failing at the site of
the defect, the forehead flap can be supported by angulated
palacos struts or cartilaginous transplants. This paper dis-
cusses some fundamental principles of this technique, the
limits of its application and suggests some alternatives.
Method: The results obtained in a clinical series of 115 con-
secutive cases in which the forehead flap was used for clos-
ing nasal soft tissue defects are presented. Following data
were analysed: ethiology of the defects, their dimensions,
new developments in the application of the flap, problems
related to the simultaneous insertion of palacos struts and
surgical technical aspects of the pedicled flap.
Results: All 115 forehead flaps pedicled to the supra-
trochlear vessels healed uneventfully. Four out of 43 flaps
showed minor marginal healing problems. The complication
rate in case of simultaneous insertion of supporting palacos
struts when closing nasal defects with paramedian forehead
flaps (34 cases) was 15%.
Conclusions: The paramedian forehead flap can be used for
closure of all types of nasal defects. In our hands it has
proved its versatility for over twenty years. The concept is
based on sound anatomical data, is secure and does not fail.
Late aesthetic and functional results are excellent.
RADIAL F O R E A R M FREE FLAP: ADAPTABILITY
AND FLEXIBILITY IN FACIAL AND ORAL CAVITY
RECONSTRUCTION.
Pic6n M.*, Marcos O. , Moreno M. ,Cebrecos A.L , Nu~ez J.
Dept. of Maxillofacial Surgery (Head." Dr R. Marzdn).
Hospital Ram6n y Cajal. Madrid. Spain.
Aims : To determine the reconstruction technique for facial
cutaneous and oral/oropharyngeal cavity defects that pro-
vides the higher grade of adaptability and flexibility.
Method:We have selected a group of 20 patients recon-
structed using the fasciocutaneous radial forearm flap
whose defects presented irregular designs or different levels
of angulation on the surface, and we have compared them
with a similar group, reconstructed with regional musculo-
cutaneous flaps or subscapular system free flaps.
Results: Only the radial forearm flap is able to adapt to all
superficial angulations of the defect, as well as to orofacial
of total thickness defects where, in spite of a 180 ° folding,
it still conserves its flexibility and elasticity. The superior
EACMFS-Abstracts, Helsinki Congress 1998 143
adaptability of this type of flap is also related to the multi-
ple possibilities in the cutaneous paddle design and the
posibility of sequentialy linked free flaps. Nevertheless in
middle facial third or big craniofacial defects, we have
observed that the volume is of first priority over
adaptability.
Conclusions: The best aesthetic and functional results
achieved in this type of defects by the radial forearm flap
are determined by their higher grade of adaptation and
mobility, being considered therefore of first choice except
in those cases that the volume takes priority.
L O N G - T E R M EVALUATION AFTER T M J
ARTHROSCOPY
Piecuch, J..*, Sorel, B.,
Department of OMFS, School of Dental Medicine,
University of Connecticut, Farmington, Connecticut, U.S.A.
AIMS:
Although Temporomandibular Joint arthroscopic surgery
has been utilized for two decades, papers presenting post-
operative results are very short-term - less than two years.
The aim of this paper was to determine the longer-term
success rates of TMJ arthroscopy.
METHOD:
Twenty patients who underwent TMJ arthroscopy for
chronic painful clicking or for a closed lock were examined
a mean of 5 years later (range 2-9 years). Indications for
surgery were failure to respond to non-surgical therapies,
which included occlusal splints, anti-inflamatory medica-
tion, and (in closed lock cases), attempts to reduce the artic-
ular disc manually. Surgical procedures consisted of joint
lavage, lysis of adhesions when present, and manipulation
of the joint under direct arthroscopic observation, under
general anaesthesia. Postoperatively, occlusal splints and
anti-inflammatory medication were used for a variable
period of time.
RESULTS:
By subjective (patient history) and objective (clinical exami-
nation) criteria, procedures were successful in all patients. All
patients reported postoperative pain to be absent or signifi-
cantly decreased. Range of motion significantly increased
postoperatively, in vertical, protrusive, and lateral excursions.
Interincisal opening was measured at a mean of 39 mm. pre-
operatively and 47 mm. at the long-term observation.
CONCLUSIONS:
This study supports the long-term efficacy of TMJ arthro-
scopic surgery.
THE USE O F CARBON DIOXIDE SURGICAL
LASERS IN THE TREATMENT O F ORAL CAVITY
TUMOURS
Piekarcyk J., Kalina M., Bednarcyk A.
Medical University of Warsaw, H Clinic of Oral and
Maxillo-Facial Surgery, PSK nr 1, Lindley'a St. 4, 02-005
Warsaw, Poland
tel~fax +48 (22) 621-2402 e-maik chirszcz@wawl.comnet.pl.
144 Journal of Cranio-MaxillofacialSurgery
Aims: To study the usability of a surgical laser in the treat-
ment for oral cavity tumours.
Method: Carbon dioxide surgical lasers with a voltage from
4 to 75 Watts were used to operate on benign and malignant
tumours. The choice of treatment and power rate depended
on the range of tumours, their morphology and anatomical
position.
Results: Carbon dioxide surgical laser treatment appeared par-
ticularly helpful in the surgery of smallish tumours situated
superficially in the mucous membrane and its immediate
vinicity. Surgery was easy to accomplish, bloodless and well
tolerated by patients. In those cases a 25 Watt laser has been
used. In other cases when tumours were widespread, well vas-
cularised and lay deeply in the tissues, over 25 Watt lasers were
used. Haemorrhages appearing during the procedure required
the use of electrocoagulation or ligation of blood vessels.
Conclusions: Carbon dioxide surgical lasers can be used in
the treatment of oral cavity tumours, it is necessary to
select the requisite laser power and use other methods if
necessary.
[~ K A P O S I ' S SARCOMA AND OTHER UNUSUAL
ORAL MANIFESTATIONS AFTER B O N E MARROW
TRANSPLANTATION.
Pineda A..*, Mareos 0., Moreno M. ,Pic6n M., Nu~ez J.
Dept. of Maxillofacial Surgery (Head." Dr. R. Marzdn).
Hospital Ramdn y Cajal. Madrid Spain.
Aims : To state the appearance of unusual oral manifesta-
tions due to inmunodeficiency after bone marow transplan-
tation.
Method : 9 year old girl with diagnosis of sickle cell disease
and severe haemolytic crisis which underwent bone marrow
transplantation. The patient presented the following com-
plication, two of them required surgery. A partial glossec-
tomy had to be performed because of tongue necrosis due to
atrophy and ulceration of the oral mucosa and oral thrush,
as well as a tracheostomy secondary to obstructive respira-
tory complications. She also presented a Kaposi Sarcoma
of the oral mucosa and skin, related to the immunosuppres-
sive treatment given, and a host-graft reaction.
Conclusions: The unusual manifestations found in this
patient show the main complications which can be encoun-
tered in the oral cavity in patient with this kind of immun-
odeficiency.
A C O N C E P T OF RESORBABLE
O S T E O S Y N T H E S I S : BASIC R E S E A R C H A N D
D E V E L O P M E N T U P TO THE CLINICAL
APPLICATION OF A RESORBABLE SCREW.
H.Pistner*, B6hm, H., Bill, J., Reuthel; J.
Department for Oral and Maxillofacial Surgery, University
of Wiirzburg, Germany
Aims: Development of resorbable devices for osteosynthesis
in cranio-maxillofacial surgery. The first element should be
an optimized resorbable screw.
Methods: In vitro and in vivo studies were carried out into
resorbability and endurance of mechanical stability of three
generations of polylactides including chemical and physical
behaviour of implants and biological behaviour of adjacent
tissue. An FEM-optimized design was developed for the
thread, the drive and the positioning of a resorbable screw.
Achievable stability in the biomechanical model was com-
pared with other methods and materials. Chewing forces in
orthodontically pretreated and surgically treated patients
were determined. A prospective randomized controlled clin-
ical study was performed in sagittal split osteotomy patients.
Results: Amorphous polylactide-copolymer-blends do
resorb in vivo over a time interval of 2-3 years, whereas
some other polylactides do not. The strength of materials
can be improved by blending and copolymerization.
Torque-control of a resorbable screw can be achieved by
having an inner canal for the blade of the screw-driver run-
ning through the whole screw. Optimized thread and posi-
tioning of the screw improves stability of the osteosynthesis,
which is equivalent to osteosynthesis with Titanium-minis-
crews. Chewing forces in orthodonticall-treated and
osteotomized patients are rather low. Optimized resorbable
screws can be used in sagittal split osteotomy with same suc-
cess as Titanium screws.
Conclusions: Resorbable materials can show their actual
resorbability. Mechanical stability lasts long enough (e.g.20
weeks) for the healing of bone. Geometry of resorbable
implants can be optimized. Biomechanical studies can com-
pare achievable stability of resorbable osteosynthesis with
real acting forces. Clinical trials using resorbables including
standard procedures of osteosynthesis can compare the
final results and rate of complications as well as the eco-
nomic implications.
PREFABRICATED VASCULARIZED CALVARIUM
FLAP B O N E R E C O N S T R U C T I O N IN THE MID-FACE
B. Pittet , D. Montandon,
HUG - University Hospital, Department of Plastic and
Reconstructive Surgery, 1211 Geneva 14, Switzerland
Aims : Maxillary defect following cancer excision or noma
usually involves bone as well as mucosa defect. The objec-
tive of the presently described surgical procedure is to
provide a vascularized bony frame work covered with a thin,
pliable cutaneous tissue.
Methods : Prefabricated vascularized calvarium flap is a
two step procedure. During the first operation the galea is
exposed and a skin graft is applied on top of it. The pedi-
cle containing the superficial temporal artery and a branch
of the deep temporal artery included in a portion of tem-
poral muscle is dissected and wrapped with a sheet of sili-
cone. The skin is closed on top of the skin graft and
silicone sheet. Two weeks later the flap is harvested includ-
ing graft, galea, periosteum and calvarium in bloc. The
bony fragment is reshaped to fit the defect and wrapped
with the grafted galea and periostal. It is then brought to
the face through a sub-peri0steum or sub-cutaneous
tunnel.
Results : We used this surgical approach in 29 patients to
reconstruct the palate, maxillary and alveolar bone, zygoma
and orbital floor, mainly in noma sequellae. Complications
included infections of the donor site (n=2), partial (n=2) or
complete (n=2) loss of the bone graft at the recipient site.
Bone consolidation was obtained in 27/29 patients with a
satisfactory aesthetical outcome.
Conclusion : The advantages of the described flap are :
1 / A simple and reliable procedure without micro-anas-
tomosis.
2/The use of a well vascularized membraneous bone flap

wrapped with periosteum insuring a high percentage of
bone consolidation.
3/It can be performed at any age, even in small children.
4/The skin cover can be tailored to any size or to replace
the skin or mucosal defect.
MANDIBULAR LENGTHENING WITH AN
IMPLANTED AUTOMATIC DEVICE - AN
EXPERIMENTAL STUDY ON SHEEP
Ploder 0 " , Mayr W, Schnetz G, Unger E, Pienk H jr,
Ewers R
Clinic of Oral and Maxillofacial Surgery, AKH Vienna
Waehringerguerte118-20, A- 1090 Vienna, Austria
Tel.: 01-40400/4259; oliver.ploder@univie,ae. at
Aim: Distraction osteogenesis is an important clinical tool with
several applications for the entire human skeleton. The tech-
nique of mandibular lengthening has been adapted to the
human mandible in 1991 by McCarthy et al. The main criti-
cism of an external apparatus has been the scars resulting from
the transcutaneous pins. With the development of an intraoral
device this disadvantage was avoidable but transmucosal access
was still necessary for length adjustment. The aim of this
experimental study was to design a completely implanted
device for continuous and automatic mandibular lengthening.
Study Design: The driving module of the internal device,
where motor and gearing are built-in, is connected to the
battery and control unit by a flexible coiled silicone lead. In
an experimental study on sheep (n=7) the device was fixed
to the mandible after an osteotomy in the anterior region
had been performed. The control unit was implanted in the
neck region. Five days after implantation, the device was
activated and it allowed calibrated distraction steps of
0.08mm every second hour, achieving 1.0mm distraction per
day. After 14 days of lengthening, the apparatus was turned
off and the bone ends maintained in their final expanded
position for an additional 6 weeks.
Results: The electromechanical implant was tolerated with-
out any complications and the animals had no difficulties in
receiving adequate oral nutrition during the study.
Clinically, the distracted gap showed mature bone forma-
tion. Measurements between the screws demonstrated a
lengthening of 13.4 mm (10.8-17.8mm) in the distracted
gap. Histologically, this area was filled with new bone and
the thin-section radiograph showed it to be slightly less
radiodense than the normal bone.
Discussion: With the development of intraoral devices, the dis-
advantages of external application could be avoided but still
transmucosal activation with a screwdriver was necessary to
gain distraction. In our experimental study, an internal device
was successfully used for callus distraction and almost continu-
ous mandibular lengthening of max. 17.8ram was achieved. The
mechanical system allows smaller devices with a distraction
range to 30mm without changing the principle construction.
Therefore a first clinical application in the near future seems
realistic. Furthermore, the system of this prototyp is open for a
variety of applications for lengthening different bones.
O=~ CLINICAL EXPERIENCE W I T H 176
AUTOTRANSPLANTED CANINES
Dr. C Politis (*), Dr. L. Vrielinck, Dr. S. Schepers, Prof. L
Lambrichts
EACMFS Abstracts, HelsinkiCongress 1998 145
Department of Oral and Maxillofacial Surgery
St. John's Hospital Genk
Schiepse Bos 2
3600 GENK
Tel. +32.89.325821
Fax. +32.89.325688
AIMS:
to evaluate the technique of autotransplantation of canines.
METHOD:
retrospective analysis, using Kaplan- Meier survival analy-
sis.
RESULTS:
Between1989-1996 640 patients were treated for impacted
canines. Out of this group 120 patients (18,75%) were
treated with a transplantation of their canine instead of a
surgical- orthodontic guided eruption of the canine. The
indications were: very deep impactions, refusal of orthodon-
tic therapy and unsuccessful previous attempts of combined
surgical-orthodontic guided eruptionof the impacted
canine. The total number of autotransplanted canines
followed, amounts to 176. Out of these, 12 transplanted
canines were lost.
Factors contributing to failure of canine-transplantation
inlcude: (1) unsuccessfull previous attempts of surgical
guidance of an impacted canine, subsequently followed by
transplantation (2) absence of orthodontic receptor site
preparation (3) delay of endodontic treatment in case of
necrotic pulp tissue (4) severing the impacted canine with
the surgical drill (5) severing the periodontal tissues of the
transplanted canine during surgery (6) traumatic occlusion
of the transplanted canine.
Kaplan-Meier analysis of the data indicates that root-
resorption is a major prognostic factor to the survival of the
canine: once root-resorption is progressing, the survival rate
declines to 50% after 3000 days of follow-up. Ankylosis does
not seem to influence canine survival in absence of root-
resorption. Endodontic treatment does not influence sur-
vival if root resorption had visibly affected the root of the
canine on radiography. Endodontic treatment is able to pre-
vent root resorption.
CONCLUSIONS:
Tranplantation of canines is a reliable method provided that
the receptor site is prepared orthodontically without previ-
ous surgical attempts to guide the eruption of the canine
and provided that the endodontic treatment is done shortly
after diagnosis of necrosis of the pulp.
Orthodontic site preparation allows for sufficient recipi-
ent space, allowing a gentle surgical technique, a simple and
effective fixation and an excellent follow-up.
RIGID EXTERNAL DISTRACTION (RED) FOR
MAXILLARY H Y P O P L A S I A
John W. Polley, MD, Alvaro A. Figueroa, DDS, MS-
The University of Illinois at Chicago, The Craniofacial
Center
Patients with severe maxillary hypoplasia present challeng-
ing problems for the reconstructive team. Traditional surgi-
cal/orthodontic approaches for these patients often fall
146 Journal of Cranio-Maxillofacial Surgery
short of expectations, especially for achieving normal facial
aesthetics and proportions. This presentation reviews our
long term clinical and cephalometric results with the use of
maxillary distraction osteogenesis for the treatment of
patients with severe maxillary deficiency.
Fifteen consecutive oro-facial cleft patients with severe
maxillary hypoplasia were treated by maxillary distraction
osteogenesis with rigid external distraction (RED). A maxil-
lary splint was prepared for each patient and all patients
underwent a high LeFort I maxillary osteotomy. All surgery
was performed as either an outpatient or as a 23 hour
admission. No patient required blood transfusions or inter-
maxillary fixation. There was no surgical morbidity in any
of the patients. For the patients in this group the mean
effective horizontal advancement of the maxilla was over 10
mm. All patients in this group were closely followed for a
period greater than 1 year after completion of their initial
distraction. The skeletal and dental relationships for all
patients were found to be stable at one year after the distrac-
tion. The long term cephalometric data as well as clinical
examples will be presented.
Maxillary distraction osteogenesis with rigid external
distraction (RED) permits full correction of the midfacial
deficiency including both the skeletal and soft tissue defi-
ciencies. Rigid external distraction (RED) in patients with
severe maxillary hypoplasia allows full correction of the
deformity through treatment of the affected region only. It
offers the distinct advantage of correcting these severe
deformities through a "minimal" procedure. Rigid external
distraction (RED) has dramatically improved our long term
treatment results for patients with severe cleft maxillary
hypoplasia.
CEPHALOMETRIC PAS STUDY IN PATIENTS
AFFECTED BY CLASS II AND TREATED WITH
O R T H O D O N T I C SURGERY
De Ponte F.S., Brunelli A., Bottini D.J., Marchetti E.
Maxillo-facial Unit- "La Sapienza" University of Rome, Italy
To define the PAS variation with a cephalometric study in
patients affected by class II and treated with orthodontic surgery.
The posterior airway space (PAS) is delimited by bone
structures and soft tissues, whose anomalies may produce
alterations in volume of PAS.
In patients with severe hypoplasia of middle and lower
facial third, a decrease in volume of PAS is present and can
result in a polisyndromic condition, OSAS (Obstructive
Sleep Apnea Syndrome).
This study considers 18 patients affected by class II who
underwent surgery to correct the maxillo-mandibular mal-
formation. This sample was selected on the basis of the
type of surgery performed (either Le Fort I osteotomy with
or without Sagittal Split Osteotomy (SSO) or only SSO).
To evaluate PAS variation, cephalometric analyses were
performed by pre and post-operative teleradiography in lat-
eral projection according to Tangugsorn et la (1995) (1-2)
and Hierl et al (1997) (3).
This study showed an increase in volume of PAS when
the maxilla is anterior and/or superior moved as that Sso is
performed. A decrease of PAS can be seen in downward
and/or backward maxillary movements.
In conclusion, cephalometric studies of the bone struc-
tures associated with exams of the soft tissues (such as
tongue, pharynx, soft palate etc,) should be performed in all
patients affected by maxillo-mandibular malformation.
Such as approach may provide basic data for the diagnosis
of respiratory pathologies which could evolve in severe syn-
dromes as the OSAS.
1- Tangugsorn V., Skatvedt O., Frogstad O., et al:
"Obstructive sleep apnea: a cephalometric study. Part I.
Cervico-craniofacial skeletal morphology."
Eur J Orth 17: 45-56. 1995.
2- Tangugsorn V., Skatvedt O., Frogstad O., et al:
"Obstructive sleep apnea: a cephalometric study. Part II.
Uvulo-glossopharyngeal morphology."
Eur J Orth 17: 57-67. 1995.
3- Hierl T., Humpfner-Hierl H., Frerich B., et al:
"obstructive sleep apnoea syndrome: results and conclu-
sions of a principal component analysis."
J Cranio-Max- Fac Surg 25: 181-185. 1997.
ULTRASONOGRAPHIC EXPLORATION OF
MAXILLOFACIAL TUMOURS - A COMPARATIVE
STUDY OF IMAGING M E T H O D S
Mihaela Popa .1, Gl: B~ciut 1, Agnes Adam,, R. Badea ~,
1Department of Oral and Maxillofacial Surgery,
:Department of Ultrasound, III Medical Clinic, "luliu
Hatieganu"
University of Medicine and Pharmacy, Cluj-Napoea,
Romdnia
Aims: High resolution ultrasonography (7 - 10 MHz) repre-
sents a non-invasive and accessible method. It allows dis-
tinct correlations with data obtained in clinical
examination. The aim of the study is to offer a comparative
evaluation of performances of high resolution ultrasonog-
raphy versus other imagistic methods.
Method: Ultrasonographic investigation with soft tissue trans-
ducer (Acuson 128 XP/10), with 7 - 10 MHz fiequency.
Exploration was done as standard ultrasonography (grey-scale),
pulsed Doppler vascular ultrasonography and power Doppler
color-coded ultrasonography. The technical approach included
analysis of perpendicular sections, systematic study of homo- and
controlateral lymphnode chains (location, number, dimensions,
echogenity, structure), study of tumor and organ demarcation.
Results: Tumors of the salivary glands appear as hypoe-
chogenic, parenchymatous masses. Assessment of tumor
vascularization offers important diagnostic and prognostic
data. Cervical metastatic lymphadenopathies appear as
round, hypoechogenic nodes, whereas inflammatory
adenopathies are oval and hyperechogenic. Adenopathies
with transsonic center are more frequently necrotized.
Conclusions: Ultrasonography can detect small tumors (ca.
2 - 3 ram) and superficial cervical adenopathies. Vascular
exploration can offer useful information regarding the
degree of vascularization of the tumor and tumoral inva-
sion in cervical vessels. Ultrasonography should become the
first imagistic investigation performed in analogy with clini-
cal examination. This method prooves to be fiable for post-
operative control, especially when CT-scan is unaccessible.
A RETROSPECTIVE STUDY AND PROGNOSIS
DATA CONCERNING THE FREQUENCY OF BONE
FRACTURES OF THE FACE
Eugenia Popescu,D. Gogalniceanu, C.Mihai, Saad Hamwi
*UM.F.. IA I-Romania

In the Clinic of Oro Maxillo Facial Surgery in Romfinia,
in a 45 year interval of time (1951-1995) there were admit-
ted 15.618 patients with fractures of the face bones,which
represents 79,08% of the total of 19.762 patients with
trauma. A number of 12.096 patients (77,44%) had
fractures of the mandible and 3522(22.56%) fractures of
the mandible and 3522(22,56%) fractures of the middle
third of the face.
The clinical statistical study pointed out that every 5
years the number of patients with fractures increased on the
average with 137%.The majority of patients(71,13%)were
between 21 and 50 years of age.
The main three etiological factors were:agres-
sion(60%),accidental falls(13,41%) and traffic acci-
dents(8,93%).
Prognosis data have shown that up to the end of the first
decade of the XXI century the number of patients with frac-
tures of the face bones will increase from 4026 in 1991 to
5399 between 2006 and 2010.
SURGICAL ACCESS TO P A T H O L O G I C A L
L E S I O N S INVOLVING THE ANTERIOR/MIDDLE
CRANIAL F O S S A - M O D I F I E D TECHNIQUE F O R
PAEDIATRIC SURGERY
R Campbell; 0 A Pospisil, P May.
SupraregionaI Craniofacial Unit, Alder Hey Children's
Hospital, Eaton Road, Liverpool, L12 2AP.
Tel." 44 0151 252 5018 Fax. 44 0151 252 5018
Choosing the right approach to pathological lesions, involv-
ing the anterior/middle cranial fossa in paediatric cranio-
facial surgery will often determine the curative or palliative
nature of this surgery. Special consideration must be given
to the preservation of anatomical landmarks, determining
further development of cranial and facial structures - yet
exposure to the pathological field; safety of the surgical
manoeuvres and complete excision of the abnormal tissue
must not be compromised. The use of the technique of
combined cranial, partial orbital and facial partition with
maxillary mobilisation designed by the authors' team will be
described in detail and demonstrated on representative
cases. This access to the operation site allows the operator
to visualise the tumour from above, front and below, thus
achieving complete and safe excision of the lesion under
direct vision. However, all facial contours can be recon-
structed using original cranio-facial segments or newly
reconstructed with split calvarial bone graft, peri-cranium
and muscles when necessary. This modified total facial par-
tition and technique, which differs from those described
elsewhere used in adult sm'gery, facilitates safe and often
curative surgery.
CLOSED VERSUS OPEN S E P T O R H I N O P L A S T Y
0 A Pospisil,
Consultant Maxillofacial Surgeon, Walton Hospital, Rice
Lane, Liverpool L9 1AE.
Tel 44 0151 529 4726 (Secretary)
44 0378 893489 Mobile Mr Pospisil
Fax 44 0151 529 4257
44 0151 353 0673 - Home Fax
EACMFS- Abstracts, Helsinki Congress 1998 147
Cosmetic septorhinoplasty as a dosed procedure has its limita-
tions when dealing with gross tip reconstruction or post cleft
nasal deformities A combination of intercartilaginous, transcar-
tilaginous and para-rim incisions is used to expose the nasal skele-
ton. Criteria for use of these incisions individually or in
combination will be defined, as they vary depending on the fea-
tures of the nasal deformity to be corrected and requirements of
stability of the post surgical result. Reduction or reconstruction
of the tip definitions with or without graft material is also a cru-
cial factor in making decision on which approach is to be utilised;
various cases described by the author will demonstrate the limita-
tions of dosed rhinoplasty. Open rhinoplasty as an alternative
technique used for reconstruction of post cleft deformities in par-
ticular, will be demonstrated and compared with the dosed pro-
cedures. Comparison of two techniques with clear delineation of
criteria for each will be demonstrated on illustrative cases.
MANAGEMENT OF DISLOCATED CONDYLAR
NECK FRACTURES: OPERATIVE VS.
CONSERVATIVE TREATMENT
Priiger TM, Klesper B, Siessegger M, Zrller JE
Department of Oral and Maxillofacial Surgery, University of
Cologne, Germany
AIMS:
The aim of our study was to compare the outcome and
treatment costs in two groups of patients with dislocated
condylar neck fractures.
MATERIALS AND M E T H O D S :
From 1991 to 1997, 132 patients with isolated and dislo-
cated fractures of the condylar neck were treated in our
department. Fifty nine patients (group 1) had an osteosyn-
thesis with an Eckelt's screw, 73 (group 2) were treated by
intermaxillary fixation.
Postoperative clinical and radiographic examination was
performed in all patients. Eighty seven patients were exam-
ined functionally according to the TMJ-questionnaire of
the D G Z M K . Twenty seven of the patients with functional
disturbances had an MRI-scan.
RESULTS:
The clinical and functional results did not show significant
differences between the two groups. An advantage in group
1 was the anatomical repositioning which could be identi-
fied radiographically. In group 1, the hospital stay was 9.6
days. The days the patient spent off work were 19.3 at the
first hospitalization and 5.2 when the screw was removed.
The patients in group 2 spent 13.2 days at hospital and the
period of disability was 32.5 days.
CONCLUSIONS:
The present results indicate that the surgical treatment of dislo-
cated fractures of the mandibular condylar neck is a comfort-
able and successful alternative for the treatment of these
fractures due to the shorter period of disability, an earlier rein-
tegration of the patients in the social environment, and compa-
rable functional results. Prospective studies are necessary for a
better clarification of the functional results in the two groups.
EXPERIMENTAL RECONSTRUCTION OF THE ORBIT
IN SHEEP WITH BIODEGRADABLE MEMBRANES
de Roche, R., Kuhn, A., de Roche-Weber, P., Rahn, B.,
148 Journal of Cranio-MaxillofacialSurgery
Gogolewski, S., Printzen, G., De Jager, M., Hammer, B.,
Prein, J. (Speaker: Prein, Z)
University Hospital Basel, Clinicfor Reconstructive Surgery,
Basel (Switzerland)
Aim: With the help of this experimental study in sheep, a
comparison of new membranes made of Polylactat (L/DL
80/20) and Polydioxanon (PDS) was undertaken.
Subsequently it was investigated whether it is better to
reconstruct orbital walls with Polylactat membranes only, or
with Polylactat membranes together with free bone grafts
fixed in a cantilever manner.
Method: Three series of experiments were undertaken. Series no
1: In 12 orbits of 6 sheep, defects of the orbits extending into the
frontal sinus and the maxillary sinus were reconstructed with
either membranes made of Polylactat or PDS. Series no 2:
Reconstruction of 6 orbits with Polylactat membranes together
with autologous bone grafts, and 6 orbits had reconstruction
with Polylactat only. Series no 3: In 20 orbits 10 were recon-
structed with Polylactat membranes 0.5mm thickness and 10
were reconstructed with Polylactat membranes 0.25mm. All 20
orbits were reconstructed with membranes only.
Results: PDS membranes resorbed too quickly. Polylactat
membranes are superior. Free bone grafts seem to remain
non vital for a long time. Orbits reconstructed with
Polylactat membranes only showed undisturbed healing and
good reossification of the orbital walls. In series no 3 the
sheep were kept alive for one year.
Conclusion: Polylactat membranes are superior to PDS
membranes. It seems to be possible to reconstruct major
defects, even inclusive of the frontal and maxillary sinuses
with membranes only.
THE NEED OF SURGICAL-ORTHODONTIC
COLLABORATION IN THE TREATMENT OF
HEMIFACIAL MICROSOMIA THROUGH
MANDIBULAR DISTRACTION OSTEOGENESIS: A
PRELIMINARY REPORT
Pricca M., Meazzini M., Mazzoleni F., Caronni E.,
S. Gerardo Hospital, Monza, Italy
INTRODUCTION: Hemifacial microsomia (HFM) is
mainly characterized by unilateral underdevelopment of the
ear, mandible and associated musculature and soft tissues.
The mandible is deviated upward and toward the affected
side and is associated with canting of the occlusal plane.
Distraction osteogenesis (DO) is gaining popularity in the
treatment of mandibular deformity in H F M , being less
invasive and applicable at a younger patient age. Excellent
facial results have been obtained with DO, but very often
severe occlusal problems are created, with severe open bites
or cross bites, substantially due to the lack of team work.
Two factors can and should be controlled through the close
collaboration with an orthodontist. First of all the den-
toalveolar change. When no prior orthopedics has been
performed a lateral open bite is usually created on the dis-
tracted side. This occlusal instability is a possible cause of
partial relapse as the maxillary cant does not have enough
time to self-correct during the skeletal retention phase.
Secondly, although DO has been shown to induce muscle
increment, with myofibrillogenesis and serial sarcomere
addition, maximal muscle response is only achieved with a
much lower rate of elongation (0.2ram per day) than the
standardized l m m a day, at which, though, bony fusion
would occur. Therefore, muscular and dentoalveolar prepa-
ration should be performed prior to DO and continued after
it to maximize the results. The purpose of this clinical and
cephalometric study was to evaluate the changes in maxil-
lary asymmetry after orthopedic treatment combined to
unilateral distraction of the mandible in growing children
MATERIALS & METHODS: Postero-anterior cephalo-
metric radiographs of 3 patients with H F M treated with
unilateral DO were analyzed. The average age of the
patients at the time of distraction was 5. 6 years. All of
those patients underwent orthopedic-orthodontic interven-
tion to level the occlusal plane. At the end of the orthopedic
treatment a controlateral open bite was created.
Immediately post-distraction the typical ipsilateral open-
bite was avoided in all of the patients. To evaluate maxillary
skeletal base and dentoalveolar asymmetry before and
immediately after mandibular distraction combined to
dentofacial orthopedics 10 landmarks were identified and
angular measurements involving the infraorbital plane, the
nasal floor, the maxillary occlusal plane and the mandibular
skeletal base were analyzed.
RESULTS and CONCLUSIONS: N o changes were seen in
the maxillary skeletal base, but dentoalveolar remodeling
was obtained with an average reduction in the occlusal cant
of 6 degrees during the presurgical orthopedic and the dis-
traction phase (range 5 to 7 degrees) leading to an excellent
occlusion and a flattened occlusal plane. A longer follow up
will be needed to evaluate the actual grade of long term
stability of this type of a coordinated procedure versus a
distraction with no orthopedic support.
COMPUTER-ASSISTED-PLANNING OF
DISTRACTION-OSTEO-GENESIS.
Puelacher W.C, lq¢~ Waldhart E. 1, Eder R. 2, Zur Nedden D.2
JDepartment of Oral and Maxillofacial Surgery, Leopold
Franzens University, Innsbruck, Austria
2University Clinic of Radiology, Leopold Franzens
University, Innsbruck Austria
Callus distraction of the craniofacial skeleton represents an
advanced technique of controlled, gradual neomorphogene-
sis of tissue. Depending on the degree of hypoplasia, age of
the patient etc. uni-, bi- or multidirectional lengthening pro-
cedures after one or two osteotomies on each affected side
of the mandible are performed. Planning of direction and
amount of distraction is still a problem.
The exact anatomical reconstruction is facilitated using
computerassisted 3D planning. The surgical intervention is
simulated using the software package "3D- VIEWNIX"
implemented of a SGI/Indigo graphics workstation. Using
the shell-rendering technique "3D-VIEWNIX" allows fast
interactive computer graphics visualisation, manipulation
(i.e. to mirror, to cut or to move 3D-objects) and quantita-
tive measurements of 3D-structures reconstructed from CT
cross sections.
Additionally the surgical distraction procedure is simu-
lated using a stereolithographic model. An occlusal splint
is produced preoperatively to control the desired mandibu-
lar elongation and to stabilize the result. An orthodontic
treatment follows the mandibular callus distraction
procedures.
The computer assisted 3D-planning is demonstrated
using a case report.
Distraction histiogenesis may have many applications in
craniomaxillofacial surgery.

7h OSSEOINTEGRATED I M P L A N T S IN
MICROVASCULAR MANDIBULAR
RECONSTRUCTION
Pulkkinen, J.*,DDS., Suominen, E. MD, Ph D.,
Department of Plastic Surgery, Helsinki University Central
Hospital
Aims: To analyse our experiments with osseointegrated
implants in large mandibular defects treated with vascular-
ized fibular or crista iliaca bone grafts and dental prostheses.
Subjects: Fibular (6 grafts) or crista iliaca (2 grafts) vascu-
larized bone grafts were used together with Brgmemark
osseointegrated implants in eight patients. The fate of the
dental implants was followed clinically and radiographically
from 9 months to 39 months. Immediate implant placement
was performed in two patients at the time of mandibular
reconstruction with vascularized fibular bone grafts.
Results: All bone grafts were successful and later remodel-
ling or resorption of the grafts did not lead to loosening of
the implants. Out of 43 implants, 38 were successfully
osseointegrated and were able to support dental prostheses.
Conclusions: No differences were noticed in implant place-
ment or in survival of dental implants between vascularized
fibular or crista iliaca bone grafts. Close collaboration
between the reconstructive surgeon and the prosthodontist
is essential for successful dental rehabilitation of these
patients.
N E U R O M U S C U L A R "PACIFICATION" IN
TREATMENT P L A N N I N G F O R ORTHOGNATIC
SURGERY
Quevedo, Luis. DDS.
Department of OMFS. School of Dentistry University of
Chile. S6tero del Rio Hospital OMFS Training Program.
Santiago, Chile
Aims: To demonstrate variations in surgical options in the
treatment planning of orthognatic surgery patients after
neuromuscular "pacification".
Study Design: Three different groups of 10 patients with
skeletal deformities were divided in class I, class II with
open bite and class II without open bite. All of them
underwent neuromuscular "pacification" via 2 to 3 months
of neuromuscular "pacification" using a full arch acrylic
splint for 24 hours a day. Clinical photos, model and radi-
ographic records were obtained in usual bite relation before
the splint therapy and the same was obtained in centric rela-
tion after completed the neuromuscular "pacification".
Treatment planning was done in each patient using their
two different set of records. Result were compared for each
patients to see the differences in surgical options for each
one of them.
Results: Mandibular position change up to the point to give
totally different surgical options in the same patient depend-
ing on neuromuscular pacification. Class III patients shows
very few changes in mandibular position. Class II without
open bite patients show up to 4 ram. posterior movement
after neuromuscular pacification, changing the surgical
treatment options. Class II with open bite patients show the
greatest change in mandibular position and surgical treat-
ment options. Statistics are shown individually for each
patient and as a group of skeletal deformity.
EACMFS Abstracts, HelsinkiCongress 1998 149
Conclusions: Based on our findings, we believe that every
patient who undergoes orthognatic surgery must have a neu-
romuscular "pacification" for the period of time it takes to
have the mandibular appropriate position, prior to the
treatment planning in order to select the best surgical treat-
ment.
Quevedo Luis. DDS
Francisco Noguera 41 3° Piso
Providencia- Santiago
Chile
Fax: 56-2-2334849
56-2-2344146
e-mail: H Y P E R L I N K mailto:luisquevedo@interactiva.cl
luisquevedo @interactiva.cl
GROWTH AFTER C O S T O C O N D R A L GRAFT IN
GROWING PATIENTS W I T H FACIAL
MICROSOMIA
Quevedo, Luis. DDS.
Department of OMFS. School of Dentistry University of
Chile. Sdtero del Rio Hospital. OMFS Training Program.
Santiago, Chile
Aims: To study growth after costocondral graft for
mandibular reconstruction in growing facial microsomia
patients with class IIb and class III skeletal deformities.
Subject: Twenty four growing facial microsomia patients
with class IIb and class III skeletal deformities who under-
went growth center transplantation with costocondral graft
were study to verify the type and the amount of growth.
Computerized cephalometric analysis and superimposition
were used to estimate the amount and direction of growth.
Clinical and full radiographic evaluation was used for
knowing the type of growth
Results: Two different well defined types of growth were
found. Clinical and radiographic findings are shown and
compared with each other. Exuberant and Lineal type of
growth result in a non specific type of patients or per-
operative conditions and both lineal and exuberant type
can be seen along with or without overgrowth. In regard
to the amount of growth, our patient population show
different spectrum starting from one to two and half years
post-op, the clinical evidences of it. Long term follow up
show continue growth in cases with overgrowth but lim-
ited growth is seen in other cases with no overgrowth. This
is in spite of similar post surgical management, however
we have found differences in the surgical management in
patients with overgrowth. We have correlated overgrowth
with the load or overload of the grafted new condilar unit.
On the other hand. we have found no correlation with the
amount of cartilage left in the top of the graft at the time
o f surgery.
Conclusions: Based on our findings, we believe that costo-
condral graft is a good way to treat class IIb and III skeletal
deformity patients who are non good candidate to perform
distraction osteogenesis. It is important to know the differ-
ent type of growth we could have and the management the
patient need in either case.
Quevedo, Luis DDS
Francisco Noguera 41 3°Piso
Prividencia - Santiago - CHILE
Fax: 56-2-2344146 - 2334849
Luisquevedo@interactiva.cl
150 Journal of Cranio-MaxillofacialSurgery
A L L O P L A S T I C RECONSTRUCTION O F THE
TEMPOROMANDIBULAR JOINT
Peter D. Quinn, DMD, AID,
University of Pennsylvania, Philadelphia, PA
AIM: Overview of six different alloplastic temporo-
mandibular joint prostheses used over a fifteen year period.
SUBJECT: Theoretically, a successful alloplastic prosthesis
for joint replacement would offer the following advantages
in the adult patient:
Lack of donor-site morbidity
Occlusal stability (compared with autogenous grafts, which
have variable resorption rates)
No need for intermaxillary fixation
Early range of motion with attendant dietary improve-
ment
Decreased risk of ankylosis from heterotopic bone formation
Decreased surgical and anesthetic time
We will review our experience with the following pros-
thetic joint systems: Synthes, Kent-Vitek, Delrin-TiMesh,
Christensen, Tech-Medica, and Biomet-Lorenz. Special
emphasis will be placed on the bio-compatibility and wear
care characteristics of the various biomaterials, surgical indi-
cations and techniques, complications and failure rates, and
future direction of research in alloplastic implants. A total of
260 patients will be presented with long-term follow-up in
pain levels, masticatory function, and life of the prosthesis.
ORAL SURGERY TREATMENT N E E D IN
PATIENTS REFERRED FOR CORONARY ARTERY
BYPASS SURGERY
Qvarustr6m M l'z , Meurman J. H. 2, Nuutiuen ps, Rehnberg
S, Halonen p4.
University of Kuopio, Faculty of Medicine/Department of
Oral and Dental Diseases 1 and Kuopio University Hospital,
Clinics of Otolaryngology / Clinics of Oral and Dental
Diseases 3 Clinics of Surgery: and Internal Medicine6 ,
University of Kuopio/Department of Statistics, University of
Helsinki, Institute of Dentistry 2, Finland
Aim: to study oral surgery treatment needs in patients with
cardio-vascular heart disease referred for coronary artery
bypass surgery.
Methods: the patients were studied clinically and panoramic
tomographs were taken. Signs of dental infectious foci were
examined and recorded. The findings were summarized and
expressed as the total panoramic risk index (Mattila 1989). All
the x-rays (n=250) was examined twice by one investigator, (
MQ). The statistical difference between the two examinations
was not significant as expressed by the kappa -value (0.90).
Results: the patient's heart disease was at least class II
according to the New York Heart Association classification.
The mean age of the patients was 60.3 "9.3 years, men 58.8+
9.9 years and women 63.0+ 7.5 (p<0.001) and 63.8% were
men, 6.2 % women. In this group, 65 % were dentate and 35
% were edentulous (p< 0.0001). Of the men 73 % were den-
tate compared with 50.5 % in women (p<0.0001) The mean
number of remaining teeth was 8.8_+ 9. 1, men 9.9 ± 8.9 and
women 7.0_+ 9.1 (p=0.17). The mean number of retained
roots was 0.5_+ 1.5, 0.5 _+ 1.7 in men and 0.4 _+ 1.0 in women
(n.s.). The mean number of periapical lesions was 0.6_+ 1.0,
and 0.6 _+ 1.1 in men and 0.4 _+0.8 in women (p<0.001). Signs
of pericoronitis were detected in 9.4 % of the patients, 63.7 %
in men and 36.3% in women (p=0.2). When all the signs of
infection foci recorded from the x-rays were summarized, the
patients had a mean number of 3.2 lesions in comparison with
1.7 + 3.3 in men and 0.9+ 1.8 in women (p=0.03).
Conclusion: There are statistically significant differences
between both sexes in this study and signs of infectio in
patients with CHD, which need oral surgical treatment.
D BIODEGRADABLE SELF-REINFORCED
POLYLACTIDE O S T E O S Y N T H E S I S IN
MAXILLOFACIAL TRAUMATOLOGY
Sailer H.FJ*, Haers P.E, 1, Suuronen R. 2, Lindqvist C.2
1Department of Cranio-MaxilloJi~cial Surgery, University
Hospital Zurich, Switzerland. :Department of Oral and
Maxillofacial Surgery, University Hospital Helsinki, Finland.
Introduction: Metallic osteosynthesis material in maxillofa-
cial traumatology has the disadvantage that it has to be
removed after the osteotomy has consolidated, which often
requires general anaesthesia. Titanium plates have been
introduced to bypass this need for secondary intervention.
However, due to corrosion, titanium particles have been
found in scar tissue covering these plates and regional lymph
nodes. Moreover, if plates remain in situ for life, they cause
artefacts in CT-imaging and especially in MRI-examination
of the midface and oral cavity. In earlier studies, self rein-
forced polyactide devices have proven to be strong enough
to bypass the need of additional support for the fixation of
fractures in experimental and clinical conditions.
Method: Four different systems of self-reinforced polyactide
osteosynthesis material were developed in order to enable
osteosynthesis with biodegradable material in craniofacial
and orthognathic surgery as well as in maxillofacial trauma-
tology. These systems consist of the same material with
screws in different diameters (1.5 ram; 2.0 ram; 2.5 mm and
2.7 ram) and plates with different profiles (0.6 ram; 1.0 ram;
1.2 ram; 1.4 mm).
The new systems of self-reinforced polyactide biodegrad-
able osteosynthesis were consequently used in all patients vol-
unteering when undergoing craniofacial surgery, orthognathic
surgery and presenting with fractures of the maxillofacial
skeleton. Excluded were fractures causing discontinuity of the
mandible, patients suspected of H.I.V.-infection and patients
with systemic diseases. In all cases, clinical examinations were
done on a weekly basis until the sixth postoperative week,
three and six months postoperatively. Radiological examina-
tions were performed preoperatively, immediately postopera-
tively, six weeks, three and six months postoperatively.
The preliminary results (follow-up period from six weeks
to six months) concerning the clinical use of this new mate-
rial (fit in the bone, damage of the material by manipula-
tion, need of emergency screws) and postoperative findings
(incidence of material-related complications, skeletal stabil-
ity) will be reported.
DISTRACTION OSTEOGENESIS O F CRANIO-
FACIAL SKELETON - RESEARCH & CLINICAL
APPLICATIONS
A. Rachmiel,
Dept. of OMS, Rambam Medical Centet, Haifa, Israel

Distraction osteogenesis is a method of generating new
bone by gradual distraction. The method was developed by
Ilizarov in long enchondral bones. We started a series of
studies on membranous facial bones in animals. We did Le
Fort II osteotomies, following by gradual distraction in
young adult sheep and obtained a mid-facial elongation of
40mm with new bone formation at the distraction site. An
additional 1 year study demonstrated that the new bone for-
mation offers long term stability, obviating the need for
bone grafting. Another study demonstrates a concomitant
3-dimensional correction of several facial bones with the
possibility of changing the direction of lengthening at the
time of distraction. This offers the advantage of a 3-dimen-
sional control of movement of the facial bones. Biopsies
were taken every 5 days during the first 3 weeks in order to
follow the early generation of new bone, again after 6 addi-
tional weeks, and 1 year later. The specimens are analysed
histologically, histochemically, and by scanning electron
microscopy for the ultrastructural pattern and mineralisa-
tion. The process of osteogenesis, angiogenesis and mineral-
isation will be demonstrated. The effect of cytokins as TGF
- on the osteogenic process will be shown. Following labora-
tory studies, we commenced, 6 years ago, distraction osteo-
genesis in the human hypoplastic mandible by using both
the extraoral and intraoral devices. The advantages of both
methods will be presented. In cases of maxillary retrusion in
young children, and especially with cleft lip and palate, bet-
ter results are obtained by early skeletal advancement of the
maxilla by distraction osteogenesis. There is no need for
intermaxillary fixation (difficult in young patients) or rigid
fixation of the maxilla by miniplates which can damage the
tooth buds and roots at this age. In conclusion, lengthening
of facial bones by distraction osteogenesis provides treat-
ment for these youngsters, with new bone formation obviat-
ing the need for bonegrafting and further complex surgery.
[~ COMBINED SURGICAL TREATMENT AND
BRACHYTHERAPY IN SQ. CELL CA. OF MAXILLA
(MAXILLARY SINUS).
RachmM A. % Rosenblatt E., Ardekian L., Blumenfeld L, Laufer D.
Department of Oral & MaxilIofacial Surgery, Department of
Oneology, Rambam Medical Center, Haifa, Israel.
Maxillary sinus carcinoma usually appears, in advanced
stages, as a mass in either the oral cavity, nose, or cheek. It
is rarely confined to the maxillary sinus at the time of diag-
nosis. In advanced stages the combination of surgical
resection and radiotherapy yields the best results, as resid-
ual microscopic disease can be controlled by radiotherapy.
The problem is compounded by the proximity to critical
structures such as orbit, cranial nerves,and base of skull.
Thus, in order to deliver relatively high doses of postoper-
ative radiation without excessively irradiating sensitive
organs as orbits, we perform postoperative brachytherapy
by using an obturator loaded with Iridium-192 sources. 18
patients with maxillary sinus carcinoma in size T2-T4 were
treated by combining surgery and focal brachytherapy.
Only selected patients with advanced stages received addi-
tional external beam irradiation. After a median follow-up
of 46 months, 15 of the 18 patients were alive and free of
disease. The main advantage of brachytherapy following
surgery is a localized higher dose of radiation adjacent to
surgical margin areas, sparing high doses of external radi-
ation from organs at risk as eyes, optic pathways, and
brain.
EACMFS- Abstracts, Helsinki Congress 1998 151
BONE GRAFTING OF THE MAXILLA WITH
AUTOGENOUS BONE TO ENABLE PLACEMENT OF
ENDOSSEOUS IMPLANTS
Raghoebar, G.M.*, Batenburg, R.H.K., Timmenga, N.M.,
Reintsema, H., Vissink, A.
Dept. of Oral & Maxillofac. Surg., Univ. Hospital
Groningen, The Netherlands
Aim: Placement of endosseous implants in the atrophic
maxilla is often limited because of lack of supporting bone.
Augmentation of the floor of the maxillary sinus with auto-
genous bone grafts is one of the treatment modalities to
solve this problem. The aim of this study was to evaluate the
morbidity and complication rate of this treatment modality.
Methods: In 99 patients the maxillary sinus floor was aug-
mented with iliac crest (N=83, 163 sinuses, 353 implants),
mandibular symphysis (N=14, 18 sinuses, 37 implants), or
the maxillary tuberosity (N=2, 2 sinuses, 2 implants) grafts.
Nine of these patients had a predisposition for sinusitis.
Peri-operative (a.o. perforation of the sinus membrane) and
postoperative (a.o. sinusitis, inflammation, mucosal
dehisence, loss of bone particles) parameters were scored.
Results: Perforation of the sinus membrane, which
occurred in 47 cases, did not predispose to development of
sinusitis. Symptoms of transient sinusitis were observed in
two out of the nine patients with a predisposition for
sinusitis only. These symptoms were successfully treated
with decongestants and antibiotics. A third patient from
latter group developed a purulent sinusitis which resolved
after a nasal antrostomy. Loss of bone particles and
sequesters was observed in one (diabetic) patient only, in
whom a mucosal dehiscence occurred. A second augmen-
tation procedure was successful. In all cases the bone vol-
ume was sufficient for insertion implants. Thirty-two of
392 inserted Brgmemark implants (8.2%) were lost during
the follow-up (mean 47.6 months, median 48.1 months,
range 8 to 107 months), no sinus pathology was observed
post implantation. The patients received implant sup-
ported overdentures (74 patients) or fixed bridges (25 pa-
tients) and experienced no complaints with regard to the
grafts and implants.
Conclusion: It is concluded that the morbidity and compli-
cation rate of bone grafting of the floor of the maxillary
sinus floor with autogenous bone is neglectable.
EFFECTS OF CHEMICAL C O M P O S I T I O N AND
DESIGN OF POLY (L/DL-LACTIDE) IMPLANTS ON
THE HEALING OF CRANIAL DEFECTS
*LeiggeneJ; C.S 1), Curtis, R. ~) , Rahn, B.A. 1)
A O-Research Institute l j, A O-Development Institute 2J, Davos,
Switzerland
Subject: In defects involving inner and outer table of the cranial
vault, there is a tendency that intra- and extracranial tissues are
pressed into the defect, thus interfering with the regeneration
process. The goal of the study was to compare the healing of
cranial defects in rabbits assisted by bioresorbable guiding
structures of different design and different chemical
composition.
Method: Bilateral circular cranial defects (diameter 8.3mm)
were produced in New Zealand white rabbits. In 16 animals
152 Journal of Cranio-Maxillofacial Surgery
the defects were covered externally with extruded and laser-
cut poly (L/DL-lactide) foils, whereby each animal received
a perforated (1 mm holes) and a non perforated defect cover.
In an additional 16 rabbits, the defect spaces were kept open
with foils which created hollow chambers. The foils were
manufactured from poly (L/DL-lactide) 70:30 or 80:20,
both materials were implanted in each animal. Bone seeking
fluorochromes were administered at regular intervals. After
an observation period of 8 weeks bone regeneration in the
defects was assessed radiologically and histologically.
Radiographs were used to quantitate new bone formation in
the defect, dynamics of bone formation was assessed by flu-
orescence microscopy, and stained sections served to
analyse morphologic differences
Results: In the case of external covers a wide variation in the
healing patterns was caused by a varying extent of hernia-
tion of intracranial tissues into the defect. Thus no signifi-
cant difference in bone formation was produced by the
perforation of the foil. The non perforated foils had a slight
tendency to permit bone formation in a morphology closer
to the original structure than did the perforated cover. The
use of hollow chambers resulted in a clear reduction of vari-
ation in the amount of bone formation. Defects were almost
completely bridged with newly formed bone of the same
thickness, and of a similar structure, as the surrounding
bone. No significant statistical difference in bone formation
was induced by the different chemical composition of the
implants. No signs of osteolysis or inflammatory tissue
reactions became evident, neither for the different chemical
compositions nor for the different designs.
Conclusions: Perforated foils offered no advantage for defect
healing compared to non perforated foils. It seems to be of
paramount importance that any herniation of soft tissues
into the defect is prevented. An appropriate spaceholder
permits primary bone regeneration in a geometry and a
structure which is site specific. In the early phase of bone
regeneration the chemical composition of the poly (L/DL-
lactide) had no effect on amount and morphology of the
regenerate.
[~ SIS-IMPLANTS: A NEW I M P L A N T O L O G I C A L
CONCEPT W I T H MAINTENANCE-FREE KINETIC
ELEMENTS AND F U L L ADJUSTABLE ABUTMENT
SYSTEM
*Dr. Heribert Rainer, Dr. Alexander Gaggi
Dentist, Cranio-Maxillofacial Surgeon, Bahnhofstrasse 22/1,
A-9020 Klagenfurt/Austria
Dental Surgeon Auenbruggerplatz 2, A-8020 Graz/Austria
The paper presents a new implantological concept with SIS-
Implant-System. This Austrian system consists of a selfcut-
ting titanium screw with laserprocessed surface. There are
two types of implants: one with built- in shock absorber
and one conventional without. Maximum diameter is
3.3ram and 4.1mm .The straight abutments are prefabri-
cated,the angulated abutments may be individually manu-
factured in the dental laboratory on the base of
premanufactured components, thus providing an unlimited
amount of three-dimensional corrections. Also the super-
structure is waxed up upon premanufactured components,
providing individuality and highest precision at the con-
junction.
"Decision transfer on to the model" is a concept,
reducing time-consuming work and decisions in the
mouth, because all abutments are selected and mounted
on the cast in the dental laboratory. The decision for
angulated abutments is done under control of a paral-
lelometer and the processing does exact three-dimen-
sional correction of any disangulation. A very low
amount of components are responsible for easy handling
and simple logistics as well as highest industrial precision
at full variability.
KEY WORDS:
Dental implants, kinetic elements, laserroughened surface,
individual abutments, premanufactured basic attachments.
SIS-IMPLANTS: A NEW I M P L A N T O L O G I C A L
CONCEPT W I T H MAINTENANCE FREE KINETIC
ELEMENTS AND F U L L ADJUSTABLE ABUTMENT
SYSTEM
*Dr.Heribert Rainer, Dr. Alexandr Gaggl,
Dentist, Cranio-Maxillofacial Surgeon, Bahnhofstrasse 22,
A 9020 Klagenfurt/A USTRIA
Dental Surgeon, Auenbruggerplatz 2, A-8020 Graz/AUSTRIA
SUBJECT:
The paper presents a new implantological concept with SIS-
implant system. This Austria systems consists of a selfcut-
ting titanium screw with laserprocessed surface. There are
two types of implants: conventional implants and implants
with built-in shock absorbers. Maximum diameter is 3.3 and
4.1ram. The straight abutments are pre-fabricated, the
angulated abutments may be individually manufactured in
the dental laboratory on the base of premanufactured com-
ponents, thus providing an unlimited amount of three
dimensional corrections. Also the superstructure is waxed
up upon premanufactured components, providing individu-
ality and highest precision at the conjunction.
"Decision transfer onto the model" is a concept, reduc-
ing time consuming work and decisions in the mouth,
because all abutments are selected and mounted on the cast
in the dental laboratory. The decision for the angulated
abutments is done under the control of a parallelometer and
the processing does exact three dimensional correction of
any disangulation. A very low amount of components are
responsible for easy handling and simple logistics as well as
highest industrial precision at full variability.
KEY-WORDS:
dental implants, kinetic elements, laserroughened surface,
individual abutments,
SIGNS AND S Y M P T O M S PREDICTING NEED F O R
INTENSIVE CARE IN PATIENTS S U F F E R I N G F R O M
SEVERE DENTOGENIC INFECTIONS
Riiisiinen, S. *, Paatsama, J., Jousimies-Somer, H.,
Meurman, J., Lindqvist, C
Department of Oral and Maxillofacial Surgery, Helsinki
University Central Hospital, Institute of Dentistry,
University of Helsinki, and National Public Health Institute,
Helsinki, Finland
Aims: To find out whether any signs or symptoms on admis-
sion might predict the occurrence of complications or

a g g r a v a t e d infectious disease in d e n t o g e n i c infec-
tions.
Method: 100 consecutive patients requiring hospitalization
due to dentogenic infection were studied clinically and radi-
ographically. Of these, 18 required intensive care (ICU) due
to cardiorespiratory problems or infectious complications
such as carditis, mediastinitis and sepsis. Blood samples
were analysed for several parameters including C-reactive
protein (CRP). The results were analysed statistically (cross
tabulation, t-test).
Results: The 18 ICU patients were 39.9 ± 10.7 years old, the
82 non-lCU patients were 41,2 ± 16.8 years (n.s.). 12 ICU
patients were men (66.6%), while the respective percentage
in the other group was 57.5% (n.s.). In all the ICU patients
the infectious focus was in the mandible, while in the other
group they were more randomly distributed. On admission
to hospital, the mean CRP of the ICU patients was 132.3 ±
67.3mgll compared to that of the others 78.8 ± 71.6mg/1,
respectively (p<0.01). There was no difference in social
class, smoking habits and consumption of alcohol, duration
of symptoms, antibiotic therapy and dental operative proce-
dures prior to hospitalization. Surprisingly, the number of
systemic diseases was higher among the non-ICU (31.7%)
than in the ICU patients (11.1%, n.s.).
Conclusions: No particular background variable was found
that could be used to assess the need for intensive care in the
treatment of patients with severe dentogenic infection.
Nevertheless, a high CRP concentration on admission
might be used as a predictive inflammatory sign for aggra-
vated infection.
BACTERAEMIA CAUSED BY OPERATIVE
EXTRACTION OF THIRD M O L A R S
Rajasuo A. *~,~,Perkki K. 3, Nyfors S. 4, Jousimies-Somer H. 4,
Meurman J.H. 1
1Inst. of Dentistry, Univ. of HelsinkL 2Helsinki Univ. Central
Hospital,
3Central Military Hospital, 4National Public Health Inst.,
HelsinkL Finland
Aims: The aim of this study was to investigate the occur-
rence of bacteraemia associated with operative extraction
of lower third molars, and to examine if the per±coronal
pocket or extraction socket was the source of the bacter-
aemia.
Material: The subjects were generally and periodontally
healthy (9 male and one female Finnish conscripts (mean
age 21.4 + 1.5 yrs)) and one male officer (39.3 yrs). All had
symptomless or mildly symptomatic chronic pericoronitis
associated with a partly erupted (less than half visible) lower
third molar.
Methods: Bacterial samples were absorbed using a sterile
endodontic paper point in the per±coronal pocket (average
depth 7.9 mm, SD 2.8) for 30 seconds and postoperatively in
the extraction socket and transported in V M G A III
medium. The lower third molar was removed in 10 + 3 min-
utes (mean and SD) after soft tissue incision. Eight out of
11 cases required buccal osteotomy and tooth separation.
Sixteen ml blood samples were taken from the cubital vein 1
min after incision and 1, 5, 10, 15 and 30 minutes after
extraction of the tooth. Qualitative Beeton Dickinson-
method and quantitative Isolator T M Oxoid-method were
used in the blood cultivation. Established aerobic / anaero-
bic methods were used in the cultivation and identification
of the bacterial isolates.
EACMFS Abstracts, Helsinki Congress 1998 153
Results: All but two cases had a detectable bacteraemia
(82%), most frequently one minute after extraction (45% of
the samples were positive), but also at 10 rain (45%), 15 rain
(36%) and 30 rain postoperatively (9%). Thirty-four differ-
ent bacterial species or groups were isolated from the blood
cultures, 4.8 + 2.7 species (mean and SD) per subject. Sixty-
eight percent of the microorganisms were anaerobes. The
species most frequently found were Prevotella (4 species),
Viridans group streptococci (3 different species),
Eubacterium timidum, E. minutum and other Eubacterium
species, Peptostreptococcus micros, P anaerobius and other
Peptostreptococcal species, and Propionibacterium acnes. In
all of the cases with detectable bacteraemia the same
microorganisms (mean 2.1 species) were also isolated from
the subject's pericoronal pocket.
Conclusion: The present results confirm that oral operative
procedures are associated with a very high frequency and
long duration of bacteraemia involving anaerobic bacteria
which emphasizes the need for discussion concerning
antimicrobial prophylactics with a wider spectrum against
anaerobic species.
Supported by the Finnish Dental Association and the
Finnish Defence Forces.
[~ PLATE O S T E O S Y N T H E S I S O F SUBCONDYLAR
FRACTURES: A REVIEW OF 45 PATIENTS.
Rallis, G. * Mezitis, M., Ainatzoglou, 3/1., Skoura, K.,
Zachariades N.
Department of OMFS, Accidents' Hospital of Athens
"K.A.T.", Athens, Greece.
Aims: To present the type of osteosynthesis used for the
treatment of subeondylar fractures, the postoperative
results and the complications observed.
Method: Between 1990 and 1997, 45 patients with sub-
condylar fractures underwent open reduction and osteosyn-
thesis with plates and screws. The surgical approach was, in
most cases, via a submandibular incision.
Results: Stabilization was achieved in the majority of the
cases with a single or double 2.0ram mini plate, but mini
dynamic 2.0 mm or 2.7 mm compression plates plates were
also used. The complications we had concerned mainly inad-
equate reduction, screw loosening and limitation of mouth
opening. No plate fracture or infections were observed.
Conclusions: The treatment of subcondylar fractures
remains controversial. We believe that in case of open
reduction and plate osteosynthesis, the use of two 2.0mm
mini plates, produces the better results.
IN-VITRO STUDY O F GENETIC P R E D I S P O S I T I O N
IN HEAD AND NECK CANCER
Ramchandani PL *, Scott D, Cowan RA,
Department of Cancer Genetics, Paterson Institute for Cancer
Research, Christie Hospital NHS Trust, Manchester, England.
Aims: It has been speculated that head and neck cancer
(HANC) in young adults may be a dissimilar entity from the
counterpart in the older population, with absence of the
classic predisposing factors and with genetic influences
assuming a more important role. A study was designed to
(1) assess the significance of risk factors in the development
154 Journal of Cranio-MaxillofaciatSurgery
of H A N C (2) assess differences in radiosensitivity between
patients with early onset H A N C and an older population
with HANC.
Method: (1) A questionnaire was used to assess age, smok-
ing, alcohol consumption, dietary habits, occupational
exposure and family history of cancer, in 13 patients who
developed H A N C before or at 45 years of age (early onset
cases). The results were compared with 17 patients who
developed H A N C after 45 years of age (late onset cases).
(2) In the second part of the study, the GO phase micronu-
cleus assay with high dose rate ~3VCsgamma-irradiation, was
used to assess the intrinsic radiosensitivity of phytohaemag-
glutinin stimulated peripheral blood lymphocytes in 13
patients with early onset HANC, 13 patients with late onset
H A N C and 13 normal healthy controls.
Results: (1) Compared with late onset H A N C patients,
fewer early onset patients gave a history of tobacco and
alcohol consumption and occupational exposure to carcino-
gens, although this difference was not statistically signifi-
cant. In addition a family history of H A N C was only seen
in one out of 13 early onset cases, and was absent in late
onset cases. (2) There was no significant difference in sensi-
tivity between patients with early onset H A N C and those
with late onset HANC. There was however a trend of
increasing sensitivity from early onset H A N C cases
(p=0.20) to late onset cases (p=0.01) who were significantly
more sensitive than controls. In addition all H A N C patients
were significantly more sensitive than normal healthy con-
trols (p=0.025).
Conclusions: (1) All HANCs may be biologically similar, the
difference in age of onset could be explained by early onset
cancer patients being part of the normal distribution of
H A N C and occurring at the end of the distribution. (2)
Early onset H A N C may not have a genetic basis, and there
may be an as yet undiscovered agent acting in its aetiology.
(3) Chromosomal radiosensitivity may reflect cumulative
exposure to carcinogens which increases with age, resulting
in greater sensitivity in normal onset patients compared
with early onset patients. (4) The lymphocyte may not be the
ideal cell to use in radiosensitivity assays in HANCs, which
are epithelial in origin, because these two cell types may
have widely differing mechanisms of chromosomal damage
and repair. Future studies will need to utilise bigger sample
sizes and be better matched to allow more meaningful con-
clusions to be drawn.
CORRELATION O F VOLUME CHANGES IN
TRAUMATIC ORBITS AND LATE E N O P H T H A L M O S
AS EVALUATED BY 3D-CT.
Ramieri, G.*, Spada, C., Bianchi, S.D. °, Fasolis, M.,
Gerbino, G., Berrone, S.
Departments of Maxillofacial Surgery and °Radiology,
University of Turin, Italy
Aims: The present investigation was set up to assess the
post-traumatic dimensional changes in the orbit and orbital
tissues, and to evaluate their correlation with ocular posi-
tion, by image analysis and volumetric elaboration of raw
CT data.
Method: Thirty adult patients treated for fractures involving
the orbits were studied 6-12 months after operation (35 frac-
tured orbits and 25 controls). Axial, 1ram thick, contiguous
CT scans were elaborated for 3D reconstruction and linear
and volumetric measurements. The 3D surfaces of the inter-
nal orbit (bony contour), extraocular muscles and orbital
fat were reconstructed and their volumes calculated.
Different sagittal, frontal and transverse linear measure-
ments were also obtained, as well as the sagittal eye posi-
tion. Mean values and standard deviations were statistically
compared in fractured, enophthalmic and control orbits.
Results: The eye sagittal projection strictly correlates to
orbital length, volume, and posterior width. Traumatic
orbits significantly differ from controls with regard to the
sagittal eye projection (CT evaluated enophthalmos),
orbital floor morphology (postero-medial enlargement),
and total volume increase. Orbital muscles and fat density
are not apparently altered. Fat volume does not directly cor-
relate to enophthalmos, though fat atrophy is commonly
observed in the more compromised orbits. Differences may
be clearly appreciated in the 3D shape of the orbital con-
tent. The most common observation is that the traumatic
orbit is transformed from a conical to a rounded shape with
a constant enlargement of the posterior segment in enoph-
thalmic patients.
Conclusions: 3D-CT orbital investigation suggests that late
post-traumatic enophthalmos is more commonly related to
retrobulbar enlargements and not to changes in total vol-
ume or fat content. This investigation may provide valuable
information in the planning of secondary corrections.
FUNCTIONAL AND AESTHETIC RESULTS OF
L I P - S P L I T T I N G INCISIONS IN
HEMIMANDIBULECTOMIES
Rapidis, A.D. *, Valsamis, S., Anteriotis, D., Skouteris, C.A.
Department of Maxillofacial Surgery, Greek Anticancer
Institute, St Savvas Hospital, Athens, Greece
Aims: The surgical treatment of malignant tumours of the
lower third of the face frequently involves composite resec-
tions. During this type of surgery, function and aesthetics
are often sacrificed in the surgeon's effort to eradicate dis-
ease. Lip-splitting incisions improve access to the oral cavity
and facilitate exposure of the mandible, the floor of the
mouth and the posterior third of the tongue. It leaves
though a visible scar on the patients' face.
Methods: In order to evaluate the functional and aesthetic
results of various types of lip-splitting incisions, we retro-
spectively reviewed all patients in whom this approach was
employed during the years 1993 to 1997. Forty eight
patients were subjected to either mandibulotomy or
mandibulectomy during this 5 year period. Four types of
lip splitting incisions were used. The Roux/Trotter, the
Robson, the McGregor and the McGregor's modification
proposed by Heyter et al. All patients answered a question-
naire about cosmetic satisfaction with the scar and possible
sensory and functional problems that had resulted from the
incision.
Results: Most problems presented in patients operated
on by Robson's incision. In all cases, dysfunction result-
ing from injury to the m a n d i b u l a r branch of the facial
nerve was noted. Second in decreasing order was the
Roux/Trotter incision with problems usually associated
with inferior suturing technique. Patients operated on
by McGregor's technique presented with the least prob-
lems. The modification proposed by Heyter et al was the
easier to close especially by the less experienced mem-
bers of the surgical team who usually carry out this
task.
Conclusion: From the study of our material it was clearly
evident that Robson's lip-splitting incision presented the

fewest post-operative problems and the incision with the
best results was the modified McGregor one.
REJUVENATION O F THE FACE
Dr. Christian Raulin* and Prof. Dr. Dr. Rainer Drommer
Karlsruhe, Germany and Heidelberg, Germany
In many cases, face lifting alone does not lead to optimal
positive post-operative changes in the face. Pre-operatively,
the particular requirements of the aged face need to be eval-
uated and a complete individual treatment plan designed. In
our experience, only the combination of face lifting, over
and under lid, nasal correction, laser-therapy and when
indicated a chin-lengthening procedure lead to a rejuvena-
tion effect. Our report deals with experience in past years
using the shared resources of the Laser Therapy Centre and
the Centre for Plastic Surgery.
CENTRALISED CLEFT TREATMENT IN
FINLAND-AN ANALYSIS O F FIFTY YEARS
Rautio, J. *
Cleft Centre, Division of Plastic Surgery, Helsinki
University, Helsinki, Finland
Aims: Primary and secondary cleft treatment has been cen-
tralised in Finland for fifty years. This allows us to calculate
the costs and amount of surgical treatment needed for vari-
ous cleft types in a clearly defined population.
Method: A computer database has been created to analyse
the surgical treatment given to over 6000 patients.
In the early (Soivio) period (1947-1969) treatment
according to a set protocol was instituted. Lip repair
evolved from Veau to
LeMesurier and Skoog to Millard performed at three
months and palatal repair at 1 fi years according to Veau-
Kilner. In the intermediate period (Rintala) 1970-1989, a
multidisciplinary team was formed and especially secondary
treatment such as velopharyngeoplasty, alveolar bone graft-
ing was improved, as were orthodontics and prosthodontics.
In the current period, 1990 onwards, less traumatic methods
have been employed to simplify the protocol and to dimin-
ish the need for secondary surgery to cut the costs of com-
prehensive cleft care for the population.
Results: Data on primary and secondary surgery will be pre-
sented and factors leading to secondary surgery will be
analysed. Typical patients from various decades will be
presented.
Conclusion: Centralised treatment provides a comprehensive
model for analysis of the treatment load imposed on society
by clefts of the lip and palate.
ORIENTAL R H I N O P L A S T Y
N. Ravindranathan
Maxillo-Facial Unit, Ripas Hospital BSB, Darussalam,
Brunei
EACMFS Abstracts, HelsinkiCongress 1998 155
Oriental facial features are quite distinctively different to the
features seen in Caucasians. In todays world, migration has
placed many Orientals in European cities and therefore any
aspiring surgeon interested in cosmetic surgery should have
a basic understanding to appreciate how rhinoplasty in ori-
entals differs from the procedures undertaken for
Caucasians.
The author would like to share his 5 year experience and
study of the results in correcting common oriental rhino-
plasty problems and especially the good results which can
be achieved with silicone implants in oriental patients. This
paper will also clearly illustrate the procedures used by the
author in correcting wide alar bases and overhanging alar
margins seen in oriental patients. In patients who belong to
the Islamic faith, modifications are necessary to respect
Islamic religious practice and this will be discussed in the
context of rhinoplasty.
SKELETAL DISTRACTION FOR MANDIBULAR
LENGTHENING WITH A COMPLETELY
INTRAORAL TOOTHBORNE DISTRACTOR;
Yan Razdolsky * and Stuart Dessner
Department of Orthodontics, University of Illinois, Chicago,
USA
Private Practice, BufJalo Grove, USA
AIMS: To develop a predictable method of mandibular
skeletal deficiency correction for adults Class II patients
that causes them less inconvenience, is less costly, and deliv-
ers consistent and predictable results. The non-extraction
hypothesis to correct skeletal mandibular deficiencies with
lower, incisor crowding or compensations was tested. A
question was raised, is it possible to distract between the
teeth first and then to upright or to decrowd the incisors
into the new regenerate bone? Our experience with
osteodistraction has evolved since 1992 with 71 osteotomies
in 46 patients.
M E T H O D S AND M A T E R I A L S : The technique we
employ for distraction osteogenesis entails four phases: 1)
performance of a corticotomy, 2) period of distraction,
3) remodeling of the regenerate, followed by 4) stabiliza-
tion. 12 orthodontic patients underwent intraoral corti-
cotomies and application of intraoral (ROD TM)
toothborne distraction devices to facilitate complex multi-
planar distraction as mandated by the patient's specific
deformity. Patients underwent gradual bony and soft tis-
sue distraction at a rate and rhythm of l m m per day in
three divided treatments. A period of stabilization of 6-7
weeks after the last turn was utilized. Morphologic
changes were documented with serial radiographs and
clinical photography.
C O N C L U S I O N : All the patients exhibited marked
improvement in their postoperative occlusal status in addi-
tion to dramatic aesthetic improvement. Patients with the
intraoral (ROD TM) toothborne distraction device under-
went the procedure in a surgical office setting without
admitting them to the hospital and reducing the patient's
expense by as much as 80% from the conventional saggital
split osteotomy costs when done in a hospital. Patients
with an intraoral (ROD TM) toothborne distractor under-
went advancements of 10-14 mm and were able to return
to work (school) only 3 days after the procedure. Full
recovery of neuro sensory mechanism was also observed 3
days post-corticotomy. Intraoral corticotomies performed
156 Journal of Cranio-Maxillofacial Surgery
in conjunction with skeletal distraction appears to offer sig-
nificant advantages over classical treatment of micrognathia
in Class II mandibular deficiency patients. Soft tissues as
well as bone are expanded to a normal configuration. Bone
of a type native to the region is created and the surgical pro-
cedure itself is markedly less traumatic to the patient. There
is no donor site morbidity. Teeth were moved through the
distraction site with a great ease.
Q=m MANDIBULAR OSTEORADIONECROSIS: IS
THERE EVIDENCE TO USE HYPERBARIC OXYGEN
INSTEAD OF ULTRASOUND?
Reher, p.,m, Meghfi, S. I, Harris, 34.1
1Department of Oral & Max. Fac. Surgery, EDI, UCL,
London, UK,"2Dep. of Morphology, UFMG, Belo Horizonte,
Brazil
Introduction: The treatment for mandibular osteora-
dionecrosis include antibiotics and curettage, hyperbaric
oxygen therapy (HBO), surgery, and most recently, thera-
peutic ultrasound.
Aims: The aim of this study was to establish the possible
mechanisms of action of ultrasound, that could explain its
excellent clinical results.
Methods: Two ultrasound machines were evaluated, a 'tradi-
tional' (1 MHz) and a 'long wave' machine (45 kHz). The
ultrasound was applied to human mandibular osteoblasts,
gingival fibroblasts, peripheral blood monocytes and mice
calvaria. The following assays were performed: cell prolifer-
ation, collagen and non-collagenous protein (NCP) synthe-
sis, bone resorption, cytokines and angiogenesis factors
production using ELISA,
Results: Ultrasound induced cell proliferation in fibroblasts
and osteoblasts, up to 52%. Collagen/NCP synthesis was
also enhanced, in fibroblasts up to 48%, and in osteoblats
up to 112%. Bone resorption, part of the bone turnover
process, could also be noted in the mice calvaria assay. In
relation to cytokine production, a slight stimulation of IL-
l[3 was noted in all cell types. There was no difference in IL-
6 and TNFcz levels. The angiogenesis factors, IL-8 and
bFGF, were significantly stimulated in osteoblasts, and
V E G F was significantly stimulated in both osteoblasts and
monocytes. The best intensities were 15 and 30 mW/cm 2(sATA)
with 45 kHz ultrasound, and 0.1 and 0.4 W / c m 2(sATA)with 1
MHz ultrasound.
Conclusions: These results show that ultrasound addresses
the hypocelluarity, hypoxia and hypovascularity observed in
osteoradionecrosis. It stimulates cell proliferation, bone for-
mation, healing, and angiogenesis. Ultrasound is a preferred
option instead of hyperbaric oxygen therapy, since it is
effective, inexpensive and readily available.
r7 G R O W T H M O D I F Y I N G SURGERY, INCLUDING
H I G H CONDYLECTOMY AND TRANSPLANTATION
O F GROWTH INCLUS1NG GRAFTS (VERSUS THE
ILIZAROW-TECHNIQUE)
Reich, R.H.*, B. Niederhagen, 1:.Appe~ £ Berten,
Bonn, Germany
In primary or secondary hypoplasia of the mandibular
condyle, impaired growth of the affected mandibel and
consecutively, of the maxilla is found frequently. For repair,
during the growth period, basicly one of two different
strategies can be followed
1. Induction of growth by transplantation of active free autol-
ogous osteochondral (i. e. costochondral or iliac crest) grafts.
2. Reconstruction of hypoplastic areas by the distraction
osteogenesis.
With respect of the literature and our own experiences on 12
(group 1., age 4 - 14, follow up 4 - 14 yrs) and 4 patients
(Group 2., age 10 - 11 yrs, follow up fi bis 3 fi yrs) respec-
tively, the indication, techniques, advantages and disadvan-
tages of both options are discussed. According to current
knowledge, osteochondral grafting should be reserved for
early childhood ankylosis and severe hypoplasia cases,
extending beyond the mandibular ankle. In the remaining
conditions, the ILIZAROW-technique seems to be pre-
ferrable. It is technically less expensive and more predictable
in results.
Prof. Dr.Dr. R.H. REICH, University of Bonn,
Department of Oral and Maxillofacial Surgery,
Welschnonnenstr. 17, D - 53111 Bonn
Tel. 2 28 / 287 24 52, Fax 2 28 / 287 26 04, eMail: mkg@uni-bonn.de
TECHNIQUE AND RESULTS OF O S T E O P L A S T I C
RECONSTRUCTION O F THE SEVERELY
RESORBED MAXILLA IN COMBINATION W I T H
IMPLANTS
Reinert, S. 1~, K6nig, St. 2, Eufinger, H. 1, Bremerieh, if. 2
1Dept. of Oral and Maxillofacial Surgery, Ruhr University
Bochum, Bochum, Germany, 2Dept. of Oral and Maxillofacial
Surgery, Hospital St. Jiirgenstr., Bremen, Germany
Aims: In the severely resorbed maxillla, a 10-year success
rate of only 48.8-73.8% of implants in combination with
autogenous bone grafts has been reported. We have devel-
oped a modified technique of antral inlay grafting and lat-
eral and vertical onlay grafting of the severely resorbed
maxilla for the insertion of implants to retain dentures. In
this study, the clinical and radiological results are presented.
Method: In 23 patients with severely a resorbed maxilla, a total
of 19 bilateral and 4 unilateral antral inlay graftings and lat-
eral and vertical onlay graftings were performed after a
prosthodontic set-up. We opened the maxillary sinus by
removing a bony window from the anterolateral wall and,
after elevation of the sinus lining, grafted the sinus floor with
cortico-cancellous iliac crest bone grafts. The maxilla was also
augmented in the lateral and vertical dimensions. The bone
grafts were fixed by osteosynthesis. After a median period of 5
months, a total of 135 implants (Branemark) were placed and
later loaded by prosthodontic rehabilitation. Before the graft-
ing procedure, immediately after grafting, after an additional 4
months and every year, CT scans were performed.
Results: 94.5% of the implants have been successful over an
average follow-up period of 2.5 years. Implant failure was
observed only at the time of the abutment operation. Most
patients were provided with implant-borne dentures. CT
scans showed an average initial gain of vertical bone height
of 17.7 mm. One year after grafting a loss of 1.7 mm
occurred. In the following 2 years no major atrophy was
observed. Statistical analysis showed no correlation between
sex, bone height before augmentation, augmented bone
height and resorption of the grafted bone.
Conclusions: As we observed undisturbed healing and
obtained large vertical bone height increases, a high success
rate, minimal resorption and fully satisfying prosthodontic

rehabilitation, we can recomend our modified technique of
reconstruction of the severely resorbed maxilla for routine use.
O N C O L O G Y CATEGORY FACTORS
I N F L U E N C I N G SURVIVAL SUBSEQUENT TO
DISTANT METASTASIS F R O M SALIVARY GLAND
CARCINOMA.
Andrew Renehan 1, Mark McGurk 1, E Neville Gleave ~
1Department of Oral & Maxillofacial Surgery, UMDS,
London; 2Department of Surgery, ChristieHospital,
Manchester, UK.
Background Distant metastases (DM) occur in approxi-
mately 25% patients with salivary gland carcinomas and
their presence is the most important factor in limiting sur-
vival. We have previously reported that tumour size, nodal
involvement and grade are the main predictors of the devel-
opment of DM. Few studies have examined factors which
determine subsequent survival.
Patients and Methods Of a total 244 salivary carcinomas
managed by two consecutive surgeons between 1952 and
1992, there were 69 patients with clinically recognisable
DM. Survival calculations were performed using Kaplan-
Meier analysis with the date of D M diagnosis as the start
point.
Results The sites of metastases were as follows: pulmonary,
65%; skeletal, 20%; brain, 15%; hepatic, 13%; miscella-
neous sites, 15% and disseminated disease, 6%.
Locoregional recurrences preceding a n d / o r accompanying
D M occurred in 58 per cent. Of the 26 patients with D M
from adenoid cystic carcinoma, 79% developed pulmonary
lesions but only two patients (7%) developed brain metas-
tases. Following the diagnosis of DM, the two main factors
influencing survival were (i) isolated metastasis (median
survival for isolated vs. multiple DMs: 10 [95% CI 4-16] mo.
vs. 4 [95% CI 0-8] mo., P=0.03) and (ii) a histology of ade-
noid cystic carcinoma (median survival for adenoid cystic
vs. others: 21 [95% CI 10-32] mo. vs. 4 [95% CI 1-7] mo.,
P--0.008).
Conclusions Almost half D M develop despite locoregional
control. Adenoid cystic carcinoma forms a distinct entity
characterised by a high incidence of pulmonary DM,
longer survival after D M diagnosis and a low incidence of
brain metastases. The latter raises doubt about the signifi-
cance of its reputation as a tumour which spreads via
nerves.
PLASTIC SURGERY F O R CRANIOFACIAL
MALIGNANT TUMOURS.
Reshetov L, Chissov E, Sdvizhkov A., Tanyashin S.,
Polyakov A.,
Moscow. Russia
Cranio-orbitofacial resections in 48 patients with tumours
of nasal cavity, accessory nasal sinuses and maxilla resulted
in large lifethreatening defects exposing skull base ele-
ments, dura mater, and brain which needed to be immedi-
ately corrected using plastic surgery methods. Plastic
reconstruction of the defects was realized by transferring
frontal and fornical fasciocutaneus flaps, broad femoral
EACMFS Abstracts, HelsinkiCongress 1998 157
fascia or musculus temporalis. When microvuscular tech-
niques were to by employed, the defects were closed with a
latissimus dorsi myocutaneous flap sometimes with the
use of musculus serratus anterior, a latissimus dorsi
osteomyocutaneus flap with a rib fragment or an axially
split rib, and great omentum. Complications rate were 28%
and don't postoperative mortality. The rate of recurrence
of the tumours were low ( 10 %). The full rehabilitation
were in 34 % of observations. Such an approach offers a
real chance to help patients who were formerly considered
incurable.
LYMPHATIC DRAINAGE O F PALPEBRAL
R E G I O N ANATOMIC STUDY AESTHETIC AND
PLASTIC SURGICAL A P P L I C A T I O N S
Ricbourg B.
Chu Besanfon, 25000 France
Observation of oedema on a scar after a lower or sub-
orbital approach is frequent.
We identified this oedema as a lymphoedema. We had
already realised an anatomical study of lymph vessels of the
eyelid using 20 fresh cadavers and 6 foetuses.
This study confirmed the classical anatomic sketch.
However, usually, the lower palpebral approach cuts the
lymph vessels and therefore induces lymphoedema.
Transconjuctival approach can resolve this problem. We
have tested this approach on more than 1000 consecutive
cases of orbital traumas.
In 98% of this cases, results are excellent. The only com-
plication that occurred was a few cases of entropion which
were solved surgically.
Exploration of lower, external, internal floor, and
osteosynthesis or implant are possible by this way.
We have also used the technical approach in aesthetic
blepharoplasty.
A daily use of this approach makes it simple, fast,
unbleeding and very aesthetic because no visible scars
remain.
For us, this approach has become very easy, usual and
quite exclusive.
SYNOVIAL C H O N D R O M A T O S I S O F T H E
TEMPOROMANDIBULAR JOINT
REPORT OF A CASE
Rodrlguez-Campo FJ*., Gil-DiezJL., Mu~oz-GuervaM.,
Padr6n-Monedero A., Diaz-Gonzdlez FJ., Elices
Apellaniz M.#
Department of Maxillofacial Surgery
# Department of Pathology
University Hospital La Princesa, Madrid, Spain
Synovial Chondromatosis of the temporomandibular joint
(T.M.J.) is an uncommon benign condition characterized
by metaplastic formation of multiple foci of highly cellular
cartilage in the synovium and loose bodies in the joint
space.
We present a case of synovial chondromatosis of the
T.M.J. diagnosed and treated by arthroscopy. The signs
and symptoms of the patient were similar to the internal
158 Journal of Cranio-MaxillofacialSurgery
derangement. No abnormalities were found in the plain
radiographs. Nonsurgical treatments were unsuccessful.
Arthroscopic T.M.J. surgery was performed. Loose bodies
and foci of metaplastic synovium were found, all of them
were removed arthroscopically. The pathology report was
consistent with synovial chondromatosis. Although the
clinical improvement persist at the moment (6 months
post-surgery), a long time follow-up is necessary to con-
firm the clinical improvement and no recurrence of this
entity.
A C O M P A R I S O N BETWEEN THE UNIVERSITY O F
WASHINGTON HEAD AND NECK QUALITY OF LIFE
M E A S U R E AND THE M E D I C A L SHORT F O R M 36,
EORTC QOQ-C33 AND EORTC HEAD AND NECK.
S N Rogers ~, D Lowe,
Regional Maxillofacial Unit, Walton Hospital, Aintree
Trust, Liverpool.
The aim of this study was to compare the University of
Washington Head and Neck Quality of Life measure (UW-
QOL) with three validated measures in a group of patients
having primary surgery for oral cancer.
Between May and December 1995, 34 consecutive
patients with previously untreated oral and oropharyngeal
squamous cell carcinoma underwent primary surgery.
Patients self completed the following questionnaires; UW-
QOL, Medical Outcomes Short Form 36 (SF-36), the
European Organisation for Research and Treatment of
Cancer (EORTC) QOQ-C33 and the EORTC Head and
Neck. Questionnaires were distributed at four time inter-
vals: pre-operatively, and a 3, 6, and 12 months. Patients
were withdrawn if they developed recurrent disease.
Twenty nine patients agreed to participate in this
prospective study and at one year 14 patients completed
questionnaires.
Longitudinal data for each measure will be presented
and discussed, as will Spearman correlations at P<0.001
level across the four measures.
This study emphasises the difficulties of One measure to
adequately assess QOL, however it would appear that the
UW-QOL offers a broad tool suitable for routine 'low cost'
clinical quality of life evaluation.
REHABILITATION OF CHILDREN WITH
CONGENITAL DEFECTS AND D E F O R M I T I E S O F
MAXILLO-FACIAL AND CRANIOFACIAL AREA
V. V. Roginsky, I/..34. Bezrukov, M. V. Ananov, G.M.
Savitskaya, L. E Ageeva, O.L Arsenina, IV. V. Kuzhelko, G.A.
Pavelko, A.E. Reznikova, M.M. Beriova
Moscow Children Maxillo-facial Surgery Center (Central
Research Institute of Dentistry, St. Vladimir Hospital).
Neuro-surgery Institute n.a. N.N. Burdenko, Moscow, Russia
At the time the possibility of reconstruction of different
defects and deformities of maxillo-facial and craniofacial
area and complete social rehabilitation was already demon-
strated.
The most important issue for today is the creation of the
conception of aid for these patients, since this kind of aid
includes some specific organizational, medico-technical and
social elements. The terms of surgery procedures, relevant
areas, the sequence of the said procedures, taken as a whole,
early medical and social rehabilitation need a good
approval.
The experience of clinical observation, which is more
than 1000 cases, made it possible for the authors to make a
sort of analysis of the stages of aid, to find a ground for the
time period of surgery procedures and to work out a list of
methods and ways of bringing a medical assistance to this
group of patients. A program of rehabilitation of children
with congenital defects and deformities of maxillo-facial
and craniofacial area was carried out.
The lowering of the age limits for surgery procedures for
these groups of patients is considered to be a prior task for
the surgeons at the moment. The lowering will make the
rehabilitation of lost functions more effective and it will also
let the early medical and social rehabilitation possible.
DIAGNOSTIC P O T E N T I A L OF DYNAMIC M R I IN
STAGING O F T M J DISORDERS
D.Rohner*, B.Hammer, J.Prein, A. Geissmann* *
Clinic for Reconstructive Surgery, University hospital, CH-
4031 Basel
**Private Clinic for Radiology, Riimelinbachweg 6, CH-4031
Basel
MR-examinations of both TMJ's were carried out on 43
patients who clinically had an acute anterior disc displace-
ment. Clinical criteria included painful mouth opening,
translation deficits of the mandibular condyles and devia-
tion of the lower jaw of the affected side.The MR-examina-
tion was carried out statically and dynamically in the sagital
and coronal directions.
In 30 cases, a correlation was found between the clinical
diagnosis and the MR-findings.
In 6 patients, an anterior disc displacement on both sides
was found on the MRI. With another 7 patients no luxation
was recognized, but on the dynamic M R I adhesions were
detected causing restriction of condylar movement.
This study showed, that the dynamic MR-examination
allowed an important diagnostic differentiation, resulting in
30% of the patients requiring a modification of therapy. The
dynamic M R I provided more additional information than
the static MRI.
RECONSTRUCTIVE TECHNIQUES IN CRANIAL
BASE T U M O U R SURGERY
Romance, A. *, Sdnchez Aniceto, G., Gutidrrez, R., Montalvo,
J., Diez-Lobato, R., Cabrera, A.
Deparment of Maxillofacial Sugery. Deparment of
Neurosurgery. Hospital 12 de Octubre. Madrid. Spain.
Aims. In this article the authors describe their experience in the
surgical treatment of 43 patients presenting a skull base neo-
plasm. Special attention is given to reconstructive techniques
and final results in terms of survival and major complications.
Method: Forty three patients with a skull base neoplasm,
underwent surgical treatment between October 1992 and
January 1998. Twenty three patients presented with benign

tumours or pseudotumours, and twenty had malignancies.
Seventeen patients had had previous surgical procedures
and four had received irradiation therapy. Most of the neo-
plasm affected the middle cranial fossa, anterior segment
(n=23), or the anterior cranial fossa, lateral portion (n=15)
or central portion (n= 14). Twenty seven patients underwent
combined intra-extracranial approaches. The most com-
monly used approaches were: transfronto-orbital (n=19)
and lateral preauricular-infratemporal (n= 18). We describe
the 43 postsurgical deflects, detailing the state of integrity of
the duramater, upper aerodigestive tract, skin, craniofacial
skeleton, cavities, cranial nerves, and internal carotid artery.
Reconstructive techniques included: local flap (galeal-peri-
cranial, 23 cases; temporoparietal fascia 4), myofascial flaps
(temporalis muscle, 11 cases; galea frontalis, 2 cases),
myocutaneus (pectoralis major, 4 cases), and microvascular
free flaps (lattissimus dorsi, 3 cases; rectus abdominis, 3
cases). In 25 cases, autologous bone grafts were used to
reconstruct the orbital rims, walls or cranial vault defects.
Thirteen patients underwent cranial vault or temporal fossa
methyl-methacrylate reconstruction.
Results: In thirty-seven cases (86%) complete resection of
the tumour was achieved. One patient succumbed in the late
postoperative period ( 4 weeks) due to internal carotid
artery bleeding. Sixteen patients received postoperative irra-
diation therapy. Median follow-up has been 36 months
(range 8-73 months); the overall survival rate was 83.7%
(70% for malignant tumours) and the disease-free survival
rate 58% (51% for malignant tumors). Twenty one patients
(56%) suffered postsurgical complications: neurological (11
patients), aproach-related (9 patients), surgical wound
related (8 patients), cerebrospinal fluid fistula (4 patients)
and systemic (3 patients).
Conclusions: Suitable reconstructive principles are essential
to achieve fair results in terms of survival and life-quality in
patients with skull base neoplasms.
" R E D U C T I O N " OF "BIG EYES" IN P E O P L E W I T H
S H A L L O W ORBITS
Roncevic R.
Clinicfor Burns, Plastic and Reconstructive Surgery
University Clinical Centre, Beograd, Yugoslavia
Aims: To explain the phenomenon of "big eyes" in healthy
people and t o present the author's own method of surgical
correction of this phenomenon.
Method: In three healthy individuals with "big eyes" the sur-
gical "re-duction" of the "big eyes" was performed. The sur-
gical proedure consists of the symmetric removal of the
retrobulbar part of the orbital floor and intraorbital fat via
an eyelid approach.
Results: In all three individuals excellent results were
achieved. The eyes are "reduced" to a desirable size, i.e., 5
mm in two persons and 4 mm in the third. Postoperatively,
there were no sight disorders or cases of double vision in
any patients operated on. The eye movements were normal
in all directions.By "reducing" the eyes the total appearance
of the face changed, i.e., face looked more aesthetically
pleasing.
Conclusion: "Big eyes" in healthy people are a conse-
quence of a shallow orbital floor and short longitudinal
diameter of the orbit. It is possible to correct this aesthetic
drawback relatively easily by removal of the retrobulbar
part of the orbital floor and intra-orbital fat.
EACMFS- Abstracts, Helsinki Congress 1998 159
CO2-LASER TREATMENT OF ORAL
LEUKOPLAKIA
Roodenburg, JLN *~,Nauta, JM, Vermey, A.
Department of OMFS, UniversityHmpital Groningen,
Groningen, The Netherlands
Aims: Due to the strong absorption, CO2-1aser light causes
superficial evaporation of soft tissues. This makes the CO z-
laser an excellent modality for treatment of superficial
lesions. The efficiency of CO2-1aser in the treatment of oral
leukoplakia was evaluated.
Method: Oral leukoplakia of different clinical and histologi-
cal types has been treated since 1976. The first 103 cases
were followed extensively. After that about another 400
cases were treated routinely by CO)-laser evaporation.
Results: Almost all treatments were done under local anaesthesia
on an out patient basis. Wound healing was excellent with minimal
cicatrization and a good functional result. The first 103 cases
showed a cure rate of 90%. In the total group, only 3 cases of squa-
mous cell carcinoma, developing in a laser- treated area were seen.
Conclusions: CO2-1aser evaporation is a good prophylactic
modality for oral leukoplakia, with a high cure rate. The
functional results are excellent.
P O S I T R O N E M I S S I O N T O M O G R A P H Y (PET) FOR
THE DETECTION O F L Y M P H N O D E METASTASES
OF SQUAMOUS CELL CARCINOMAS IN THE NECK
Roodenburg, JLN, Braams, JW, Vermey, A, Vaalburg, W..
Department of OMFS, Department of Surgery, PET Centre,
University Hospital Groningen, Groningen, The Netherlands
Aims: By using radioactive tracers such as glucose ana-
logues or amino acids, PET enables visualization of biologi-
cal processes. The value of this technique for the detection
of lymphnode metastases of squamous cell carcinoma in
the neck was evaluated.
Method: In this study 2-deoxy-2- [lSF] fluoro-D-glucose
(FDG)(185-370 MBq) and L-[1-HC] tyrosine (Tyr)(370
MBq) was applied for the detection of neck node metas-
tases of the head and neck squamous cell carcinoma with
a Siemens ECAT 951/31 PET camera. Tyr was also used
in a PET whole body mode (Tyn WB) registration to
reduce the camera time from 2 h to 30 min. the results
were correlated with the pathology and sensitivity, speci-
ficity and positive and negative prediction value were
calculated.
Results: N Sens Spec Pred Val
PET-FDG 12 91 88 99
PET-Tyr 11 83 95 98
PET-Tyr 22 83 97 97
(whole body)
Because of the resolution of the camera, the minimum
size of a metastatic lymphnode detected by PET was 5 mm.
A drawback of F D G was the uptake in inflamed nodes,
resulting in relatively high false positive results. The uptake
of Tyr in salivary glands hampered the detection of metas-
tases located close to the glands.
Conclusions: PET-FDG/Tyr/Tyr WB showed a high negative
predictive value, that is useful to confirm a negative neck. PET-
F D G is hampered by a false negative results and PET-Tyr by
160 Journal of Cranio-MaxillofacialSurgery
uptake in salivary glands. The reduced camera time, using
PET-TyR WB has no negative effect on sensitivity, specificity,
positive predictive value and negative predictive value.
[~ A LIFE THREATENING ANEURYSMAL BONE
CYST
Z. Roscie* B. Gattinger, M. Malek, L H6pfel, £ Obwegeser
Department of OMFS, AKh-Linz, Austria
Aims: Concerning the differential diagnosis of pronounced
masses in the cervical region during childhood in most cases
lymphomas, lymphangiomas, haemangiomas and cysts are
expected. The case demonstrated shows that very rare
lesions should also be included in diagnostic reflections.
Subject: The case history presented is of an eight year old boy
with a large expansion in the cranial part of the neck on the
right side. Neurological defects did not appear but a severe
limitation ofmobility of the cervical vertebral column was
present. Five years previously an acute lymphatic leukaemia
was successfully treated. During the surgical exploration a
large cystic lesion filled with clotted and unclotted blood was
found. After removing the lesion the defect reached the
epidural space in the region of the first and second cervical
vertebrae. The right vertebral artery had to be ligated.
Results: The histological investigation revealed an aneurys-
mal bone cyst. In the postoperative period, no signs of ver-
tebral instability were detectable. A radiographic check
showed no signs of a relapse after 1 year.
Conelusions: Aneurysmal bone cysts represent one of the
most rapidly growing bone lesions. They account for only
1.4% of primary bone turnouts. In the literature, different
findings are documented. The incidence in the vertebral
region amounts to 3% - 20%; 13% - 50% of them are mani-
fested in the cervical vertebral region. Most authors recom-
mend radical removal as adequate therapy.
[~ ALAR BASE C L I N C H SUTURE, OR NO ALAR
BASE CLINCH SUTURE?
*Rosenberg dr. A., Muradin M.
Aim: Ventralisation and impaction of the maxilla might
result in widening of the alar base. To prevent this, an alar
base clinch suture is recommended. From a theoretical
point of view this might move the pronasale upwards result-
ing in a buttonhole nose. From 1993 on we refrained from
using the alar base clinch suture. In this paper the effects on
the nose and upper lip are described.
Method: From 201 patients who underwent several
osteotomies, a subgroup of 32 patients (average age 26years
7 months) was constituted in whom the maxilla had been
moved upwards and or forwards. Cleft-lip palate patients
were not included. Alar base width was measured preopera-
tively and 12 months after the Le Fort I osteotomy. Tracings
were made preoperatively andl2 months post-operatively.
All tracings were digitized (DFPlus 15 in an IBM compati-
ble Microscan computer). An X-Y coordinate system was
used in order to observe changes in the X and in the Y direc-
tions. Bony points included SNA, A-point, and I-point. Soft
tissue points: pronasale, subnasale, superior labial sulcus
Labrale superior and stomion superior. Error was measured
on 10 randomly selected patients.
Results: The post-operative course was uneventful in 29
patients. In 2 patients secondary correction of the septum
was necessary. In l case the tissue around the osteosynthetic
material became infected and it had to be removed after 3
months.
Mean impaction of the maxilla at A-point was 1.69 mm.
Mean ventralisation: 2.29 ram. Alar base width increased
1.89 mm. Pronasale moved forward 0.84ram. Pronasale
moved upwards 0.98 mm.
It is therefore concluded, that refraining from inserting
an alar base clinch suture gives a minimal increase in alar
base width and is not indicated in the average Le Fort I
osteotomy with upward and/or forward movements. It
should be stressed, that the movements in each patient can
differ greatly, and so are the soft tissue changes. In these
cases the individual aspects should be looked at, before one
refrains from inserting an alar base clinch suture.
L I P O S U C T I O N IN ORTHOGNATHIC SURGERY
*Rosenberg, dr. A., Muradin, M
Dept, of Cranio-Maxillofacial Surgery, University Hospital
Utrecht, The Netherlands.
Aim: To evaluate the benefit of liposuction in combination
with mandibular advancement in the elderly patient with a
Class II deformity and in cases of mandibular setback for
correction of mandibular prognatism.
Material and Methods: From the Utrecht database
(Osteodat), which contains 201 relevant patients, 4 patients
were selected who have had liposuction of the submental
area in combination with mandibular surgery. All patients
were female, mean age: 38 years (range 26-51). Three
patients had a Class II deformity. One patient had a Class
III deformity. Average follow-up time was 1 year and 3
months.
Results: All patients were very satisfied with the result. Two
elderly patients with Class II deformity appeared to have
benefitted most from liposuction in combination with
mandibular advancement. Mandibular advancement alone,
as is normally done in the adolescent Class II patient, is not
sufficient to create a nice neck form in the elderly. This is
due to loss of laxity of the skin and subcutaneous tissue,
and sagging of fatty tissue between the two platysma mus-
cles. In cases of mandibular prognathism this is an impor-
tant tool to prevent the ugly complication of the double
chin. Despite the limited number of patients, it is concluded
that liposuction has its value in the elderly Class II patient
and to prevent the double chin in cases of mandibular prog-
nathism of any case.
ABLATION O F T U M O U R S EXTENDING TO THE
I N F R A T E M P O R A L SPACE
AL Rotaru*, R. S. C~mpian, Lucia Hurubeanu, Mihaela
Popa, Gr. Baciup,
Department of Oral and Maxillofacial Surgery, "Iuliu
Hapieganu'" University of Medicine and Pharmacy, Cluj-
Napoca, Romania
Aims: Various authors have presented different techniques
of approach for benign tumours with invasive behavior
(such as the ameloblastoma) and for malignant tumors

(especially maxillary carcinoma extending to the infratem-
poral space). Each specific case needs proper adaptation of
the surgical technique. The authors present an adjusted
technique applied in a complex case.
Subject: Diagnosis and tumour dimensions required exten-
sive ablation of any tumour growing beneath the cranial
base. The complexity of the case was further increased by
the limits of the turnout extension, the histological type
(mucoepidermoid carcinoma, with poor response to addi-
tional radiation therapy), the patient's profession (painter),
because of the invasion of the eye.
Method: The technique comprised a face - split in the vicinity
of mediosagittal plane, allowing extensive ablation of the
tumour and preservation of vital anatomical elements at the
cranial base. The exposed dura mater resulting from partial
resection of the sphenoid bone was covered with a homolat-
eral fasciomuscular temporal flap. The flap was also used for
plastic conformation of the orbit in view of the prosthetic
rehabilitation of the eye. Reconstruction of the facial contour
was provisionally attained with a two-component prosthesis.
Results: The postoperative course was uneventful, the
patient adapted well to the new situation. The postoperative
improvement of his psychological condition is attested
impressively in his pre- and postoperative paintings.
Conclusions: The efficiency of the method is emphasized
with regard to the eradication of the tumour and satisfac-
tory functional rehabilitation.
A COMPARATIVE CLINICAL STUDY OF THREE
DIFFERENT E N D O S S E O U S I M P L A N T S IN
E D E N T U L O U S MANDIBLES
Roynesdal A.K., DDS, Ambjornsen E., DDS, PhD, Haanaes
H.R., Professor, DD, MD, Phd.
Oslo, Norway
The purpose of this prospective clinical study was to investi-
gate the outcome of three different endosseous, non-sub-
merged implants in the anterior part of the mandible.
Fourteen elderly edentulous patients, 10 women and 4 men
were included, ages ranging from 65 to 80 years (mean age
71.9 years). All participants had three different endosseous
implants placed in the anterior mandible. One was a tita-
nium plasma-sprayed cylinder implant (d=4mm), one a tita-
nium cylinder implant with hydroxyapatite coating
(d--4mm) and one a standard-threaded titanium implant
(d--3.75mm). The three types of implant were originally
made for a two-step procedure. At this stage however, all
implants were simultaneously provided with a temporary
abutment which penetrated the mucosa. Three months later
they were replaced by ball abutments which were connected
to an overdenture. At 12, 24 and 36 months marginal bone
resorption and Periotest® values were recorded. Two
patients died within the two first postoperative years. Five
implants out of 45 (11.9%) failed to osseointegrate (3
threaded titanium implants, 1 plasma-sprayed cylinder and
one hydroxyapatite-coated cylinder). After 3 years, marginal
bone resorption around titanium plasma-sprayed cylinders
was significantly increased compared with the other implant
types. Additionally, threaded titanium implants had signifi-
cantly better scores than hydroxyapatite coated implants
(p>0.05). Periotest® values for hydroxyapatite-coated
implants were significantly better than test values for the
other implants, after 3 years (p>0.05). The conclusion from
the study is that non- submerged implants have less good
prognoses compared with implants inserted according to
EACMFS- Abstracts, Helsinki Congress 1998 161
the two-stage concept, when used in the anterior mandible.
It was observed that titanium plasma-sprayed cylinder
implants demonstrated more marginal bone loss compared
with the other implants used. Furthermore the Periotest®
values for hydroxyapatite-coated cylinder implants were
superior to titanium plasma-sprayed and pure titanium
implant surfaces. When the non-submerged method is cho-
sen, implants made specifically for this concept should be
used.
[~ CHRONIC MAXILLARY SINUSITIS OF
O D O N T O G E N I C ORIGIN
Krupski, W..,Rdzylo, ZKd, Ziomaniec, J., Bryc, S., R6zylo, L*
Department of General Radiology, Faculty of Medicine,
Medical University of Lublin, Lublin, Polanck
1Department of Stomatology, Laboratory of Maxillofacial
and Dental Radiodiagnostics, Faculty of Medicine, Medical
University of Lublin, Lublin, Poland
Aim: In clinical practice there are observed cases of
chronic maxillary sinusitis not responding to conservative
treatment. The aim of the paper was to prove that such
cases of chronic maxillary sinusitis are of odontogenic
origin.
Material and method: CT examinations were carried out in
51 patients with chronic maxillary sinusitis. 3D CT recon-
structions were supplementary to standard scans.
Results: In 42 cases the pathological changes were limited to
a single sinus. There were observed: polypous hypertrophy of
maxillary mucous in the base of maxillary sinus, mostly
spherical in shape as well as heaped-up, polycyclic thickening
of all sinus walls. Complete filling of maxillary cavity with
polypous mass was found in 8 cases. The most often encoun-
tered symptom was the lack of pneumatization of alveolar
recess of maxillary sinus. Thinning or destruction of dense
bone of alveolar recess of maxillary sinus was visualised in
21 patients. In 3 patients maxillary sinusitis was caused by
the presence of an oro-antral fistula. In these cases segmen-
tal discontinuity of alveolar dense bone which at the same
time comprises the mass of maxillary" sinus was observed. In
high-resolution programme in 27 persons there were visu-
alised focal reductions in density of alveolar bone. Periapical
changes were present in 38 patients. In two cases impaction
of a tooth root into maxillary sinus was revealed. 3D recon-
structions obtained on the basis of standard CT scans
showed relationships between lesions within the maxillary
cavity.
Conclusion: The use of CT in diagnostics of chronic maxil-
lary sinusitis creates new possibilities of determination of
odontogenic ethiology which is fundamental in choice of
the course of treatment.
THE USE OF 3D RECONSTRUCTIONS F O R
DIAGNOSTICS O F MAXILLOFACIAL TRAUMA
R6zylo, T.K.I, Krupski, IV..,Zlomaniec, J., Bryc, S., R6zylo, L *
L * Department of General Radiology, Faculty of Medicine,
Medical University of Lublin, Lublin, Poland;
1Department of Stomatology, Laboratory of MaxilloJacial
and Dental Radiodiagnostics, Faculty of Medicine, Medical
University of Lublin, Lublin, Poland
162 Journal of Cranio-MaxillofacialSurgery
Aim and method: The aim of the study is evaluation of max-
illofacial fractures by means of 3D CT reconstructions
obtained on the basis of computer data from axial CT
scans.
Material: The material comprised 43 patients with complex
maxillofacial fractures requiring 3D reconstruction.
Results: In 28 persons displacements of bone fragments
were multidirectional with torsion and oblique inclination.
3D reconstructions from different scans determined the
extent of damage as well as the degree of displacement and
torsion of bone fragments. The fragments dislocated to
orbit and maxillary sinus were visualised in 17 cases and
ones displaced to frontal sinus in 12 cases. In 3 cases they
were separated from the anterior cranial fossa. The depth
dimension enables reconstruction of the extent and charac-
ter of fractures with bone impression. It also makes it possi-
ble to determine spatial relationships between walls of orbit
and maxillary sinus by showing their internal depth.
Conclusions: The 3D CT images are a valuable supplement
to 2D CT scans. The 3D option enables cutting, turning and
leaning of images of bony structures at any angle which
makes it possible to observe isolated bone walls also from
the inside of the skull. The reconstruction of reciprocal spa-
tial relationships is essential in treatment planning.
Ph MANDIBULAR DISTRACTION O S T E O G E N E S I S
TO CORRECT H Y P O P L A S T I C MANDIBLES.
Rubio P *, Naval L, Rodriguez F, Gil-Diez JL, Mu~oz M,
Padr6n A, Sastre J, Villa E, Carre~o A, Sdnchez M, Diaz F.
Department of 34axillofacial SurgelT, University Hospital de
la Princesa, Madrid, Spain.
Aims: To present our results in mandibular distraction
osteogenesis using external and internal devices.
Method: Six bone lengthening devices for external applica-
tion and six intraoral devices were used in nine patients.
Results: The average amount of bone lengthening was 25
mm, ranging from 15 to 37 mm. The mandibles were main-
tained in fixation for an average of 11 weeks subsequent to
the period of active lengthening.
Conclusions: Despite of the short follow-up of these
patients, the mandibular distraction osteogenesis appears to
be an useful method to correct hypoplastic mandibles.
When the desired increase is up to 30 ram, the intraoral dis-
traction is the treatment of choice.
Abstract For the XXXIIIrd Congress of the European
Society for Surgical Research,
April 22-25, 1998, Padua
A NEW M O D E L FOR QUANTITATIVE IN VIVO
A S S E S S M E N T OF THE INFLAMMATORY
R E S P O N S E IN PEDICLED AND TRANSFERRED
OSTEOMYO-CUTANEOUS F L A P S
Riicker, M. ~, Schiifev, T., Roesken, F., Spitzer, W..,Menger, M.D.
Dep. of OMFS and Inst. for Clin. & Exp. Surgery, Univ. of
Saarland, 66421 Homburg, Germany
Aims: Despite anastomotic patency, there are still individual
cases of failure of osteomyocutaneous (OMC) flaps in clini-
cal practice. Due to the lack of appropriate animal models,
little is known whether these types of flap failure are caused
by inflammatory processes induced by the surgical trauma
and/or by the transfer-related ischaemia/reperfu-sion insult.
Therefore, the purpose of our study was to establish a rat
model to assess the inflammatory response in pedicled and
transferred OMC flaps in vivo.
Methods: For our study we used pentobarbital-anaes-
thetized Wistar rats (n=10). A circular skin island was cir-
cumcised anteromedially on the left hind limb. The tibial
bone was cut proximally and distally and the lateral and
dorsal aspects of the bone segment were dissected free. The
gracilis and semitendinosus muscles connected with the
tibia segment were cut at their medial aspects. After subse-
quent dissection of the femoral vessels to the inguinal liga-
ment, harvesting of the OMC flap, pedicled on the femoral
vessels and consisting of tibial bone, two muscles and over-
lying subcutis and skin, was completed. Exterioration of the
flap allowed intravital fluorescence microscopy
(Rhodamine-6G 2gmol/kg iv) with analysis of leukocyte-
endothelium interaction in muscle, subcutis and periosteum.
Parameters assessed in postcapillary venules were leukocyte
rolling [%], leukocyte adherence [n/mm=] and macromolecu-
lar (FITC-dextran, M W 150.000) leakage [%] as a measure
of endothelial integrity. In 5 animals, the OMC flap was
transferred to the contralateral hindlimb and anastomosed
end-to-end to the right femoral vessels.
Results: Intravital fluorescence microscopy demonstrated an
inflammatory response in pedicled OMC flaps, character-
ized by leukocyte rolling and adherence in muscle (35.7 +
5.7 %; 308.9 + 40.1 ram-2), subcutis (41.9 + 6.6 %; 391.l +
26.8 mm -2) and periosteum (36 _+ 5.5 %; 431.9 _+43.2 ram-Z).
Subsequent transfer, involving a 1 hour ischaemia, did not
further affect leukocyte rolling (muscle: 33.9 _+ 4 % / sub-
cutis: 48.4 + 7 % / periost: 41.3 + 2.1%), but induced signif-
icant (p<0.05) aggravation of leukocyte adherence (muscle:
607.2 _+ 16 lnm -2 / subcutis: 573.2 + 44 mm 2/ periost: 691.1
_+ 31.9 ram-2), which was associated with increased macro-
molecular leakage (muscle: 20.8 %, p<0.05 / subcutis: 11.9
%, p<0.05 / periosteum: 2.2 %).
Conclusions: Herein we demonstrate a new model which
allows quantitative in vivo analysis of leukocyte-endothe-
lium interaction in pedicled and transferred OMC flaps.
Our study indicates an inflammatory response in pedicled
flaps, which is probably caused by the surgical trauma.
Additional flap transfer associated with an ischaemia/reper-
fusion insult induces augmentation of the inflammatory
response and microvascular injury, as indicated by increased
leukocyte-endothelium interaction and loss of endothelial
integrity.
PRELIMINARY FINDINGS ON EXTRAORAL
OSSEOINTEGRATED IMPLANTS AND
PROSTHESES
Saarinen, P. * and Pulkkinen, J.
Cleft Cente~ Department of Plastic Surgery,
Helsinki University Central Hospital, Helsinki, Finland
Aims: To present our experience on reconstruction of cran-
iofacial defects with Brgmemark osseointegrated implants
and orbital or auricular prostheses.
Material: Sixteen patients were treated. Eight patients
suffered from deformity of one or both ears (3 microtia, 3
hemifacial microsomia, 2 cancer of the external ear). The
ears were reconstructed with 26 implants and 10 auricular
prostheses. Eight patients suffered from loss of one eye (2

explosion trauma, 5 carcinoma, one congenital
anopthalmia). They were reconstructed with 32 implants
and 8 orbital prostheses. Auricular prostheses were sup-
ported by bar splints with gold clip attachment and orbital
prostheses by magnets. All prostheses were made of silicone.
Results: Primary osseointegration was successful in all cases.
Seven out of 32 implants were lost (21,8%). One patient lost
all four implants because of late healing problems due to
previous radiation therapy. One patient lost two and one
patient lost one orbital implant, but both of them can use
the prostheses in a normal way. None of the 26 auricular
implants were lost. Some prostheses were replaced later due
to discolouring and minor defects.
Conclusions: Osseointegrated implants are a significant
advance in the treatment of craniofacial defects. Careful
patient selection and planning of procedures are needed for
good results. The number of failures seems to be greater in
the orbital region than in the auricular region. Regular fol-
low-up is important to prevent late implant loss.
THE CO2 LASER IN ORAL SURGERY
R. Sacco, R. Borloni, A. Lucchi, M. Macchi, R. Vinci
Department of Maxillofacial Surgery (Head." R. Vinci
MD), Istituto Stomatologico Baliano, Milan, Italy
The use of the C02 laser in the oral cavity has been
described in the past 20 years, initially in the United States
in the years 1978/79.
In our Institute, this method was introduced in 1990.
This study involved the clinical audit of 160 patients who
had undergone laser surgery in the oral cavity in our
Institute during 1990 to 1997.
The diagnoses of the 160 patients were benign, premalig-
nant or malignant lesions. The most common sites of the
lesions were the floor of the mouth, the surface of the
tongue, followed by upper alveolus and/or palate, angle of
the mouth and/or cheeks, lower alveolus, and lips.
The results showed that the use of the C02 laser in treating
oral soft-tissue pathology presented advantages over conven-
tional techniques. The advantages of lasers include a rela-
tively bloodless surgical and post-surgical course, minimal
swelling and scarring, coagulation, vaporization and cutting,
minimal or no suturing, reduction in surgical time and, in a
majority of cases, much less or no post-surgical pain.
DISTRACTION O S T E O G E N E S I S O F PREVIOUSLY
GRAFTED SITES IN THE LOWER JAW
A. E1-Fattah. A. Sadakah.
Oral and Maxillofacial Surgery Department, Faculty of
Dentistry, Tanta University, Egypt.
Aims: To evaluate both clinically and radiologically the
opportunities of using the distraction osteogenesis prin-
ciple in elongating mandibles previously grafted with
costochondral grats which failed to give satisfactory
growth.
Method: Five patients suffering from unilateral mandibular
hypoplasia who have previously been treated with costo-
chondral grafts which gave inadequate growth were
included. They were treated by the use of a unidirectional
EACMFS Abstracts, Helsinki Congress 1998 163
external distractor for gradually distracting callus formed at
an osteotomy line performed in the previously grafted sites
at a rate of 1 m m / d a y for 3 to 4 weeks. They were followed
up both clinically & radiologically for about two years.
Results: All patients showed marked improvement in facial
contour with horizontalization of the occlusal plane. The
newly formed bone was of the same density and height as
the surrounding bone.
Conclusions: Based on the promising results of this study.
The distraction osteogenesis of previously grafted sites in
the lower jaw proved to be a simple, successful and reliable
technique for correcting mandibular hypoplasia.
NEW INVESTIGATIONS IN VELOPHARYNGEAL
INSUFFICIENCY IN PATIENTS W I T H CLEFT
PALATE
Sadet;R.*, Horch, H.H.,Bressmann, T. Zeilhofer, H.F.T.,
Hannig, Ch., Hess, U.,Brockmeier, J.
Dpt. of Oral and MaxilloJacial Surgery, University of
Technology, Munich, Germany
The indication for operative improvement of the rhinopho-
nia in cleft palate patients is mainly based on subjective
logopedics or nasopharyngoscopy. But often an insufficient
postoperative functional result can be seen. Acustic phonet-
ics in combination with an imaging method lead to an
objectivation and dif-ferentiation of the rhinophonia and
have much influence on operative corrections.
Based on a retrospective survey on 89 patients who
underwent a velopharyngoplasty from 1988-1993, we per-
formed a prospective study from 1994-1997 in 50 cleft
patients where the question for a velopharyngoplasty was
discussed. For this, the velopharyngeal movements were
represented by highfrequency-videocineradiography and by
nasopharyngoscopy pre- and postoperatively. The speech
was evaluated by computerized spectrography, the nasal air
flow was objectively measured by detecting the oral and
nasal sound intensity (nasalance).
In 32 patients with rhinophonic speech, only an articu-
latoric disturbance with-out velopharyngeal insufficiency
was found. Here, an operative concept was avoi-ded but
an intensive logopedic training was performed. In 6
patients a sufficient velopharyngeal closure was shown by
the imaging procedures but a pathological nasalance was
found. Here an individually pharyngoplasty was per-
formed. In 12 patients with a large velopharyngeal gap a
velopharyngoplasty was performed whereby the pharyn-
geal flap was designed individually according to the radio-
logical analysis, for example lateralization of the flap.
Postoperatively in all patients an improvment of the
speech parameters and the nasalance could be prooven,
the radiological analysis showed an improved velopharyn-
geal closure.
Our results, based on radiological analysis of velopharyn-
geal movements in all over 214 cleft palate patients, show
that the orovelopharyngeal muscle dysfunction has high
influence on rhinophonia in cleft patients, not only the
velopharyngeal gap. Considering the different parameters,
we could individualize and improve the used operative tech-
niques. But the analysis of our results shows as well that the
known speech improving operations are really unphysiologic
and that there is a demand for new operation techniques
regarding a restitution of the velopharyngeal muscle
function.
 164 Journal of Cranio-Maxillofacial Surgery
r7 BIODEGRADABLE SELF-REINFORCED
POLYLACTIDE OSTEOSYNTHESIS IN
ORTHOGNATHIC SURGERY
Haers P.Efl*, Suuronen Rfl, Lindqvist C 2, Sailer H.Ffl.
1Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland. 2Department of Oral and
Maxillofacial Surgery, University Hospital Helsinki
Introduction: Metallic osteosynthesis material in orthog-
nathic surgery has the disadvantage that it has to be
removed after the osteotomy has consolidated, which often
requires general anaesthesia. Titanium plates have been
introduced to bypass this need for secondary intervention.
However, due to corrosion, titanium particles have been
found in scar tissue covering these plates and in regional
lymph nodes. Therefore, their removal has been advocated
too. Moreover, if plates remain in situ for life, they cause
artefacts in CT-imaging and especially MRI-examination of
the midface and oral cavity is impossible. In earlier studies,
self-reinforced polylactide devices have proven to have
sufficient strength to bypass the need of additional support
for the fixation of fractures and mandibular osteotomies.
Method: Self-reinforced polylactide plates and screws were
used for osteosynthesis in 10 consecutive cases of bimaxil-
lary osteotomies with simultaneous genioplasty (January-
February 1998). Exclusion criteria were syndromes,
systemic diseases, cleft deformities and refusal to participate
in the study. The plates used in the maxilla (two on each
side) and at the level of the sagittal split (one on each side)
were fixated with 2 mm screws, whereas the chin fragment
was fixated with two 2.7 mm bicortical screws. The self-rein-
forced plates and screws were bent at room temperature.
Training elastics were used postoperatively. The clinical fol-
low-up took place on a weekly base during the first six post-
operative weeks. Cephalograms and orthopantomograms
were made preoperatively, immediately postoperatively and
six weeks, three and six months postoperatively.
Results: There were no postoperative complications linked
to the osteosynthesis material. Wound dehiscence, infection
or pseudarthrosis did not occur. All bone fragments were
clinically stable. Cephalometric analysis after six weeks
showed normal initial skeletal stability, comparable with the
pattern reported following osteosynthesis with titanium
plates. The six months results concerning skeletal stability
will be reported.
Conclusion: The results of this study so far suggest that
biodegradable SR-PLLA plates and screws can be used for
osteosynthesis in bimaxillary orthognathic procedures and
genioplasties. Long term follow-up is mandatory to obtain
data concerning skeletal stability one year and more postop-
eratively.
SANDWICH PROCEDURES WITH INTERPOSED
GRAFTS AND TITANIUM IMPLANTS
Sailer, H.F.,
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland
In 1987 we established and performed several kinds of sand-
wich procedures of the upper and lower jaw in combination
with bone grafts and simultaneous placement of dental tita-
nium implants. From the beginning our aim was not only to
achieve good functional but also excellent results of the
facial aesthetics.
For the mandible we developed the anterior and poste-
rior sandwich procedures (Sailer 1989, 1991), using from the
beginning not only autologous but also homologous
lyophilized bone. The autologous bone was taken from the
iliac crest, the calvarium or from the ascending ramus of the
mandible.
The posterior mandibular sandwich procedure made the
lateralisation of the inferior alveolar nerve necessary. The
anterior mandibular sandwich procedure we performed
from a height of 5 mm on. The same procedure was also
used in a modified way in patients with spontaneous frac-
tures due to extreme mandibular atrophy. From 1991 on we
used also bone morphogenetic proteins (Sailer and Kolb
1994) in some of these procedures.
In the upper jaw we developed in 1987 two procedures:
One was the Le Fort-I osteotomy of the edentulous highly
atrophic jaw (Cawood Class VI) with removal of the sinus
floor mucosa, the placement of autologous bone grafts
(from the hip or calvarium) and the simultaneous setting of
titanium implants. The indication for these procedures was
again a functional and especially an aesthetic one because
the whole osteotomized part of the maxilla was simultane-
ously moved forward and downward to re-establish the for-
mer facial height.
The second procedure for the upper jaw was the vertical
circular sandwich procedure with splitting of the extremely
narrow alveolar ridge of the maxilla (Cawood Class IV):
The thin outer bone lamella is left pedicled to the perios-
teum and some submucous tissue and moved forward and
outward; the gap in between was filled again by bone grafts
which were loaded outside the oral cavity with titanium
implants. Both the outer and palatal lamellae were then
fixed to each other by compression screws.
The partial vertical sandwich procedure is often used in
posttraumatic cases were several teeth are lost and the nar-
row ridge should be widened for the placement of implants.
The outcome of the procedures described above is pre-
sented, the problems and complications discussed.
NEUROMUSCULAR CONTROLLED
HYDROXYLAPATITE OCULAR IMPLANTS. A
FUNCTIONAL AND AESTHETIC TREATMENT
CONCEPT.
Sailer 11.F.
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland.
Introduction: Patients who have lost an eye due to trauma or
turnout often suffer from aesthetic and functional problems
with conventional eye prostheses. Most of the problems are
caused by the lack of motility of the prosthesis and by post-
operative conditions following enucleation or exenteration
of the orbit resulting in inadequate conjunctival pockets,
ptosis, deep superior sulcus syndrome etc.. The insertion of
a neuromuscular controlled hydroxylapatite globe can
correct these deficiencies.
Method: Immediate or delayed insertion of hydroxylapatite
globes following enucleation of the bulbus oculi was per-
formed in ten patients. The fixation of the rectus muscles to
this globular implant is the main principle of this method
and of utmost importance for functional and aesthetic suc-
cess. Therefore, the Tenon's capsule together with the four
rectus muscles are preserved during enucleation or exentera-

tion when performing immediate insertion of the implant.
In case of delayed insertion the four muscles are identified.
in both cases the muscles are directly fixated with resorbable
sutures through small burr holes at the periphery of the
implant. Six months later, following capillary in-sprouting
into the porous hydroxylapatite globe, a sleeved peg is
inserted into the orbital implant for fixation of the eye-pros-
thesis.
Results: G o o d aesthetic results could be achieved in all
patients. The insertion of the rectus muscles resulted in ade-
quate motility of the ocular prosthesis. The movements of
the prosthesis were symmetrical and most cases with the
same amplitude when compared to the contralateral intact
eye. In one patient with an inadequate small implant, the
low position of the implant and the deep superior sulcus
could be corrected by transplantation of lyophilized carti-
lage sheets into the depth of the orbit. No complications
(infection, dehiscencies, implant migration or extrusion)
were seen in this small series.
Conclusions: The replacement of the bulbus oculi is recom-
mended in all cases of eye enucleation or exenteration, as
long as oncological radicality is not compromised. This
method is especially useful in case of an empty orbit with
malpositioned eyelids and short conjunctival fornices which
are insufficient for incorporation of an adequate prosthesis.
In these cases it is mandatory to insert a hydroxylapatite
globe for fixation of the eye prosthesis.
HARD D R I L L I N G AND CUTTING W I T H LASERS
H.F. Sailer, M. Niibler-Moritz, M. Makek, G. Eyrieh
Hard tissue cutting with lasers was the most prestigious
challenge for many physicists and clinicians over the last
decade. Especially, as far as cranio and maxillofacial
surgery is concerned, none of the current available laser sys-
tems are useful. Very recently, an ultrapulsed CO2 laser
emitting at 9600 nm has been developed, providing efficient
drilling and cutting of hard tissues such as teeth and bone.
A series of in vitro and in vivo examinations in patients was
performed. Histology from osteotomy areas and from cavi-
ties and pulps of vital teeth shows absence of hard tissue
necrosis and of inflammatory reaction of the dental pulp.
LASER INDUCED INTERSTITIAL
THERMOTHERAPY
H.F. Sailer, M. Niibler-Moritz, G. Eyrich, P. Hilfiker
The possibility of localized tissue coagulation has formed
the basis of a novel turnout treatment technique called laser
induced interstitial thermotherapy (LITT). It was recently
introduced to the treatment of various types of head and
neck tumours such as AV-malformations, hemangiomas and
lymphangiomas. The principle idea of laser induced intersti-
tial thermotherapy is to position an appropriate laser fibre
inside the tissue to be coagulated and to achieve necrosis by
heating cells above 60°C. Denaturation of proteins and
coagulation occur at these temperatures. In order to achieve
a safe LITT procedure, knowledge of the final amount of
damaged tissue is essential. Especially in O M F surgery, it is
very important to prevent injury from adjacent healthy and
sensitive structures. Therefore, special laser fibres are needed
and an imaging-guided monitoring is mandatory. Either
temperature probes, ultrasonography, CT or M R I can be
EACMFS- Abstracts, Helsinki Congress 1998 165
used for this purpose. The best in terms of qualified moni-
toring is currently provided by real time open M R I tech-
niques which will be illustrated and explained by means of
clinical cases and computer simulations, respectively.
M A N D I B U L A R ALLOGRAFT: A NEW M E T H O D
F O R EXPLANTATION AND TRANSPLANTATION OF
VASCULARIZED MANDIBLES USING
M I C R O S U R G I C A L A N A S T O M O S I S IN RATS.
Saka, B., Gundlach, K.,
Medical School Department of Maxillofacial and Plastic
Surgery, Rostock University, Rostock, Germany
Aims: One of the major problems in reconstructive cranio-
facial surgery is reconstruction of the mandible following
tumor surgery or trauma. Vascularized allografts would
offer many possibilities for reconstructive craniofacial
surgery. A method of explantation and microsurgical trans-
plantation of one side of the mandible has been examined
and has been successful in rats.
Method: 60 Wistar rat with a weight of 300 g each were used
for anatomical studies and establishing a method of explanta-
tion and transplantation of the mandible. The inferior alveolar
artery and vein were identified and followed up to mandibular
foramen. Medial and lateral muscles of mastication had been
removed and osteotomy in the region of the chin were followed
by opening the articular capsule in order to detach the trans-
plant.Transplantation was done as replantation and began
with microplate osteosynthesis of the mandible. The inferior
alveolar vessels were attached microsurgically end to side : infe-
rior alveolar artery to external carotid artery, inferior alveolar
vein to the retromandibular vein.
Results: 60 transplantations of right and left mandibles were
performed. The anastomosis of inferior alveolar artery and
vein were satisafying in all rats. No size problem was found
in transplantation when the rats were of the same age.
Conclusion: A standardized method for allograft explanta-
tion and transplantation of vascularized mandibles in the
rat was established. This is the first step introducing micro-
surgical mandibular allografts in reconstructive craniofacial
surgery.
2 CASES O F P E M P H I G U S
Y.Sakuma, N.Kawatsu. 34[.Uehida
The Nippon Dental University, School of Dentistry at Tokyo,
Department of Oral and Maxillofacial Surgery
Aims: To analyzed the immunological changes in 2
Pemphigus patients.
Method: We conducted histopathological diagnosis pemphi-
gus a 63-year old male and 62-year old female as our test
subjects. White blood cells, platelets,lymphocytes,
IgG, IgA,IgM,ILl-13,IL12,and lymphocytes surface antigens
CD?,CD4,CD8,CD16, CD45RA,CD45RO,CD56,HLADR
and CD4/CD8 ratio were determined to assess
Immunological competence.
Results: There were no changed white blood cells Platelets
lymphocytes, IgA,IgM, ILl-g, ILl2. IgG was
increased.Among the subset of lymphocyte N K cells
decreased.
166 Journal of Cranio-MaxillofacialSurgery
[h MELANOTIC NEUROECTODERMAL TUMOUR
O F INFANCY
C, Salazar Ferndndez,* PhD, A. Perez-Sanchez PhD, A.
Roil6n MD, P. Aparieio MD, J.C. Arboleda PhD.
Oral and MaxillofaciaI Surge1T. Virgen Macarena Hospital
from Sevilla (Spain).
AIMS: The purpose of this abstract is to present a docu-
mented case of M N T I of right maxilla in a 3 month-old girl
and discuss clinical, radiological, histopahological and ther-
apeutic features of the disease.
METHODS: A 3 month-old girl was referred to our depart-
ment for the evaluation of a darkened mass on the right
maxilla with a history of accelerated growth. Examination
showed a bluish, firm, expansive mass of the right anterior
maxilla. The tumor elevated the right upper lip and alar base,
and the mucosa overlying the area was thin and mobile. CT
revealed a big, hyperdense mass in right maxilla with osto-
blastic and osteolitic lesions. It apparented to have the floor
of the orbit extension. A biopsy was performed and showed
melanotic neuroectodermal tumor of infancy: Urinary levels
of vanilmandelic acid (VMA) was normal. Under general
anesthesia, the lesion was removed by enucleation, currettage
and any bone that had unusual pigmentation or texture was
removed 5 mm past the involved area. Superiorly it appeared
to fill the maxillar with bony expansion of the orbit floor
and involvement pterigomaxillar fossa. Postoperative course
was satisfactory.Histologic study and electron microscopic
confirmed the diagnostic. CT scan was obtained six months
postsurgery that showed no evidence of recurrent tumor.
There has been no recurrence after 1.5 year follow-up.
RESULTS AND CONCLUSIONS: The importance of early
conservative surgical excision toghether with removal of adja-
cent teeth and any bone that had unusual pigmentation or
texture is emphasized with, in general, a good prognosis. It
should be followed up for long periods of time because of the
rare malignant change is possible in the tumor.
T E M P O R O M A N D I B U L A R J O I N T DISCOPEXY
WITH THE MITEK® DEVICE.
Salmerdn, JL *; A cero, £; Ferndndez-Alba, £; Cuesta, M.;
Concejo, C.
Department of Oral and Maxillofacial Surgery, Hospital
General Universitario "'Gregorio Maratgon", Universidad
Complutense de Madrid, Madrid, Spain.
Aim: We present a new technique for meniscopexy, employ-
ing the Mitek® mini-anchor, which has been used in
orthopaedic surgery to anchor soft tissues to bone, and has
been adapted for surgery on the TMJ by Cotrel and
Woldford. The anchor consists of a titanium cylinder, 5 mm
long and 1,8 mm wide with two Nitinol wings in a pre-set
position but with superelastic properties. The device is
inserted into the posterolateral aspect of the condyle; a
braided suture already passed through the anchor's orifice
allows meniscopexy to be performed.
M & Methods: This video shows the characteristics of the
device with illustrations of bone marrow penetration by the
wings, which then expand to secure the device in place. To
demonstrate the technique, we show here a case of ache in
which, following condylectomy, we employ the Mitek®
device which adjust the meniscus to the new condyle. Here
we show the clinical investigations of the patients, as well as
clear detailed views of the surgical technique. We also show
other cases in which the technique may be indicated: menis-
copexy in cases of disc subluxation where other treatment
has failed; and readjusment of the meniscus after excision of
benign tumours (we show a case of condylar osteoma).
Conclusion: The Mitek® mini-anchor is a device which
allows meniscopexy of the TMJ disc to be performed in a
stable fashion; also used both in cases where readjustment
of the articular disc after high condylectomy is necessary,
and in cases of disc subluxation where conservative mea-
sures have failed.
FREE F L A P S FOR RECONSTRUCTION O F THE
PALATE
SalvatorL P. *, Podrecca, S., Fallahdar, D., Tomic, 0.,
Nardo, L.
Head & Neck Surgery, Istituto Nazionale Tumori, Milan,
Italy
Aims: Defects following extirpation of tumours involving
the palate may be treated with prosthetic appliances or local
flaps. However, major resections are difficult to repair unless
free tissue transfer is used. We report our experience on this
matter.
Subject: Thirty patients underwent microsurgical recon-
struction of the palate. Charts were reviewed as regards to
demographicss, histology, extent of the resection, type of
free flap, functional, short and long term results.
Results: Defects to be repaired always included more than
half the palate (soft and/or hard palate) along with other
structures involved (skin, orbita, etc.). In some instances the
whole palate has been reconstructed. Flaps were harvested
from the latissimus dorsi and rectus abdominis (as myocuta-
neous flaps), forearm (as fasciocutaneous or osteofasciocu-
taneous flaps), scapula and fibula (as an osteocutaneous
flap). Success rates of the transfer reached 95%. Dehiscence
and retraction were the most common morbidity/sequelae.
Good functional results were achieved in the majority of
patients, whereas survival mainly varied according to the
histology.
Conclusions: Free tissue transfer offers a formidable oppor-
tunity in palate reconstruction. The choice of the flap
should be made according to the volume of the resection,
the expected prognosis and the dental rehabilitation
planned.
CORRELATION O F S C I N T I G R A P H Y WITH
PREVALENCE O F T M J S Y M P T O M S IN ACTIVE
CONDYLAR H Y P E R P L A S I A
Samman, N. ~, Cheung, L.K., Tideman, H.
Oral and Maxillofi~cial Surgery, University of Hong Kong,
Hong Kong, China
Aims: To correlate the prevalence of pain and clicking in the
TMJ with scintigraphic findings in active condylar hyper-
plasia.
Methods: 239 consecutive patients with mandibular asym-
metry due to condylar hyperplasia (CH) received a 99Tc
bone scan. 194 patients (81%) exhibited increased isotope

uptake by the condyles beyond the normal level and were
included in the study. Clinical examination for masticatory mus-
cle and joint pain or dicking was carried out for the study group.
Results: The M:F ratio was 1:1.4 and the age range was 12-
48 years (mean 23 years). The prevalence of masticatory
muscle pain and/or joint clicking was 32% (pain 6%, click-
ing 14%, pain and clicking 12%). The incidence of pain
with or without clicking was 18%, clicking with or without
pain 26%, and there was no predilection for either side. 80%
of the study group (151 patients) exhibited increased isotope
uptake by the condyles bilaterally, but only 11% of patients
had pain or clicking on the normal side.
Conclusions: In mandibular asymmetry due to active CH, the
normal condyle frequently shows an increased isotope uptake
but to a lesser degree than the CH side. Scintigraphic findings
do not correlate with TMJ disorder in condylar hyperplasia.
[~ RECONSTRUCTION OF THE FACIAL SKELETON
AS A PREPARATION FOR PROSTHETIC
REHABILITATION
Piekarczyk J., Samolczyk-Wanyura D., Spiechowicz E.,
Siemi~ska-Piekarezyk B.
Medical University of Warsaw, H Clinic of Oral and
Maxillo-Facial Surgery, PSK nr I, Lindley'a St. 4, 02-005
Warsaw, Poland, tel/fax +48 (22) 621-24-02
e-mail: chirszcz @wawl. comnet.pl.
Aims: Presentation of indications for and results of, surgical
preparation for prosthetic rehabilitation.
Method: Patients with widespreaded atrophy of the alveolar
process and the mandibular body have been treated. In
these cases, reconstruction procedures using appropriate
bone parts was carried out using a sandwich-type autoge-
nous bone graft. A group of patients with loss of maxillary
bone structures resulting from congenital diseases or surgi-
cal interventions has also been treated with autogenous
bone grafting. After a healing of the bone grafts,
intraosseous implants have been inserted. After mandibular
resection benign tumours, simultaneous bone graft recon-
structions have been combined with intraosseous implants.
Results: The methods gave satisfactory results. No early
complications have been observed. Long term results have
been estimated to be good. Clinical and radiological exami-
nation proved the incorporation of the grafted bone.
Conclusions: The methods of surgical technique presented enable
good, more functional prosthetic rehabilitation to be achieved.
HEMIMANDIBULAR HYPERPLASIA TREATED
WITH MINI-ANCHOR MENISCOPEXY AND NERVE
REPOSITIONING
Sdnchez-Cudilar A, Martin-Gran&o R*, G6mez F, de Pedro
M, Sdnchez-Gutidrrez J, Pdrez MC, Berguer A.
Department of Oral & Maxillofacial Surgery. University
"Hospital Clinico San Carlos", Madrid, Spain.
Aim: Hemimandibular hyperplasia is characterized by
homogeneous growth of one side of the mandible. This
growth ends lateral to the symphysis showing an abrupt
kink in that area. It has a slow growth and slight changes in
the occlusal plane inclination. We present an outstanding
case as well as the treatment used.
EACMFS - Abstracts, Helsinki Congress 1998 167
Method: A 27 year-old male presented with a left hemi-
mandibular hyperplasia, confirmed with gammagraphy
with Tc99, a TC and plain-tomograms. Surgery comprised a
high condylectomy and fixation of the remaining temporo-
mandibular joint (TMJ) disc with a Mitec mini-anchor
device. Remodelling of the horizontal mandibular ramus
was carried out after previous inferior alveolar nerve trans-
position.
Results: An optimal functional and aesthetic result was
achieved, with good mandibular opening and no pain.
Conclusions: Hemimandibulat hyperplasia with active
growth must be managed by surgical condylar excision pre-
serving the TMJ disc. Condylar remodeling is supposed to
occur during the year after surgery. Symmetry is one of the
most difficult goals to attain after mandibular remodelling.
I N T R O D U C T I O N OF A N E W 3 D - M O D E L BASED
OPERATION PLANNING, SURGERY SIMULATION
AND TRANSFER SYSTEM FOR CRANIO-
MAXILLOFACIAL SURGERY
Santler, (7.
Department of OMFS, Institute of Dentistry, University of
Graz, Austria
Aims: Development of a system allowing precise replace-
ment of dental arches of 3D-model by plaster models,
three-dimensional measurements of asymmetry and bone
cephalometry, life-like simulation surgery and easy transfer
into operation.
Method: A bite device with 3 radio-opaque hemispheres is
used during CT-scanning for replacement of dental arches
of the 3D-model with plaster models. A new model opera-
tion platform with 3D-digitizer and 6D-tracker enables
three-dimensional measurements of bony anatomy
(cephalometry) and movements of the jaws during simula-
tion surgery. A transfer device based on a neurosurgical halo
frame is used as a reference for three-dimensional position-
ing of osteotomized segments. Accuracy analysis is per-
formed concerning replacement of the dental arches,
precision of the 3D-digitizer and transfer of the planned
position. The clinical results in nine patients are presented.
Results: Replacement of dental arches of 3D-models was
achieved with a three-dimensional accuracy of 0.52 mm
(range: -0.91 to 0.91 mm) with a CT-feed of 3 mm. Transfer
of the upper jaw position was possible with a spherical pre-
cision of 0.14 mm (range: -0.36 to 0.69 mm).
Conlusion: This newly introduced system allows precise
replacement of the dental arches of 3D-models, three-
dimensional simulation surgery with on-line visualisation of
the movements and an accurate transfer of the therapeutic
position into the operation room. Especially in patients with
asymmetric malformations and severe dysgnathia this sys-
tem will help in achieving symmetric and aesthetic propor-
tions with a definitive outcome.
THE C O M P A R I S O N OF B O N E GRAFTS OF
DIFFERENT EMBRYOLOGICAL ORIGIN UNDER
BIOMECHANICAL FORCES. AN EXPERIMENTAL
STUDY ON CANINES: PRELIMINARY REPORT
Mollaoglu, N*., Sarisoy, \, Yiicel, E., Erkmen, E.,
BSrkan, U.
168 Journal of Cranio-MaxillofacialSurgery
Department of Oral & Maxillofacial Surgery, Faculty of
Dentistry, Gazi University, Ankara, Turkey
Aims: To discover the success of bone grafts in bone trans-
plantation procedures to compare bone grafts under differ-
ent local environmental factors by considering their types
and embriologic origins
Method: Four beagle dogs were used in this study. Standard
defects were constructed in the maxilla, mandible, and tibias
of the dogs. The endocondral allografts that were obtained
from these defects were transplanted to the mandible, and
similarly the membranous allografts to tibia. The maxilla,
mandible and tibias of one of the dogs were used as control.
Compression force was applied to the standard segments
that were obtained from the dogs after three months
Results: Ossification was terminated without any problems as
assessed by gross observation. No evident difference was observed
in the resistance autografts and allografts and bone grafts of endo-
chondral and membranous origin to compression forces. But, the
control areas were found to be slightly more resistant
Conclusion: It would affect the results to do the transplanta-
tion in the identical areas and to extend the study peiod.
MAXILLOFACIAL ACCESS F O R ORBITAL AND
SKULL BASE T U M O U R S IN JORDAN
Dr: Sartawi, 3/1.*, Consultant OMF Surgeon
Dr. Sbeih, L Consultant Neurosurgeon
Amman, Jordan
AIMS:
To present our experience in Jordan regarding skull base
tumors by our team which consists of O M F Surgeon,
Neurosurgeon, ENT Surgeon and Ophthalmic Surgeon.
METHOD:
Short history of each case with presentation of preop, and
postop, imaging and describing our surgical methods.
RESULTS:
10 Cases are presented. Cases include:
Orbital Tumors, e.g. epidermoid, Rabdomyosarcoma,
meningocelle (trauma).
Aggressive psomammatoid ossifying fibroma of the
sinonasal region.
Skull base tumors, e.g. clivus tumors, menengiomas.
CONCLUSIONS:
The team work presented illustrates the need for a combined
effort of multisurgical disciplines to achieve radical or com-
plete excision of such tumors.
EXPERIMENTAL STUDY O F SEGMENTAL
MANDIBULAR RECONSTRUCTION BY
DISTRACTION O S T E O G E N E S I S USING
OSSEOINTEGRATED I M P L A N T S
Sawaki Y., Oda T., Hagino H., Mizutani H., Ueda M.
Department of Oral Surgery, Nagoya University, School of
Medicine, Nagoya, Japan
Aims: The purpose of this study is to establish a treatment
technique for segmental mandibular reconstruction by dis-
traction osteogenesis using osseointegrated implants and an
intraoral device.
Materials: Three adult dogs served as the subject of this
experiment.
Method: After teeth extraction of their left mandibular pre-
molars and first molar, three 10mmX3.75mm osseointegrated
implants were installed. After 12 weeks for osseointegration,
abutments and intraoral devices were connected. Then, a
bone defect the size of 15mm was created and immediate
reconstruction by metal plate was performed. The mandible
was resected and fixed with a reconstruction plate. An
osteotomy created a transport disk of a 10mm segment of the
mandible. Waiting for a week as the latency period, distrac-
tion of the transport disk was begun at a rate of lmm/day.
After distraction was completed, the distraction device was
left for 8 weeks as the consolidation period. Six months later,
an additional implant to the lengthened bone was installed.
Results: Mandibular defects were filled with regenerated
bone. No mobility of the implants was observed before and
after distraction, and the implants could be tolerant of the
distraction stress. The gingiva which covered the defect was
pushed out, and the gingiva over the regenerated bone were
lengthened by distraction.
Radiographic evaluation demonstrated new bone forma-
tion in the distraction gap and no bone resorption around
the implants.
Conclusion: This study demonstrates a potentiality for using
distraction osteogenesis with the implant-anchorage for seg-
mental mandibular reconstruction.
[h PAIN RELIEF AND E L E C T R O M Y O G R A P H I C
EVALUATION IN PATIENTS S U F F E R I N G F R O M
PAIN DYSFUNCTION SYNDROME OF THE
T E M P O R O M A N D I B U L A R JOINT.
Scarsella S*., Ladisa R., Appia F., Cutilli T.
Maxillofacial Institute, Department of Surgery - L'Aquila
University - L'Aquila - Italy
(Head Prof. A. Corbacelli)
Aims: To evaluate the effectiveness of the analgesic response to
two electric physiotherapy techniques: electroacupuncture
(E.A.) and transcutaneus electrical nerve stimulation (T.E.N.S.)
, in patients suffering from the pain dysfunction syndrome.
Moreover, we checked the effects of E.A. and T.E.N.S. on the
masseter and temporalis anterior muscles of the same patients.
Method: Fourteen patients, (8 females and 6 males, aged 18-
51), suffering from T.M.J. pain dysfunction syndrome were
divided into two groups and treated 7 with E.A. and 7 with
T.E.N.S.; we used continuous waves at 10-50 Hz for each 20
minute treatment; the Scott-Huskisson Visual Analogue
Scale (V.A.S.) was used to assess the intensity of pain both
before and after the treatments. We have investigated the
changes in activity of two masticatory muscles; the masseter
and temporalis anterior using superficial electromyography.
Results: Our results show that, in relation to the changes in
the masseter and temporalis muscle activity, both E.A. and
T.E.N.S. have a good effect on the balance of the muscles;
meanwhile, using the Signed Ranked Test, the E.A. is more
effective than T.E.N.S. in relieving the pain, with a signifi-
cant statistical difference (p=0.03).
Conclusions: The results indicate that E.A. and T.E.N.S.
are effective physiotherapy techniques and suggest their
use to relieve pain and to balance masticatory muscles in

patients suffering from T.M.J. pain dysfunction syn-
drome.
THE APPLICATION OF COLLAGEN W O O L COATED
WITH CLOTTING SUBSTANCES (TACHCOMB®) IN
DENTOALVEOLAR SURGERY PERFORMED IN ORAL
ANTICOAGULATED PATIENTS
Scheer, M. *, Schweigert, H.G., Mischkowski, R.A.,
Hassfeld, S., Miihling, J., Z611er, J.E., Steveling, H.
Department of Oral and Maxillofacial Surgery, University of
Cologne, Germany
Aims: To assess the risk of postoperative bleeding after elec-
tive dentoalveolar surgery in patients treated with oral anti-
coagulants using collagen wool with clottable substances
(TachoComb®).
Method: The study includes 12 patients (3 female, 9 male)
admitted to our hospital between January 1997 and
February 1998. All patients were treated with vitamin K
antagonists and required such dentoalveolar procedures as
extractions and osteotomies. A reduced dose of the antico-
agulants was not taken. Oral surgery was performed under
local anaesthesia using intraligamentary injections. After
removal of the teeth, collagen wool coated with fibrinogen,
thrombin and aprotinin (TachoComb®) was inserted into
the alveolus. The wounds were sutured and a preoperatively
made prosthesis was inserted. Postoperatively all patients
were instructed to report every episode of bleeding. As a
three week follow up examination, the patients were ques-
tioned about haemorrhage and other complications.
Results: In 16 surgical procedures, 98 teeth were extracted
and 6 osteotomies were performed. The average preoperative
I N R was 2,17 (Range: 1.27-3.26). No episode of severe
bleeding occured. Mild bleeding without an indication for
further intervention was reported by nine patients. Other
complications were not seen during the three week follow up.
Conclusions: Regard to the small number of patients
included in our study we can not supply definitve data about
the application of the TachoComb®-wool. Our results are,
however, very promising. The application of TachoComb®
may provide a secure and cost effective method of managing
patients treated with oral anticoagulants.
I M P R E S S I O N - C Y T O L O G Y AS A NEW M E T H O D
IN DETERMINATION O F DIGNITY IN
P R E N E O P L A S T I C M A L F O R M A T I O N S O F ORAL
MUCOSA
Schemmeret; E., Budweg, Chr., Buchmann, J., Schubert, J.,
Department of Maxillo-faeial surgery, Martin-Luther-
University Halle-Wittenberg, Halle, Germany
A frequent question in treatment of patients with congenital
malformations of oral mucosa is determination of rate of
dysplasia.
Up to now a reliable confirmation needs a biopsy.
However this procedure is an invasive method, accompanied
by a certain morbidity caused by surgical intervention, local
anaesthesia and need of early recall. Therefore we intro-
duced the impression-cytology as a useful, reliable, econom-
ical and non-invasive screening method in the diagnosis and
long-term follow-up of preneoplastic malformations.
EACMFS Abstracts, HelsinkiCongress 1998 169
In fifty patients with congenital malformations (26 oral
leukoplakia, 22 lichen ruber erosivus, 1 carcinoma in situ, 1
squamous cell carcinoma) acquisition of cytological probes
were performed by taking two impression probes both of
undeseased and macroscopical changed mucosal areas. By
means of taking two probes out of the same location squa-
mous cell layers of different depth may get microscopically
examined and determined by rate of dysplasia.
In this study a high correlation and specifity of cytologi-
cal and histological specimens was found. Results suggest
the future option for supplementary biopsy only in cases
with a rate of dysplasia of grade 3 and more.
Impression-cytology improves follow up of patients with
congenital malformations and simultaneously reduces num-
ber of bioptical excisions.
GUIDED BONE REGENERATION BY TITANIUM
REINFORCED GORE MEMBRANES IN
EXPERIMENTALLY CREATED CLEFTS IN RABBITS.
A PRELIMINARY REPORT BASED ON CT-SCANS.
Schemmerer, E.J., Beck, R.M., Schubert, J.,
Department of Maxillo-facial surgery and Department of
Diagnostic Radiology, Martin-Luther-University Halle-
Wittenberg, Halle, Germany
It was the aim of this study to get more informations about
guided bone regeneration in large three dimensional bone
defects like in cleft malformations.
Therefore standarised bone defects with a length of 10
mm, width of 5 mm and depth of 5 mm were created in both
sides of the upper jaw of 20 rabbits. After two weeks in a
second surgical procedure a titanium reinforced Gore mem-
brane was implanted on one side, covering the bony alveolar
ridge defect. After a healing period of three months bone
regeneration was examined in 17 rabbits by CT-scans (3 rab-
bits died by Pasteurella-infections).
By means of axial CT-scans with slice thickness of 1
mm complete bone regeneration was seen in 4 rabbits, 8
rabbits showed quite good bone regeneration with only lit-
tle decreased vertical and transversal dimensions. In 5 rab-
bits wound healing was disturbed by Pasteurella
infections, causing exposure of membranes. In all these
cases bone regeneration was incomplete. Infections in
early healing period caused a wide junction between nasal
and oral cavity. Measurement of bone density gave sup-
plementary informations about bone quality and mineral-
isation.
As a conclusion complete, respectively almost complete
bone regeneration in large three-dimensional bone defects
was seen in 12 out of 17 rabbits. We hope, that the combina-
tion of regenerative techniques by membranes and degrade-
ble biomaterials (right in testings) make osteoplasty without
transplantation of autogenious bone possible.
DIAGNOSIS AND TREATMENT OF ABSCESSES
AND INFLAMMATORY S W E L L I N G S AT T H E BASE
O F THE SKULL
Dumitru Scherbatiuk *, Sergiu Lungu, lurie Melnik
The N. Testemitsanu SMFU,
Department of the Oro-Maxillofacial Surgery, Chisinau, the
Republic of Moldova
170 Journal of Cranio-MaxillofacialSurgery
Aims: The high incidence of inflammatory diseases of the
oromaxillofacial regionnecessitates detailed investigation of
this problem.
Method: We have studied and treated 723 patients with inflam-
matory processes in the head and neck regions in the Republican
Centre for the Oro-Maxillofacial Surgery from 1992-1997.
In order to diagnose the inflammatory swellings, their
localization, mode of spread and prevalence. Methods for
active distance thermography, computerized tomography,
biophotometry have been used.
When performing the microbiological diagnosis, rapid
methods for detection and identification of pathogenic
agents were applied.
Results: According to the diagnosis, the patients were classi-
fied as follows: the odontogenous abscesses and inflamma-
tory swellings - 56.4%, nonodontogenous abscesses and
inflammatory swellings - 43.6%. In 487, (67.4%) of patients
the purulent foci were localized in a single anatomical
region, two or more regions were detected in 236 (32.6%) of
cases; 82 (17.34%) of them were at the skull base. It is very
effective to use the method of active surgical intervention on
inflammatory swellings with primary suture of the postop-
erative wound and the application of antimicrobial therapy
with the catheterization of the a.carotis through a.facialis
and a.temporalis superficialis. For the chemical homeostasis
of the organism, antioxidant therapy in the treatment of
these oro-maxillofacial region phlegmons was used.
Conclusions: The use of new methods for the diagnosis and
complex treatment of the patients with inflammatory
swellings of the oro-maxilofacial region has halved the num-
ber of complications and deaths.
GUIDED T R A N S P O R T O S T E O D I S T R A C T I O N -
INFLUENCE OF RESORBABLE BARRIERS O N THE
NEWLY GENERATED B O N E
Hannes P. Schierle, Henning Schliephake, Markus Gagalick
Dept. of Oral and Maxillofacial Surgery, Hannover Medical
University, Germany
Transport distraction osteogenesis is currently used for clo-
sure of long bone and mandibular segmental defects. To our
knowledge, no investigation has been reported on closure of
large defects of the cranium and the role of the adjacent soft
tissues in bone regeneration.
The aim of the presented study was to investigate differ-
ent placements of resorbable barriers in the defect area.
Therefore 5x4 cm large defects were created in the calvarial
area of 24 adult sheep. An osteotomy was performed on the
dorsal margin of the defect, creating a bone segment, which
was to be transported through the defect at a daily rate of 2
mm until contact with the frontal margin was achieved. The
sheep were randomly assigned to the following groups
Group 1: no barrier, group 2: subperiosteal and subcranial
isolation of the defect using a 500 (.,urn) thick polylactic
acid barrier, completely overlapping the defect.' Group 3:
placement of an epidural film, also overlapping the defect
and group 4: bilateral film placement. The distraction was
commenced on the third postoperative day and after termi-
nation of the distraction period the defects were allowed to
consolidate for another 6 weeks. After 6 weeks, the skulls
were harvested and bone regeneration was assessed using
histology, radiography, computer tomography and fluores-
cence microscopy. Of 24 animals 3 were lost, one due to
infection of the operated area and 2 others due to unrelated
causes. Continuous bony bridging was found in all groups,
while there was strong bone formation in the control group
and only thin bone formation in the bilateral group. The
other 2 groups ranged between these extremes.
The results presented show that transport distraction
osteogenesis is useful too in reconstruction of large calvarial
defects. The Ilizarov principles of a distraction rate of 1 mm
can be neglected in the craniofacial area without the risk of
pseudarthrosis and distraction osteogenesis can be per-
formed even under almost complete isolation from the sur-
rounding soft tissues.
Fh APPLICATION OF DISTRACTION
O S T E O G E N E S I S IN THE ATROPHIC M A N D I B L E TO
INCREASE THE INTERMAXILLARY DISTANCE AS
A P R E C O N D I T I O N FOR ORAL I M P L A N T S -
REPORT OF A CASE.
Hannes P. Schierle 1), Henning Schliephake 1), Felicitas
Schierle 2), Franz-Josef Kramer i)
l) Dept. of Oral & Maxillofaeial Surgery, Hannover
Medical School
2) Dept. for Orthodontics, Hannover Medical Sc,~ool
Treatment of severe atrophic mandibles using oral implants
and bone grafts requires an adequate interalveolar vertical
dimension for prosthodontic rehabilitation. Limited inter-
alveolar distance requires either osteotomies and/or bone
grafts to lengthen the ascending ramus or modifications in
the prosthetic suprastructure, which might be a hazard for
long-term stability and function. Distraction osteogenesis,
introduced into the craniofacial area for the correction of
hemifacial microsomia and paediatric patients, is now
widely used in many age groups.
The case presented shows a 45-year-old female patient
who sustained severe facial trauma in early infancy, causing
severe growth retardation in the whole midfacial and
mandibular area on the right side. Due to an almost complete
loss of vertical growth of the mandible, alveolar ridges were
in permanent contact and she was not able to wear any kind
of denture. Treatment with oral implants required an increase
in the interalveolar distance. Elevation of the sinus floor of
the affected side and augmentation of the alveolar ridge in
the anterior unaffected side were performed, using autoge-
nous iliac bone grafting. In the same operation preparations
for distraction osteogenesis of the ascending ramus were per-
formed, creating an osteotomy after placement of transcuta-
neous pins and fixation of a distraction device. A reasonable
vertical dimension was achieved during the following weeks.
Osteointegrated implants were placed after removal of the
distraction device and healing of the bone grafts.
The case demonstrated shows the possibilities of distrac-
tion osteogenesis, even in the atrophic mandible, which can
be used in combination with other reconstructive proce-
dures due to the less invasive character of the treatment.
MALIGNANCY A S S O C I A T E D C H A N G E S IN
S Q U A M O U S E P I T H E L I U M O F THE ORAL CAVITY
1)Schimming, R.*, 1)Frenzel,L 2)Haroske, G.,
1)Department of Oral- and Maxillofacial Surgery,
2)Department of Pathology
Universityof Dresden, Fetscherstr.74, D-01307Dresden, Germany

Aims: Malignancy associated changes (MACs) have been
described as subtle morphologic changes in normal appear-
ing tissues adjacent to or distant from malignant tumors.
MACs might be applicable as a marker of occult malig-
nancy, increased risk of subsequent carcinoma or recur-
rence of tumor after therapy. The aim of this study was to
verify the existence of MACs in normal appearing squa-
mous epithelium adjacent to squamous cell carcinoma of
the oral cavity (SCCOC).
Method: Image analysis were performed on sections cut
from formaldehyde-fixed tissue blocks of 30 patients oper-
ated on in case of SCCOC. Every cut did include three dif-
ferent tissue parts: Tumor tissue (TT), tissue from the tumor
edge (TE) and normal tissue (NT). 133 nuclear contour and
texture features were analyzed. All three components were
compared in a first step. In the second part the features of
the TE and the NT were related. The third step did include a
comparison of those features which did show statistically
significant differences in step one and two.
Results: Statistically significant variances between TT, TE,
and NT and between TE and NT were observed. The most
important differences were found in term of the following
features: Irregularity of the contour, number of the nodes in
the texture, width of the texture tree and number of coarse
chromatin particles.
Conclusions: The results of our investigation may indicate
that MACs can be an additional hint confirming the theory
of field cancerisation in SCCOC.
ELECTIVE SELECTIVE NECK DISSECTION AND
WATCH AND WAIT P O L I C Y IN THE CASE O F T1
AND T2 ORAL CARCINOMA W I T H CLINICALLY
NEGATIVE NECK
Schimming, R.*, Feller,K.-U., Eckelt, U.
Department of Oral- and Maxillofacial Surgery,
University of Dresden, Fetseherstr. 74, D-01307 Dresden,
Germany
Aims: The purpose of this retrospective investigation was to
compare the clinical outcome of patients who received elec-
tive selective neck dissection (ESND) with those patients
who did not receive primary neck surgery in the case of T1
and T2 squamous cell carcinoma of the oral cavity
(SCCOC) with clinically negative (NO) neck.
Method: 162 patients (70-T1/92-T2) entered this retrospec-
tive study. 57 patients (12/45) underwent ESND simultane-
ously with their surgery for the primary tumor. 105 patients
(58/47) did not obtain neck surgery. Tumor localization
were tongue, floor of the mouth and alveolar gingiva of the
mandible. The outcomes measured include local recurrence,
regional metastasis, distant metastasis, failure free survival
(FFS) and overall survival (OS).
Results: ESND did not reduce the local recurrence rate (chi-
squared test, p = 1.0) but did significantly diminish the
regional metastasis rate (chi-squared test, p = 0.04). The
regional metastasis related mortality was significantly
decreased (chi-squared test, p = 0.03) for patients treated
with ESND. No significant correlation was observed in the
case of F F S (Log-rank test, p -- 0.7) and OS (Log-rank test,
p = 0.7). T N M classification (UICC 1987), histopathologi-
cal grading, tumor localization as well as gender and age of
the patients did not effect the clinical outcome in uni- and
multivariate analysis.
Conclusions: This study establishes that SND has a greater
benefit in the treatment of T1 and T2 SCCOC with clini-
EACMFS- Abstracts, Helsinki Congress 1998 171
cally negative (NO) neck than observation. It suggests that
ESND is a treatment strategy of choice for T1 and T2
SCCOC with clinically negative (NO) neck.
@ ~ CONTROLLED RELEASE OF POLYPEPTIDE
GROWTH FACTORS FROM RESORBABLE
POLYMER DEVICES
Schliephake, H., MD, DDS] Tschakaloff, A., MD, DDS,2
1Pinneberg, Germany, :Hannovet; Germany
The aim of the present in-vitro pilot study was to test the suit-
ability of a resorbable polymer device for controlled release of
growth factors. Lyophylized recombinant human basic
fibroblast growth factor (rhbFGF) was used for this experi-
ment and was incorporated in polylactic acid pellets of 3ram
in diameter and 1 mm thickness. The lyophylized growth fac-
tor was prepared as a mixture of the polypeptide with saccha-
rose (bFGF/S) forming a firm solid mass. The pellets were
fabricated from amorphous poIy-(D.L-lactic) acid granules,
to which different portions of bFGF/S were added (10%,
25%, 50%, 66% volume ratio). Polymerisation was performed
at low temperature (37.0 .C) under high-pressure carbon
dioxide, creating a microcellular foam structure. Pellets of
pure b F G F / S and unloaded polymer pellets served as con-
trols. The pellets were placed in a buffered electrolyte solu-
tion. Samples of the media were examined for their b F G F
content after lh, 5 h, 24h, 2 days, 3 days and 4 days by EL1-
SA and the overall release of the substance was weighed after
8 weeks and 10 weeks in order to determine whether degrada-
tion of the polylactic acid changed after release of the differ-
ent portions of b F G F inside the pellets. All experiments were
performed in triplicate. The results showed a continuous
decrease in the b F G F concentration after the first 5 hours of
immersion. Initial concentrations after 1 hour Z(IJg/ml)
ranged between 40.77 (100% bFGF/S), 14.6 (66% bFGF/S),
12.77 (50% bFGF/S), 1.12 (25% bFGF/S) and 0.19 (10%
bFGF/S). Pellets with 10 % bFGF/S content showed concen-
trations at the detection level already after 24 h (0.01 *g/ml).
Pellets containing 25% and 50% bFGF/S exhibited a continu-
ous decrease in b F G F content with concentrations around
0.01 *g/ml after 3 days. Pellets with 66% bFGF/S maintained
a concentration of 0.07 and 0.08 *g/ml at days 3 and 4, while
100% b F G F / S exhibited a level of 9.17 and 9.89 pg/ml at the
two last intervals. It is concluded, that the prepared poly-
(D.L-lactic) acid device was capable of providing a reservoir
function for the polypeptide growth factor tested. From these
preliminary results, a volume ratio of less than 50 % poly-
laclic acid appears to be favourable for providing a slow
release.
[~ INTERSTITIAL LUNG DISEASE SUBSEQUENT
TO THE INSERTION O F TITANIUM I M P L A N T S
Schliephake, H., MD, DDS, Lehmann, H., PhD, Kunz, U..,
Kilbourn, J.P., MD, Abraham, £L.
Hannover, Germany, Portland, USA, New York, USA
The present study reports the case history of a patient with
interstitial lung disease subsequent to the insertion of tita-
nium implants. A 55-year-old white female suffered a left
midfacial fracture in a fall on the pavement while she was
running. She underwent open fracture reduction and place-
172 Journal of Cranio-Maxillofacial Surgery
ment of three miniplates and screws of commercially pure
titanium across her left frontozygomatic suture, infraorbital
rim and zygomaticomaxillary buttress. During the following
months, the patient developed interstitial lung disease
strongly suggestive of sarcoidosis. 8 months after the first
operation, an open lung biopsy for microbiological and
histopathological analysis was performed. Two months
later, the titanium plates were removed at the request of the
patient because of her personal concerns regarding the
implants. Symptoms of lung disease were controlled by
antimicrobial medication and prednisone therapy. A second
lung biopsy was obtained after four years because of wors-
ening clinical conditions. This second procured lung tissue
was embedded in epoxy resin and sectioned into semi-thin
and ultra-thin sections. Light microscopy analysis showed
contamination of the lung tissue by dark foreign material,
which was scattered across large areas of the sections and
appeared to be located both intra- and extracellularly. TEM
images exhibited electron dense particles of both polygonal
contour and needle like shape, which were seen inside
fibroblasts and macrophages. Electron-energy-loss spec-
troscopy (EELS) and electron spectroscopic imaging (ESI)
showed that the electron dense material contained Si, A1, Fe
and Ti. No other hard metals such as Co, W, Ta or N b were
found. The intracellular location of A1 and Si was almost
identical and always associated with the presence of oxygen,
suggesting that there was some type of chemical compound
of these three elements present. The location of Ti was dif-
ferent to that of A1 and Si and also associated with the pres-
ence of oxygen, but all elements were frequently located
inside the same cells. The findings are discussed with regard
to the possible pathogenic role of the individual elements in
the occurrence of interstitial lung disease.
[~ L O N G - T E R M RESULTS AFTER A L L O P L A S T I C
I N T E R P O S I T I O N A L GRAFTING IN THE
TEMPOROMANDIBULAR JOINT
Schliephake, H. MD, DDS, Sehierle, H.P., MD, DDS,
Schmelzeisen, R., MD, DDS,
Hannover, Germany, Freiburg, Germany
The aim of the present study was to evaluate long-term
results of the use of silastic implants for interpositional
grafting in the TMJ in 49 Joints in 48 patients with
osteoarthritis after a mean follow up period of 7.4 years.
All patients were examined for clinical function, subjec-
tive complaints and degree of handicap in daily life. The
range of pre- and postoperative interincisal opening, pro-
trusion and lateral excursions was rated according to four
categories: neither limitation (< 36 mm Interincisal open-
ing) nor pain, either limitation or pain and both limitation
and pain. In 4 patients, the implants had to be removed
after an average interval of 4.7 years (3.4 - 8.1 y) due to
persistent or recurrent pain during jaw movement and
function. The calculated Kaplan-Meler survival of silastic
implants was thus 88.9 %. In 2 patients with failing
implants, a temporalis fascia graft was used for disc
replacement, while 2 received a costochondral graft for
TMJ reconstruction. Painful restriction of joint function
subsequently to implant breakdown has necessitated mul-
tiple secondary surgery without final relief in two
patients. In patients with implants still in place, 5.8 %
showed improvement in interincisal opening in terms of
pain relief, while 29.4 % encountered an increase in pain
during mouth opening. Limitation in interincisal opening
improved in 23.5 % while it became worse in 5.8 % of the
patients. Range of lateral movement of the mandible was
improved in 25.0 %, with pain relief in only 6.3 %.
Postoperative range of movement was worse in lateral excur-
sions in 25.0 % and pain was increased in 18.8 %. The results
show that the use of silastic implants for interpositional graft-
ing has a moderate long-term failure rate in terms of implant
removals. However, an increase in joint pain was registered in
18.8 - 29.4, while the range of joint movement was improved
only in 23.5 to 25 % of the patients treated. It is concluded that
this treatment modality has not been successful in patients
with osteoarthritis of the TMJ and that the use of silastic
implants for interpositional grafting has been abandoned.
(~ FUTURE PERSPECTIVES IN CRANIO-
MAXILLOFACIAL RECONSTRUCTION
R. Schmelzeisen,
Freiburg, Germany
In cranio-maxillofacial reconstructive procedures chal-
lenges for the future have changed within the last ten years.
Some reconstructive tasks, that were regarded as demand-
ing in earlier years are now solved to a highly satisfying
degree. Most aspects of traumatology of the mandible now
can be handled with a great variety of osteosynthetic mate-
rials and strategies. Microvascular tissue reconstruction
following trauma and tumour including principles of mas-
ticatory rehabilitation using dental implants have reached
an extremely high surgical level. Tasks for the future aim at
developing reconstructive procedures following trauma and
tumour in anatomically difficult areas as the midface, orbit
and cranial base. In posttraumatic reconstructive proce-
dures lessons were learnt from cranio facial surgery, for
example in children with cranio-synostosis. Procedures
with radical exposure of the craniofacial skeleton and
reconstructions using various types of bone grafts and
bone substitutes will create a reconstructive standard that is
far beyond closed fracture treatment and wire suspensions
that were still used a few years ago. Concepts must include
specific diagnostic and principal details as for example
optic nerve management, navigation and endoscopically
assisted procedures. Microvascular reconstruction tech-
niques are increasingly used for reconstructive purposes in
the maxilla, in the midface and the cranial base. Future
perspectives in tumour reconstruction will be to further
improve graft selection and tailoring of the grafts in order
to further improve life quality after pallative tumour
surgery. Further specific developments in implantology as
for example zygoma implants, tissue engineering proce-
dures and the use of bone substitutes will become valuable
reconstructive tools. Future perspectives in both trauma
and tumour reconstruction will be demonstrated in experi-
ences gained with endoscopically assisted procedures
(N=10), use of neuronavigation in reconstructive proce-
dures (N= 15) and the application of advanced microvascu-
lar reconstruction techniques of maxillary, midfacial and
skull based defects (N=35). Tasks will be to establish
reconstructive standards and to transfer reconstructive pro-
cedures into what Russell (1974) called constructive surgery.
BIORESORPTION OF ALGIPORE® AT H U M A N
RECIPIENT SITES
C. Schopper*, R. Ewers, D. Moser

Clinic of Oral and Maxillofacial Surgery, AKH Vienna,
Waehringer Guerte118-20, A- 1090 Vienna, Austria
Tel.." 01-40400/4259; Fax.." 4253 e-mail." r.ewers@akh-
wien.ac.at
Implantation of hydroxyapatite is a well established and
commonly accepted method for bone augmentation in den-
tistry and maxillofacial surgery. Though extensively used,
little is known about biodegradative processes. The purpose
of our histological examinations was to elucidate these
processes of bioresorption. Algipore® is an algae-derived,
highly porous, granular hydroxyapatite. One outstanding
spatial feature compared with the vast array of biomaterials
is its interconnecting microporosity. We have used this mate-
rial in a total of 402 cases over the last decade. In 47 cases or
11.7%, trephine specimens have been harvested for histolog-
ical investigation. Specimens were plastic-embedded with-
out decalcification and prepared by means of an Exakt®
Cutting-Grinding-System. Routine processing included
toluidine blue and thionine stains, additional information
was acquired by immunohistochemical techniques.
Morphological and morphometrical evaluation was per-
formed under light microscopy. Intraosseous duration
ranged from 8 to 380 weeks, with an average value of 78.5
weeks, resulting in different grades of osseointegration and
degradation of the implanted material. Time-correlated
stages can be assessed: an initial period of assimilation into
the site of implantation is followed by transformation of cell
populations into osteoblastic tissue. Formation of osteoid
around as well as into the granules is accompanied by prolif-
erating capillary vessels. Extensive mineralization fronts are
visible. Degradative processes are carried out by mono- and
multinucleated resorbing cells and by enzymatic dissolution
of the hydroxyapatite matrix, the latter being termed halis-
teresis. Terminal result of fading interfaces is an almost
complete substitution of the bioceramic by newly formed
bone, termed 'resorption with creeping replacement'.
Results are presented using photomicrographs and statisti-
cal data sites. Algipore® not only proves clinically reliable,
but also proves to be a sufficient temporary scaffold until
bony replacement has taken place.
Furthermore it is able to serve as a carrier for osteoin-
ductive proteins because of its surface architecture.
C O M P U T E R ASSISTED TREATMENT O F
MAXILLOFACIAL T U M O U R S
Schramm, A. *, Gellrich, IV. (7., Buitrago-Tdllez, C.,
Frommhold, H, Schmelzeisen, R.
Department of OMFS, Department of Diagnostic
Radiology, Department of Radiotherapy, Albert-Ludwigs
University Freiburg, Freiburg i: Br, Germany
Aims: Ablative tumor surgery needs detailed and exact plan-
ning using computed tomography (CT) or magnetic reso-
nance imaging (MRI) to show extension of the malignoma,
define intended safety margins and point out vital struc-
tures. Radiotherapy whether intra- or postoperative requires
the same informations. Furthermore reconstruction follow-
ing tumor resection needs reliable information also to
choose correct type and volume of grafts and to predict the
outcome.
Method: On the base of an axial spiral CT data set and if
needed additional M R I data set the STN-Navigation-
System (Leibinger/Zeiss) is used for preoperative planning
EACMFS Abstracts, Helsinki Congress 1998 173
and intraoperative controlling of radical tumor resection,
complex reconstruction and guiding of external beem irra-
diation. Three patients with squamous cell carcinoma were
treated in this study. In two cases tumor resection
(mandible, skull base) was preoperatively planned and intra-
operatively navigated; in one case a secondary reconstruc-
tion of the right midface was performed following surgery
and radiotherapy. Preoperatively measuring of required soft
and hard tissue was done on the mirrored data set of the left
intact midface; size and location of the composite graft
from the scapula were chosen virtually. Intraoperatively
contours of transplanted soft and hard tissue were navi-
gated to preoperatively simulated reconstruction.
Results: Computer assisted treatment (CAT) was success-
fully completed in both cases of radical tumor resection and
adjuvant radiotherapy. Preoperatively outlined safety mar-
gins could be exactly controlled during tumor resection. In
the secondary reconstructive case the composite graft could
be designed and positioned precisely as virtually planned.
Bony and soft tissue reconstruction fitted perfectly to the
demands.
Conclusions: CAT improves preoperative planning by com-
bining CT and M R I data for valid 3D visualization of the
anatomic situs, the intended reconstructive outcome and
simulation of the radiation fields. Intraoperative navigation
makes radical tumor surgery more reliable by going for the
safety margins, saving vital structures, guiding the radiation
tube and leading the reconstruction to preplanned results.
OROFACIAL CHARACTERISTICS IN PATIENTS
W I T H UNTREATED CRANIOSYNOSTOSIS
Schubert, J.* Gr6b, D.
Clinic of OMFS, Faculty of Medicine, Martin Luther
University Halle- Wittenberg, Germany
Aim: To describe the influence of abnormal cranial skeletal
growth on the subsequent orofacial development.
Method: A group of 100 probands (age 27 + 14 years) with
surgically untreated cranial abnormalities was compiled
from the inhabitants of nursing homes for the handicapped,
to investigate oral and facial symptoms.
Results: Besides neurological disturbances and mental retar-
dation in 100 % as the criterion for selection of the group,
we found ophthalmological signs in 96% and anomalies of
the dental arch and occlusion in 92 % (table). However only
50 % of the latter could be considered to be a sequence of
disturbed skeletal growth.
Table: Orofacial Signs in Craniostenosis
Type and number Most frequent dentofacial
of patients anomaly
Trigonocephaly 10 open bite 50 %
Plagiocephaly 10 cross bite, open bite 44 % each
Oxycephaly 20 overjet 40 %
Brachycephaly 40 crowding of teeth 37 %
Scaphocephaly 20 surplus of space 53 %
Conclusions: Craniosynostosis is linked with a high rate of sub-
sequent orofacial anomalies and malocclusion. The present
study may be useful for the comparison and the evaluation of
the influence of surgical treatment on the facial development.
174 Journal of Cranio-MaxillofacialSurgery
PROSPECTIVE STUDY ON POSTTRAUMATIC
AND POSTOPERATIVE NERVE LESIONS AND
REGENERATION OF THE INFERIOR ALVEOLAR
NERVE AND INFRAORBITAL NERVE AFTER
MANDIBULAR AND MIDFACIAL FRACTURES
S. Schultze-Mosgau, M. Erbe, D. Rudolph, R. Ott, S. Girod,
E W. Neukam
Dep. of Oral and Maxillofacial Surgeon University
Erlangen-Nuremberg, Glfickstr. 11, 91065 Erlangen,
Germany
Introduction: In the literature data on sensitivity distur-
bances after osteosynthesis of mandibular fractures and
midfacial fractures range between 11% to 80%. This data is
almost exclusively based on retrospective studies without
differentiation between posttraumatic and postoperative
nerve disturbances. The aim of this prospective study was to
evalutate the rate and regeneration period of posttraumatic
and postoperative nerve disturbances in the inferior alveolar
nerve and the infraorbital nerve after mandibular and mid-
facial fractures.
Material and Methods: From 1/96 to 12/97 34 patients
(mean: 32 years; 15-68 years) with osteosynthesis of 26
mandibular fractures (group 1) and 20 midfacial fractures
(group 2) were evalutated. Preoperatively and postopera-
tively (7 days, 4 weeks, 3, 6 and 12 months) a sensitivity sta-
tus was performed by the following methods:
sharp-blunt-differentiation, 2-point-discrimination, electro-
myographic detection of masseter reflex.
Results/Conclusions: Posttraumatic sensitivity disturbances
were detected in 46 % (11 of 26) of the mandibular fractures
and 65 % (13 of 20) in midfacial fractures. Postoperative
sensitivity disturbances varied from 77 % (20 of 26) in group
1 to 55 % (11 of 20) in group 2. The rate of permanent nerve
lesions after 12 months was 8 % (2 of 26) in group 1 and 15
% (3 of 20) in group 2. The period of nerve regeneration
took longer in patients with posttranmatic sensitivity distur-
bances compared to patients with only postoperative distur-
bances. Sensitivity disturbances depended on the fracture
dislocation. Patients with a fracture dislocation of 4-5 mm
showed permanent sensitivity disturbances. The electromyo-
graphic detection of masseter reflex was a reliable method
for objective assessment of nerve lesions in the inferior alve-
olar nerve and the infraorbital nerve.
The knowledge of the rates of posttraumatic and post-
operative sensitivity disturbances is important regarding
preoperative inform consent and forensic questions.
BASYC (BACTERIAL SYNTHESIZED
CELLULOSE) - FIRST RESULTS O F ITS
DEVELOPMENT TO A MICROVESSEL P R O S T H E S I S
Schumann, D.* and Marsch, S.
Clinic of Maxillofacial Surgery and Plastic Surgery,
Friedrich Schiller University Jena, Germany
Aims: Qualification of a biomaterial synthesized from the
bacterium Acetobacter xylinum in form of tubes during the
synthesis as micro endoprosthesis,
Method: A BASYC-tube with a length of 10mm and an
inner diameter of 0.6mm was interpositioned in the carotid
artery of the rat under microsurgical conditions.
Results: After 4 weeks the blood flow trough the interposi-
tion was examined. It was unhindered. The histological
findings confirm this result.
Conclusions: BASYC has good characteristics e.g. a uniform
and high-molecular structure, hydrophilicity and biocom-
patibility. The success of the first tests to use this material as
a micro prosthesis show a perspective for its further devel-
opment.
[~ INVASION-ASSOCIATED O N C O F O E T A L AND
STRUCTURAL FIBRONECTIN (FN) AND L A M I N I N
(LAM) EXTRACELLULAR MATRIX M O D U L A T I O N
IN ORAL S Q U A M O U S CELL CARCINOMA (OSCC).
Strassburger, S. ~, Hyckel, P., Berndt, A., Kosmehl, H.,
Schumann, 1).
Clinicfor Maxillofacial Surgery/Plastic Surgery and
Institute of Pathology, Friedrich Schiller University of Jena,
D-07740 arena, Germany
Aims: Demonstration of transformation and invasion asso-
ciated biochemical and structural matrix modulation in
relation to the new L A M and F N isoforms. Correlation of
the L A M chain pattern and ED-B F N in OSCC to malig-
nancy grade.
Method: Native shock frozen samples of foetal (2), normal
(5), hyper- plastic (5), dysplastic (3) squamous epithelium
and OSCC (27) were subjected to immunohistochemistry
(APAAP method). Primary antibodies: L A M cd chain
(clone 4C7), c¢2 chain (clone 5H2), c~3 chain (clone BM165),
131 chain (clone 4El0), 132 chain (clone C4), 71 chain (clone
2E8), 3'2 chain (clone GB3), ED-B F N (clone BC1), ED-A
F N (clone IST9), de novo glycosylated F N (clone 5C10).
Non radioactive m R N A in situ hybridisation for ED-B FN.
Results: The L A M 132 chain is present in foetal, but not in
adult normal oral epithelium. In hyperplastic and dysplastic
epithelium as well as in OSCC, the 132 chain is deposited de
novo. With increase in the malignancy grade, there was an
increased loss of all L A M chains in the basement membrane
region.and an additional strong diffuse immunostaining of
c~3 and 132 in the invasion front. A de novo expression of de
novo glycosylated F N and ED- B F N was visualised in the
tumour stroma of all carcinomas; stroma myofibroblasts
could be identified as ED-B F N synthesising cells.
Conclusions: First." In OSCC, there is a conversion to an
oncofoetal extracellular matrix pattern concerning L A M
and F N isoforms. Second." c~3 and "/2 (LAM-5) are consid-
ered as a guide to invasion. Third." Our results recommend
the oncofoetal FNs as a tumour marker. The ED-B F N syn-
thesis does not correlate to the malignancy grade. It reflects
the ability of the tumour cells to recruit a stroma.
A NOVEL TREATMENT CONCEPT F O R INFANTS
WITH PIERRE-ROBIN SEQUENCE
Schwenzet; IV.*, Bachet; M., Speer, C.P.
Clinic of Maxillofacial Surgery, Department of
Orthodontics, Department of Neonatology, University of
Tiibingen, Germany
Aims: To manage the respiratory complications of Pierre-
Robin sequence by an orthopaedic appliance, and to per-

form surgical closure of the palatal cleft as early as
possible.
Subject: 48 infants aged 1 - 90 days with Pierre-Robin
sequence were referred to our clinic with respiratory distress
symptoms ranging from moderate to life-threatening. The
severe cases were characaterized by massive obstruction
requiring oxygen supplementation, PCO 2 values above 80
mm Hg with metabolic compensation and base excess val-
ues above 10 mM/l. All 48 infants were treated with a special
palatal plate (Tuebingen plate). The essential feature of the
plate is a long velar processus extending almost to the level
of the epiglottis. The correct anatomical form of the appli-
ance is obtained by endoscopic control using a fiberoptic
bronchoscope with a diameter of 2.2 mm. The surgical clo-
sure of the soft palate, sometimes of the hard and soft
palate, was already performed at an age of 4 months by a
modified intravelar technique.
Results: Respiratory and metabolic function was achieved
in all 48 cases. Respiratory parameters were normalized,
and oxygen supplementation could be terminated. Gastric
tube feeding could be discontinued in all but 4 patients who
had severe neuroanatomical malformations. The palatal
plates were conducive to significant narrowing of the clefts,
thus facilitating the surgical correction of the defect.
Conclusions: The noninvasive therapeutic concept can
replace all traditional procedures such as mechanical exten-
sion of the mandible, surgical fixation of the tongue and
tracheostomy.
EXPERIMENTS WITH THE FREE ELECTRON
L A S E R (FEL) IN T H E I N F R A R E D S P E C T R U M
Schwenzer, K.*, Jean, B., Weber, H., Ehrenfeld, M.
Department of O MFS, Munich L M University, Department
of Ophthalmology, Department of Dentistry, Tuebingen
University~Germany
Introduction: When working with hard and soft tissue, dif-
ferent kinds of lasers are available at present. The specific
laser characteristics are given by the wave length (1), pulse
length (t), and energy (e) parameters. Usually these parame-
ters cannot be changed independently of one another when
employing currently used systems. Because of the many
variables involved, comparisons between different lasers
with respect to efficiency and suitability for particular appli-
cations are difficult to make.
Methods: The F E L represents an experimental laser in
which the wave lengths can be varied separately from all
other parameters, the latter being kept constant. Therefore,
comparisons between different wave length regions - de
facto "different" lasers - under constant experimental con-
ditions are possible.
Results: In the course of our experiments, dental hard sub-
stances are systematically investigated in wave length
regions in which the absorption spectrum of the targeted
substance showed maxima. It could be demonstrated (n =
120 craters) that when targeting the substances with light of
9.5 mm-wave length, in which the absorption spectrum of
enamel and dentine shows the absorption maximum of
hydroxylapatite, a markedly more efficient ablation with
fewer side effects can be achieved compared with neighbor-
ing wave lengths (7.0 mm, 7.5 ram, 8.0 mm, 8.5 mm), all
other parameters being kept constant.
Conclusion: On the basis of these experiments, we believe
that it makes sense in our day to establish for which specific
purposes the laser is to be used in the preclinical stage and
EACMFS - Abstracts, Helsinki Congress 1998 175
then to select the appropriate parameters and finally
develop an optimal laser system with these characteristics.
H I S T O L O G I C CHANGE F O L L O W I N G
DIAGNOSTIC ARTHROSCOPY OF THE
TEMPEROMANDIBULAR JOINT; AN
E X P E R I M E N T A L S T U D Y IN S H E E P
Segami, Nil, Kaneyama, K. 1, Miyamoto, K. 2, Cross, A.N. 2
Dept. Oral and Maxillofacial Surgery, Kanazawa Medical
University, Japan 1 and Oral and Maxillofacial Surgery Unit,
Adelaide University, South Australia 2
Aims: The purpose of this experimental study was to investi-
gate the postoperative intra-articular change following diag-
nostic arthroscopy of the temperomandibular joint (TMJ),
especially focused into whether degenerative change may
take place or not.
Materials & Method: Ten pure bred Merino sheep weighting
approximately 60 kilograms were subjected. Under general
anesthesia, the superior compartment of the right TMJ
underwent diagnostic arthroscopy using 1.gmm arthroscope
similar to the clinical manner and the left TMJ was used as
control. Immediately, 2weeks, lmonth, 2 months and 3
months after the procedure, the sheep was sacrificed and
prepared for light microscopic examination.
Results: Immediately after the arthroscopy synovial mem-
brane and fibrous cartilage of the eminence disclosed par-
tial abrasion due to iatrogenic scaffing during arthroscopic
puncture or intra-articular manipulation. Main findings
through 2 weeks to 3 months can be raised as,
1. synovial hyperplasia of the retro discal tissue,
2. Subsynovial bone remodeling of the mandibular fossa,
3. incomplete regeneration of fibrocartilage of the emi-
nence.
There was no further degenerative change for example
disc perforation or condylar deformity. The control TMJs
showed normal appearances.
Conclusion: It is indicated that diagnostic arthroscopy does
not produce major degenerative change of the articular tis-
sue, however the surgeon needs to recognize that the postop-
erative minor histologic change may possibly occur due to
the surgical intervention.
EMINECTOMY FOR RECURRENT
D I S L O C A T I O N O F THE T.M.J
P.Seguin, T. Lefort, L. Sallaz
St Etienne - France
This video tape shows the different types of an eminectomy
according to Myraugh, performed to cure recurrent disloca-
tion of the T.M.J
Are detailled :
- Temporo-pre-auricular incision
- Supra fascial approach
- Exposition and incision of the capsule
- Exposition and protection of the meniscus
- Osteotomy to reduce the articular eminence
- Disc repositioning
176 Journal of Cranio-MaxillofacialSurgery
- T.M.J static and dynamic check
- Closure of capsule and skin
The indication for this procedure is recurrent dislocation
of the T.M.J
MAXILLOFACIAL R E G I O N DEFECTS AND
D E F O R M A T I O N S PLASTY W I T H COMBINATION
A L L O T R A N S P L A N T S O F THE "ALLOPLANT"
SERIES
N.Selsky, E.Muldashev, M.Soiovjov.
Russian Eye and Plastic"Surgery
Center, Ufa, Russia
Aim: To replace various defects and deformations of the
maxillofacial region with combination allogenic materials of
the "Alloplant" series.
Methods: The restoration of the supporting tissues as well
as the reconstruction of the soft tissues relief or their com-
bined deformations including a complete reconstruction of
the auricle floor have been performed on 150 patients. The
material used for the plasty of the supporting tissues defects
was a combination allotransplant which is a membrane
formed from the allogenic dermal layer of the sole skin. A
dense allogenic frame consisting of the allocartilage and
allobone is being placed in the layer. The restoration of the
soft tissues contours has been performed with the usage of
the sole subcutaneous fatty tissue.
Results: The follow-up of the maxillofacial region defects
and deformations plasty was observed within the range of 1
to 15 years. The positive results have been observed in 81%
of the patients and the negative ones in 19 % of the patients.
Conclusion: Thus the results of the combined allotrans-
plants ("Alloplant" series) testify to their high efficacy in the
plasty of various defects and deformations of the maxillofa-
cial region.
A L L O G E N I C BONE GRAFTING O F S M A L L AND
M E D I U M DEFECTS O F THE JAWS
Alexopoulou, M.* Semergidis, T., Sereti, M.
Clinic of OMFS, Larissa General Hospital, Larissa, Greece
Aims: To present our experience from the reconstruction of
small and medium sized defects of the maxilla and the
mandible, by the use of an allogeneic bone graft (Tutoplast)
following a protocol of diagnosis, surgical treatment and
follow-up.
Method: We have treated in a period of one year ( January
1997-February 1998 ) 28 patients using allogeneic bone
chemically prepared and preserved. 17 were male ( 15 to 65
years old ) and 11 were female
(12 to 57 years old). Mean age was 41.3 years.
Postoperatively patients were examined clinically in 7 and 15
days and then at 1, 2, 3, 6 and 12 month intervals.
Orthopantomograms were also obtained in 1, 2, 3, 6 and 12
months.
Results: Results were evaluated regarding volume, texture
and contour of the grafted site. Wound and bone healing
was normal and there was no case of sloughing, graft rejec-
tion or clinically apparent absorption. After 6 months
lamellar patterns were observed in most patients, especially
in the mandible. Main postoperative complications included
local swelling and mild pain for one or two days. Involved
and adjacent teeth presented no symptoms postoperativelly.
There was one case of transient mental nerve hypesthesia in
a patient with a large cyst of the mandibular body.
Conclusions: Although autogenous bone is considered to be
the optimum restorative material, allogeneic bone grafting is
a useful, simple and safe alternative for small and medium
defects of the jaws.
M R I I M A G I N G IN H E M A N G I O M A S O F THE FACE
Semergidis, 11.*,Karantanas, A.H., Sotereanos, G.
Clinic of OMFS and MRI Dept. Larissa General Hospital,
Larissa, Greece and Division of Plastic and Maxillofacial
Surgery, University of Pittsburgh Medical Center,
Pittsburgh, US.A.
Aims: To present the role of non invasive radiological tech-
niques, such as magnetic resonance imaging (MRI) in docu-
menting the extent and flow characteristics of vascular
malformations and hemangiomas of the face.
Subject: 2 female patients, 9 and 64 years old and an 8 year
old male patient presented with hemangiomas of the sym-
physeal region, the cheek and mandibular body respectively.
Diagnosis was based on clinical examination and history
but exact measurements as regards the volume, flow and
margins of the lesions were obtained by MRI.
Results: Excellent images were obtained delineating the
margins of the thrombosed hemangioma in the first young
patient permitting accurate preoperative planning that
enabled an uneventful surgical removal. A novel technical
modification was used in the second patient. M R <<heman-
giogram~> is performed with heavily T2-weighted Turbo Spin
Echo pulse sequence with MIP ( maximum intensity projec-
tion ) reconstruction. These images gave tissue resolution in
three plane slices demonstrating relation with adjacent
structures. Afferent vessels originating from the parotid
parenchyma were also portrayed. This patient refused any
treatment. M R I in the third patient suggested the need of
angiographical embolism which was successfully performed
in another center.
Conclusions: MR1 for vascular lesions of the face and oral
region can be the <<gold standard >~in differential diagnosis
as well as in preoperative evaluation and planning.
USE O F A L L O G E N I C BONE GRAFTS IN ONLAY
AND S A N D W I C H AUGMENTATION TECHNIQUES
Sener BC, Tasar F, Akkocaoglu M. Ozgen S, Kasapoglu 0
Department of Oral Surgery, Faculty of Dentistry,
Hacettepe University, Ankara, Turkey
Onlay and sandwich augmentation techniques are used suc-
cessfully for management of atrophic jaws. As bone grafts in
chip or granule forms may migrate into the surrounding soft
tissues, block shaped grafts are preferred. Allogenic bone
grafts are preferred rather than otogene grafts are preferred
rather than otogene grafts due to the patient comfort. We
aimed to compare success rates of both methods. Eighteen
patients (6 male: 10 female) between 29-67 (mean 53+4.5)
ages were presented. Nine sandwich augmentations and 9
only augmentations were performed on mandible. Allogenic

bone grafts (Tutoplast®, Biodynamikcs, U.S.A.) in block
form was used in all cases. Two (22.2%) of only grafts
were rejected due to insufficient vascularization and one
(11,1%) graft due to postoperative infection. No rejection
was observed in sandwich group. Regarding the result of
this small study group we can conclude that, success rate
of sandwich augmentation is higher than onlay grafts,
however, further studies are needed to investigate effects
of other factors, such as osteosynthesis methods and
suturing techniques, affecting bone healing on larger
study groups.
This study will be presented by B. Cem Sener from
Department of Oral Surgery, Faculty of Dentistry, Hacettepe
University, Ankara, Turkey as an Oral Presentation.
[~ COMBINATION O F M I C R O S U R G I C A L BONE
GRAFT RECONSTRUCTION W I T H
OSTEOINTEGRATED DENTAL I M P L A N T S
(REPORT O F TWO CASES)
Safak, T*., Tiimev, C**., Senfift, K**., Erdem, 0"*.,
Metal, G., Araz, K *e
*Department of Plastic ( Reconstructive Surgery, Faculty of
Medicine, University of Hacettepe, Ankara, Turkey.
** Department of Oral Surgery, Faculty of Dentistry,
University of Hacettepe, Ankara, Turkey.
Local excision of a small accessible ameloblastoma is indi-
cated in the young, provided they agree to regular follow-up
and a radical resection when recurrence occurs. Recurrences
are unusual after curettage. Block section of the involved
bone should extend into and include some normal periph-
eral bone surrounding osseous structures is the accepted
treatment of choice. The reconstruction aim of a mandibu-
lar discontinuity defect using autogenous bone grafts
include; anatomic reconstruction to restore the contours of
the face and functional rehabilitation of mastication, articu-
lation, swallowing and respiration. Due to the difficult
anatomic and functional situation, mastication and articu-
lation can only be restored with implant-supported prosthe-
sis. The experience of the authors showed that contour and
functional restoration can best be accomplished in a step-
by-step procedure, namely reconstruction of the continuity
defect with a bone graft; secondarily soft tissue augmenta-
tion and implant placement. We have seen that the use of
vascularized bone graft results in marked improvement in
intraoral rehabilitation of the patient. The advantage of the
vascularized bone graft is to make possible a one-stage
reconstruction in cases in which multiple procedures were
required formerly. In our two cases after the partial resec-
tion of the mandible for removal of an ameloblastoma,
functional and aesthetic rehabilitation was performed with
implant supported prosthesis.
APPLICATION OF rhBMP-2 FOR FUNCTIONAL
RECONSTRUCTION OF MANDIBLE
lchiro Seto 1., Noriko Tachikawa 2, Masaji Mori 1, Hiroshi
Nagao 1, Kozue Masaka 1, Satoru Hoshino 1 and Shofi
Enomoto 1,2
The 2 "dDept of Oral and Maxillojacial Surgery, 2 Clinicfor
Oral Implant, Faculty of Dentistry, Tokyo Medical and
Dental University
EACMFS- Abstracts, Helsinki Congress 1998 177
Aims: To examine the efficacy of recombinant human bone
morphogenic protein-2 (rhBMP-2) for mandibular func-
tional reconstruction with osseointegrated implants.
Method: In this experiment, adult beagle dogs were used.
Three months after extraction of P2, P3 and P4, a 30ram
segmental bone defect was made on the mandible and
rhBMP-2 was applied to the defect with a polylactic/glyco
licacid copolymer carrier coated with gelatin in a sponge-
like form (PGS). After 16 weeks, 3 titanium implants were
inserted in the newly formed bone. 8 weeks after implanta-
tion prosthetic suprastructure was placed and loaded under
appropriate conditions. The remodeling of the new bone
around the implants were evaluated radiographically and
histologically.
Results: In the segmental osteotomy, new bone formation
with rhBMP-2 was observed and resected mandible was
restored in 8 weeks.
We evaluated the quality of the new bone by peripheral
quantitative computed tomography (pQCT) and found the
amount of calcified bone increased almost to the level of the
original cortical bone density in 16 weeks. Then we were able
to implant the fixtures in the newly-formed bone and subse-
quently dense new bone was found around the implant fix-
tures. After a cerain period of loading, the bone tissue around
the implant became more dense toward the implant surface.
Conclusion: PGS/rhBMP-2 complex can be applied not only
to the reconstruction of large defects, but also to the inser-
tion of implants for functional rehabilitation.
ACCURACY OF COMPUTER-GENERATED
GROWTH PREDICTION
Shall, IV.*, Davies, T.M., Turnbull, N., Thuau, H.
Departments of OMFS & Orthodontics, Central Middlesex
Hospital NHS Trust, London, U.K.
Aims: To evaluate the accuracy of a commercially available
(OrthoVision, OTP for Windows) computer growth- fore-
casting program for patients who have had no surgical or
orthodontic intervention.
Method: Three consecutive cephalograms of 40 adolescent
individuals (20 class II Division I, 20 class III cases), taken at
least one year apart were submitted for analysis. Hard and
soft tissue landmarks were digitised using the on-screen facil-
ity. The OTP software uses Bolton's composite templates of
optomised male/female growth. The computer-generated
growth prediction using the first cephalogram was compared
with the actual cephalograms taken at a later age.
Results: For some parameters, these showed statistically sig-
nificant differences between the computer growth prediction
and the actual cephalograms. Considerable individual varia-
tion was noticeable for most individuals within the group.
Conclusions: The computer program is user friendly and
offers advantages of quicker access to information, greater
accuracy in producing the tracing and it helps in patient edu-
cation. Its disadvantages include the fact that that the com-
puter growth prediction forecast does not include any other
modifiers such as race, sex or a severe class III malocclusion.
LASER-ASSISTED UVULA-PALATOPLASTY BY
H O L M I U M SURGICAL LASER F O R S N O R I N G AND
SLEEP APNOEA.
Shakhov A.A.,Nerobeyev A.L
178 Journal of Cranio-MaxillofacialSurgery
Department of Plastic and Reconstructive Surgery, Russian
Medical Academy of Postgraduate Education, Moscow,
Russia
AIMS:
The effect of laser-assisted uvulapalatoplasty (LAUP) by
utilising holmium surgical laser was investigated in 97 heavy
snorers.
METHOD:
LAUP is an effective surgical method for the elimination of
habitual snoring and mild obstructive sleep apnoea. LAUP
is safely performed under local anaesthesia in the office, and
it provides progressive enlargement of the oropharyngeal air
space by reshaping and restructuring the uvula, soft palate,
and pharyngeal pillars utilising the holmium laser. LAUP
can also reduce oropharyngeal obstruction that may occur
during sleep in patients with obstructive sleep apnoea syn-
drome. Our experience includes 97 patients evaluated and
treated past years.
RESULTS:
Succesive laser ablation of a vibrating structure, such as the
uvula, soft palate, and posterior pharyngeal pillars,
provided an 82% cure rate, in patients with obstruction
types I and II by the Fujita classification. In addition, 10%
of the patients reported significant reduction of snoring.
CONCLUSIONS:
LAUP with a specially designed holmium surgical laser is a
reliable and effective procedure for the treatment some sleep
breathing disorders that can be performed in the office. A
major advantage of this method is its simplicity, safety and
absence of bleeding.
THE A P P L I C A T I O N O F INTRA-BUCCAL
C O M P R E S S I O N AND DISTRACTION DEVICES IN
MANAGING PATIENTS W I T H CONGENITAL
A P L A S I A O F THE LOWER JAW (MICROGNATHIA).
Kh. Shamsudinov, N. V. Bukatiua, A. L Arsenina.
Central Scient~'c Research Institute of Stomatology
( CSRIS ), Moscow, Russia
Conventional surgical methods of treating patients with
micrognathia do not produce satisfactory aesthetic and
functional results. The reasons being recurrent deformities,
anaesthesia in the lower alveolar nerve, distribution and
inflammation. Commencing in 1997, intra-buccal osseous
compression and distraction devices (CDD), were intro-
duced in order to reduce post-operative complications and
improve the long-term results of surgical operations in the
CSRIS clinic.
The basis of the distraction osteogenisis method was
developed by G.A. Ilizarov. Treatment of 9 patients was car-
ried out: with symmetrical and asymetrical underdeveloped
jaws. The patients underwent ostetomy of the mandible
down to the cortical layer with fracturing and fixation of the
fragments with the CDD. With the aid of the device, com-
pression was created. Within 7 days, distraction, at the rate
of lmm per day, was commenced. On achieving the desired
size, regenerative distraction was continued for an addi-
tional 4-6 weeks.
As a result of the treatment, a complete and healthy
bone was regenerated, with a length of 2,5cm on either side.
The operation time was 1.5 hours, bleeding was minimal. A
week after the operation, the result of electrical pulp tests of
the anterior teeth, consisted of 2-5mcA, which is the norm
for intact teeth in an undamaged jaw.
The main advantage of this new method is that it allows
avoidance of many intra- and post operative complications.
CORRECTED STANDARDISED UPTAKE VALUE
(SUV) FOR 18- FDG IN HEAD AND NECK
SQUAMOUS CELL CARCINOMA (SCC)
CORRELATES WITH HISTOLOGICAL GRADING
BUT NOT WITH CLINICAL STAGE.
J A Sherman* L Biassoni, PK Marsden, M McGurk, M
Malsey.
Maxillofacial Surgery Department and the Clinical PET
Centre, Guy's & St Thomas' Hospitals, London, United
Kingdom
Aim: To investigate the relationship of SUV for 18-FDG
with histological grading and clinical staging in patients
with SCC of the head and neck.
Method: Grading was evaluated in 45 patients prior to ther-
apy and in 8 patients with residual disease or recurrences. 3,
35 and 15 lesions were histologically classified as well, mod-
erately or poorly differentiated SCCs respectively.
Staging was evaluated prior to therapy in all patients
(n=53) and was defined according to the American Joint
Committee on Cancer. A mean activity of 270 Mbq (range
155-363 Mbq) was recorded following injection of 18-FDG.
Emission and transmission scans were then performed.
Images were corrected for decay and attenuation. SUVs
were calculated for the highest value pixels in each lesion
and corrections were made for blood glucose level, lean
body mass and partial volume effect.
Results: A correlation was observed between pre-therapy
SUV and grading (p=0.024, Kruskal-Wallis test), however
no significant correlation was observed when corrections for
blood glucose level, lean body mass and partial volume
effect were omitted (p=0.21, Kruskal-Wallis test). In the
post-therapy group no correlation between SUV and grad-
ing was observed. There was no correlation of SUV with
the clinical stage.
Conelusion: Our data suggest that a correlation exists
between SUV and histological grading in pre-therapy
patients with head and neck SCC, provided SUV are calcu-
lated using the relevant correction factors.
NEW CONCEPT O F THE INITIAL SURGICAL
MANAGEMENT O F G U N S H O T FRACTURES O F
THE MANDIBLE
Shvyrkov M.B.*
Department of Maxillofacial Traumatology
Moscow Medical Stomatological Institute, Moscow, Russia
At present saving surgery management of gunshot wound is
generally acknowledged conception. There are a lot of com-
plications due to this conception: gunshot osteomyelitis
occurs in 45-68% of the wounded, the mandible defect - in
22-27%, wound inflammation - in 26-28%, pseudarthrosis -
in 5,1-8,2%, scar contracture - in 3,3-4,8% of the wounded.
Disabled persons were 20-25%. To decrease complications

quantity author elaborated on the basis of his own experi-
ence in Afghanistan war a radical first surgery management
instead of conservative management. It consists of more
extensive excision of wound margines up to active capillary
bleeding, removal all bony debris, removal of dead bone
until a bleeding surface and joining them together or bring
them closer to each other. Due to that occlusion was dis-
turbed, the wound diminished, tissue abundance around the
wound created, and the wounds could be sutured. To elimi-
nate the gunshot mandible defect author designed, and used
special compressive-distractive apparatus. Besides for rid-
dance of the mandible defects five methods of osteoplasty
have been elaborated. Moreover blood and urine biochemi-
cal examinations and functional tests (Kawezki, Rotter)
were carried out. Statistical analysis permit to create joint
criterion for prognosis of gunshot wound and gunshot frac-
tures especially. The criterion allows to foresee gunshot
osteomyelitis development.
This conception was applied in 130 Afghan wounded
with very high results. Owing to these osteoplasty methods
and device the mandible defects varying from 2 to 15 cm in
length. Number of the wounded with gunshot osteomyelitis
and wound inflammation decreased up to 6,4%, the
mandible defect - to 1,6%, pseudarthrosis and scar contrac-
ture were absent. Invalids became 4,3%.
Results suggest application of the radical first surgery
management in the gunshot mandible fractures is beneficial.
REPAIR OF THE RADIAL FREE F L A P D O N O R
SITE. A PROSPECTIVE STUDY COMPARING F U L L
AND PARTIAL THICKNESS SKIN.
AJ Sidebottom*, JC Devine, P Magennis, JS Brown, ED
Vaughan
Regional Maxillofacial Unit, Walton Hospital, Aintree
Trust, Liverpool, UK
The radial forearm free flap is frequently used as the method
of reconstruction in the head and neck. Repair of the defect is
preferably with direct closure, however this is often not possi-
ble. The options then include split or full thickness skin grafts.
METHODS
We prospectively allocated all patients having radial free
flaps at the Regional Maxillofacial Unit, Liverpool, U K to
having either full or partial thickness skin graft repair of the
defect. The patients were assessed postoperatively for donor
and recipient site wound complications and at one year for
aesthetic appearance.
RESULTS
65 patients were recruited between May 1996 and December
1997.
The detailed findings and early aesthetic outcomes will
be presented.
SUBMANDIBULAR GLAND TRANSFER FOR
CORRECTION OF THE DRY EYE -SURGICAL
EXPERIENCE AND 4-YEAR-FOLLOW-UP-
P. Sieg", K. W. Warneeke, G. Geerling
Luebeck / Germany
EACMFS - Abstracts, Helsinki Congress 1998 179
Dry Eye Syndrome or Xerophthalmia describes a condition
of absent or reduction in quantity of tears. Despite the effi-
cacy of many well known "manoeuvres" used to prevent the
development of keratitis sicca and their deleterious effects
up to blindness and loss of the eyes there is still a percentage
of patients who do not gain adequate relief. Microvascular
submandibular gland transfer to the temple with implanta-
tion of Wharton's duct into the upper conjunctival fold
offers a surgical approach for performing permanent, autol-
ogous substitution of tears.
Within the last four years, 28 submandibular glands have
been transplanted in our department, using microsurgical
techniques. After successful gland transfer the clinical
results differ from total vanishing of symptoms of the dry
eye syndrome up to nonresponsiveness. Four vascular com-
plications caused three total and one partial gland loss in
this series. Our experiences with this surgical method includ-
ing modifications based on the underlying disease as well as
the clinical results of the 4-year-follow-up will be described
in detail in the oral presentation.
THE PATHOLOGY AND THERAPY O F KELOIDS
Skagers, A.*, Auzins, V., Dalmane, A., Lauskis, G., Salms, G.
Department of OMFS, Laboratory of Electronmicroscopy
Medical Academy of Latvia, Latvian Cancer Cente~ Riga, Latvia
AIMS:
To evaluate pathomorphology and outcomes of combined
(surgical and radiotherapy) treatment of keloids in facial
region.
METHOD:
In 11 patients (8 women, average age 24 years) with keloid-
safter burns (4), wounds (3), earlobe holes (3), ache (1) as
backset after surgery, injections of steroids and pressure in
7cases were treated by economical excision and postopera-
tiveshort focus X-ray therapy 20 - 40 Gy totally. The under-
mine depidermal layer was used to cover the wound. The
histological and electronmicroscopic evaluation of scar tis-
sue was used to choose the protocol of X-ray therapy. The
X-ray therapy was started 2 - 3 weeks after excision when
healing of wound was complete. 5 % dieton liniment as
radioprotector was used before irradiation to diminish the
damage of epidermis.
RESULTS:
The main feature in the pathomorphology was increased
amount of large, functionally hyperactive fibroblasts, thick
homogeneously eosinophilic bands of collagen, thin col-
lagenous fibers. In cases of red, painful keloids the inflam-
matory cell infiltration and hypervascularity was observed.
The epidermal layer was normal or atrophic without expres-
sive changes in cellular arrangement. The subjective and
objective improvement in the period 1-15 years after treat-
ment was observed in all cases. Full disappearing of keloids
was in 8 patients.
CONCLUSIONS:
The pathomorphological and clinical data substantiate the
use of epidermal layer over the keloids to cover the wound
after excision of keloids. Combined surgical and radiother-
apy provides satisfactory late results of keloid treatment.
The side effects of radiotherapy must be discussed with
patient before treatment.
180 Journal of Cranio-Maxillofacial Surgery
ADVANCED IMAGING OF MAXILLARY
ALVEOLAR CLEFTS
Skouteris, C *, Aiexandridis, C, Datseris, G., Marti, If.,
Angelopoulos, A.
University of Athens, Department of OMFS,
"'Evangelismos" Hospital, Athens, Greece
Aims: To compare the routine imaging techniques for preop-
erative and postoperative assessment of grafted maxillary
alveolar clefts with the panoramic and 3-D reconstruction
of the Dentascan CT images of the maxilla.
Method: Pre- and postoperative conventional orthopanto-
mographic and occlusal views of patients with grafted
maxillary alveolar clefts were obtained and compared with
panoramic and 3-D reconstruction Dentascan CT images
taken from the same patients. Particular attention was
directed to the comparative evaluation of the postoperative
routine and Dentascan images that were taken soon after
the grafting procedure and at six months and one year post-
operatively.
Results: The preoperative Dentascan panoramic and 3-D
reconstruction images were clearly superior to the routine
studies in precisely outlining cleft bony involvement, discov-
ering spontaneous bone bridging, measuring residual thick-
ness of alveolar bone segments, and describing deviation of
the bony palatal shelves and their possible bony excres-
cences. Superior results were also obtained from the postop-
erative Dentascan studies relative to the evaluation of the
progression of bone healing at the grafted cleft site.
Conclusions: This study indicates that the panoramic and 3-
D reconstruction Dentascan CT images are a superb alter-
native to routine radiographic studies for the pre- and
postoperative evaluation of bone grafted maxillary alveolar
clefts. The relative disadvantages of these advanced imag-
ing techniques such as cost, radiation dose, and image dete-
rioration due to patient movement can be minimized by
effective technique modifications and in our view these pos-
sible shortcomings are outweighed by the wealth of useful
information that these methods provide in the detailed
assessment of patients with maxillary alveolar clefts.
[~ HEPARIN-INDUCED THROMBOCYTOPENIA
TYPE II AS A CAUSE OF LOSS OF A RADIAL
FOREARM FLAP FOR MICROSURGICAL
OROMANDIBULAR RECONSTRUCTION: A CASE
REPORT.
Smoika K .1, Jahn U R 2, Meyer J, Ostermann I-F, Piffko 3~,
Joos U1
JCranio-Maxillofacial Surgery, University of Muenster,
Germany
2Anaesthesiology and Critical Care Medicine, University of
Muenster, Germany
Introduction: Heparin-induced thrombocytopenia type II
(HIT I1) is the severe form of acquired hypercoagulability
caused by antibodies against heparin-platelet factor 4-com-
plexes (heparin-PF4). HIT II usually occurs 4-14 days after
heparin administration and may have fatal thromboembolic
consequences. The incidence of HIT II is 1-3%.
Subject: A 70-year-old male patient received microsurgical
reconstruction using a vascularized radial forearm flap for
covering a defect following resection of a squamous cell car-
cinoma of the anterior floor of the mouth. Surgical treat-
ment included partial glossectomy, segmental mandibulec-
tomy, bilateral functional neck dissection, mandibular
reconstruction with a T H O R P plate and microvascular
anastomosis of the flap to the superior thyroideal artery and
vene.
Results: Commencing therapy with unfractioned heparin
(125-250 I.E./h) the initial postoperative platelet count was
160.000/pL. Five days after surgery the flap developed
general ischemia and loss of refill and platelet count was
80.000/~tL. HIT II antibody testing proved that the patient
was positive for anti-heparin-PF4-complex-antibodies. In
spite of immediate surgical revision revascularisation was
impossible. Histological examination of the removed flap
showed arterial thrombosis of the radial artery and arter-
ial and venous microthromboembolism. Anticoagulation
was altered to the heparinoid Danaparoid (Orgaran)
effecting an increase of platelets to 150.000/~tl within 3
days.
Conclusions: We highly recommend consequent platelet
monitoring and screening for anti-heparin-PF4-antibodies
in patients with platelet counts below 100.000/~tl for early
diagnosis of HIT II in order to improve the prognosis of
flaps in these patients.
REHABILITATION OF ORAL CANCER PATIENTS
Anna-Lisa Sgderholm, Annu Korpijaakko-Huuhka, Matti
Lehtihalmes, Liisa Ertama
Depts of Maxillofacial Surgery & Radiology, Helsinki
University Hospital, Dept. of Phonetics, Helsinki
University, Dept. of Finnish, Saami and Logopedics,
University of Oulu, Finland
The aims of this study was to examine the variety and
extent of oral dysfunctions and evaluate the need for reha-
bilitation in patients treated for oral cancer. Despite new
treatment techniques in surgery and radiotherapy many
patients suffer from various oral dysfunctions, often
severe. How can we reach the goals facilitated by surgery
and reconstructions - a good quality of life. Methods: In
1995 we started a retrospective and prospective study on
patients treated surgically in the Department of
Maxillofacial Surgery, Helsinki University Hospital. The
patients oral function and speech were examined by a
spech-language therapist, a videofluoroscopy of the swal-
lowing procedure was performed. Results: According to
the retrospective part of the study on patients treated
before 1995 we observed dysphagia in 80%, swallowing
dysfunction in 70% (86% of them severe). Speech problems
was observed in 67,5%, (15% of them with severely
decresed intelligibility, further 15% unable to use the tele-
phone). Other common problems were severe dryness of
the mouth, nutrition disturbances, TMJ-dysfunction, den-
tal problems, improved arm function and pain after neck
dissection, problems at flap donor sites, esthetic and psy-
chosocial problems. However, despite these observed dys-
functions the patients on average assessed their quality of
life as fairly good (5) on a scale from l=poor to 7=excel-
lent. Conclusions: Adequate, continuing patient informa-
tion is a corner stone in rehabilitation and a basis for
success. Rehabilitation means teamwork by many profes-
sionals. Rigth timing is important. Treatment and rehabili-
tation cannot be separated, rehabilitation actually starts at
diagnosis. According to our study-results we have created a
rehabilitation schedule.

[~ DENTAL ARCH MEASUREMENTS AND
VELOPHARYNGEAL CLOSURE IN CLP CHILDREN
AFTER SURGICAL TREATMENT. PRIVATE
*Soots M.,M.D.; L6vi-Kalnin M.,M.D.,Ph.D.,Dr.Med.Sc.;
Jagomiigi T.,M.D.,MSc.
Tartu University, Estonia
The present study analyses some dental arch measurements
(transverse and sagittal) of the upper jaw, and velopharyn-
geal closure in children who have been operated on by using
the method of bipedicle flaps, and for comparison, by using
radical uranoplasty.
Cast models were made 1-5 years after operation in 49
children operated on for cleft palate. Dental arch measure-
ments were taken by the Korkhaus-Pont method. The
results reveal the decrease in the maxillary measurements
with the raising of the bipedicle flaps is smaller than with
that of the radical one. The biggest difference was in mea-
surements of the partial cleft palate operated on using
bipedicle flaps: T~ was 3.3 mm; T2 was 2.2 mm; LO1 was 3.2
mm, to compare with radical uranoplasty.
The most common malocclusion in cleft lip and palate
children was crossbite (74.1% of the cases). Scissorsbite was
rare, (5.6% of cases). Most of cleft children (55.6%) had
normal molar occlusion, 27.8% had molar distal occlusion
and 16.7% had mesial molar occlusion. Thirty two percent
of patients had an anterior crossbite. Anterior open bite was
present in 14.8% of cases and a deep bite in 7.4% of
patients. Thirty five percent of patients had a lateral open
bite. Thirty seven percent of patients had crowded mandibu-
lar incisors and 9.3% had spaced mandibular incisors.
Thirty five percent of patients had maxillary anterior teeth
crowded and 24.1% had maxillary frontal teeth spaced.
Spacing was more common in the maxillary left posterior
teeth compared with the right side.
The length and function of the soft palate has been X-
ray-checked. The group for study consisted of 32 children
aged from 6-18 years. For this study we used lateral cephalo-
grams. In each child 2 lateral cephalogramms were taken at
rest and during phonation. The finding of normal or
sufficient velopharyngeal closure was in 23 children, which
is 71.9%, and insufficient closure was observed in 9 cases.
According to the literature data, this can be considered a
good result in surgical cleft palate correction.
The method of bipedicled flaps with velopharyngoplasty
can be recommended for routine use in the surgical treat-
ment of partial and unilateral cleft lip and palate.
This study was supported by the Estonian Science
Foundation Grant hr. 13.
T M J ARTHROCENTESIS IN THE TREATMENT OF
TMD
Spallaccia F.*, Govoni F.A., Rivaroli A., Saltarel A.,
Cascone P.
Department of Maxillo-Faeial Surgery, University of Rome
"La Sapienza", Italy
Aims: The authors had applied the arthrocentesis without
any supplementary bite appliance just to point out the
importance of the TMJ simple washing for the resolution of
TMJ pain and the improvement of condilar excurtions.
Method: This study had involved 31 joints in 30 patients
EACMFS - Abstracts, Helsinki Congress 1998 181
with persistent TM pain frequently associated with limited
mouth opening. They were treated placing two needles in the
upper space of the joint and washing the compartment with
180 ml. of lactated Ringer solution. Clinical data were maxi-
mum mouth opening and pain before and after arthrocentesis.
Results: On a middle follow-up of 15 months, jaw opening
was improved ( average 9,7 ram.) and TM pain was higly
decreased.
Conclusions: We retain that the arthrocentesis is a very efficient
procedure that allows to drain the chemical mediators of pain
and inflammation dissolved in synovial fluid.. TMJ arthrocen-
tesis and lavage is recommended as a simple alternative to more
invasive TMJ procedures as an effective technique for the treat-
ment of subacute TM pain and limited mouth opening.
RELIABILITY OF R A D I O G R A P H I C M E T H O D S IN
THE DIAGNOSIS OF MANDIBULAR FRACTURES
Staj~i~ Z.* and Rakobevib Z.
Faculty of Stomatology, University of Belgrade, Yugoslavia
Aims: To determine the most reliable radiographic method
in the diaglt0sis of mandibular fractures and establish a pro-
tocol for radiographic examination according to fracture
sites with regard to reliability and radiation exposure.
Method: In a prospective study, 109 patients with 166 frac-
tures of the mandible were submitted to 4 plain radi-
ographic 15rocedures: Orthopantomography (OP),
Posteroanteri~ (PA) and Lateral Oblique projections, and
Linear Tomography (LT) using cortical discontinuity as a
radiographic criterion. The fracture sites were recorded as
the condylar process, ramus, angle, body and symphysis
where an Occlusal Projection (OCP) was added.
Results: LT was found to be the most reliable method in 94%
of the cases followed by OP (79%) and PA (77%). The over-
all success rate of OP for the body and angle was 90%. The
OP and PA were reliable in only 62% and 79% of fractures
of the condylar process respectively. The OCP and LT
showed 100% and 96% success rate in the symphyseal and
condylar process regions respectively.
Conclusions: A protocol: OP for the body and angle. If a
suspected fracture of the condylar process and/or symphysis
is not detected, LT and/or an OCP should be added. By
using this protocol, over 95% of accuracy with relatively low
radiation exposure can be expected.
THE H I S T O R I C A L D E V E L O P M E N T OF
BIMAXILLARY O S T E O T O M I E S
Steinhiiuser, E
University Erlangen, Germany
There is no doubt that the cradle of orthognathic surgery
was in St Louis, USA where the general surgeon, Vilray
Blair performed different types of mandibular osteotomies
about hundred years ago However, simultaneous
osteotomies in the upper and lower jaw were carried out in
Europe first and also described in the literature. The max-
illofacial surgeons Heinz Kole and Hugo Obwegeser both
native Austrians and pupils of Richard Trauner in Graz
developed surgical techniques which allowed correction of
dento-facial deformities by simultaneous operations on the
upper and lower jaws. Kole in 1961 published his method of
182 Journal of Cranio-Maxillofacial Surgery
bimaxillary alveolar surgery and Obwegeser in 1970
reported for the first time on his experience with total max-
illary and mandibular osteotomies which were carried out in
one operative session. Obwegeser also pointed out that the
main advantages of this procedure are better facial aesthet-
ics and less relapse. Later on, Lindorf and Steinh/iuser
improved this technique in 1978 with the introduction of the
double splint method for better positioning of the
osteotomized fragments. From 1980 onwards the technique
of bimaxillary surgery became quite popular and many
publications about its successful application exist. A consid-
erable improvement was the introduction of rigid fixation in
orthognathic surgery, however, it should be realized that nei-
ther Kole nor Obwegeser knew about this technical innova-
tion when they started performing bimaxillary surgery.
ORAL SURGERY IN A CASE OF MARFAN SYNDROME
Steinhilber, W.
Marfan Hilfe (Deutschland) e. V., Cologne, Germany
Marfan syndrome is a common, heritable disorder of con-
nective tissue, transmitted as an autosomal dominant trait
with variable penetrance. The molecular defect is related to
anomalies of fibrillin, an integral connective tissue protein.
Clinical manifestations include musculoskeletal, ophthal-
mologic, and cardiovascular involvement, especially aortic
aneurysm, followed by aortic dissection and aortic rupture.
All patients with Marfan syndrome should be considered
at risk for bacterial endocarditis. Therefore, they should
receive adequate prophylaxis for dental as well as surgical
procedures. Cardiology societies have issued guidelines for
antibiotic treatment for procedures that have a high likeli-
hood of transient bacteraemia such as dental procedures.
In patients with Marfan syndrome who have artifical
valves, aortic replacemant or a composite aortic graft, endo-
carditis is a devastating complication. All precautions
should be taken in these patients, and the recommendations
regarding prophylaxis for bacterial endocarditis, including
use of parenteral antibiotics, should be followed.
After cardiovascular surgery for any reason, patients mostly
take anticoagulants, often for lifetime. Interruptions are not
advised. Different principles of additional treatment avoiding
secondary haemorrhage in an of oral surgery case will be shown.
C E P H A L O M E T R I C ANALYSIS AFTER LE FORT I
OSTEOTOMIES STABILIZED BY TITANIUM
MICROPLATES
Stember, M.*, Mischkowski, R.A., Fangmann,R., Jacobi,
B., Z611er, J.E.
Department of Oral and Maxillofacial Surgery, University of
Cologne
Aims: To assess the stability of osteosynthesis with titanium
microplates in orthognathic Le Fort I osteotomies.
Study Design: Retrospective.
M e t h o d : The study includes 113 orthognathic patients
treated by Le Fort I osteotomy. In all patients, osteosynthe-
sis with titanium microplates was used. Lateral cephalo-
grams were taken preoperatively, immediate postoperatively,
6 weeks and one year postoperatively. Cephalometric analy-
sis of the cephalograms was performed.
Results: In no patients did a clinically relevant relapse occur.
In one case three of four inserted plates fractured. In 14% of
all patients a skeletal relapse could by demonstrated only by
cephalometric analysis. The amount of the relapse related
strongly to the distance of operative maxillary translation.
Conclusion: Regarding stability, microplate osteosynthesis is
equal to miniplate and wire fixation, though the microplates
arc easier to use and more convenient for the patient. The
results show that titanium microplates are very suitable for
internal fixation after Le Fort I osteotomy.
DOES ORTHOGNATIC SURGERY CURE T M J
DYSFUNCTION
Stepke, M*.; Sterz, M.; Knoll, B.; Helm, G.
Dep. of Maxillofacial Surgery, Frankfurt Univ. Medical
Center, Frankfurt, Germany
AIMS:
A high percentage of patients with malocclusion seek
orthognatic surgery because of TMJ dysfunction and pain.
The aim of this study was to determine if orthognatic
surgery cures this problem.
METHOD:
In 1996 and 1997 we did axiographies on 87 patients with
malocclusions seeking our held for orthognatic surgery. All
patients received 3 axiographies during their course of treat-
ment: before orthodontic treatment, before the operation
and 9 month post-op.
Doing so, we operated on 48 patients with class II or III
malocclusion. In case of sagittal split osteotomies, the Luhr
positioning device was used to secure the joint.
RESULTS:
In all but one patient who underwent a Le-Fort-l-osteotomy
joint function was unchanged (37%) or improved (60%). In
contrast results after bimaxillary surgery are significantly
different between class II and lII. We examined some degree
of limitation of joint function in 78% of class lI patients - in
57% even one year post-op.
CONCLUSIONS:
Although we operated only on asymptomatic TMJs the
high percentage of post-op limitations of joint function in
class II patients who underwent bimaxillary surgery shows
the necessity of intensive pre-op diagnostics including N M I
and arthroscopy.
AMELOBLASTOMA CYSTICUM MANDIBLE
RECONSTRUCTION BY VASCULAR1ZED FIBULA
FLAP - A CASE REPORT
St(tka, L., Machdlka, M.
St. Anna Faculty Hospital, Brno, 1"t Stomatological Clinic,
Czech Republic
Aims: Reconstruction of the mandible affected with a cystic
ameloblastoma by means of a vascularized bone graft taken
from fibula.
M e t h o d : Operation started with withdrawal of the vascular-
ized bone graft and identification of the nourishing vascular

peduncle. Resection of nearly the whole of the left half of
the mandible including the articular head was performed.
Bone graft was shaped and adapted by means of a mini-
plate. Vascular peduncles of arteria facialis and arteria
nutriciae fibularis were sutured by the end to end method.
Operation wound was closed, intermaxillary ligature was
retained for ten days. Rehabilitation of the mandible
followed.
Results: Up to present time, similar-looking cases were
always managed by free bone graft at our clinic. This was
the first time, the reconstruction by vascularized bone graft
using an operative microscope was performed.
Conclusions: A modern method of mandible reconstruction
is demonstrated. Very good rehabilitation of the patient in
both functional and cosmetic respect is presented.
[~ O P E N S U B M U C O U S VESTIBULOPLASTY. A
VERSATILE PRIVATE M O D I F I C A T I O N OF
K A Z A N J I A N ' S TECHNIQUE
Staj~ik Z., Radulovi~ M., Stojbev Lj.*
Clinic of Oral Surgery, Faculty of Stomatology, University
of Belgrade, Yugoslavia
Aims: To describe a modification of Kazanjian's vestibulo-
plasty, present results and discuss the advantages and the
disadvantages.
Method: The incision is placed in the labial mucosa which is
dissected off the submucosa and mentalis muscle up to the
alveolar crest. The muscle is stripped off the periosteum
down to the future sulcus. The mucosal flap is stretched and
sutured to the periosteum deep into the sulcus by leaving a 5
mm wide free mucosal margin. This mucosal strip is
stretched and its periphery sutured to the free edge of the
labial incision. This procedure was applied in 15 patients
with a shallow vestibular sulcus and sufficient volume of
underlying bone.
Results: The sulcus gain was preserved. The bottom of the
sulcus was "U" shaped. Denture-bearing areas were scar-
free. There was no raw surface left and subsequent tissue
contracture and inversion of the lip did not occur. Bony
irregularities were smoothed through the periosteal crestal
incision. It was also applicable in the upper jaw as well.
When combined with the insertion of ITI implants the
blood supply to the periphery ot~ the mucosal flap may be
compromised because of perforation through the base of
the flap.
Conclusions: Open submucous vestibuloplasty proved to be
a versatile technique with predictable results.
VASCULARISED AND NON-VASCULARISED
BONE GRAFTS FOR MANDIBLE REPAIR AFTER
WAR W O U N D S
Stosic, S.*, Jovic, N., Mirkovic, Z., Loncarevic, S., Lazic,
Z.
Clinic for maxillofacial surgery, Military Medical Academy,
Belgrade, Yugoslavia
A retrospective study of 31 patient having vascularized bone
grafts (VBG) (11 radial, 9 scapular and 11 fibular) and 83
patients having nonvascular bone grafting (NVBG) (cor-
tico-cancellous block grafts) for segmental mandibular and
EACMFS - Abstracts, Helsinki Congress 1998 183
adjacent soft tissue reconstruction that had been treated
from September 1992 until September 1995.
All bone grafting were performed as a secondary treat-
ment. Clinical and radiologic follow up had lasted from two
to five years.
This study compares succes rates for vascularized (VBG)
and non-vascularized (NVBG) free bone grafts in recon-
struction of defects of the lower jaw after war wounding.
This paper also demonstrates criteria used for VBG and
NVBG such as shape, size, location and structure of
defects and morbidity of the donor site and possibility for
dental implants placing.
7~ CRANIO-FACIAL I N J U R I E S INVESTIGATED BY
THREE-DIMENSIONAL COMPUTED
TOMOGRAPHY
Stosic-Opincal T.*(1), Stosic S. (2), Dimitrijevic 3/1. (3),
Stojanovic-Birovijev E (1)
(1)Emergency Center, Institute of Radiology, (2) Clinic for
Maxillofacial Surgery, Institute of ORL and MF surgery,
Belgrade, Yugoslavia.
P U R P O S E : The aim of this study was to present the value
of three-dimensional (3D) reconstruction of computed
tomography (CT) in detecting the bone damage of the face,
surgery planning and postoperative controls.
MATERIAL AND M E T H O D E S : During the last two years
105 patients with cranio-facial trauma were admitted to the
Emergency Center in Belgrade. All of them have been exam-
ined by axial CT scans, and 37 patients have been studied
using 3D reconstruction. All patients were surgical treated
and operative findings were compared with preoperative
findings of conventional CT and 3D reconstruction of CT.
RESULTS: From our 37 patients 31 had complex cranio-
facial fractures, 4 mandibular fracture and 2 injuried
patients had fracture of the frontal sinuses. Bone fragments
and defects in orbite and maxillary sinus shape are better
visualized using 3D reconstruction in advance with conven-
tional CT scans.
CONCLUSION: Three-dimensional reconstruction of CT
is very useful for preoperative planning and postoperative
controls of the results.
AUGMENTATION O F EDENTULOUS SEVERELY
RESORBED MAXILLAE BY LE FORT 1 PROCEDURE
F O R LATER PLACEMENT O F E N D O S T E A L
IMPLANTS
Strandkvist, T.. Hallman, M.
Department of OMFS, County Hospital, Giivle, Sweden.
Aims: The purpose of this retrospective study was to evalu-
ate fixture survival, following interpositional, iliac bone
grafting to the severely resorbed maxilla.
Method, Eleven patients, nine women and two men with an
average age of 57 years (range 45-65) were included in this
study. All patients had a severely resorbed edentulous max-
illa. The grafts, were taken from the iliac crest and all
patients had Le Fort 1 surgery with interpositional crista ili-
aca grafts. The floor of the sinuses were filled with milled
autogenous bone mixed with Tisseel. After a healing period
of 6 months 83 titanium implants (Br~nemark) were
184 Journal of Cranio-MaxillofacialSurgery
installed. Clinical and radiographic evaluations were per-
formed yearly. The mean follow-up time of 31,9 months,
ranging between 19-42 months.
Results: Implant survival rate was 94%. Five implants were
lost, all of them before loading. Four of the lost implants
were in the same patiens. However all patients still have
fixed bridges.
Conclusion: Edentolous patiens with a serve maxillary bone
loss have always been a treatment challenge in the recon-
structive implantology. In accordance to that the results
from this present study are very promising.
THE RESULTS O F A M O D I F I E D LE FORT I
O S T E O T O M Y IN CLEFT COMPARED W I T H NON-
CLEFT PATIENTS
Sugar, A. W.*, Samuels, R., Jones, M.L., Newton, (2., Bocca,
A.P.
Maxillofacial Unit, Morriston Hospital, Swansea, Wales,
U.K.
Aims: To compare the results of a modified internally fixed
Le Fort I osteotomy in cleft and non-cleft patients.
Method: 25 consecutive cases were studied prospectively in
the cleft and 25 in the non-cleft group with a minimum fol-
low-up of one year. The results were assessed in terms of
stability and complications. Lateral cephs, were digitised to
assess hard and soft-tissue changes. All cases were managed
by the same surgical team to an identical protocol of ortho-
dontics, prior grafting of any alveolar cleft, one piece
osteotomy (modified for cleft patients with an incision
which improves the vascular pedicle and a palatal protec-
tion plate to assist in radical mobilisation). Fixation was by
means of AO L-shaped 2 mm titanium mini-plates with no
inter-maxillary fixation in any case. The cleft cases were
grafted anteriorly only.
Results: Good bony union resulted in all cases with no evi-
dence of compromised blood supply to any part of the max-
illa. No fistulae were produced and few plates had to be
removed. The mean maxillary hard tissue advancement was
similar in both groups and the changes up to one year, reflect-
ing relapse or remodelling, were very small in both groups.
The difference between the operated cleft and non-cleft
relapse rates was not statistically significant. The vertical
changes were barely measurable and were all under 0.5 ram.
There was no statistically significant difference in the hori-
zontal surgical soft tissue changes between the two groups
but the upper lip tended to go up in the non-clefts and down
in the clefts. Upper lip thickness decreased in both groups.
Conclusions: This study demonstrates that cleft osteotomies
carried out in this way are safe, reliable and relatively stable
when compared with those carried out in non-cleft patients.
Study funded by the AO Research Commission, Bern,
Switzerland
RECONSTRUCTION AFTER T U M O U R
RESECTION W I T H BONE A N C H O R E D FACIAL
P R O S T H E S E S USING AN I M M E D I A T E ONE STAGE
PROCEDURE: INDICATIONS AND RESULTS
Clark, R.N. *, Sugm; A.W., Evans, P.L., Bocca, A.P.,
Barrett, P., Stafford, G.D.
Maxillofacial Unit, Morriston Hospital, Swansea, Wales, U.K.
Aims: To assess the indications for, and efficacy of, the inser-
tion of titanium implants for retention of facial prostheses
as a one stage procedure at the time of tumour resection.
Method: The results of the insertion of Brgmemark cranio-
facial titanium flange fixtures and abutments into 14 adult
patients, at the same time as resection of ears, noses and
orbits, were compared with the results in 14 adult cases in
which the one stage procedure was carried out some time
after tumour resection. These results in turn were compared
with those of 50 patients in which a more conventional two
stage procedure was performed, usually at least one year
after tumour resection.
Results: In terms of osseointegration, the results were com-
parable between the three groups. The incidence of delayed
healing in the one stage groups was higher than the two
stage and in some cases this caused significant delay before
a prosthesis could be constructed. A modified dressing
technique reduced the incidence of delayed healing. It was
noted that patients benefitted from careful pre- operative
preparation and planning with the prosthetist, especially of
the nature of the resection and the siting of implants.
Conclusions: Insertion of titanium implants as a one stage
procedure at the same time as the resection of certain facial
tumours, for example the external ear, is the treatment of
choice in most cases. All patients should be carefully
assessed, counselled and planned in advance of surgery in
conjunction with the prosthetist. A modified dressing tech-
nique reduces the incidence of delayed soft-tissue healing.
Caution should be exercised in patients in whom the opera-
tive site has been exposed previously to radiotherapy.
THE A P P L I C A T I O N TECHNIQUES AND THE
CLINICAL EVALUATION O F RESORBABLE POLY L-
LACTIDE (ORIENTED PLLA) PLATES AND
SCREWS IN BONE SURGERY
Sugiyama, Y.*I, Tachikawa N.2, Miki Z2, Sekiyama, S.1,
Enomoto, S.2,
1 The Second Department of Oral and Maxillofacial
Surgery, School of
Dentistry, Iwate Medical University,
Morioka, JAPAN, 2 The Second Department of Oral and
Maxillofacial Surgery,
Faculty of Dentistry, Tokyo
Medical and Dental University, Tokyo, JAPAN
Aims: To present the operation techniques of applying
resorbable poly L-lactide (Oriented PLLA) plates and
screws in bone surgery and to evaluate the long term results.
Subject:In 1992 and 1993, fifty-one patients were treated
with Oriented PLLA plates and screws; 24 cases of facial
bone fracture (including 20 cases of mandibular fracture),
11 of cleft lip and/or palate, 12 of facial deformity, 1 of
tongue tumor, 1 of maxillary cyst, 1 of mandibular cyst and
1 of impacted tooth.
Methods: After the reduction of the bone fragments,
Oriented PLLA plates were softened by dipping into hot
sterile water and were contoured to the bone surface. After
the procedure of drilling holes in bone and tapping with a
hand screw tap, the plates were fixed by several Oriented
P L L A screws. A long term follow-up study was done by
clinical and radiographic examinations.
Results: Forty-eight cases showed no problem in the exami-
nations. The remaining 3 cases exhibited slight dislocation
of bone segments radiographically at two weeks postopera-
tively. However, the healing of the bone wound was clini-

cally uneventful in every case at three months after opera-
tion. Until the end of 1997, no signs of inflammation or
reactions to foreign body were observed in all cases.
Conclusions: The results suggest that Oriented P L L A
osteosynthesis system could be considered safe and useful
for internal fixation in maxillofacial surgery.
IMPLANT POSITION PLANNING OF
EDENTULOUS M A X I L L A AFTER BONE GRAFTING
USING SCANORA T O M O G R A P H I C AND
DENTASCAN CT - IMAGES
Sundquist, Kfl *, Salonen, M. 2, Ylikontiola, L. l, Niemi, S. 1,
Kainulainen, Vfl, Oikarinen, 1£.1, Raustia, A. 2
Institute of Dentistry, Departments of Oral and
Maxillofacial Surgerj and Prosthodontiese, University of
Oulu, Oulu, Finland
Aims: To study the value of Scanora and DentaScan images
for implant position planning in patiens with severely
resorbed maxilla treated by bone grafts and sinus lifts.
Medhod: 7 patients with severely resorbed edentulous max-
illa were treated using bone grafts from the anterior iliacal
crest. L-shape bone blocks were stabiliced by screws to the
anterior alveolar crest and bone chips were packed tightly to
the anterior part of the sinuses. 40 Astra Tio-Blast implants
were installed after the 4 4 mounths healing period to the
places that showed adecuate bone in preoperative Scanora
and DentaScan-imagines.
The secondary operations were done after 6 months.
Results: The implant position plan done according to the
DentaScan and Scanora imagines corresponded to the clini-
cal situation and the implants were able to be installed to the
preferred sites. The DentaScan images were of a great value
in sinus lift areas were the thickness of new bone was diffi-
cult to estimate clinically. 4 implants were lost due to lack of
osseointegration, 3 of them from one patient who was a
heavy smoker. All patiens could be treated prosthetically, 2
patients with fixed bridges (8 and 9 implants) and 5 with
removable prothesis (4 to 5 implants).
Conclusion: 90 % of the installed implants osseointegrated
and were able to be used for prosthetic constructions. All
patients received the preferred prosthesis. We conclude that
our success rates are high compared to the literature due to
the precise preoperative implant position planning.
Especially the information given by DentaScan images in
1:1 scale enables exact positioning of the implant.
MANDIBULAR AND MAXII J ARY RECONSTRUCYION
WITH MICROVASCUXAR BONE GRAFIS
Suominen, E.*, MD, Pulkkinen, J., DDS,
Department of Plastic Surgery, Helsinki University Central
Hospital, Helsinki, Finland
Aims: To review our experience during a 10-year period in
performing 24 mandibular and 4 maxillary reconstructions
with vascularized free bone grafts from the ilium, scapula
and fibula.
Method: Patients were reviewed retrospectively from their
medical records. The bone defects were caused by trauma
(19), tumour (8) and congenital anomaly (1). To achieve
both bone and soft tissue reconstruction, skin islands were
included in all primary cases. 5 crista iliac, 12 fibula and 11
EACMFS - Abstracts, Helsinki Congress 1998 185
scapula vascularized bone grafts were used in these patients.
Results: 27 flaps were successful in re-establishing bone con-
tinuity in either mandible or maxilla. One fibular flap was
lost in a 65-year old man because of peripheral vascular dis-
ease in the flap artery. Re-exploration was done only on this
patient. The overall success rate for vascularized bone grafts
was 96.4 %. A part of another fibula graft in the upper jaw
was resorbed, indicating vascular problems behind the sec-
ond osteotomy site.
Conclusions: Each type of bone graft was good in establish-
ing bone continuity. In large bone defects the fibula is an
ideal choice for mandibular reconstruction. When an exten-
sive soft tissue defect is involved, the scapula bone flap
should be considered because it is able to transport a variety
of soft tissues.
EXPERIENCE OF THE USE OF EXTERNAL
FIXATOR IN A CASE O F MANDIBULAR FRACTURE
Suri Cs, * Szalontay T, Gdspdr L.
Oral Surgical Department of Central Military Hospital of
HHDF
• Traumatological Department of Central Military Hospital
of HHOF
Budapest, Hungary
Aim- To demonstrate the use of external fixator as an alter-
native method in maxillofacial surgery.
Subject: 48 year old man suffered open fracture of the right
corpus and the left collum of the mandibula. Pneumonia
with high fever developed before the planned operation so
general anaesthesia was not possible.
The intermaxillary-fixation as a conservative method
could not be performed due to the collum fracture and due
to the missing of high number of teeth.
For these reason ,,Manuflex" external fixator was
applied, which is generally used in hand surgery. This fixator
can be used under local anaesthesia, it can be easily shaped
and it is cheap.
Results: The corpus fracture of the mandibula was fixed in
the original anatomic position by external fixator. At the
same time the functional treatment of the collum fracture
was performed.
The patient could clean the instrument without any trou-
ble.
The plate osteosynthesis was not necessary later on,
either. After six weeks the removal of the fixator was easily
performed without any anaesthetic.
Conclusion: External fixation is a good alternative method
in maxillofacial surgery:
1.) To maintain structures until the definitive treatment of
serious defects of soft tissue and bone injuries.
2.) When general anaesthesia can not be performed.
3.) Initial therapy of polytraumatised patients.
4.) War-injured patients.
Its adventage is that it can easily be applied and is very unexpensive.
FUTURE OF BIOMATERIALS IN
MAXILLOFACIAL SURGERY
Suuronen Riitta, MD, DDS, Ph.D.
Department of Oral and Maxillofacial Surgery,
Helsinki University Central Hospital Helsinki, Finland
186 Journal of Cranio-MaxillofacialSurgery
During the last decade the use of biomaterials has spread to
new applications from membranes for guided bone regener-
ation and devices for fracture fixation to bone substitutes.
The biodegradable membranes can now help new bone
regeneration, and if substances that help enhance bone or
cartilage growth can be added to these membranes, we will
be able to create new tissue wherever needed thus decreasing
the need for transplants.
The fixation devices have become smaller and easier to
handle and today in many indications they can replace
metallic devices totally. Their strength has also become
markedly better, thus enabling the use of these devices in
several demanding applications. When there will be a possi-
bility to add substances to enhance bone growth these
devices will be used almost in all indications.
The bone substitutes will also make the need of trans-
plants rare, hence decreasing the morbidity of the patient.
The handling of these materials has become easier and they
can now routinely be used in several augmentation proce-
dures. As before, bone substitutes will definitely benefit
growth factors.
When we start the new millenium we should, through
education, encourage the use of biomaterials and further
increase the interest in biomaterial research. We should
develop new biocompatible materials, and as pioneers,
open-heartedly and wide-scopedly strive for better solutions
to improve our patient care. After all, we have a very impor-
tant and unique biomaterial to take care of, the patient.
BIODEGRADABLE MATERIALS AS FIXATION
DEVICES IN MAXILLOFACIAL SURGERY
Suuronen Rfftta, MD, DDS, Ph.D. P Laine, R Kontio, I
Kallela, M Eekholm, P Helander, P T6rmiilii, C Limlqvist
Department of Oral and Maxillofacial Surgery,
Helsinki University Central Hospital, Helsinki, Finland
Biodegradable devices have been used in orthopedic and in
oral and maxillofacial surgery for over 10 years. The three
most used materials are polyglycolide (PGA), polylactide
(PLA) and polydioxanone (PDS). The use of these materials
started as sutures and has thereafter spread to many differ-
ent fields of surgery, and today pins, plates, screws, tacks
and membranes are used in clinical surgery.
Biodegradable materials have been reported to be osteo-
conductive, the property that could be of use in several dif-
ferent applications. The best property, which makes
biodegradable fracture fixation devices more attractive than
metallic ones, is that they need no removal operation after
the tissue has healed. Despite the fact that PLA has been
studied for the past 30 years the number of clinical applica-
tions of the PLA based materials has grown only recently,
possibly because of the past nonreinforced implants have
been mechanically weak. At our department self-reinforced
SR-PLLA and - P D L L A have been materials of special
interest because of good mechanical properties. The use of
these implants in fracture fixation started in the area of
orthopedic surgery, after which it has been gradually
extended also to the field of oral and maxillofacial surgery.
We started our experimental studies over 10 years ago by
fixing mandibular osteomies in sheep with SR-PLLA multi-
layer plates and/or screws. Clinical use of these devices
started in our department almost seven years ago and today it
is known that an osteotomy or a sagittal mandibular fracture
and a symphyseal mandibular fracture can be fixed with SR-
PLLA screws, allowing free mandibular movement after oper-
ation. Also miniplates made of SR-PDLLA have been used
to fix bimaxillary osteotomies and genioplasties in orthog-
nathic surgery; osteotomies needed in head and neck cancer
surgery have been successfully fixed by the same devices.
IS OPERATIVE MANAGEMENT O F BLOW OUT
FRACTURE W I T H PLANE PDS F O L I O EFFECTIVE?
AN OBJECTIVE ASSESSMENT
R. Kontio, Riitta Suuronen, Antero Saio, Christian Lindqvist
The complications after orbital floor fracture reconstruc-
tion vary but include diplopia, proptosis, enophtalmos as
well as implant problems. CT is considered as the most
accurate to demonstrate the presence of the orbital floor
fracture, however, MRI is considered equal or better in most
soft tissue injuries.
16 consecutive isolated blow out fracture patients were
included in the study. The orbital floor was reconstructed
with resorbable PDS folio. The criteria for inclusion were
diplopia, enophtalmos, herniation. The study protocol
comprised 36 weeks clinical and CT/MRI follow up.
Male to female ratio was 2, 2/1. Average age for males
was 39,7 and females 31,3 years. Because of oedema 1 PDS
plate was removed. The enlargement of the fibrotic sac
around PDS was visualised by MRI, not by CT, at 2 week
follow up. Clinical symptoms appeared 4 weeks later.
Similar enlargement was documented in 10/16 patients but
resolved without symptoms. The relapse of restored form
was noticable. While 53% had primary diplopia, at the fol-
low up at 2 weeks 82% had diplopia. At the end of the study
diplopia was observed in 20% of the patients. While no one
had primary exophtalmos but 20% had enophtalmos, 2
week postop, more than 50% had exophtalmos and 8%
exophtalmos. After 36 weeks none had exophtalmos but
over 40% exophtalmos. Primary pupillary imbalance -
0,7ram (st.dev=2) was improved at 1 week up to +0,9ram
(st.dev=2) but a clear relapse down to -0,9ram (st.dev=l)
was then observed.
Although hard tissue can't be visualised by MRI, M R I
gave superior view over the soft tissues making the evalua-
tion of the bony injury also possible. Detailed view of the
soft tissue herniation seen by M R I predicted well to the
complexity of the fracture.
Both CT, M R I and clinical result showed well that recon-
struction with plane plate was not beneficial. Specially, the
mid portion of the orbit with complex anatomy, can't be
reduced effectively with plane folio or plate PDS.
AURICULAR CARTILAGE GRAFTS AT
MANDIBULAR CONDYLE ARTHROPLASTY.
Svensson, B.
Department of Oral & Maxillofacial Surgery, Orebro
Medical Centre Hospital, Orebro, Sweden.
Aims: To evaluate the clinical outcome of auricular cartilage
grafting at arthroplasty of the mandibular condyle in patients
with degenerative temporo-mandibular joint disease.
Method: In 14 patients with degenerative disorder in 18 tem-
poro-mandibular joints with deterioration of the mandibu-
lar condyle surface high partial condylectomies were
performed. The condylar surfaces were covered with com-
bined auricular car tilage/perichondrium grafts.

Preoperatively and at follow-ups 6 and 12 months after
surgery temporo-mandibular joint symptoms and function
were registered and evaluated.
Results: Preoperatively all patients had pain in their affected
temporo-mandibular joints and a decrease in maximal
mouth opening capacity. At the 6 months follow-up total
relief of pain and increase in maximal mouth opening
capacity were seen in most of the patients. At the 12 months
follow-up these patients were still free from pain and had
good mouth opening capacities and impairment was seen in
one patient only.
Conclusions: Mandibular condyle arthroplasty with grafting
of auricular cartilage at degenerative temporo-mandibular
joint disease seems to have a good effect on pain and to
increase mandibular function in the one year perspective
after surgery.
SCLEROTIC C A R C I N O M A AS A RARE T U M O R OF
THE U P P E R LIP A N D CHEEK
Swaid, S.*, Lauer, G., Schmeizeisen, R.
Department of OMFS, Albert-Ludwigs UniversityFreiburg,
Freiburg i. B~, Germany
Aims: This case shows an aesthetic and functional recon-
struction of the midface with a microvascular radial fore-
arm flap after the removal of a rare sclerotic carcinoma of
the upper lip and cheek.
Method: A 72 year old woman was admitted with a sclerotic
carcinoma of the upper lip. The tumor growth of more than
10 years is very slowly, and had been diagnosed late.
Because of the histology and the finding of adenoid struc-
tures a mammography has been performed to exclude a
metastasis of a mamma carcinoma. The diagnostic and
staging procedures, the tumor resection and the microvascu-
lar reconstruction of the defect are presented.
Results: The tumor resection included half of the upper lip
includinglip mucosa, the floor of the nose, the left alar wing and
anterior part of the maxilla. The primary reconstruction of the
defect was done with a microvascular radial forearm flap from
the left arm. With this flap the floor of the nose, the left alar wing
and the intraoral soft tissue defect as well as the philtrum and the
cheek were reconstructed. The partially resected maxilla was not
reconstructed primarily with a bone graft.
Conclusions: This example demonstrates an aesthetically
and functional satisfying reconstruction with a microvascu-
lar radial forearm flap by multiple deepithelizations and
folding procedures. Possible alternatives are discussed.
COMPARISON OF SUTURES AND TISSUE
ADHESIVES IN THE TREATMENT OF FACIAL
LACERATIONS: A CLINICAL TRIAL.
Symeonogiou G*., Songra A.
Department of Oral and Maxillofacial Surgery. The Royal
Hospitals NHS Trust London, England
Facial lacerations are probably one of the commonest
injuries seen by maxillofacial surgeons. Suturing has tradi-
tionally been the standard means of achieving closure. New
products such as Cyanoacrylate tissue adhesives, can be
used with favourable resultsand minimum stress for the
patient. A randomised, prospective, blind, controlled clini-
cal clinical trial was carried at the Royal London Hospital
EACMFS Abstracts, Helsinki Congress 1998 187
over a three month period in order to compare tissue adhe-
sives and suturing.
The patients were divided into groups based on age and
clinical characteristics i.e. site and depth of facial injuries.
The patients from these groups were then randomly allo-
cated to receive treatment either by suturing, or the use of
two different cyanoacrylates. The results were compared
for each of these groups at five days and at three months
by means of a visual analogue scale and Symeonoglou and
Songra's cosmetic scale score. Statistical analysis of the
results was carried out and conclusions will be discussed.
3D CT FOR PLANNING AND CONTROL OF SINUS
ELEVATION
Gyrrgy Szab6 and Kdroly Hrabdk
Semmelweis Universityof Medicine, Department of Oral-
and Maxillofacial Surgery, Budapest, Hungary
AIM OF THE LECTURE
To use 3D CT to control the success of planned sinus eleva-
tion and grafting, and further to control the osseous inte-
gration of implant materials (HTR Bioplant, Algipore,
autologous bone).
METHOD
3D CT examinations were performed before and after 12
bilateral sinus elevations, and immediately prior to loading
of implants. Comparison of the results with those of
panoramic and customary CT examinations yielded the fol-
lowing useful information.
RESULTS
- Any possible difference between planning and perfor-
mance may be controlled.
- The fate of biomaterial implanted in the maxillary sinus
was followed.
- The 3D CT projections providing most information were
established (from a superior position downwards; from lat-
eral and posterior positions forwards).
- Possible errors can be discovered before the implant is
loaded.
- The cases in which it is worthwhile to perform this costly
examination were determined: surgical complications, docu-
mentation, extensive alveolar atrophy etc.
- The results of sinus elevation with different bone substitute
materials can readily be compared (e.g. autogenous bone +
HTR Bioplant on one side, and autogenous bone +
Algipore on the other side).
CONCLUSION
Our investigations indicate that, this is particularly impor-
tant in areas with compromising anatomical structures or
perceived anatomical limitations.
[~ MRI FINDINGS IN THE OPERATED JOINT, IN
PATIENTS AFTER A LONG INTERVAL FOLLOWING
DISCECTOMY W I T H O U T DISC REPLACEMENT IN
THE TEMPOROMANDIBULAR JOINT
Susumu Takaku, T. Sano, 34. Yoshida
Department of Oral and Maxillofacial Surgery, Saitama
Medical School, Saitama, Japan
188 Journal of Cranio-MaxillofacialSurgery
Changes in the intracapsular tissue were examined by
employing M R I after a prolonged interval following discec-
tomy in patients.
Materials and Methods: Thirty-three patients (35 joints),
who had temporomandibular disorders with severely dam-
aged discs, were subjected to a total discectomy without
implants and they were examined after a mean postopera-
tive interval of 9.4 years. The operated joints were examined
by M R I using 3D-FISP methods and the findings and the
results of postoperative clinical observations were com-
pared.
Results and Conclusions: No masticatory disorders or joint
pain were found in the clinical evaluations, which included
those of two patients with slight limitations of mouth open-
ing. M R I observations depicted soft tissue with intermedi-
ate or high intensity signals in the joint space, together with
flattening of the condylar fossa and articular surfaces in all
patients. By comparing M R I on mouth opening and clo-
sure, it was found that this soft tissue in the joint space was
mobile. Joint noise was detected in 10 joints; but there were
deformities of the soft tissue in the joint space. M R I indi-
cated that a satisfactory clinical course following discectomy
is associated with the presence of mobile soft tissue between
the articular surfaces of the condyle and fossa. It was pre-
sumed that this soft tissue is derived from the tissue of the
medical side of the articular capsule; however, the signal
intensity of M R I was not sufficient to ascertain this tissue
characteristics.
7~ EFFECTS O F CO2 LASER VAPORIZATION IN
ORAL PRECANCEROUS L E S I O N S
Takeuchi, S. *, Kato, M., Kaneko, M., Yoshida K.
First Department of Oral and Maxillofacial Surgery, School
of Dentist~% Aichi-Gakuin University, Nagoya, Japan
Aims: To determine the cancer promoting or inhibiting
effects of laser irradiation in oral precancerous lesions.
Methods: Premalignant lesions were experimentally induced
in F344 rat tongues by 20 ppm 4NQO dissolved in their
drinking water for 8 weeks. Laser vaporizations were per-
formed with a CO2 laser device using 6 W power output.
Tongues were excised at 3 days, 1, 2 and 4 weeks after laser
vaporization to observe the early wound healing process
following laser vaporization. The early tissue repair follow-
ing laser vaporization was investigated histopathologically,
and cell proliferation in normal and premalignant lesions
was assessed using BrdU and GST-P immunohistochemi-
cally. To observe the long-term wound healing process, the
incidence of neoplasms was investigated histopathologically
at 16 weeks after laser vaporization.
Results: In the early tissue repair, the wound healing in pre-
cancerous lesions tended to take longer. Also, the surviving
premalignant epithelia showing GST-P positive staining
and the epithelia regenerated from those portions were
observed. Moreover, the BrdU-labeling index of the regen-
erated epithelia showing GST-P negative staining (i.e., nor-
mal) at first indicated temporary cell growth, and a decrease
2 weeks later. However, the cell growth of the regenerated
epitheliums in premalignant portions showing GST-P posi-
tive staining was lower than that with GST-P negative stain-
ing and tended to take longer. In the long-term wound
healing process, a decrease in the incidence of neoplasms
was observed in the laser vaporization groups. However, the
depth of invasion and tumor area were enhanced.
Conclusions: When oral precancerous lesions were not com-
pletely removed by laser vaporization, it was suggested that
there was a risk of cancer promotion from the surviving
epithelia.
C L I N I C O P A T H O L O G I C A L STUDY O F
ODONTOGENIC TUMOURS
Tamme T. *, Tuhkanen A., Pintson 0., Leibur, E.
Department of Maxillofacial Surgery, University of
Tartu, Tartu, Estonia.
The aim of the present study was to analyze the results of
clinicopathological and radiological investigations in the
treatment of odontogenic tumours. Subject. Between 1986
and 1997 there were 46 odontogenic tumors operated on at
the Department of Maxillofacial Surgery, Tartu University
Hospital.. There were 18 females and 20 males. Their age
ranged between 4 and 79 years. The tumours were diag-
nosed clinicopathologically as 22 ameloblastomas, 5
ameloblastic fibroodontomas, 17 compound complex
odontomas and one odontogenic myxoma. There were two
malignant cases of cylindroma recurrent from maxillary
ameloblastoma and mandibular adenoameloblastoma. To
determine the bone structure of the jaws, plain x-ray films,
ortopantomographs, CT and 3-dimensional radiography
were used. Results. Histopathologically -in atypical speci-
men of ameloblastoma the epithelium was arranged and
the sheets or strands were bordered by columnar cells
resembling ameloblasts, and closely packed polyhedral cells
which were arranged in a loose structure like the stellate
reticulum of the tooth germ .In case of odontomas, exuber-
ant growth of the epithelial sheets originating from dental
lamina was seen to give rise to a number of additional
tooth germs, each of which formed a separate denticle. The
ameloblastic fibro-odontomas, cells in one or more foci
continue the differentiation process and produce enamel
and dentin. Odontogenic myxoma had loosely arranged
stellate fibroblasts and highly scattered collagenous matrix.
Long-term studies of the treatment of the above mentioned
tumors correlated with both histologic and clinical features.
Personal interviews with patients revealed that delays by
patients were the main factors which contributed to delayed
diagnosis. It can be concluded that in most cases these odon-
togenic tumours were asymptomatic, but the incidence and
typical basic features such as age, location, pathology and
radiographic appearence of the various odontogenic
turnouts were close to the data found in other previously
published reports.
References
1. Eversole,L.R.;Tomich C.E; Cherrick,H.M. Histogenesis of
odontogenic turnouts. Oral Surg 1971; 32: 569.
2. Gold, C. Biologic behavior of ameloblastoma. Oral and
Maxillofacial surgery of North America 1991;31:21.
3. Leider A.S.;Eversole L.R.;Barkin, M.E. Cystic
ameloblastoma. A clinico pathologic analysis. Oral Surg 1985;
60:624.
7h CLINICAL EVALUATION OF H Y P E R T H E R M I A
THERAPY F O R HEAD AND NECK CANCER
Tanaka, A. *, Mataga, L And lshihara, O.
Department of OMFS II, School of Dentistry at Niigata,
The Nippon Dental University, Niigata, Japan

AIMS:
Hyperthermia therapy combined with radiotherapy and/or
chemotherapy has established the situation of one of many
multidisciplinary treatments for oral cancer. Clinical evalu-
ation and significance of this treatment is retrospectively
discussed.
M E T H O D AND SUBJECTS:
Thirty-one sites of twenty-eight patients with head and neck
malignant tumors have been treated by this therapy in our
department since 1987. Employed thermal equipment was
HEH-500C 13.56MHz RF-inductive hyperthermia system
(OMRON Comp.,Japan). Size of applicaters were 7cm,
10cm, 15cm, 20cm in diameter and a special oral applicater
which we made in co-operation with O M R O N Comp was
used when a tumor existed inside the oral cavity. Heated
tumors were 21 necks and others were oral cavities. 25
tumors were squamous cell carcinomas. Indications for this
treatment are presurgical treatment combined with radia-
tion plus chemotherapy and pariative control with radiation
a n d / o r chemotherapy for non-surgical patients.
RESULTS AND CONCLUSIONS:
Results of this treatment were 71% of all tumors showed
more than PR effectiveness assessed by tumor size,changes
of density of CT, and histopathological evaluations.
THE TREATMENT OF INFECTED W O U N D S IN
MAXILLO-FACIAL REGION W I T H USE O F
H Y D R O P H I L BASED PREPARATIONS.
*Tarasenko S., Aleksashina L, Agapov E, Kurakin A., Masur
L., Mursina T..
Medical stomatological institute, department of oral and
maxillo-facial surgery. Moscow. Russia.
ALMS: Development of local treatment of infected wounds
after opening of odontogenic flegmons in maxillo-facial
area using phase related application of complex hydrophil
based preparations nitacide and hyposole-n.
METHODS: Comparative assessment of clinical, bacterio-
logical and immunological analysis data in two groups of
54 patients in each. In the first group were used previously
tested preparations levomecol and levovinizol. In the second
group the investigated nitacide and hyposole-n.
RESULTS: Study data has shown preference of nitacide
and hyposole-n. The time of purulent discharge has short-
ened for 4-5 days, disappearance of bacterial grow was ear-
lier by 4 -5 days, granulation tissues started to develop 5-6
days earlier comparing with first group. Efficiency of tested
preparations was noticed particularly in patients with low
immunological status.
CONCLUSION: For optimization of wound treatment
after opening of odontogenic flegmons can be recommend
the use of nitacide in the first phase and of hyposole-n in
second phase of the wound healing.
ANTIMICROBIAL EFFECT O F ND:YAG LASER ON
MEMBERS O F ORAL M I C R O F L O R A
Tasar F*, Sener BC*, Metal G*, Kocagoz S**
*Department of Oral Surgery, Faculty of Dentistry,
Hacettepe University
EACMFS Abstracts, Helsinki Congress 1998 189
**Unit of Infection, Department of Internal Medicine,
Faculty of Medicine, Hacettepe University
Aim" Minimum bactericidal energy level (MBEL) of
Nd:YAG laser was investigated on oral microflora.
Method: Bacterioides fragilis, Streptococcous salivarius, ?-
Hemolytic Streptococcous, neisseria, Staphylococcous aureus,
Candida albicans were used as members of oral flora.
Erythrocyte suspension was added into the suspensions as dye
material. 100?1 of each microorganism at 104 and 108 CFU/ml
concentration was irradiated with Nd:YAG laser beam with a
constant distance between fiber tip and microorganism sus-
pension. Power shots were increased gradually. After irradia-
tion, 10~tl of each sample with controls were inoculated to
blood agar and incubated for 18 hours at 350C. After the incu-
bation, colony count was performed.
Results: For 108 CFU/ml concentration Neisseria and
B.fragilis were eradicated with 160 J/cm2, C.albicans and
Staph.aureus at 150 J/cm2, ?-Hemolytic Strept.s at 130
J/cm2 and Strep. Salivarius at 120 160 J/cm2.
[h THE TREATMENT AND L O N G - T E R M F O L L O W -
UP O F MANDIBULAR M O N O S T O T I C FIBROUS
DYSPLASIA (A CASE REPORT)
Tasar, F*., Senfift, K., Sener, C., Esen, E., Tiimer, C.
Department of Oral Surgery, Faculty of Dentistry,
University of Hacettepe, Ankara, Turkey
Fibrous dysplasia is a benign pathologic condition of bone
in which fibrous tissue gradually expands and replaces nor-
mal bone. The disease usually begins in childhood and
progress throughout puberty and adolescence. Fibrous dys-
plasia may be monostotic or polyostotic patients, in patients
with jaw involvement the lesion is usually a solitary one
occurring more often in maxilla than mandible. Fibrous
dysplasia of the jaw causes facial asymmetry, a tilted
occlusal plane, loss of teeth or a big facial deformity. The
treatment of monostotic fibrous dysplasia consists of surgi-
cal removal of the lesion. This case report presents the treat-
ment of mandibular monostotic fibrous dysplasia with
surgical excision and long-term follow-up without recur-
rence.
C L I N I C O P A T H O L O G I C A L STUDY OF STAGE I
AND II ORAL S Q U A M O U S CELL CARCINOMA IN
PATIENTS U N D E R G O I N G SURGICAL TREATMENT
Tateishi, A.*, Mise, K., Muraki, E, Fukuda,J.
Department of OMFS, Kyusha Dental College, Kitakyushu,
Japan
Aims: To identify the prognostic factors in patients with
stage I and II oral squamous cell carcinoma who underwent
surgical treatment.
Methods: Sixty-six patients with newly diagnosed, stage I
and II oral squamous cell carcinoma who underwent opera-
tion at our Department between 1985 and 1994 were retro-
spectively analyzed. The clinical factors studied were tumor
location, method of excision, prophylactic neck dissection,
and the method of treatment. The pathological factors
studied in biopsy materials were the degree of differentia-
190 Journal of Cranio-MaxillofacialSurgery
tion, vessel invasion, tumour depth, YK-classification
(1983), and the histological malignancy grafting as defined
Anneroth (1987).
Results: Local recurrence occurred in patients who under-
went mandibular marginal resection and had stage II dis-
ease, a tumour depth of I 4mm, and a Y K classification of
4c or 4D. There was a significant correlation between out-
come and the histological malignancy grading of Anneroth
(1987) (Step-wise method).
Conclusion: Based on the results of this study, the histologi-
cal malignancy grading of Anneroth is the most evaluative
prognostic factor in patients with stage I or II oral squa-
mous cell carcinoma who underwent surgical treatment.
I M P L A N T TREATMENT O F EDENTULOUS
ATROPHIC MANDIBLE
Tatum H.*, Chanavaz M.
Department of Oral and Maxillofacial Implantology, Lille
University-2 Medical School, France.
The conventional removable prosthetic treatment of patients
presenting advanced atrophy of the edentulous mandible fre-
quently produces unstable and poorly tolerated results. The
insertion of endosseous implants in the symphyseal region
improvesDr. Tatum these results, especially when they support
a cantilevered cemented or screwed in prosthetic superstruc-
ture. In such cases, patients are functionally handicapped dur-
ing the healing period, the overall cost may be excessive and
prosthetic component revisions are often necessary. A more
cost effective general tendency today is to use removable over-
dentures with posterior soft tissue support. This unfortunately
reduces both function and comfort. If the mandible has under-
gone extreme atrophy, autogenous bone grafting, with or with-
out nerve repositioning may be required. This increases the
treatment time, the cost and the risk factors before any multiple
root form implant placement could be envisaged.
The ramus frame implant may be considered as an
improved alternative. This is an individually adapted tripo-
dal implant with one endosteal support in each ramus and
one in the symphysis. It requires meticulous preoperative
records and identification of anatomical landmarks. The
one stage surgical procedure is predictable and follows an
orderly sequence using these landmarks. The patient is
immediately equipped with an entirely implant supported
provisional prosthesis. Once the healing period is over, the
integrated ramus frame implant offers a superior biome-
chanical support in comparison with most other endosteal
implants inserted in the atrophied mandible. The patients
are immediately in function and the entire procedure is very
cost effective. Furthermore, the insertion of the ramus
frame is compatible with the simultaneous augmentation of
the severely atrophied mandible if necessary.
M A L I G N A N T CUTANEOUS SPINDLE CELL
T U M O U R S O F THE HEAD AND NECK
Taylor J *, Otter M, Johnson PA.
Department of Maxi[lofacial Surgery, Royal Surrey County
Hospital, Guildford, Surrey, England, UK.
Aims: Spindle cell neoplasms in the head and neck region
are rare. For the clinician they can cause difficulties in diag-
nosis and treatment. To the Histo-pathologist they also rep-
resent a considerable diagnostic challenge often requiring
specialised techniques to confirm the diagnosis. This study
was carried out to examine the clinical behaviour of these
lesions many of which are recently described pathological
entities.
Method: This was a retrospective clinical study in a consecu-
tive series of fourteen patients. All case notes, histopathol-
ogy and patients were reviewed for the purposes of this
study. Follow up ranged from at least one year to five years.
Results: Clinically the lesions in this study presented as a
heterogeneous group of morphologically indistinct cuta-
neous tumours. Typically the patients were elderly and male.
Included in this group are three cases of desmoplastic
melanoma, two of squamous carcinoma, two atypical
fibroxanthomas, one schwannoma and various sarcomas.
Conclusions: All these tumours need excision with wide sur-
gical margins. Thus it is essential that the correct diagnosis
is made for appropriate treatment planning and ultimate
success.
PREOPERATIVE A S S E S S M E N T OF CERVICAL
LYMPH-NODE METASTASES IN HEAD AND NECK
CANCER W I T H F D G USING A DUAL HEAD PET
CAMERA: A FEASIBILITY STUDY
Ten Broek, F. W., Stokkel, M.P.M.
Departments of OMFS, Nuclear Medicine, University
Hospital Utrecht, Utrecht, The Netherlands
Aims: To investigate whether in patients with primary head
and neck cancer staging was possible with F 18-FDG using a
dual head PET camera.
Method: Sixteen patients (9 men, 7 women) (mean age 61.4
years) were studied using 3.5 mCi(130MBq) F18-FDG, The
images were visually analysed and the results were corre-
lated with CT, US and pathological findings
F D G Pet depicted all 14 primary tumours compared
with 7 of 13 detected by CT revealing a sensitivity of 100%
and 54%, respectively (p<0.001). In five patients lymphnode
metastases were found in the neck specimen. Two patients
had bilateral metastases F D G PET correctly identified all
seven pathological neck sides whereas CT and ultrasonogra-
phy depicted 6 of 7 and 5 of 6 pathological sides, respec-
tively. In three patients, false positive F D G uptake was seen
which was due to a preceding biopsy in two patients. The
sensitivity for identifying pathological neck sides for F D G
PET, CT and US was 96%, 100% and 60% respectively
Conclusion: Measurement of F 1 8 - F D G with a dual head
PET camera is very sensitive in the detection of primary
head and neck cancers and accurate in the preoperative
assessment of lymph node metastases. The results justify a
prospective study on the identification of metastases in head
and neck cancer. In addition it is also justified to start a
study on the detection of unknown primary tumours in
patients with cervical metastases.
THE SURGICAL TREATMENT OF THE INFERIOR
PROGNATHIA
Pranas Tercijonas, Rasa Babi~enko
Dept. Maxillo-facial, Surgery,
Kaunas Academic Clinic, Lithuania

There were 35 patients from 17 to 20 years old with
mandibular prognathism treated surgicaly at the Kaunas
Academical Hospital, the Department of Maxillo-facial
Surgery. Every patient received the complex examination:
orthopantomography, cephalometric analysis, photometry,
also diagnostic antropometric casts were made. The follow-
ing operations were performed: the sagital osteotomy of the
ramus of the mandible according to Obevexer-Dal Pont and
different types of osteotomies of the corpus of the mandible.
The orthodontic treatment was not applied because the
patients could not afford it. The occlusions were completely
restored by prosthodontist. Our experience have demon-
strated that the complex examination, surgical and prostho-
dontic treatment of the patients with inferior prognathia
enable to receive good functional and aesthetic results.
MAXILLARY SINUS AUGMENTATION IN THE
MINIATURE P I G W I T H SIMULTANEOUS
PLACEMENT O F DENTAL I M P L A N T S USING
NATURAL BONE M I N E R A L AND RECOMBINANT
H U M A N O S T E O G E N I C PROTEIN-1
Terheyden, H. % Jepsen, S., Moiler. B., Tucker. M.. Rueger D.
Dept. of Oral and Maxillofacial Surgery, University of Kiel,
Kiel. Germany
Aims: To examine whether combining an osteoinductive
protein, recombinant human osteogenic protein-1 (rhOP-1
= bone morphogenetic protein-7), with natural bone min-
eral (BioOss®) would improve ossification and implant-to-
bone contact in sinus floor augmentation with simultaneous
placement of implants avoiding autogenous bone grafts.
Method: The maxillary sinus floors in 9 Gottingen minia-
ture pigs were augmented with 3ml BioOss® ' containing
420"g rhOP 1 on the test side and 3ml BioOss®" alone on
the control side. At the time of augmentation a titanium
implant (ITI®) was inserted from a laterocaudal direction.
After 3 months (5 animals) and 6 months (4 animals) the
sites of augmentation were removed and examined in non
decalcified sections by microradiography, fluorescence
microscopy of sequentially labelled specimens and by his-
tometry.
Results: On both sides significant amounts of newly formed
bone were observed. However, on the rhOP-1 side the bone-
to-implant contact in the augmented area was 82.0% versus
24% on the control side (p<0.05). The fluorochromic
labelling revealed appositional bone formation from the
bony walls. However, only on the OP-1 sides was bone depo-
sition directly on the implant surfaces observed, starting
after week 3. Between 3 and 6 months, functional remodel-
ling and stability of the regenerated bone volume was
observed.
Conclusions: The advantage of using bone morphogenetic
proteins in sinus floor augmentation is a more rapid and
enhanced osseointegration of simultaneously placed
implants compared with bone substitute alone. Thus, in
sinus floor augmentation osteogenic protein-1 delivered by
natural bone mineral could become a clinical alternative for
autogenous bone grafts.
USE O F DIFFERENT GRAFTS IN THE
RECONSTRUCTION O F ORBITAL FRACTURES.
latrou A.L, Theoiogie-Lygidakis N.N*., Angelopoulos A.P.
EACMFS - Abstracts, Helsinki Congress 1998 191
Department of OMFS, Athens University, Athens, Greece
AIMS:
To present and analyze the clinical results derived from the
use of different types of grafts in a 6 years period.
METHOD:
During the years 1989-1995, amongst the patients treated in
our Department for fractures of the orbit, 40 cases presenting
with bony defect requiring graft reconstruction were selected.
The chosen patients had suffered a blow out type fracture,
fracture of the zygomatic complex or had multiple fractures.
After the reconstruction of the fracture the remaining
bone defect was in all cases restored by using various types
of graft. Membranes such as lyophilised dura were used
for minor orbital defects. In cases with severe bone loss,
resulting in enophthalmos or ptosis of the globe, bone
autografts or bony substitutes covered by membrane were
applied. All patients have been regularly evaluated clini-
cally and radiographically for at least one year post-
operatively.
CONCLUSIONS:
The wide variety of grafts allows the successful reconstruc-
tion of all types of bone defect of the orbit.
The clinician should be able to use different types of grafts
depending on the type and size of the defect.
RESULTS:
All grafts were successful. Diplopia subsided in all but 3
cases (9.5%), occular motility was fully restored in all but 2
cases (95.0%). In cases with a severe bony defect aesthetics
were improved.
THE S U P R A O M O H Y O I D NECK DISSECTION IN
NEGATIVE N (NO) PATIENTS
Tilaveridis J*, Lazaridis N., Karakasis D.
In patients with squamous cell carcinoma of the oral cavity
the supraomohyoid neck dissection (SOHND) consists of
selective en block removal of those lymph node groups that
are most likely to contain metastases. Such groups are the
lymph nodes in the submental and submandibular triangles
(Level I), the upper jugular (Level II) and the middle jugu-
lar (Level III). Those are included in the lymph node - bear-
ing tissues located anterior to the cutaneous branches of
the cervical plexus and above the upper belly of omohyoid
muscle. This type of neck dissection is performed preserv-
ing the sternocleidomastoid muscle, the spinal accessory
nerve, and the internal jugular vein. In patients with a clin-
ically NO neck the levels at risk for nodal metastasis are lev-
els I, II and III. Therefore a supraomohyoid neck dissection
would adequatelly address the neck in these oral cancer
patients.
In patients in whom it was consequently proved to have a
pathologically negative neck it seems that the operation can
control the disease. In those NO patients in whom it was
found to have pathologically proved occult metastasis the
SOHND was followed by postoperative radiation. In the
later group we had a 15% failure rate depending on the
number of positive nodes and presence of extra capsular
spread. In conclusion SOHND is therapeutic for patholog-
ically negative cases and provides sufficient information to
consider postoperative radiation therapy in pathologically
positive cases.
192 Journal of Cranio-Maxillofacial Surgery
Fh ON THE USE OF S I M P L E AND DOUBLE
T E M P O R A L MUSCLE FASCIA FLAPS TO THE TMJ.
A COMPARATIVE AXIOGRAPHIC STUDY.
Tiiile, P.; Umstadt, H.E.
Department of Oral & Maxillofacial Surgery, Philipps-
University, Marburg, Germany
Methods: In our study, 28 patients were treated operatively,
having had persisting painful degenerative diseases of the
TMJ. In all cases, extirpation of the articular disc has been
absolutely necessary. Fourteen patients received a simple, 14
others a double fascia-flap. The axiographic investigations
of these patients took place just pre-operatively and seven
months post-operatively. Within the bounds of the elec-
tronic axiography (Axiotron III, SAM[, Munich,
Germany), mouth-opening, mediotrusion left and right and
protrusion paths were registered (each independent of the
other side) in all three planes.
Results: Being mainly important for articulation and masti-
cation, we primarily concentrated on mouth-opening and
mediotrusion paths.
Comparison of pre- and post-operative results: all paths
became more harmonious with nearly identical opening and
closing movements, which showed less or no disturbances,
but the pathways were shortened by 20-30% in comparison
with the pre-operation situation.
Comparison of the two groups pre- and post-op:
although the pathways (group with simple flap) were short-
ened less (+10%, less sutures in the operation area), the
paths at double flaps became even more harmonious and
therefore nearly physiologic.
Summary: Although distinctly reducing the maximum path
in comparison with nontreated joints by 30% and even 10%
in joints with a simple flap, a double one gives the patient
better comfort. In all cases, every patient could be totally
freed from arthritic pain.
Conclusion: To achieve more comfort in the patient's TMJ
post-operatively, surgeons may consider the use of a double
fascia-flap although the surgical expenditure is a little
higher than with simple flaps.
Written on: Microsoft Word for Windows 95 (Intel-
Pentium)
Written by: Peter T611e, Am Vogelherd 37, 35 043
Marburg/Lahn, Germany Klinik ffir Mund-, Kiefer- &
Gesichtschirurgie der Philipps-Universit/it Georg-Voigt-Str.
3, D- 35 033 Marburg/Lahn, Germany
Marburg/Lahn, February 8th, 1998
DEVELOPMENT OF SELF-REINFORCED
BIODEGRADABLE POLYMERIC COMPOSITE
MATERIALS
T6rmiilii, P., Pohjonen, Z, Happonen, H., Rokkanen, P.*.
Institute of Biomaterials, Tampere University of Technology,
Tampere, Finland and *Department of Orthopaedics and
Traumatology, Helsinki University Central Hospital,
Helsinki, Finland
Aims: To develop ultra-high strength, ductile, biodegradable
(No-absorbable) polymeric composites which can be used in
manufacturing of cranio maxillofacial screws and plates.
Method: (1) Solid state deformation of biodegradable poly-
mers, like poly-lactides and their copolymers, into an ori-
ented or partially fibrillated form and (2) mechanical
machining of self-reinforced preforms to screws and plates
Results: Solid state deformation, like drawing and compres-
sion increase the strength of bioabsorbable polymers signifi-
cantly. Strong and ductile screws and plates can be machined
mechanically from self-reinforced preforms. A special advan-
tage for cranio maxillofacial surgery is that self-reinforced
plates can be bended permanently at room temperature with-
out the inconvenient and slow heating-cooling procedure
needed in clinical use of non-reinforced plates.
Conclusions: Self-reinforcing offers new opportunities to
develop biodegradable screws and plates for cranio maxillo-
facial surgery.
RELATIONSHIP BETWEEN THE LINE OF
MANDIBULAR ANGLE FRACTURE AND THE
PRESENCE IMPACTED THIRD MOLARS.
Triantafillidou If., Daios A., Iordanidis S., Karnezi E.
Dept. of Oral and Maxillofacial Surgery, Aristotle
University of Thessaloniki, Greece
A number of studies have indicated that unerupted third
molar teeth present an area of potential weakness of the
mandible to fracture. In addition, bilateral unerupted third
molars predispose at least the angle region to fracture signif-
icantly more than do unilateral impacted third molars. In
the literature different opinions are referred whether a third
molar in the line of the fracture should be extracted or
retained and whether conservative closed reduction results
in a lower frequency of complications.
This study is a retrospective analysis of 150 cases with
mandibular angle fractures treated at the department of
Oral and Maxillofacial Surgery at ~@apanikolaow> General
Hospital, Thessaloniki, Greece.
The purpose of the present study is to relate the influence
of unerupted third molar teeth on the incidence of fractures,
the method of treatment and postoperative complications.
DISTRACTION OSTEOGENESIS IN A
PORCINE MODEL.
M.£ Troulis, E.B.Seldin, J. Glowacki, D.H.Perrott, J. Gordon,
and L.B. Kaban. *
Massachusetts GeneralHospital. Boston, Massachusetts, U S.A.
Introduction: Craniomaxillofacial distraction osteogenesis
(DO) is limited by the size, complexity, and extraoral place-
ment of distraction devices. Lengthy fixation protocols are
based only on experience with distraction of long bones.
The ultimate goal of our laboratory is to develop a minia-
turized, buried, remotely activated distraction device and to
decrease the DO fixation period by use of growth factors.
Aims: The purpose of this study was to develop a model for
DO and to determine the optimal latency period, rate, and
duration of fixation.
Methods: The Yucatan minipig has a bone turnover rate,
mandibular shape and TMJ physiology, similar to humans
and was chosen as the experimental animal. Under general
anaesthesia, 11 minipigs underwent extraoral placement of
a single vector, buried, mandibular distraction device
(Synthes Maxillofacial, Paoli, PA), through a standard sub-
mandibular incision. A corticotomy, extending from the

junction of the ramus and body of the mandible (anterior),
to the angle of the mandible (posterior), was created with a
side-cutting fissure bur. The distraction device was fixed
with four 2.4mm diameter titanium screws. Radio-opaque
bone markers were placed, the osteotomy was completed
and the wound closed. The pigs received antibiotics, anal-
gesics, a putted diet and were divided into 4 groups.
RESULTS:
Experiment/Animal group - all
Observations at end of fixation period.clinical exam.x-ray
findings postmortem exam.postmortem x-ray exp # 1" grp
A latency = 0 days, n--4 pigs no mobility bone filling no
mobility bone filling
grp B latency = 4 days, n=2 no mobility bone filling no
mobility bone filling
exp # 2** grp C rate =4mm/day, n=4 mobile no bone filling
mobile no bone filling
control*** grp D n = l no mobility bone filling no mobility
bone filling
*Experimental variable- latency (0 and 4 days);
rate=lmm/day; distraction gap= 7ram; fixation= twice the
duration of distraction.
**Experimental variable- rate (4ram/day), latency=0 days; dis-
traction gap= 12mm; f~xation= twice the duration of distraction.
***Osteotomy, placement of distractor only
Conclusions: A porcine model for mandibular DO has been
developed. The preliminary results of this study indicate
that distraction of the mandible can be successfully per-
formed with zero latency. The fixation period does not
appear to be specifically related to the number of days of
active distraction, but may be related to the size of the dis-
traction gap as well as other factors to be determined.
USE O F BIOACTIVE GLASS GRANULES AND
A U T O L O G O U S BONE C H I P S F O R AUGMENTATION
OF MAXILLARY SINUS F L O O R
Turunen, T. .l, Peltola, j.1, Yli-Urpo, A. 2, Happonen, R-PJ
Departments of Oral and Maxillofacial Surgery1and
Prosthodonties2, Institute of Dentistry, University of Turku,
Turku, Finland
Aims: To study usefulness of bioactive glass (BG) granules
mixed with autologous bone (AB) chips for augmentation
of maxillary sinus floor and to analyze histological and
chemical responses of BG.
Methods: The posterior part of 6 maxillary sinuses in 6
patients with an edentulous upper jaw was augmented with a
mixture of BG granules (composition: SiO2 53.0, Na20 23.0,
CaO 20.0 and P2Os 4.0 weight percentages; --+ 800-1000 gm)
and AB chips harvested from the iliac crest The anterior part
of the same sinuses was filled with AB chips. Opposite sinuses,
augmented with AB chips only, served as a control. Biopsies
for histological, scanning electron microscopy (SEM) and
energy- dispersive X-ray (EDX) analyses were taken with a
trephine drill from the posterior sinuses 6 months after aug-
mentation, at the time of insertion of dental implants.
Radiological examinations were done preoperatively as well as
one week, 6 and 12 months after the augmentation.
Results: Histological evaluation revealed no sign of inflam-
mation in any specimen. Lamellar bone growth was noted in
all specimens. BG granules were seen with and without bone
contact. In the contact areas bone was growing along the
glass surfaces connecting them together. SEM/EDX analy-
sis showed a tight contact/chemical bonding between glass
EACMFS - Abstracts, Helsinki Congress 1998 193
and bone. No resorption of BG granules was seen.
Radiological analyses are in hand.
Conclusions: The results indicate that BG granules can be used
together with autologous bone chips for the sinus floor aug-
mentation procedure, thus decreasing the amount of bone
needed. Further studies, especially on biomechanical properties
and metabolism of the BG-bone composite area, are needed.
G = ~ H E M I M A N D I B U L A R HYPERTROPHY:
MANIFESTATIONS, INCIDENCE AND TREATMENT
*Turvey, T.A., Ruiz, R., Martinez, J.
Dept. of Oral and Maxillofacial Surgery, University of
N. Carolina, USA
Aim: 1) To describe a series of patient with facial hemihy-
pertrophy and to establish the incidence of this condition in
a general facial deformity population.
2) To identify the manifestations of this condition.
3) To delineate the treatment and results.
Method: A series of 18 patients with facial hemihypertrophy
has been identified from a bank of facial deformity patients
approaching 4000. The findings apparent in each patient
has been recorded as well as the extent of surgery.
Results: The incidence in this series is < 0.5%. Although
some suggest that the condition begins post-pubertally, the
onset occurred in the first decade in some patients. The con-
dition presented as elongation of the mandible on the
effected side, but anthropometric measurements confirmed
hypoplasia of the uneffected side as well in most individuals.
The maxilla was commonly involved, either primarily or
secondarily, as were the soft tissues.
The extent of surgery was determined on the basis of the
clinical findings. Infrequently, inferior border osteotomy of
the entire mandible was adequate. In other instances, ramus
osteotomies, maxillary osteotomies, and genioplasty as well
as soft tissue revisions and bone grafting were necessary.
When active growth of the mandibular condyle was docu-
mented, condylectomy was performed. In all instances in
this series, the remaining ramus was used to reconstruct the
missing condyle with successful results.
Conclusion: Facial hemihypertrophy is a rare condition
which can be improved by a variety of facial osteotomies,
bone grafts, and occasionally soft tissue surgery. When
active growth is documented, condylectomy in addition to
other osteotomies is indicated to achieve stable results.
A MINIMALLY INVASIVE APPROACH TO
D I S S E C T I O N O F THE DURA AND E N D O S C O P I C
ASSISTED OSTEOTOMIES, IN CRANIOFACIAL
SURGERY.
Tutino, M.*, MD., Chico, F, Ochoa, 172., Goodrich3., J.T..,
Ortiz Monasterio, F4.
1University of Palermo, It,. eHospital Infantil de Mexico
FGomez, Mexico, University of Palermo, It., 3Albert
Einstein College of Medicine. NY., 4Hosp.M. Gea
Gonzales, Mexico.
Objective: The authors describe the techniques for craniofacial
surgical procedures through minimal skin incisions and
trepanation. Osteotomies, endoscopically assisted, and
distraction osteogenesis are dealt with.
Methods: Twelve patients were selected : 10 patients were
194 Journal of Cranio-Maxillofacial Surgery
affected by complex Craniosynostosis, including
Plagiocephaly, Brachicephaly, and Scaphocephaly,
Crouzon's and Ap6rt's syndromes. The endoscopic dissec-
tion of the dura mater was performed in the anterior and
middle fossa, through minimal skin incisions and trepana-
tion.
Two patients had a posterior fossa tumour. In these
patients the dura was gently dissected over the lateral sinus,
occipital sinus, and the confluence of the transverse and
sagittal sinuses. The dissections were performed using some
prototype malleable instruments, a 3ram Olympus rigid
endoscope, and the craniotomies where performed under
endoscopic assistance with a special Midas Rex attachment.
Results: In the first patient, after raising a frontal flap, the
dura was dissected endoscopically through minimal trepa-
nations. In the other nine patients, the dura in the anterior
and middle fossa, was dissected similarly through minimal
skin incisions through which we performed the trepanations
in order to have access to the cranial epidural space.
In the other 2 patients careful endoscopic dissection of
the dura enabled us to perform a complete occipital cran-
iotomy with a decreased risk of vascular injury, including
the transverse sinus and the torcular region, were the con-
fluence of the sagittal and transverse sinus is most vulnera-
ble. The bleeding was markedly reduced in all cases, as the
perforating vessels could be coagulated in advance with a
specially designed malleable cautery under endoscopic con-
trol.
Conclusions: In selected craniofacial disorders this endo-
scopic technique will allow the surgical team to perform
complex endoscopic intracranial osteotomies.
This may in turn reduce the hospital stay, surgical costs
and reduce potential intra- operative complications such as
haemorrage, surgical infections and cerebral oedema from
brain retraction.
MANDIBULAR SANDWICHPLASTY AND
ENDOSSEOUS IMPLANTS
Tveten, Stein*" Weischer, Thomas*; Mohr, Christopher*
*Department of Oral & MaxilloJacial Surgery, University
Essen,
Hufelandstr. 55, D-45122 Essen, Germany.
Implant insertion in extremely atrophied mandibles is only
implantologically and prothetically posssible after ridge
augmentation. Mandibular sandwich-plasty with an inter-
positional non-vascularized iliac bone graft by the tech-
nique of Schettler makes even extremely atrophied
mandibles prosthetically and implantologically utilizable.
In cases of planned implant-supported prosthetics in
atrophied mandibles, there is the question whether
mandibular sandwich-plasty and simultaneous implant
placement or secondary implant placement is convenient.
Therefore, the purpose of the following study is to ana-
lyze the success rates of treatment of fifteen patients in
whom mandibular sandwich-plasty and simultaneously or
secondarily implant placement has been performed, since
1982.
The first collective consisted of two patients who
received a total of nine endosseous implants simultaneously
with sandwich-plasty. The second collective consisted of
thirteen patients who received a total of 55 endosseous
implants 3-120 months after 15-20 mm sandwich augmenta-
tion of the atrophed mandibles. In a follow-up of 63
months, an average seven implants of the first collective
were lost. In a follow-up of 51 months an average of only
two implants of the second collective failed.
It is suggested that the failure of collective one implants
is caused by deformation of the mandible in
articulation/mastication and myogen stress on interposi-
tional bone graft and bone cover. The favourable results in
collective two patients are attributed to advantageous
anatomical-implantological conditions even years after
sandwich augmentation due to low resorption and cortical
mineralization of the bone graft.
The results demonstrate a high success rate of osseointe-
grated implants in atrophied mandibles after sandwich-
plasty and secondary implant placement. In contrast,
mandibular sandwich augmentation combined with a simul-
taneous fixture installation involves a high failure rate.
Therfore the one-step procedure is not recommendable. The
two-step procedure, sandwich-plasty and secondary inser-
tion if fixtures has to be recommended.
[~ THE EFFECT OF RH-IGF ADMINISTRATION ON
INTRAMEMBRANOUS OSSIFICATION
Takaaki Ueno D.D.S., Katsuaki Mishima D.D.S. Ph.D.,
Nobuyoshi Mizukawa D.D.S., and Toshio Sugahara D.D.S.
Ph.D.
Department of Oral and Maxillofacial Surgery 1, Okayama
University Dental School 2-5-1 Shikata-eho, Okayama. 700.
Japan
Aims: The process of bone formation is regulated by bone
growth factors such as BMPs, TGFs, IGFs FGF, and
P D G E Many reports with regards to these growth factors
in ossification have been published previously. There are,
however, only a few studies investigating the role of IGF-I in
intramembranous ossification. In this study, we evaluated
the efficacy of IGF-I in intramembranous ossification with
Japanese rabbit periosteum.
Method: Eighteen young Japanese rabbits were used and
divided into two groups, controls and I G E Periosteum was
taken from the tibia and grafted in the submandibular area
through muscles, under anaesthesia. Rh-IGF
(1.0mg/kg/day) was administered to the IGF group. Newly
formed bone from periosteum was evaluated by radi-
ographic and histological examination 2, 3, and 4 weeks
after surgery.
Results: Newly formed bone, induced by the periosteum, in
the IGF group, was augmented by the administration of
IGF-I as compared with the control group (in IGF group
18, 1 * 5.53, 20.5 * 2.65, 26.0 + 3.58 *m / Control group =
1.43 * 0.39, 10.0 * 3.20, 22.4 ** 7.40 *m trabecular thick-
ness, 14 days, 21 days, 28 days, respectively, after grafting.
P<0.01). On histological examination, the more developed
bone was observed in the I G F group.
Conclusion: In this study, we evaluated IGF's efficacy for
bone regeneration in grafted periosteum and acceleration of
intramembranous bone formation with IGF-I was implied.
[h ANATOMICAL INVESTIGATION OF THE
MAXILLARY TUBEROSITY FOR PLACEMENT OF
OSSEOINTEGRATED IMPLANTS
Takaaki Ueno D.D.S., Katsuaki Mishima D.D.S. Ph.D.,
Nobuyoshi Mizukawa D.D.S., and Toshio Sugahara D.D.S.
Ph.D.

Department of Oral and Maxillofacial Surgery I, Okayama
University Dental School 2-5-1 Shikata-cho, Okayama. 700,
Japan
Aims: Osseointegrated implants for completely and partially
edentulous patients have been accepted in the clinical field.
Even for the patient with a severely atrophic maxilla, the
bone augmentation technique with autogenous bone graft-
ing has been developed and a lot of papers have reported the
high survival rate of implant fixtures. Augmentation with
autogenous bone grafts requires a double surgical area,
either intraoral or extraoral, to harvest enough bone.
Therefore, hospitalization of the patient usually become
longer. Some investigators have promoted the utilization of
the maxillary tuberosity for the placement of screw-type
implants for an atrophied maxilla. There are, however, very
few articles regarding this region involving anatomical
analysis for implant placement. In this study, we discuss the
statistical analysis of the maxillary tuberosity for placement
of screw type implants, using 15 Japanese cadavers, based
on anatomical investigation.
Method: The measurement parameters were determined as
followed. 1) The length from the junction of the pyramidal
process of the palatine bone and the pterygoid plates of the
sphenoid bone (=A point) to alveolar bone, distal to the sec-
ond molar tooth area. 2) The distance between the posterior
sinus wall and posterior boundary of the maxillary tuberos-
ity. 3) The distance from the major palatine fossa to point A.
Result: The averages of 1), 2), and 3) were 22.5 * 4.86, 9.05 *
1.55, 7.08 * 2.05 ram, respectively.
Conclusion: Based on this study, it can be concluded that the
maxillary tuberosity area is of benefit in the placement of
screw type implants.
[~ INITIAL EVALUATION O F A SELF-SETTING,
BIORESORBABLE, BARRIER MEMBRANE MADE
W I T H S O D I U M ALGINATE AND C A L C I U M
CHLORIDE
Ueyama, Y. ,1, Ishikawa, K. ~, Mano, T 1 Matsumura, T 1,
Suzuki, K :
1Department of Oral and Maxillofacial Surgery II,
:Department of Dental Materials,
Okayama University Dental school, Okayama, Japan
Aim: This investigation aimed at evaluating the feasibility of
using a calcium alginate barrier membrane as a self-setting
bioresorbable barrier membrane for guided bone generation
(GBR).
Method: Fifteen-week old male Wistar rats were used as
subjects. The medial end of the tibia was exposed, and a 3
X 10mm bone cavity was formed with a dental fissure bur.
The cavity was filled with an aqueous sodium alginate solu-
tion, then an aqueous calcium chloride solution was
dropped onto the sodium alginate solution. After the for-
mation of the calcium alginate membrane was confirmed,
the wound was carefully closed. The animals were sacrificed
at regular intervals, and the specimens taken from the ani-
mals were examined histologically.
Results: A calcium alginate membrane was formed on the
surface of the bone cavity when calcium chloride solution
was dropped into the bone cavity filled with the sodium algi-
nate solution. Free sodium alginate was, however, found
inside the bone cavity without having formed the calcium
alginate. The calcium alginate barrier membrane or sodium
EACMFS-Abstracts, Helsinki Congress 1998 195
alginate caused no inflammatory response throughout the
experiment. The calcium alginate barrier membrane gradu-
ally, but steadily resorbed within implantation time. No
connective tissues were observed inside the bone cavity cov-
ered with the calcium alginate barrier membrane. In con-
trast, new bone formation was observed from the original
bone inside the calcium alginate barrier membrane.
Conclusions: Based on the findings obtained in this study,
we concluded that a calcium alginate membrane, made with
sodium alginate and calcium chloride, could be a useful
bioresorbable barrier membrane that may be useful for
GBR procedures.
F U N C T I O N A L RECONSTRUCTION OF THE T M J
IN CASES O F LUXATION FRACTURES
Umstadt, H.E., Ellers, M., Hochban, IV..,Austermann, K.H.
Klinik fiir MKG-Chirurgie
Klinikum der Philipps- Universitiit Marburg, Marburg,
Germany
Luxation-fractures of the condyle head combined with tear-
ing of the articular ligaments lead, if treated noneopera-
tively, to nearthrosis and loss of vertical dimension and
translation of the condyle. Even the operative reposition in
a correct anatomic position is followed by a progressive
damage of the stomatognathic system if position and state
of the artikular disc are not considered.
Method: Open revision via a preauricular approach gives
both, repositioning of the bony fragments (fixation with
resorbable material) and reconstruction of peri- and
intraarticular soft tissue. Since 1996 23 Patients were treated
in this way. For comparison 28 patients were treatened via
an intraoral appproach without reconstruction of the soft
tissues. All patients have been examined six months postop-
eratively. Clinical erxaminations followed the dysfunction
index of Helkimo, mobility of the joints was documented
by electronical axiography.
Results: 6 of 28 Patients without joint-revision reached the
group Do, 8 D 1 , 12 O 2 and 2 D 3. In Comparison to this 5 of
23 patients with joint-revision reached group Do, 12 D 1 and
6 D 2 Concerning axiographic criteria joints show more har-
monious paths after revision. While non of the joints treated
with open revision showed relevant deviation on X-rays, 7 of
the joints treated with fixation only showed a deviation of
more than 10°. Two of the osteosynthesis had to be com-
pletely renewed.
Conclusions: In cases of luxation fractures of the condyle
the described procedure gives advantage to postoperative
function. It should be accepted as an essential part in func-
tional rehabilitation of the TMJ.
[h SURGICAL TREATMENT OF BILATERAL CLEFTS
OF THE LIP AND PALATE WITH SEVERE
PREMAXILLA PROTRUSION
Urtila, E. *, Pricop, M., Streian, F.
Department of OMFS. University of Medicine and
Pharmacy,
Timisoara, Romania.
Aims: Our experience in the surgical treatment of clefts with
severe displaced premaxilla is reported. For an appropriate
196 Journal of Cranio-Maxillofacial Surgery
plasty of the alveolar ridge, presurgical active orthognathic
treatment is a possible alternative to push back the premax-
illa. However, orthopedic devices are hardly tolerated by
children and interfere with facial growth.
Methods: Closure of the defects can be achieved operatively
through a surgical procedure that involves the nasal septum
behind the premaxilla, allowing us to line up the premaxilla
to the lateral segments. The surgical technique is explained
and figured in detail. The plasty is then accomplished
through the Barsky method, with constant good results.
Results: For 5 years, 10 patients were treated using this tech-
nique.The size of the defect ranged widely and in some cases
the premaxilla was also rotated. No functional difficulties
were observed during a 3 to 5 years follow-up period.
Immediate aesthetic and functional results were obtained.
The treatment time was significantly shorter and no ortho-
pedic devices were used.
Conclusions: Based on our long-term experience and good
results in the field of clefts, we consider this procedure has
real advantages and is especially referred to social cases.
RECURRENT ODONTOGENIC KERATOCYSTS:
AGNOR AND A M O R P H O L O G I C STUDY
*Usubiitiin A, **Sener BC, **Tasar F, **Ertu~ E
*Department of Pathology, Faculty of Medicine, Hacettepe
University, Turkey
**Department of Oral Surgery, Faculty of Dentistry,
Hacettepe University, Turkey.
Objectives: Odontogenic keratocysts (OKC) have high
recurrence potential. Increased proliferative activity is one
of the factors that is thought to be responsible for recur-
rence. Relation of "proliferative activity" of the OKC's
epithelium and recurrence was evaluated by AgNOR cont.
Study Design: We evaluated clinical, microscopic features
and AgNOR counts of 48 OKC from 31 patients. In
AgNOR stained sections 100 nuclei of basal epithelium
were counted. If daughter cysts were present another 100
nuclei were examined.
Results: Although not statistically significant, daughter cyst
had lower AgNOR count means thatn the cyst epithelium.
Neither AgNOR counts of OKC and daughter cyst epithe-
lium nor any of the histologic parameters had statistical sig-
nificant relation with recurrence (p>0.05).
Conclusion: Proliferative activity of the OKC's epithelium is
not related with recurrence. Showing lower AgNOR counts;
daughter cysts of OKC are not the counterparts of an
aggressive tumor.
RESORBABLE FIXATION PLATES AND SCREWS
IN ORAL AND MAXILLOFACIAL SURGERY.
Valiente Alvarez, A.; Daura Sfiez, A.; Bermudo Afiino,L.;
Yafiez Vilas, J.I. and Montes Jim6nez, J.
Introducction: Resorbables plates and screws have become
part of the armamentarium for maxillofacial traumatology.
This report describes our inicial experience regarding the
use of resorbable fixation plates and screws.
Patients and Method: We show our experience in mandibu-
lar fractures and zygomatic fractures with resorbables
plates. Sheets with multiples holes ared used for bone
defects reconstruction in blow-out fractures.
Results: We obtained good stability in all structures. No
postoperative infection. Postoperative X-ray control shows
healed fractures.
Conclusion: Resorbables plates and screws have successfully
been used in our Department for fractures of the facial
skeleton. Indications are discussed.
APPROACH TO THE ANTERO-LATERAL
COMPARTMENT OF THE SKULL BASE
M. Valldosera*; D. Malet; A. Arcas; J. Gonzalez; G.
Raspall.
Maxillofacial Department. J. Sahuquillo. Neurosurgery
Department. Hospital Universitario Vall d'Hebron.
Barcelona, Spain.
The anterior segment of the skull base lateral compartment is
accessed extra-orally through transfacial approaches These tech-
niques gain access to infratemporal and pterigomaxillary fossa.
We present our experience in twenty three patients with
neoplasms involved the retromaxilary space: Infratemporal
approach (8 cases), Transparotid approach (5 cases), lateral
transfacial approach (1 case), transmandibular approach (5
cases), transcervical approach (4 cases). In 10 patients we
work together with neurosurgeons, the other 13 were extracra-
nial excision. The tumors were: 8 intracraneal meningiomas, 4
Adenoid Cystic carcinomas, 2 mucoepidermoid carcinomas, 1
acinic cell carcinoma, 1 melanoma, l giant cell tumor, 1 chor-
doma, 1 desmoplasic fibroma, 1 mixofibroma, 1 neurinoma, 1
metastasic clear cells tumor and 1 paraganglioma.
These kind of approaches improve the surgical manag-
ment of head and neck tumors with extension to the retro-
maxillary space. The advantages are larger excision and
more control of vascular and neurologic structures and
hence more safe without increase the morbidity.
AN I M M U N O H I S T O C H E M I C A L AND IMAGE
CYTOMETRIC DNA STUDY ON A SPINDLE CELL
SQUAMOUS CARCINOMA OF THE MAXILLARY
SINUS, W I T H SPECIAL EMPHASIS ON THE
EXPRESSION OF P53 AND CYCLIN-DI.
E.M. Van Cann *, P.C.M. de Wilde.
Oral and Maxillofacial Department, University of Nijmegen,
The Netherlands.
Spindle cell squamous carcinoma (SCSC) is a biphasic
turnout, consisting of sarcomatoid proliferation of spindle-
shaped cells and squamous cell carcinoma. In the literature,
it is suggested that the sarcomatous part originates from the
epithelial component of the tumour by functional loss of
genes that control epithelial cell differentiation.
Aims: To give further support to this hypothesis.
Method: Immunohistochemical and Image cytometric DNA
analyses with special emphasis on the expression of P53 and
Cyclin-D 1.
Results: Some carcinomatous cells have lost several of their
epithelial characteristics (such as the expression of cytoker-
atin and CEA). Some sarcomatons cells show epithelial
characteristics (such as the expression of Collagen IV).
Mutation of P53 and amplification of Cyclin-D1 gene was
not only found in dysplastic epithelium and the carcinoma-

tous part but also in a fraction of the nuclei in the sarcoma-
tous part of the tumour. Image cytometric D N A analysis
showed the existence of at least three different stemlines.
Conclusion: These results suggest that the carcinomatous
and sarcomatous cells of this SCSC originate from dysplas-
tically changed squamous metaplastic respiratory epithe-
lium of the maxillary sinus with mutation of P53 and
amplification of the Cyclin-D 1 gene. From these genetically
unstable cells at least three subpopulations seem to have
developed, with differences on a chromosomal level. Some
subpopulations have lost a part of their epithelial differenti-
ation characteristics.
These findings further support the hypothesis that the
sarcomatous part of the SCSC is of epithelial origin and is
caused by chromosomal changes.
FRACTURE O F THE TIBIA AFTER THE
M O D I F I E D TIBIAL BONE-GRAFT-HARVESTING
TECHNIQUE - A REPORT O F TWO CASES
Van Damme, Ph.A.
Department of OMFS, University Hospital Nijmegen St.
Radboud, Nijmegen, The Netherlands
Aims: To report the tibial bone-graft-harvesting associated
fracture in two cases and to warn of this serious postoper-
ative complication where stress and/or strain beyond nor-
mal weight bearing is applied e.g. in tennis-playing and
running.
Method: Two patients underwent routine O M F S - i n t e r -
ventions in which tibial bone-grafting was indicated.
The patients were treated according to the protocol
described in the International Journal of Oral and
Maxillofacial Surgery 1996; 25:346-348 - A modifica-
tion of the tibial bone-graft-harvesting technique. The
operations and direct postoperative period in hospital
were uneventful.
Results: However, after release from hospital, during tennis-
playing and running respectively, in both cases within one
week postoperatively,
a sudden pain and disability appeared and a fracture of the
tibia was diagnosed and had to be treated conservatively
with a plaster of Paris splint.
Conclusions: It should be stressed that despite the low mor-
bidity of the technique and allowing the patients normal
movement and weight bearing, sports, such as running and
jumping should be avoided for at least four to six weeks
postoperatively.
Reference: Van Damme PhA, Merkx MAW. A modification
of the tibial bone-graft-harvesting technique. Int. J. Oral
Maxillofac. Surg. 1996; 25: 346-348.
BLOW-OUT FRACTURE O F THE M E D I A L
ORBITAL WALL
K.G.H. Van Der Wal* J.G.A.M. de Visscher.
Department of Oral and Maxillofacial Surgery,
Leeuwarden, Medisch Centrum Leeuwarden, The
Netherlands.
Introduction: Isolated medial orbital blow-out fractures
are uncommon. Of orbital fractures the incidence of
EACMFS Abstracts, HelsinkiCongress 1998 197
medial wall fractures is 1.67%, whereas medial orbital wall
fracture is involved in a percent of cases of blow-out frac-
ture of the orbital floor. A blow-out fracture of the medial
wall should be suspected when there is: periorbital oedema,
subconjunctival haemorrhage, epistaxis, enopthalmos, sub-
cutaneous emphysema,narrowing of the palpebral fissure
on abduction, traumatic muscle paresis, acquired retrac-
tion syndrome and horizontal diplopia.
Only CT scanning gives sufficient information regarding
the bone and soft tissue injury and displacement.
Material and Methods: Five patients with a fracture of the
medial orbital wall were operated on. Via a bicoronal
approach the entrapped soft tissue was reduced followed
by reconstruction of the medial wall with an autogenous
bone graft. In 3 patients with a bone graft, it was taken
from the iliac bone in 2 patients and from the cranium in
one.
Results: in all patients the post-operative results were excel-
lent. The advantages are: excellent and direct exposure of
the medial wall, no visible scar, correction of the enopthal-
mos with a non-foreign-body implant and, if necessary,
reconstruction of the medial canthus
PERILESIONAL RECOMBINANT IL-2 IN THE VX2
RABBIT AURICLE TUMOUR MODEL
Van Es R.J.J.*, Baselmans T.., Den Otter W., Koole R.
Department of Oral and Maxillofacial Surgery, Utrecht
University Hospital.
Department of Functional Morphology, Faculty of
Veterinary Medicine, Utrecht
University, PO Box 85500, 3508 GA Utrecht, The
Netherlands.
Introduction: Variable results have been reported with perile-
sional r(ecombinant)IL-2 injections in patients with head &
neck squamous cell carcinomas (HNSCC). Animal models,
such as VX2-carcinomas in rabbits, might be appropriate to
determine optimal treatment schedules.
Aim: To evaluate the effect of perilesional rI1-2 injections in
the VX2- carcinoma in rabbits, used as a new HNSCC ani-
mal model.
Methods: A double blind placebo-controlled study on 8
NZW:ICO rabbits with VX2 tumours induced in the dorso-
lateral portion of both auricles. Peri-tumoral rIL-2 injec-
tions (Chiron) on 5 consecutive days in tumours > 2 cm2:
Group A (n=3) l x l 0 5 U; Group B (n=3) 3x10 5 U; Group
C (n-2) solvent only. Biopsies at day 8 (after rlL-2 injec-
tion). Measurement of turnout size and cervical lym-
phomas. Sacrificed at week 7-9 and histological evaluation.
Results: In 2/6 rabbits (one in Group A and one in Group B)
treated with rIL-2, there was complete tumour regression.
Progressive growth of tumours was observed in the other
animals. Also the tumour in the contralateral auricle and
lymphnode metastasis disappeared. This was verified histo-
logically. Biopsies did not reveal a difference in inflamma-
tory cell populations and necrosis.
Conclusion: Locally injected rIL-2, 1-3x10 5 U/day, for 5
consecutive days can cause complete remission of the
VX2 auricle carcinoma. Simultaneous regression of
tumours in the contralateral auricle and lymphnodes sug-
gests turnout kill mediated by the immune system instead
of direct cytotoxicity. This animal model can be of use in
the development of future immunotherapy regimens
against HNSCC.
198 Journal of Cranio-MaxillofacialSurgery
MANAGEMENT OF JEHOVAH'S WITNESS
PATIENTS UNDERGOING MAJOR HEAD & NECK
SURGERY
Van Hemelen, G.*, Avery, C, Venn P., Curran J., Brown A.,
Lavery K.
Department of Maxillofacial Surgery,
Queen Victoria Hospital, East Grinstead, West Sussex, UK.
Subject: Several diverse strategies have been recommended
for managing Jehovah's Witnesses undergoing surgery when
significant blood loss is expected. However, many of the
proposed management strategies cannot be used when the
urgent nature of the disease precludes adequate pre-opera-
tive preparation of the patient.
Aims: We present our experience of the management of
Jehovah's Witnesses with oral carcinoma requiring exten-
sive resection, neck dissection and reconstruction with free
tissue transfer.
Method: Hypervolaemic haemodilution, hypotensive anaes-
thesia, meticulous surgical haemostasis and anti-fibrinolytic
therapy were used as an alternative to blood products or
transfusion.
Conclusion: Radical surgical ablation and 'State of the art'
reconstruction were possible, as a single-stage procedure,
even though blood transfusion or blood product replace-
ment therapy was refused. There would have been no
advantage in raising the red cell mass pre-operatively as the
packed cell volume was ideal for the free tissue transfer.
MANDIBULAR STABILITY ONE YEAR AFTER
BILATERAL DISTRACTION OF THE MANDIBLE.
P.J. van Strijen*, F.B.T. Perdijk, K.H. Breuning.
Department of OMFS "Gelderse Vallei" Hospital,
Bennekom, The Netherlands.
Tiel, The Netherlands
AIMS:
To investigate mandibular stability after bilateral distraction
of the mandible to correct class II malocclusions.
METHOD:
Since 1996, over 20 patients have been treated using
mandibular distraction to lengthen the mandible. Most of
the cases had a class II-1 malocclusion, with a proven resis-
tance to classical orthodontic functional therapy. Bilateral
man-dibular distraction was performed with monocortical
fixated distraction devices. Distraction started 6 days after
the initial surgery, by 1 mm a day. The distraction devices
were removed after a 6 week retention period. Orthodontic
treatment continued directly after ending the active distrac-
tion.The first 9 patients (13.1y-15.9y, mean 14.5y), with a
follow-up time of more than one year, were investigated for
relapse.
RESULTS:
In all patients with pre- and post-distraction orthodontics
the new mandibular position has proved to be stable (relapse
0-1 mm) with mainly a dental movement due to the ortho-
dontic treatment or dental relapse. One patient having had
only post-distraction orthodontics had a mandibular
relapse probably due to the poor occlusal stability directly
after removal of the distraction devices.
CONCLUSIONS:
The stable results in patients having pre-and post-distraction
orthodontics make it likely that orthodontic treatment
resulting in a good interdigitation is of great importance in
the prevention of a relapse of the mandible after distraction.
THE ELECTIVE S U P R A - O M O H Y O I D NECK
DISSECTION IN THE TREATMENT O F PATIENTS
W I T H ORAL AND OROPHARYNGEAL SQUAMOUS
CELL CARCINOMA.
Van Veen, A. * Roodenburg, J.L.N., Nauta J.M.,
Dept. of Oral and Maxillofacial Surgery, University
Hospital Groningen, Groningen, The Netherlands.
AIMS:
To stage a node negative neck in oral and oropharyngeal squa-
mous cell carcinoma (SCC) with a risk of occult metastasis an
elective supra omohyoid neck dissection (SOHND) was car-
ried out. This procedure was also done in patients with small
SCC of the floor of the mouth that were close to the duct of
the submandibular gland. The procedure was evaluated for
local and regional tumor control, survival and the value of
fresh frozen section examination of midjugular lymphnodes.
METHOD:
This study was done on a group of 66 patients with oral and
oropharyngeal SCC treated according the protocol of the
multi-disciplinary head and neck oncology group. During
the procedure frozen sections were examined from midjugu-
lar nodes. In case of a positive neck, the treatment was
extended to a modified radical neck dissection. The pN+
stage was an indication for postoperative radiotherapy,
except for the N1 cases without extra nodal spread in the
first echelon.
RESULTS:
The group consisted of 62 cases of oral SCC and 4 cases of
oropharyngeal SCC. The T-stage was 12 T1, 40 T2, 3 T3
and 12 T4. The mean follow up was 38.28 months (range 12
- 101). Only in 4.5% of the cases, tumor growth was found in
the frozen section specimens, resulting in a MRND. The
pathology resulted in a pN+ stage of 23.9% and was an indi-
cation for radiotherapy. In 20% of the cases turnoff actors
were the indication for radiotherapy. The overall disease free
survival was 73.7%. The disease free survival in the pN+
group was 66%.
CONCL.:
The SOHND is a reliable method for staging the neck in
patients with oral- and oropharyngeal SCC and a clinically
NO neck. The use of frozen section examination of nodes
during the operation is of value only in a small group of
patients. This treatment protocol shows good disease free
survival rates.
THE USE O F PLATELET RICH P L A S M A (PRP) AS
ADJUVANT IN BONEGRAFTING.
B. Vanassehe*, J. Defrancq, F. Noorman van tier Dussen, 1t.
Vercruysse
Eeuwfeestkliniek-Klina Antwerp, Belgium.

Mesenchymal stemcells from the condensed bonegraft are
responsible for initiating bone healing of the graft. By con-
densing the harvested bone we substantionally increase their
number in the grafted bone.
Growth factors, small polypeptides, (molecular mass
25000-30000) are responsible for the initiation of the celdu-
plication.
Best known are the T G F a and b, and P D G F (Transient
Growth Factors, Platelet Derived Growth Factors) who are
abundant in the platelets.
After sequestration of 0,450 1 of the patients blood a gel
rich in growth factors and platelets is obtained and mixed
with the bonegraft.
This gel acts as a physiological glue and promotes faster
duplication of the mesenchymal stemeells thus increasing
maturation speed and quality of the grafted bone.
The procedure and scientific background will be dis-
cussed.
r7 CLINICAL A P P L I C A T I O N OF ABSORBABLE
I M P L A N T S IN SURGERY
Jarkko Vasenius,M.D., Phi).
Unit of Hand Surgery, Department of Surgery, University
Central Hospital, Helsinki, Finland
Introduction: Since the introduction of first absorbable
osteosynthesis implants (Schmitt and Polistina 1969) a vast
number of experimental and clinical studies has been done
during the progress towards the routine clinical use of
absorbable implants. In these studies mechanical and fixa-
tion properties and the tissue compatibility of absorbable
implants has proved to be good. The only adverse reaction
that may occur during their degradation is the transient
fluid accumulation that is more common for polyglycolic
acid (PGA)(average 6%) and rare for polylactic acid (PLA),
but it does not affect the bone healing.
Orthopaedics: Today absorbable screws, pins, tacks and
anchors are in routine clinical use in the fixation of certain
fractures and osteotomies of cancellous bone such as malle-
olar fractures, radial head fractures, intra-articular osteo-
chondral fractures and ligament avulsions and tears. These
are all injuries of non-weight bearing bones, but recently
PLA implants have showed promising properties in the fix-
ation of fractures of weight bearing bones, such as femoral
neck fractures.
Microsurgery: Absorbable tubes of P G A can be used as
conduits in microsurgical nerve repair.
Urology: Spirals of P G A and PLA have been used as stents
to keep prosthatic urethra open to prevent postoperative
urinary retention after laser ablation of the prostate.
Gastroenterology: A fabric constructed P G A has been suc-
cessfully utilised to control bleeding from injured organ
surfaces and to close organ parenchymal defects.
Conclusions: The clinical application of absorbable implants
is still rather limited. One reason for this is their slightly
more demanding operation technique. However, in some
indications, such as in ligament avulsions, their use is at least
as easy as conventional methods. In those indications
absorbable implants are widely used.
BENEFICIAL EFFECT OF ONE SIDED EXTIRPATION
OF SALIVARY GLANDS IN PATIENTS WITH
SJOGREN'S SYNDROME AND MIKULICZ DISEASE
EACMFS- Abstracts, Helsinki Congress 1998 199
Vasilevski, B.*, Benedeti, A., Kirkov, T., Arifi, B.
Clinic of maxillofacial surgery, University "'St. Cyril and
Metodius", Skopje, R. Macedonia
Aims: Sj6gren's syndrome and Mikulicz disease are still a
problem both from the point of view of diagnosis and of
treatment. Often the patient is referred to the maxillofacial
surgeon who has a very important part in the early diagno-
sis. Usually Sj6gen's syndrome is treated non-surgically, but
problems of abscess formation, recurrent infection, disfig-
urement and malignant transformation may result in the
need for total parotidectomy with facial nerve preservation.
Method: We use many different methods in the diagnosis of
this syndrome: sialography, the dynamic test of scintigraphy,
histopathological examination, the Shirmer test and
immunological tests.
Results: The authors report on a 45 year old male with
Sj6gren's syndrome presenting with swelling of the parotid
glands, irritation of the eyes and polyarthritis. A notable
positive response after surgical therapy (total parotidectomy
on the right side) was achieved. Now, the patient has a
appearance (the left parotid reduced spontaneously). He
can cry, producing tears and is capable of working and lead-
ing a normal life. Another case was with Mikulicz disease
which underwent surgical extirpation of both submandibu-
lar glands. After the surgery he had spontaneous reduction
of the swelling of the other salivary glands and acquired a
normal facial appearance.
Conclusions: The efficiency of the surgical treatment of
Sj6gren's syndrome and Mikulicz disease resulted in opti-
mal results. All the patients showed subjective improvement
in the related symptoms. We recommend this procedure in
the treatment of the type of disease as described above and
we highly recommended it in our practice.
[~ OTP FOR W I N D O W S - THE FUTURE O F
ORTHOGNATHIC TREATMENT PLANNING?
Vasir, N.S., Davies, T.M., Tan, A.C.
Department of OMFS and Orthodontics, Central Middlesex
Hospital NHS Trust, London, UK.
Aims: With the increasing use of orthognathic surgery, there
is a need for accurate planning of the hard tissue movements
and a visual display of the soft tissue changes that result.
Several software packages have become available for plan-
ning of combined cases. Orthodontic/Orthognathic
Treatment Planner (OTP) for Windows is one such system.
Method: Cephalometric data is entered either using a back-
lit digitiser or the 'on-screen' facility. The facial image of the
patient is entered by either using a digital camera, a video or
photographic slides. The software allows linking of the
cephalometric tracing and the facial image by superimpos-
ing on the soft tissue. Movements are achieved by transla-
tion, autorotation or by rotation of parts. The soft tissues
respond in ratios that are either standardised or specified for
individual cases by the operator.
Results: 13 cephalometric analyses are available which can
be performed on the original cephalograms or those created
during treatment planning, with data for various races, ages
and sexes. The software also allows for superimposition of
up to six Xrays over the active Xray or over Bolton tem-
plates from age 10 through to 18 years.
Conclusions: Image capturing and manipulation offers two
significant advantages over previous prediction techniques.
200 Journal of Cranio-MaxillofacialSurgery
Firstly, the predicted image facilitates communication
between the clinician and patient by establishing visual
treatment goals for surgery. Secondly, the system should aid
in treatment planning by providing an image that can be
manipulated so a consensus decision can be made on the
desired soft tissue outcome. With practice, the system is
quick and easy to use and can provide a direct comparison
of presurgical and surgical predictions.
XENOGENEIC BONE M O R P H O G E N E T I C
PROTEIN IN EXPERIMENTAL AND CLINICAL
SKELETAL RECONSTRUCTION
Veikko V. Viljanen*, Pekka Jalovaava and T. Sam Lindholm,
Bone Transplantation Research Group, Dept of Surgery,
University of Oulu, Finland
Introduction: Efforts to develop advanced methods for the
stimulation of bone healing are proceeding along several
pathways, research on bone morphogenetic proteins (BMP)
being at the moment among the most promising. The Bone
Transplantation Research Group at the University of Oulu is
to date the only group in Scandinavia and to our knowledge
even in EU countries to concentrate its efforts on the extrac-
tion, purification, characterization and testing of native
bone morphogenetic proteins from different animal species.
Also the production of osteoinductive plasmids for local
BMP gene transfers and recombinant BMP are in progress.
Aims of the study: The focus has been on extraction, experi-
mental testing methods, identification of possible immuno-
genicity and finally clinical utilization of naturally
occurring xenogenic BMPs in skeletal reconstruction.
Results and discussion During the past years animal-source
BMPs were extracted and partially purified among others
from bovine, sheep, canine, reindeer (Rangifer Tarandus),
moose (Alees alces) bone matrices according to a modified
method. Usually three main fractions of proteins could be
identified and separated from each other using HPLC gel
filtration. Both osteoinductive and apparently immunogenic
and osteoinhibitive fractions could be identified. The
osteoinductivity of the semipurified protein complex was
found to increase with removal of the immunogenic frac-
tions. The usually found fraction with a M W of 15-25 kD
was considered to contain monocomponent BMR and the
other osteoinductive fraction with a M W of 100-700kD was
thought to comprise an association of BMP monomers
and dimers with other non-collagenous bone matrix pro-
teins after one-step gel filtration. New bone formation was
tested except in the traditional mouse bioassay, also in the
critical-size skull and segmental defect models with various
carriers. New low-cost radiomorphometry methods for
quantitation of new bone were developed including a new
guided muscle flap bioassay model. A marked difference
between heterotopic and orthotopic implantation of xeno-
geneic BMP was generally found. In the former case, in
intramuscular implantation, no new bone could be found in
sheep or other higher animals, whereas in the latter, in the
sheep skull or segmental defect model, complete bony
regeneration could be achieved.
Conclusion: The most noteworthy outcome of these studies
would be that excellent osteoinductivity with no local or sys-
temic side effects were observed with xenogeneic BMP in
orthotopic implantation.. Based on preceding experimental
work, a clinical trial has been started last year with very
promising initial results in the first ten patients with resis-
tant tibial, ulnar, humeral and scaphoid non-unions, treated
by a composite of bovine BMP, collagen and coral. This was
consistent with observations on clinical series with native
bovine BMP reported by others.
CRAN1OMANDIBULAR DYSFUNCTION AND
OPEN BITE DUE TO SCLERODERMA. A CASE
REPORT.
Venetis* G., Triantafillidou K., Karakasis D.
A case of scleroderma in a young woman is presented and
emphasis is given to skeletal maxillofacial manifestations of
the disease.
The patient was suffering from Reynaud's syndrome for
approximately two years. Symptoms were lapsed for a short
period of time during a pregnancy but after labor they pro-
gressively relapsed and generalized. Initially the patient
referred to us for limitation in mouth opening and a consid-
erable anterior open bite. Refinement of the lips and facial
skin was obvious. Radiological examination revealed atro-
phy of the articulating surfaces of the TMJ bilaterally that
bad produced disappearance of the mandibular condyle.
Laboratory studies established the diagnosis of scleroderma
and the patient was admitted to a specific center for treat-
ment.
Current literature and relative data will be discussed and
will be correlated to the mandibular vanishing syndrome.
D T U M O U R S METASTATIC TO THE JAWS.
PRESENTATION O F THREE CLINICAL CASES.
Ferndndez-Alba, J.; Acero, J.; Salmeron, JI.; Ochandiano, S.,
Verdaguer, JJ.*
Department of Oral and Maxillofacial Surgery, Hospital
General Universitario " Gregorio Mara~on", Universidad
Complutense de Madrid, Madrid, Spain.
Aims: To identify three of the most interesting cases treated
in our department, for an unusual condition - mandibular
and maxillary metastasis from systemic tumours. The most
frequent form of cancer involving bone is metastasis. The
most frequent tumours producing metastasis are breast,
prostate and kidney carcinoma; and the places most fre-
quently affected are the vertebrae, ribs, pelvis and cranium.
Of the overall tumours of the maxillofacial area (5%), the
metastases represent only 1-8%. However, the bone affected
by extraoral tumours is the most frequent form of metasta-
sis, in the oral cavity, most of them being to the mandible
(80%). The most frequent tumours metastatic to the jaws
are: breast adenocarcinoma, bronchogenic carcinoma and
prostate and kidney carcinoma.
M & Methods: We present three cases of mandibular and
maxillary metastasis. One of them is a female who presented
with an adenocarcinoma of the breast, which had been hid-
den for forty years, due to her modesty. Second is another
female with two cranial metastases from a kidney carci-
noma which had been treated many years before. And the
last one was a male presented with a maxillary metastasis
from a lung cancer; this lesion being the first sign of his sys-
temic disease.
Results: In two of them the diagnosis was made through
their metastatic lesions and this permitted the neoplasm to
be treated. In the other the diagnosis permitted further
treatment of her original cancer.

Conclusions: The definitive diagnosis of this type of lesion,
given its rarity in this location, involves a high grade suspi-
cion; therefore, the clinical history and physical examination
are of paramount importance.
CAROTID ARTERY RESECTION AFTER
BALLOON TEST OCCLUSION
Vert E. *, Escutia E., Monner A., Escuder 0., Garcia*Rocado
A., De Miquel M.A. (#)
Department of Oral and Maxillofacial Surgery. University
Hospital of Bellvitge. L'Hospitalet. Barcelona. Catalonia.
Spain. (#: Department of Neuroradiology).
Aims: To study the survival and complications after
carotidectomy in patients with advanced H e a d and
Neck Cancer with the carotid artery infiltrated by the
tumor.
Method: When the carotid artery is suspected to be infil-
trated by tumor we identify individuals at risk for neurologic
complications with a temporary balloon occlusion, with
neurologic examination and farmacologic stress. We per-
formed fiveteen carotid artery reections in our Centre dur-
ing the last two years.
Results: Among the fiveteen patients with carotid resection
one has permanent neurologic deficit (mild left hemiparesia)
and there is no death caused by stroke.
Conclusions: Surgical resection of advanced tumour involv-
ing the carotid artery offers the greatest (although still low)
ossibility of cure. The Balloon Test Occlusion with simulta-
neous farmacologic stress and neurologic examination
seems to be an appropiate alternative when it is not possible
to perform an Occlusion Test with Positron Emision
Tomography to quantify the blood flow
RESORBABLE POLY-L-LACTIC ACID (PLLA)
PLATE FOR COVERING SMALL CRANIAL BONE
HOLES: AN EXPERIMENTAL STUDY IN RABBITS.
Anna-Liisa Vesala* (1), Matti Kallioinen (2), Outi Kaarela
(1), Timo Pohjonen (3), Pertti Tormala (3), Timo Waris
(1).
Departments of (1) Surgery and (2) Pathology, Oulu.
University Central Hospital, Oulu, Finland and (3)
Biomaterials Laboratory, Institute of Plastics Technology,
Tampere University of Technology, Tampere, Finland.
Aims: P L L A is a synthetic polymer which degrades to cellu-
lar metabolites and finally to carbon dioxide and water. We
studied the role of P L L A in the regeneration of cranial
bone defects in twenty five New Zealand White rabbits.
Methods: There were thirteen animals in the first group. Two
holes, sized 5ram x 5mm, were drilled into the parietal bone
under the periosteal pocket One of the holes was covered by
a PLLA-plate while the other one was left empty In the
other group were 12 rabbits and two holes, sized 1Omm x
1Omm, were drilled; the rest of the procedure being the
same as in the first group. The skulls were radiographed and
samples were taken for histological examination 3, 6, 24 and
48 weeks postoperatively.
Results: There were no special findings on x-ray. New bone
formation was clearly seen on the implant side in rabbits 24
EACMFS -Abstracts, Helsinki Congress 1998 201
and 48 weeks after the operation, while there was only a
slight reaction on the control side in the same animals.
Conclusions: We concluded that the PLLA-plate seemed to
enhance the regeneration of the cranial bone. Therefore it
could have a clinical use as an implant material.
SENSORY RECOVERY IN LATISSIMUS DORSI
FLAPS
Vesper, ]14.* Garau, L, Girmann, N., Bschorer, R. °, Hellner,
D., Gehrke, G., Schmelzle, R.
Department of OMFS, University Hospital Hamburg, D-
20251 Hamburg, Germany, ° Department of OMFS,
Hospital Schwerin, D-19049 Schwerin, Germany
AIMS:
The aim of this study was to clarify the following questions:
(1) Does sensory recovery occur at the center of the flap or
at its margins? (2) To what extend can sensibility recover ?
(3) Does irradiation influence the sensory recovery ? (4)
Exist a difference between a pedMed and a free flap ?
METHOD:
23 Patients, 9 females and 14 males aged from 17 to 79 years
(mean 52.4 years) were investigated between 15 days (and
than later) and 7 years after they underwent a free (8) or a
pedicled (15) noninnervated latissimus dorsi flap. 16
patients were previosly irradiated. Pinprick was tested with
a needle, hot and cold with water (42°C, 5°C), touch with
light pressure of a Wattetrfiger, 128- and 240-Hz vibration
with the corresponding tuning fork and static two-point dis-
crimination with two ends of an adjustable wire.
RESULTS:
2 latissimus dorsi flaps were anaesthetic for all examined
parameters, 11 show a partial recovery of sensibility, and 10
had all examined modalities all over the flap. Smaller and
thinner flaps show a faster but not better and older flaps a
better regenerating process. Constant touch recovered first,
hot and cold last.
CONCLUSIONS:
We conclude that sensory recovery occurs from the bed of
the flap but also from margin. Sensory recovery can reach
two point discrimination equal to the contralateraI healthy
skin of the latissimus dorsi flap. If the recipient site is irridi-
ated we saw the same sensivity. There was now difference
between a free or a pedicled latissimus dorsi flap.
[~ REVASCULARIZED COMPOSITE GRAFTS WITH
INSERTED IMPLANTS FOR MAXILLOFACIAL
RECONSTRUCTION - IMPROVED FLAP DESIGN
AND FLAP PREFABRICATION
Kurt G. Vinzenzm'~, J. Holle 2, J. PreissP, E. Wiiringera; all
Vienna
ZDept. for Maxillofacial Surgery, Evangelisches Krankenhaus
Wien- Wdhring
2Dept. for Plastic and Reconstructive Surgery,
Wilhelminenspital
3Research-Institutefor Reconstructive OMF-Surgery and
Tissue-integrated Prosthesis,
202 Journal of Cranio-MaxillofacialSurgery
A new technique of prefabrication of revascularised com-
posite grafts from the scapula or the iliac crest to precisely
fit a maxillary defect, is presented.
A comprehensive planning based upon CT scans and
interactive manipulation of 2D- and 3D-CT data via
graphic workstations (Voxel Flinger-ARRI; Osiris; 3D-
Viewnix) is a prerequisite for the proper shape of the trans-
plant, resulting in an improved flap design for maxillofacial
reconstruction. Stereolithographic models are used for addi-
tional operation planning.
A pedicled bony flap with a split skin graft envelope and
endosteal implants already inserted is prepared and covered
by a Goretex®-membrane. After 3 to 4 months these prefabri-
cated grafts are harvested, inserted into the maxillary defects
and reanastomosed to the facial vessels. Further improve-
ments can be achieved in complex midface reconstruction by
combining the prefabricated scapula flap with other flaps.
Results of this method are presented through some case
reports after ablative tumor surgery and Noma.
References:
Holle J, Vinzenz KG, Wfiringer E, Kulenkampff K-J, Saidi M. The
combined scapula flap for bony and soft tissue reconstruction
in extensive maxillofacial defects. Plast. Reeonstr. Surg. 1996;
98: 542-552.
Vinzenz KG, Holle J, Wfiringer E, Kulenkampff K-J.
Prefabrication of combined scapula flaps for microsurgical
reconstruction in oro-maxillofacialdefects: a new method. J.
C r a n - M a x i l l o f a e . Surg. 1996; 24: 214-223.
THREE D I M E N S I O N A L ANALYSIS AND
INTERACTIVE M A N I P U L A T I O N O F CT-SCANS F O R
PREFABRICATED F L A P S IN RECONSTRUCTIVE
OMF-SURGERY.
Johannes Preissi 13, Andreas Beer 13 Jiirgen Holle2, Kai-
Joachim Kulenkampffl, Kurt G. Vinzenz 1'2,
1Dept. for Maxillo-Facial Surgery, Evangelisches
Krankenhaus Wien- Wgil~ring2Dept. for Plastic and
Reconstructive Surgery, Wilhelminenspital 3Research
Institute for Reconstructive OMF-Surgery and Tissue
Integrated Prostheses, Vienna 4Central Institute for
Radiology, Krankenhaus Lainz
At present, the microvascular reconstruction of maxillofacial
deformities by osteomyocutaneous distant flaps from various
sources is the most timely method of reconstructive surgery.
Imaging systems like computer tomography (CT) and
magnetic resonance imaging (MRI) that show cross-sec-
tional images of a patient, quite a few of two-dimensional
(2D) and three-dimensional (3D) visualizing and manipula-
tion systems have been developed or are in the process of
development, e.g. 3DViewnix, Analyse, Osiris, A R R I Voxel
Flinger. 3D-stereolithographic models contribute preopera-
tive planning (e.g. Laserform ®, Vienna).
For an improved flap design of the transplants and
higher precision of reconstructive OMF-Surgery we include
gnathological and functional aspects into comprehensive
3D planning in complex microsurgical reconstruction. A
precise correlation between the donor site and the maxillo-
facial defects can be achieved resulting in 3D-computer-
aided tissue preparation i.e. "prefabricated flaps".
Planning procedure is described by three case reports
with microsurgical reconstruction of the maxilla, the com-
plete midface region and the mandibula.
References:
Holle J, VinzenzKG, WtiringerE, KulenkampffK-J, SaidiM. The
combinedscapulaflap for bony and soft tissuereconstructionin
extensivemaxillofacialdefects Hast ReconstrSurg 1996;98: 542-552.
Vinzenz KG, Holle J, Wfiringer E, Kulenkampff K-J.
Prefabrication of combined scapula flaps for microsurgical
reconstruction in oro-rnaxillofacial defects: a new method. J
Cran-Maxillofac Surg 1996; 24: 214-223.
I ~ THE SURGICAL APPROACH IN THE
TREATMENT OF CERVICOFACIAL M A L I G N A N T
MELANOMA
By: Dr. Ibric Cioranu Viorel, Dr. Moraru Liliana,
Dr. Carabela Mircea
We consider Malignant Melanoma, one of the most aggres-
sive and unpredictable types of cancer, to be a treatable dis-
ease nowadays in a high percentage of cases. The treatment
of Malignant Melanoma has advanced a lot in recent years,
thanks to a better knowledge of the biology of the tumour
and it is mainly surgical.
The surgical removal must be performed as widely as
possible, both in surface and in depth. For cervicofacial
Malignant Metanoma, the safety limit is smaller, according
to the regional anatomy and to the means of repairing sub-
stance loss, but it is never smaller than 2cm.
When the tumor is detected in the second stage
-Malignant Melanoma with metastasis- we prefer the
"uni-block" technique, wich includes removing the pri-
mary melanoma, the parotid salivary gland the sub-
mandibular space, the lateral-cervical and supraclavicular
spaces and, eventually, the plastic covering of the post-sur-
gical defect.
[~ TOTAL G L O S S E C T O M Y - EXPERIENCE OF 48
CASES
Virag M, Aljinovib N,, Uglegib V, Luk~ib l, Milenovi~ A
Department of Maxillofacial Surgery, University Hospital
Dubrava. Zagreb, Croatia
AIMS
The treatment of recurrent or advanced cancer involving the
tongue is always demanding and very often disappointing,
but reports with larger series of patients addressing the sur-
gical salvage and its final outcome are very few. The objec-
tive of this study was to determine the curative potential of
total glossectomy.
METHOD
The study is a retrospective chart and database review and
includes 48 patients who had had a total glossectomy in the
period 1976-97. All of the patients were treated by compos-
ite resection, 33 as the initial treatment, 15 following a recur-
rence. In four cases surgery was performed as an emergency
treatment and in four after emergency external carotid liga-
tion. All patients except four (two had a simultaneous sec-
ond primary in the hypopharynx) had had no laryngectomy
but almost all had had a cricopharyngeal myotomy. All the
patients either had a recurrent or T 4 oral cavity turnout. All
except one patient had a pectoralis major flap used for

reconstruction. Survival for all patients was calculated and
analyzed.
RESULTS
The 5-year disease-free survival rate calculated by the
Kaplan-Meier method was 39%. However, since a signifi-
cant number of patients died of tumour-unrelated reasons
(8), treatment complications (4) or were lost to follow-up
(3), the direct method gives a more realistic insight into the
results. Fourteen patients had recurrent disease: 11 local, 1
regional and 2 distant. Nineteen patients had no evidence of
disease when last seen, but only 5 out of 33 patients treated
before 1996 (15%) were alive and without evidence of dis-
ease 2 years or more after last treatment. Ten patients never
regained the ability to swallow. The functional results con-
cerning swallowing, aspiration and speech were unpre-
dictable.
CONCLUSION
The results of this study show that the long term survival is
low due to various reasons, but the surgical salvage of
patients with advanced cancer involving the tongue is war-
ranted since at this stage of the disease no better options are
available. At least, it offers substantial palliation.
[ ~ PAROTIDECTOMY - AESTHETIC APPROACH
Virag M, Milenovi~ A
Department of Maxillofacial Surgery, School of Medicine,
University Hospital Dubrava, Zagreb, Croatia.
AIMS
Various incisions have been advocated, and are being used,
for parotidectomy. For more than 15 years, the senior
author has used a facelift incision which allows good expo-
sure and leaves no visible scar. The aim of this video presen-
tation is to show details of the surgery as well as the final
results using this approach.
METHOD
Since 1982 the method has been used in our Department on
more than 200 patients. The standard facelift incision extends
into the hairline behind the mastoid. The skin flap above the
parotid and the upper part of the sternocleidomastoid is ele-
vated. The facial nerve is identified only after the posterior edge
of the parotid has been completely dissected. A wide approach
to the nerve is achieved and no "landmarks" for its identifica-
tion are used. After the trunk of the nerve is identified the
usual dissection along its branches follows. The superficial
parotid lobe is removed with the tumour. The preauricular clo-
sure is in two layers with 5-0 monofilament sutures and 4-0
sutures behind the ear. The anterior skin sutures are removed
after 3 days, the posterior ones after 6 days. This approach is
applicable to all parotidectomies except those with a neck dis-
section or previous surgery with classic incisions.
RESULTS
The technique provides adequate exposure and results in
improved patient satisfaction. The details and highlights of
this procedure, lasting about 90 minutes, will be shown in a
12 minute video including a series of postoperative results.
CONCLUSION
The conversion to this aesthetic approach is possible for any
surgeon familiar with classic parotid surgery.
EACMFS - Abstracts, Helsinki Congress 1998 203
[~ S U R G I C A L A P P R O A C H IN R H I N O P H A R Y N G E A L
ANGIOFIBROMA.
*Malchikova L.P., Tomilov LL, *Vissarionov V.A.,
Sakovich EP., Malchikov LA.
The Urals State Medical Academy, Ekaterinburg, Russia
Basal skull angiofibroma was diagnosed in 28 patients
admitted to our clinic. According to their origin, angiofi-
bromas were subdivided into three types which were distrib-
uted as follows: basillary angiofibroma- in 5 patients
(17.85%), sphenoethmoid angiofibroma - in 15 (53.57%)
and pterygomaxillary angiofibroma - in 8 patients (28.58%).
The most informative method of examination was com-
puter tomography (CT) which made it possible to determine
the turnout location, size and contours. The approach and
amount of surgical intervention was chosen individually for
each patient. A basillary tumour was separated from the
nasopharynx using special instruments and then removed
through the mouth. Haemostasis was achieved by posterior
nasal tamponade. For sphenoethmoid tumours the surgery
of choice was Moor's technique. In the pterygomaxillary
location we used a transmaxillary-buccal approach with a
preventive binding of the carotid. For this purpose a facial
skin dissection according to Weber was performed. The
maxilla was disarticulated preserving the soft tissue flap and
then pulled outward. At the end of the procedure the max-
illa with the surrounding tissues was replaced and fixed by
miniplates. The maxilla healed well and its function recov-
ered in all patients. Good results of the surgical treatment
for basal skull angiofibroma are explained by the exact iden-
tification of its location and size by CT and the improved
surgical technique using a transmaxillary-buccal approach.
RESULTS O F T R E A T M E N T O F T H E
E D E N T U L O U S PATIENT W I T H T H E H E L P O F
DENTAL I M P L A N T S O F PRIVATE
CONSTRUCTION
Vovk Y. V., Konstantinu K., Kobylnyk L 0., Halkevych P. E,
Myhovyeh LM.
Department of Oral and Maxillofacial Surgery for
Postgraduate Education of the Physicians. L'viv Medical
University, L'viv, Ukraine.
Aims: The aim of our work is to investigate dental implants
of private construction in the surgical- prosthetic treatment
of the of the edentulons patient.
Method: 045 patients from 21 to 72 years of age, edentulous
for varying periods, were subjects of the research. The
patients received altogether 121 dental implants of private
construction (Patent for the invention, Ukraine #11001).
Dental implantation was carried out by two-phase surgical
method, with the later prosthetics fixed onto the fixed com-
ponent of the implants with detachable, relatively detach-
able and non-detachable constructions. The opinion of the
implantation results was given according to the generally
accepted clinico-roentgenological criteria.
Results: For the patients, the implants proved successful and
they are pleased with the functional harmony of the pros-
thetic suprastructures. The results attained by our treatment
are testified by 2-3 years functioning of the dental implants
in 93% of the patients. Clinico-roentgenological expert
opinion on the patients' bony tissue and gum state proves
204 Journal of Cranio-Maxillofacial Surgery
the full integration of the dental implants with the tissues
around the implants. Three patients were observed with neg-
ative results of implantation.
Nine dental implants were lost, 3 of them before the
commencement of prosthetic reconstruction and 6- after it
had been completed.
Conclusions: The results of 2-3 years clinico-roentgenologi-
cal observation of the patients, who were implanted the den-
tal implants of private construction, testify their clinical
effectiveness for the maxillodental system adentia treatment.
EXPERIMENTAL RESEARCH INTO THE
MORPHOLOGICAL STRUCTURE OF THE BONE
AROUND F U N C T I O N I N G DENTAL I M P L A N T S OF
PRIVATE CONSTRUCTION
Vovk E V,, Konstantinu If., Halkevych P. Y., Kobylnyk LO.
Department of Oral and Maxillofacial Surgery and
Prosthetics for Postgraduate Education of the Physicians.
L'viv Medical University, L'viv, Ukraine.
AIMS :
The research deals with the investigation of the bony alveo-
lar process of experimental dog's lower jaw state under 1~
1.5 year functional loading of the dental implants of private
construction.
METHOD:
Under intrapleural anaesthesia, four dogs received 9 dental
implants, 3 months after atypical bilateral extraction of
lower jaw posterior teeth. After 4 months period of healing,
prosthetic constructions were fixed to the intrabony posts.
They have been functioning for 1-1.5 year. After the indi-
cated period of time, the dogs were taken out the experiment.
For the purpose of histological investigation fragments of
the dog's jaw with the last implants were resected. Jaw bony
tissue was decalcified and cut sagitally. The preparation
maintained the dental implant in its tissue environment.
Under light-optical magnification the state of the bony tissue
was investigated, where it came into contact with the
intraosteal surface of the implants, throughout their extent.
Histological preparations were produced, received and sub-
jected to expert opinion at the Department of Oral Surgery,
Vienna Medical University ( the chairman - Prof.G.Watzek),
for which the authors express their sincere gratitude.
RESULTS:
The histological investigation revealed the phenomena of
new bone formation and dynamic regeneration of jaw bony
tissue. Incidently, the phenomena is observed of a large con-
centration of osteoblasts and osteocytes in osteons of dif-
ferent diameter. In direct contact with the intraosteal
surface the admixture was also revealed of large diameter
osteons, which testified to the maturity of the osteogenic
cells. The processes of dynamic osteal laminar tissue regen-
eration (remodelling) were observed in the crevices of the
post's intraosteal surface thread.
A connective layer was revealed throughout the bony
surface of only 1 dental implant, which has been function-
ing for 1 year.
CONCLUSIONS:
The experimental research confirmed the adhesion of bony
tis-sue around and directly on the functioning implants of
private construction, which indicates full osteointegration.
~h PREOPERATIVE ASSESMENT OF ADVANCED
ORAL CARCINOMA
Vujieic, Z.* Konstantinovi6 V.S.#, Dimitrijevicic M.*,
Stogib- Opinkal, T.
*Clinicfor ORL and MaxiHofacial Surgery, <---Radiological
unit, Emergency Centre, Faculty of Medicine, Clinic Centre
of Serbia #Clinic for Maxillofacial Surgery, Faculty of
Stomatology; University of Belgrade, Belgrade, Yugoslavia.
Aim: To assess the extent of advanced oral carcinoma (T3-
T4), by preoperative diagnostic procedures and to compare
with the operation findings.
Methods: A total of 15 patients were selected. They were
evaluated by the following procedures: careful clinical exam-
ination, CT scan and MRI.
Results: Clinical examination is still very important in the
preoperative assessment. CT scan and M R I with contrast
provide very accurate information regarding the extent of
oral carcinoma and neck node involvement.
Conclusions: Compared with the operative findings, CT scan
is preferred for bone structure involvement, and M R I is
superior in defining soft tissue involvement. The main dis-
advantages of M R I are artefacts produced by dental amal-
gam fillings.
TRANSCRANIAL OPERATION AND FREE
MUSCLE FLAP RECONSTRUCTION OF TUMOURS
PERFORATING SKULL BASE
Vuola, J* Ohman, £
Department of Plastic Surgery and Department of
Neurosurgery, Helsinki University Central Hospital
Helsinki, Finland
Aims: To present our multidisciplinary approach to the
treatment of tumours penetrating the skull base.
Method: In 8 patients with a skull base penetrating tumour, a
bicoronal incision and transcranial approach was used. The
intracranial part of the tumour was resected by neurosur-
geon. The rest of the tumour in the paranasal sinuses and
nasal cavity was removed through the skull base or directly
via another facial incision by an ENT or plastic surgeon. The
defect was filled with a microvascular muscle flap. Three dif-
ferent flaps were used: rectus abdominis, latissimus dorsi and
in one case a radial forearm flap with an extracranial part for
nose reconstruction and a de-epithelialized part for skull
base filling. The flap pedicle was pulled through or over the
maxillary sinus to facial vessels or through a bur hole in the
temporalis region to the superficial temporalis artery.
Results: No reoperations were needed and after immediate
post operative c.s.f, leakage all reconstructions showed
water-tight healing.
Conclusion: The lack of a simple and reliable postopera-
tive flap monitoring device is a major drawback.
Although we did not have problems with flap blood circu-
lation, an undetected thrombosis in these patient may
have fatal consequences. These operations are not possible
without a multidisciplinary surgical team. Even though
the prognosis of the patients is poor in cases of advanced
malignant disease, we can at least offer, with this tech-
nique, a significant improvement in otherwise inoperable
cases.

[~ EXPERIENCE W I T H S O F T PALATE CLOSURE (AD
M O D U M FURLOW) IN TWO-STAGE PALATAL
REPAIRS
Vuylsteke, Ph., Mommaerts, M., Abeloos, J., De Ciercq, C.,
Neyt, L.
Division of Maxillo-Facial Surgery, AZ St-Jan, Belgium
Aims: To describe our surgical experience with the double
opposing Z-plasty for the closure of clefts in the soft palate
at the age of 1 year, with the cleft in the hard palate closed at
the age of 4 years.
Study design: Variations in surgical technique and wound
complications were analysed in a prospective manner. In a
three year period, 8 patients with unilateral cleft lip & palate
(CLP), 5 with bilateral CLP, 5 with isolated complete palatal
clefts and 4 with isolated soft palatal clefts underwent a
Furlow-plasty. The dead space between the nasal and oral
layer was obliterated with fibrin glue in every case. The nasal
and oral layers were closed with 4/0 polyglactin. Two 4/0
polydiaxone quilting sutures reinforced the muscle recon-
struction. Multiple regression analysis was applied in 14
patients to find a correlation between tension upon closure
as a dependent variable and the distances tuber maxillae-
cleft side and tuber-tuber, and the cleft width as indepen-
dent variables.
Results: Lateral relaxation incisions were performed in the
first 6 patients and V-Y closure of the residual triangular
space in the oral layer in 4 patients. There were 2 dehiscences,
of which one closed per secundam. The other persisted and
was due to wound infection. There was no correlation with
cleft width, jaw width and tissue available for closure. All
patients had a long and mobile soft palate. Early testing for
velopharyngeal incompetence was promising.
Conclusion: Furlow used a back-cut to make a rotation flap,
whereas we used lateral relaxations initially and now occa-
sionally a V-Y closure in the remaining anterior oral layer.
MANDIBLE RECONSTRUCTION W I T H
OSTEOMUSCULAR FLAPS
S. Vyrupaev
Republican Oncologic Hospital, Ufa, Russia
Aim: To improve the surgical rehabilitation results of the
patients after the mandible resection.
Methods: The reconstruction of the mandible has been per-
formed using four different methods. The indications for
this or that method depended upon the size location of the
tumor structure defect as well as upon the pre-operative
treatment. The 1-st method - The spine of the scapula on the
trapezius was used in 5 patients. The 2-nd method - The
clavicle on the sternocleidomastoid muscle was used in 9
patients. The 3-rd method - The body of the hyoid bone on
the geniohyoid was used in 1 patient. The 4-th method - The
spine of the scapula and the external part of the clavicle on
the trapezius were used in 5 patients. A dermal island was
included into the flap to reconstruct the combination
defects. Our principle of the formation of the osteomuscular
flaps is similar. We begin with the desection of the osseous
part and then we form the musculorvascular pedicle.
Results: 20 patients have been operated on. They have been
performed 14 simple and 6 combination resections of the
mandible in connection with 11 malignant and 9 benign
EACMFS - Abstracts, Helsinki Congress 1998 205
tumors. The age ranged from 8 to 65. 19 patients have been
performed a single- staged reconstruction of the mandible
using one of the above-mentioned method. The reconstruc-
tion of 1 patient was performed in two stages. 5 patients
have received 50-60 Gray radiotherapy prior to the opera-
tion in different periods of time. The suppuration of the
wound was observed in 4 patients. A complete taking root
of the flap was observed in 19 patients. The loss of the flap
was observed in 1 case due to the technical error (damages
of the feeding vessel).
Conclusion: We dispose of 4 simple and reliable methods of
the mandible reconstruction which can be used in any surgi-
cal department.
I M P L A N T SUPPORTED TREATMENT OF SEVERE
FACIAL TRAUMA IN A SEVEN YEAR OLD CHILD
Wahlmann, U, W.*, Kunkel, M., Reinhardt, R. 2, Dietrich,
H. 3, Wagner, W.
Clinic of OMFS, 2 Orthodontic department, 3 Prosthodontic
Department Johannes Gutenberg Universitat. Mainz. Germany
AIMS:
Implant therapy for children generally is confined to the age
of the secondary dentition, because growth and continued
eruption of the teeth are incompatible with the position of a
fixture, implanted earlier, in the deciduous dentition. Only in
very specific situations earlier implantation may be justified.
We want to discuss the problems, considerations and impli-
cations of early implantation with the aid of a case report.
Case Report: We present the findings and clinical course of
a five year old girl who was hit by the rotor blade of a model
helicopter. When the child was admitted to the clinic, the
facial soft tissues of the right side were avulsed, from the
temporal region down to the neck area. There was a corn-
minuted fracture of the mandible, the zygoma, the maxilla
and the temporal skull. Primary reconstruction was per-
formed with microplates, microcrews and meticulous soft
tissue repair, including the auditory canal. After reconstruc-
tion of the temporal skull, the bony fragments of the
mandible were rearranged along a microplate, the smashed
conylar head was reconstructed using two microscrews.
Secondary treatment included correction of scars, vestibulo-
plasty, plate removal and functional measures. Since most of
teeth and tooth germs on the right side were lost. we decided
to use dental implants for functional rehabilitation and to
enable further orthodontic treatment.
CONCLUSIONS:
Following severe trauma, dental implants can serve as valu-
able tools to enable mastication and functional loading of
the growing facial skeleton even in a young child.
Furthermore, they can provide anchorage for orthodontic
appliances in a traumatically reduced dentition.
MULTI-DIRECTIONAL, BURIED, MANDIBULAR
DISTRACTION O S T E O G E N E S I S A P P L I A N C E S AND
TECHNIQUES
Walker, D.A. *, Nish, L
Department of Oral and Maxillofacial Surgery, Faculty of
Dentistry, University of Toronto, Toronto, Ontario Canada
206 Journal of Cranio-Maxillofacial Surgery
Aims: To evaluate mandibular distraction osteogenesis in
primates utilizing multi-directional, buried, distraction
osteogenesis appliances.
Method: Adult macaca fasicularis adult female primates are
being utilized in this ongoing study. These primates underwent
bilateral sagittal ramus osteotomies with transoral placement of
buried multi-directional bone borne distraction appliances
under general anaesthesia. After a latency period of seven days
appliances were activated transorally 1.1ram a day, bi-laterally,
for nine days to a distance of 10rrun of distraction. Medial/lat-
eral adjustments were made at various time intervals to maintain
symmetric distraction osteogenesis in the primates. Appliances
will be removed transorally three months after the distraction.
Results: The primates thrived during the follow up period.
Clinical and radiographic evaluation demonstrated excellent
distracted bone with good consolidation at the distraction
site with firm bony union at the time of appliance removal.
Pre- and post distraction CT Scans demonstrate successful
distraction osteogenesis.
Conclusions: Multi directional buried mandibular distraction
osteogenesis appliances and techniques were successful in this
primate study. This was evidenced by excellent distracted
bone based on clinical observations, radiographic and CT
Scans. In spite of careful surgical technique and appliance
placement, medial/lateral adjustments to the vector of dis-
traction were required to maintain symmetrical bilateral
mandibular distraction. This research will help to provide a
biological basis for applying multi-directional, buried, sub
mandibular distraction osteogenesis appliances and tech-
niques in human clinical trials. This research was funded by
Innova Technologies Corporation, Toronto, CANADA.
RECONSTRUCTION OF THE ATROPHIED MAXILLA
WITH BONE GRAFFING TO ]TIE FLOOR OF THE
MAXILLARY SINUSES IN ONE OR TWO STAGES?
Wannfors, Kavin*, Johansson, B, Haliman, M,
Strandkvist, T
Stockholm S6der Hospital, Sweden, Department of Oral &
Maxillofacial Surgery, Danderyd's Hospital, Stockholm,
Sweden, and Department of Oral & Maxillofacial Surgery,
Giivle Hospital, Giivle, Sweden
Purpose: The aim of the present study was two compare two
grafting procedures, a one-stage block-bone technique and a
2- stage technique using particulate bone packed into the
floors of the maxillary sinuses, regarding implant success,
marginal bone resorption and surgery-related
complications.
Material: The material comprised 40 edentulous patients,
consecutively referred, with the need for bonegrafting for
rehabilitation with Brgmemark implants. The patients were
randomized to either of the two grafting procedures.
Distribution by age, gender, smoking habits and diseases
under medical treatment did not differ between the two
groups of patients. Grafted bone blocks were fixed with 76
implants through the sinus floor to the alveolar crest in a
one-stage procedure in 20 patients and 75 implants were
placed during a second procedure in 6 months previously
grafted bone, in 20 patients. Altogether 168 implants were
placed in the original anterior maxillary bone. In this
prospective randomized study, after one year of prosthetic
load, all bridges were removed and the implants individually
tested.
Results: No statistically significant difference was found
concerning implant failures ( 14 and 12 respectively). Nor
was there any difference concerning marginal bone loss after
the first year of loading. Perforation of the sinus mucosa
during surgery was registered in 22 (27%) sinus cavities, and
could not be correlated to later implant losses. These com-
plications were equally distributed between the two groups.
Conclusion: This study did not reveal any prognostic differ-
ence between patients treated according to the one-stage
block-bone concept and patients grafted with particulate
bone and delayed implant placement. The one-stage proce-
dure is less time-consuming, but optimal prosthetic solution
is somewhat more difficult to achieve as several angulated
abutments had to be used because of unfavourably posi-
tioned implants.
INTRAOPERATIVE NAVIGATION OF
P O S I T I O N I N G OF DENTAL IMPLANTS
F. Wanschitz*, F. Watzinger, O. Ploder, W.. Millesi, S.
Giissweinet; J. Kremser, R. Ewers
Clinic of Oral and Maxillofacial Surgery, AKH Vienna,
Waehringer Guerte118-20,
A-1090 Vienna, Austria. Tel."01-40400/4259; Fax: 4253 e-
mail r.ewers@akh-wien,ac. at
The ideal position for dental implants, taking into account
the local bone situation and a favourable prosthetic site, is
difficult to evaluate intraoperatively. The main problem is
the exact execution of the preoperative plan. Prefabricated
splints for positioning of dental implants are not a satisfac-
tory solution.
By means of intraoperative computer aided navigation
the preoperative plan, drawn up on lateral cephalograms,
CT-slices or dental study casts is exactly transferred onto
the patient.
Overlay graphics show the position of the implant bur as
well as the implant site on the images and in real time on a
video monitor.
So far, four patients have been treated with this method,
fifteen 1MZ - implants have been inserted into the mandible.
In difficult alveolar ridge situations, such as in patients
after tumour surgery or in severely atrophied alveolar
ridges, computer aided navigation was a helpful tool in
operating on these patients.
THE USE OF BIODEGRADABLE FIXATION IN
CRANIOFACIAL SURGERY: A LONG-TERM
FOLLOW-UP STUDY.
Waris, T.~, W. Serlo, Peltoniemh H., Merikanto, J., Ohman,
J., Lassila, K., Pohjonen, T., Trrmiilii, P.
Departments of Plastic and Paediatric Sul~ery, University of
Oulu, Finland
The Institute of Biomaterials, Tampere University of
Technology, Finland
Titanium plates, screws and metallic wire are commonly
used as fixation material in craniofacial surgery. However,
they interfere with modern radioimaging, and in the grow-
ing child they might migrate into or beyond the bone.
Biodegradable self-reinforced polylactic acid (SR-PLLA) has
been widely studied by our research group as regards general and
orthopaedic surgery. More than 50 000 clinical cases and over
1000 reported cases encouraged us to evaluate the use of

biodegradable fLxation in paediatric craniofacial surgery. The
study was initiated with experimental studies and cautiously
introduced into clinical craniofacial surgery. PLLA fixation was
initiallyused together with titanium implants in "safe areas", but
after encouraging results, PLLA fixation was used as such.
The study involved 14 paediatric cases at ages of six
months to ten years at surgery. The follow-up time varied
from one to eight years. The materials used were 1 mm
P L L A wire, P L L A plates (Q 0.4 - 0.5 mm), and 2 mm
P L L A screws, all specially designed for craniofacial surgery.
Plates can be moulded under heat and screws can be
trimmed as required by using heat loops or saw.
In paediatric surgery P L L A wire was used in 5 cases (2
plagiocephalies, and for fixing bone grafts in bone defects in
3 cases). P L L A plates (alone or in combination with tita-
nium or P L L A screws) were used in 7 cases (4 plagio-
cephalies and 3 bone defects), and P L L A screws in 2 cases
(1 plagiocephaly and 1 cartilage onlay-graft for orbital
hypoplasia). In addition there were three adult cases.
In these ongoing studies we are evaluating reinforcement
of thin frontal bones with P L L A plates before reshaping
deformed frontal bone.
Conclusion: Initial experience suggests that fixation in pae-
diatric cranio-facial surgery can be achieved with
biodegradable materials alone and without side effects, thus
avoiding the disadvantages of metallic implants. No compli-
cations were associated with biodegradable osteofixation
during the follow-up period of up to eight years.
WARM ISCHAEMIC T O L E R A N C E OF T H E
SUBMANDIBULAR G L A N D
Warnecke, K.K. *, Sieg, P.
L~beck / Germany
Free microvascular gland transfer to the temple region with
implantation of Wharton's duct into the upper lateral con-
junctival fornix is a surgical approach in the treatment of
the severe dry eye syndrome. The aim of this study was to
consider the warm ischaemic tolerance of the submandibu-
lar gland tissue to avoid tissue damage during the gland
transfer and therefore to optimize this operation.
Morphological changes in submandibular glands in 41
rabbits were studied after a temporary interruption of blood
flow. Under general anaesthesia, the submandibular glands
were exposed, followed by occlusion of the blood vessels
with vascular clamps for 1 h, 1.5 h, 2 h or 6 h. Fourteen days
later the glands were removed simultaneously with the con-
tralateral side for comparison.
The gland tissue of the ischaemically damaged glands as
well as the control glands were examined by conventional light
microscopy and immunohistochemical techniques. While the
gland tissue after 1 h of ischaemia remained structurally
intact, after 1.5 h and 2 h ischaemia gradually increasing cell
damage, with partial loss of vital salivary tissue, was observed.
6 h of ischaemia regularly led to total necrosis of the gland.
The results in detail and the clinical consequences will be
discussed in the oral presentation.
C O M P U T E R AIDED NAVIGATION F O R
P O S I T I O N I N G OF T H E PROXIMAL F R A G M E N T IN
SAGITTAL SPLIT OSTEOTOMIES.
F. Watzinger % F. Wanschitz, W. Millesi, F. Manna, (7. Undt,
S. G6ssweiner, J. Kremser, R. Ewers.
EACMFS - Abstracts, Helsinki Congress 1998 207
Clinic of Oral and Maxillofacial Surgery, A K H Vienna,
Waehringer Guerte118-20,
A- 1090 Vienna, Austria
Tel.: 01-40400/4259; Fax.: 4253 e-mail: r.ewers@akh-
wien. ae. at
Subject: Condylar positioning devices in orthognathic
surgery are still the subject of controversial discussion.
Criticism concerns the possibility of exactly reproducing the
preoperative situation, on the other hand there is some con-
cern whether the preoperative situation is the ideal one. We
have used a computer assisted mandibular positioning
device in six patients so far.
Methods: A centric interocclusal splint was fabricated on
study casts. This splint was duplicated, fixed to an acrylic
face bow containing 8 -12 radiopaque fiducial markers (3-D
splint). Centric occlusion was re-established by application
of this 3-D splint on the patient. Then frontal, lateral and
axial cephalograms were obtained, scanned and integrated
in the computer navigation system (ARTMA Biomed. Sys).
Intraoperatively, the 3-D splint was repositioned on the
patient<<s teeth and the head-mounted electromagnetic sen-
sor was correlated to the fiducial markers. Before the
osteotomy, two more sensors were mounted on each proxi-
mal segment. The initial centric splint was applied and inter-
maxillary fixation was performed. Coloured tracings of the
contour of the proximal segments were outlined on the radi-
ographs on the screen, in 3 planes. The virtual overlay
graphics show the initial situation. The same graphics were
duplicated and tranferred to the proximal fragment sensors
to visualize movement of both proximal fragments after the
osteotomy. Repositioning of the proximal fragment was
visualized by overlay of the virtual graphics representing the
initial and the final positions of the proximal fragment after
the osteotomy. Osteosynthesis with positioning screws was
then performed.
Conclusion: The advantage of the method presented is a 3-
dimensional control of the position without rigid fixation of
the proximal fragment to the upper jaw, this also allows
modifications in special situations: little change compared
with the initial position may avoid too large a gap between
the fragments.
P R O D U C T I O N O F RECOMBINANT H U M A N
B O N E M O R P H O G E N E T I C PROTEIN 4 IN PROTEIN-
FREE M E D I U M A N D ITS A P P L I C A T I O N VIA
BIODEGRADABLE POLY(LACTIDE-CO-
GLYCOLIDE) MICROSPHERES.
Franz.E. Weber*, Klaus W. Griitz, and Hermann F. Sailer.
University Hospital Zurich, Department of Cranio-
Maxillofacial Surgery, 8091 Zurich, Switzerland.
The elimination of serum and other proteins is a major con-
cern in modern biotech-nological production of proteins in
mammalian cell cultures due to their potential source for
viruses or other transmissible agents. The Chinese hamster
ovary (CHO) cell line CHO Kl:cycE (Cytos GmbH,
Zurich) which we use to produce human recombinant bone
morphogenetic protein 4 (BMP-4), grows in spinner flasks
on a defined protein-free medium in suspension. The full-
length human c D N A coding for BMP-4 was isolated from a
human placenta library. We could show that CHO cells
grown in protein-free medium in cell-spinner bottles pro-
duce human recombinant BMP-4. 100% of the product is
made up of BMP-4 dimers with a molecular weight of 35
208 Journal of Cranio-MaxillofacialSurgery
kDa. The yield of BMP-4 per litre is doubled in comparison
to reported yields obtained with conventionally cultured
CHO cells. In vivo experiments with protein-free produced
BMP-4 showed that it induces bone growth at ectopic sites.
Thus, the biotechnological mass production of active
human recombinant BMPs in CHO cells can be performed
in a protein-free medium. While the progress in the produc-
tion of human recombinant BMPs and the knowledge
about how BMPs work is advancing fast, the progress in the
formulation of a proper carrier for the use of BMPs in the
clinic is slow. Poly (lactide-co-glycolide) microspheres have
been studied in the past to develop controlled release carri-
ers especially for vaccinations. Because slow release carriers
could be ideal for the administration of BMPs, we decided
to use the coacervation technique to form biodegradable
poly (lactide-co-glycolide) microspheres with human
recombinant BMP-4 entrapped. These particles loaded
with BMP-4 or unloaded were implanted subcutaneously,
adjacent to the calvarial bone. After 5 weeks the calcium
content of the microspheres and the adjacent tissue was
determined by atom absorption. The calcium content of
BMP-4 loaded microspheres was elevated by a factor of 13
in comparison to unloaded microspheres. We conclude,
that biodegradable poly (lactide-co-glycolide) microspheres
could make an ideal delivery system for human recombi-
nant BMR
BIODEGRADABLE PLATES AND SCREWS IN
FRONTO-ORBITAL ADVANCEMENT
Weingart D. *Bublitz R., Michilli R. *, Class D. *,:
Department of Oral, Maxillo and Facial Plastic Surgery, *
Department of Paediatric Neurosurgery,
Katharinenhospital, Stuttgart, Germany
Aim: Craniosynostoses are treated by standardized surgical
methods. Stabilization of segments in fronto-orbital
advancement has recently been performed using titanium
miniplates. The apposition of bone during bone healing has
led to the observation of a relative movement of these
osteosynthesis materials, with an ultimate epidural position
of these devices. Biodegradable materials could avoid such
movements.
In 6 patients with craniosynostoses, during standardized
surgical procedures for fronto-orbital advancement, the seg-
ments were fixed with resorbable plates and screws
(Lactosorb (r~/, W.Lorenz). The plates were shaped using a
special procedure, using heat, and adapted to the typical
locations, conventionally used for titanium plates.
The method demonstrated - with routine use - simple
handling and exact adaptation of the plates to the bone. The
stability was sufficient for stabilizing the segments intraop-
eratively as well as during the observation period of up to
one year. In one case the use of these materials was discon-
tinued: extremely thin bone was unsuitable for the use of
these screws with their relatively wide thread pitch.
The clinical use of biodegradable plates and screws in
fronto-orbital advancement proved these to act as a stable
type of fixation in the long term.
INLAY AUGMENTATION O F THE MAXILLA
W I T H O U T PREPARATION O F THE SINUS
MEMBRANE
Denis, R. *, Weingart, D.
Department of Oral, Maxillo and Facial Plastic Surgery,
Katharinenhospital Stuttgart, Germany
This animal experimental study with beagle dogs was
designed to assess the reconstruction of the maxillary reces-
sus using an autogenous corticocancellous bone graft and
simultanous placement of osseointegrated implants after
removal of the basal mucosa.
In 6 beagle dogs autogenous corticocancellous bone
grafts were placed to the maxillary recessus on both sides
and stabilized with simultanously inserted osseointegrated
implants. To achieve a good contact between the bone graft
and the bone of the sinus floor the basal mucosa of the
maxillary recessus was removed. After a healing period of 3
months abutment connection was performed. On the test
side an exclusively implant supported suprastructure was
installed. On the control side no suprastructure was
inserted. Clinical and radiological analyses were performed
and the specimen were histologically examined.
The results showed that principally an osseointegration
of implants in the grafted bone is possible, although resorp-
tion of the graft was clearly observed. However sufficient
height of the local alveolar bone is mandatory.
Due to the relatively high incidence of implant loss (16
out of 36 implants in this study) and according to our
own clinical experience and the literature, in cases of
advanced alveolar ridge atrophy a simultanous approach
without preparation of the sinus membran is not recom-
mented.
~70NLAY/INLAY BONE G R A F T I N G O F THE CLASS
VI MANDIBLE
Weingart, D.
Department of Oral, Maxillo- and Facial Plastic Surgery,
Katharinenhospital Stuttgart, Germany
The objective of this presentation is to highlight those surgi-
cal procedures that optimize functional results in the treat-
ment of the Class VI mandible.
Specific questions to be addressed are the augmentation pro-
cedures and the comparison of paniculate versus block grafts.
Immediate versus delayed insertion of endosseous
implants will be discussed and preferred prosthetic devices
will be demonstrated. Not only the treatment of the inter-
maxillary distance but also surgical procedures for correc-
tion of discrepancies in anterior/posterior relationship
between the maxilla and mandible will be presented.
Clinical as well as experimental studies of combined treat-
ment with autogenous bone grafts and endosseous implants
will be compared with the literature.
RESORBABLE OSTEOSYNTHESIS (LACTOSORB ®)
IN SAG1TTAL SPLIT RAMUS OSTEOTOMY O F THE
MANDIBLE.
Westermark A *
Maxillofacial Surgery, Karolinska Hospital Stockholm,
Sweden.
Introduction Lactosorb ® is a copolymer of Poly-L-Lactic
Acid (82%) and Poly Glycolic Acid (18%). Lactosorb ® is

hydrolyzed in the tissues resulting in complete resorption
within 9 to 15 months.The material has been used in cranio-
facial surgery but its use in mandibular surgery has not pre-
viously been evaluated.
Aims The aim of this study was to evaluate the reliability of
Lactosorb ® resorbable osteosynthesis in sagittal split
osteotomy of the mandible.
M e t h o d s After sagittal split osteotomy for mandibular
advancement, Lactosorb ® resorbable screws, diam 2.5
m m were used instead of traditional metal screws. The
first 9 patients who reached the one year follow-up were
compared with the last 9 patients who, prior to the study,
were operated on by the same surgeon but in whom
metal screw osteosynthesis was used. Skeletal stability
was evaluated on profile radiographs. The experimental
group was followed for any type of unfavourable reac-
tion to the material used. Histological specimens were
obtained from volunteers outside the experimental
group.
Results There was no difference between the experimental
group and the control group with respect to skeletal stabil-
ity. The experimental group did not need any longer time on
intermaxillary elastics than the control group and did not
suffer from any infection or other unfavourable conditions.
There was no histological sign of foreign body reaction
around the screws.
Conclusion This study indicates that 2.5mm Lactosorb ®
resorbable screws provide adequate strength for osteosyn-
thesis after sagittal split ramus osteotomy of the mandible.
The study also supports previous findings from other sur-
gical areas with respect to the uncomplicated resorption
process involved. Utilizing resorbable osteosynthesis in
maxillofacial surgery is a way of refining the surgical pro-
cedures, leaving fainter traces and reducing the risk of
artefacts in future radiological examinations the patients
might have to undergo for other purposes.
SYNTHETIC ABSORBABLE T A M P O N A D E F O R
INTRA-ALVEOLAR H A E M O S T A S I S IN PATIENTS
W I T H COAGULATION DISORDERS
Wieding J.*, Merten, H.-A., Wiltfang J.
Department of Oral and Maxillofacial Surgery, University of
G6ttingen, Germany
INTRODUCTION:
Patients with disturbed coagulation carry a higher risk of
post operative bleeding following surgical procedures, e.g.
tooth extractions. Therefore, locally applied haemostyptic
agents are necessary and of great therapeutic interest. The
commonly used allogenous or xenogenous materials are
presently under discussion due to the risk of transmitting
infections and immunological reactions.
Therefore a synthetic absorbable material
E T H I S O R W M tamponade, consisting of polyglactin 910
and poly-p-dioxanon - was developed. This fleece-like com-
posite with its interconnecting porosity ensures homoge-
neous blood penetration. Due to its structural and
mechanical properties, effective blood clot stabilization and
tissue regeneration is achieved.
METHODS:
To determine effective haemostasis, in vitro tests with
pooled blood samples were performed.
In addition to the in vitro tests in a clinical study
ETHISORB TM tamponade has been implanted in 163 bone
EACMFS Abstracts, Helsinki Congress 1998 209
defects after tooth extractions, in patients under anticoagu-
lation therapy at high risk of post operative bleeding.
RESULTS AND DISCUSSION:
The in vitro tests with pooled blood samples indicated
platetet retention and activation, expressed by elevation of
CD 62 and 63 epitopes in the flow cytometry. Effects on
blood cells and haemostasis were superior compared with
oxidized cellulose (Tabotamp TM) and control samples.
In addition to the in vitro studies, in the clinical trial the
entirely synthetic composite material has proved to be effec-
tive for haemostasis, blood clot stabilization and reossifica-
tion after tooth extraction.
C O M P L I C A T I O N S W I T H THE J E J U N A L FREE
F L A P IN ORAL RECONSTRUCTION - R E P O R T O F
100 CASES
If. Wild*, M. Ocker, J. Zacher~ Ch. Glaser, Th. Rath, W. Millesi
Clinic of Oral and Maxillofacial Surgery, AKH Vienna,
Waehringer Guerte118-20, A- 1090 Vienna, Austria
Tel.: 01-4040014259; Fax.: 4253 e-mail. r.ewers@akh-wien.ac, at
Radical resection of oral and oropharyngeal malignancies
often leads to large soft tissue defects. Microvascular jejunal
autotransplantation is a well established method used in
reconstructive surgery.
Subjects: Between 1990 and 1997 100 patients - 78 male, 22
female, mean age 53 years underwent primary reconstruc-
tive surgery in our department using this technique.
Methods: Data of 100 patients were evaluated retrospec-
tively in respect of local and general complications.
Results: Because of local complication 15 of 100 patients
had to have revisions. Two patients had a complete loss of
the transplant, which was corrected by a secondary pedicled
distant flap. Early abdominal complications made a laparo-
tomy necessary in two cases. Fatal perioperative complica-
tions occurred in 8 patients. Forty two of 67 patients still
alive at the time of recall were evaluated in respect of late
local and abdominal complications. Six patients showed a
cicatricial hernia, none of which, however, causing subjec-
tive problems or being incarcerated. Seven patients showed
partial necrosis of the transplant, which healed by sec-
ondary intention without any special treatment.
Discussion: Perioperative mortality rate seems to be caused
by the high morbidity found in the patient collective.
Therefore a through evaluation of the patient is necessary
before the operation. G o o d vascularisation of jejunal flaps
prevents of local defects after partial necrosis of the trans-
plant. In a follow up examination no abdominal late-onset
complications except small incisional hernias were detected.
Mucus production and flexibility of the graft supports a sat-
isfying functional restoration.
THE TITANIUM ARMED STABILISED
GENIOPLASTY
A. Wilk, C. Meyer, J-L.Kahn, C.Bruant-Rodier,
Hospitaux Universitaire de Strasbourg, France
In severe retrognathia it is difficult to bring.the
osteotomized chin forward enough without loosing bony
contact between the fragments. Solid fixation may only be
210 Journal of Cranio-Maxillofacial Surgery
obtained with plates but the angle between the advanced
chin and the remaining mandible is not satisfory.
For the last few years we used, in combination with our
plate fixation, a titanium meshgraft so as to connect the
chin extremity and the mandible.
The gap left behind the meshgraft may be filled with
bone grafts. An excellent prominent chin is usualy obtained
that way, both clinically and radiologically.
The titanium meshgraft is fixed by mean of miniscrews
and really contributes to stabilise the chin extremity in a
good position.
The long term tolerance and results seems to be excellent
and the material has not so far been removed. The cost is
reasonable.
[h COMPARISON OF VARIOUS IMPLANT SYSTEMS
AND OVERDENTURES AND THEIR PROGNOSIS IN
FREE-END SITUATION PROSTHETIC TREATMENT
J. Wilier, IV. Noack, J. Hoffmann, N. Schwenzer
In a comparative study, an evaluation was conducted of
free-end situation implants which were fitted with restora-
tive prosthetics in the period from January 1985 to March
1997. The systems used were IMZ®, Frialit®-2 and
Brgmemark®. Teeth capable of receiving crowns were inter-
locked with implants either in the form of a fixed bridge or
with interlocks (IMZ® and Frialit®-2 systems). In other
cases the bridges or single-crown replacements carried out
were entirely implant-supported (Brgmemark®, Frialit®-2
and IMZ® systems).
The study material comprised 676 implants fitted in 284
patients within a twelve-year period and functionally loaded
for at least three months. Clinical parameters and radiologi-
cal findings were collected and evaluated. In implant-sup-
ported Brgmemark® and Frialit®-2 system overdentures no
losses were experienced, with the IMZ® 6 system there were
6 implant losses. There were 24 losses with tooth-and-
implant-supported tooth replacements, 20 of which were
with the IMZ® system and 4 with the Frialit®-2 system. All
in all, the prognosis for entirely implant-supported pros-
thetic treatment is judged to be more favourable.
Dr. J/irgen Willer, cand. reed. Nicole Noack*, Dr. Dr.
Jiirgen Hoffmann*, Univ.-Prof. Dr. Dr. Norbert
Schwenzer*
Praxis Dr. Jtirgen Willer, Hindenburgstr. 43, D-72762
Reutlingen, Germany
*Klinik und Poliklinik ftir Mund-, Kiefer- und
Gesichtschirurgie der Universit~it TiJbingen, Osianderstr. 2-
8, D-72076 Tfibingen, Germany
THE LACTOSORB TM ABSORBABLE MINIPLATE
SYSTEM IN A GROWING CRANIO-OSTEOPLASTY
ANIMAL M O D E L
Wiltfang J. *, Merten H.-A., Becker H.J., Luhr 11. G.:
Department of Oral and Maxillofacial Surgery, University of
G6ttingen, Germany
INTRODUCTION
In the surgical treatment of craniosynostosis and craniofa-
cial dysostosis in the growing child, passive intraosseous
transmission (PIT-effect) with intracranial dislocation of
metal plates and screws may be a problem.
METHODS
In an animal trial, four young g6ttinger minipigs (five weeks
old) were studied regarding a possible PIT-effect, using
absorbable PLA/PGA-miniplates (LactosorbTM, Fa. W. Lorenz,
USA) following cranio-osteoplasty. In addition, the mechanical
properties, the process of degradation and sub- versus epi-
periosteal application of the miniplates were evaluated.
During follow up (3, 6, 9 and 12 month) a polychromous
sequence marking was carried out. Prefmally, intra-arterial
angiography was performed using a suspension of Berlin blue
and barium sulphate. Non-decalcified thin sliced sections of bone
were examined by light and fluorescence microscopy. In addition
microangiography and microradiography was performed.
RESULTS AND DISCUSSION
During degradation, the absorbable PLA/PGA-miniplates
perfomed like metal plates as they also displayed passive
intraosseous transmission in the growing animal model.
However, in the experimental PLA/PGA miniplate setting
the internal calvarial bone was not affected. Degradation
took 12 months and was not delayed by bony incorporation.
Mechanical properties proved to be sufficient in craniofacial
surgery. Epiperiosteal plating prolonged the PIT-effect dur-
ing the first three months postoperatively.
CONCLUSION
In the growing skull, absorbable plates seem to be a promising
therapeutic approach, however, prior to a general recommen-
dation results of clinical long term studies have to be evaluated.
QUALITY ASSESSMENT BY EXTERNAL PEER
REVIEW ("VISITATION")
Witsenburg, B. *, van Beek, G.J., Lombarts, M.J.M.H.,
Schouten, L.J.M., van Weert, C.M.
TBZ Almelo and M S T Enschede, Haaksbergerstraat 55,
7513 ER Enschede, the Netherlands. Tel=fax: +31 (0) 74
2426905. E-mail." witsenburg@wxs.nl
Aims: To improve the quality of patient care, it is necessary
to monitor and evalutate professional performance system-
atically.
Method: Visitation by peers can be defined as a standards
based on site survey, conducted by professionals in order to
assess the circumstances under which clinical practice takes
place and intended to improve the level of patient care.
Visitation is based on the theory of Continuous Quality
Improvement, meaning that it acknowledges that the qual-
ity of patient care is the result of a process of individual
actions and interactions that are related directly or indi-
rectly to this care.
Results: The Dutch Association of Oral and Maxillofacial
Surgeons started its visitation program in September 1995.
The total number of visitations so far has come up to 23 and
the next 18 visitations have been scheduled. Three years of
experience with this quality assessment program indicates
that a large majority of the Dutch oral and maxillofacial
surgeons approves of this way of accreditation by positive
participation. A comprehensive questionnaire for practices
to be reviewed, visitation rules and a first set of directives
emerged from the visitations, are now available. Positive
findings were a good accessibility for patients and referring
colleagues, satisfying working climate, good conditions for
quick examination and treatment of emergency patients and
adequate patient reports to referring colleagues. The quality
of the next items could be improved: patient files, annual

report, policy planning, public relations, professional hard-
ware, accessibility of the department by telephone, availabil-
ity of dental hygienists and prosthodontic care, distance to
X-ray machines and coding of diagnostic and therapeutic
performances as well as registration of complications.
Conclusion: Quality assessment by external peer review (vis-
itation) seems to be a useful means to picture a number of
quality items of non teaching OMS practices.
Implementation of the recommendations given by the peers
is the next difficult step if quality of patient care is to be
improved.
[~ COVERING LARGE FACIAL SKIN DEFECTS:
L O C A L F L A P S OR MICROSURGICALLY
A N A S T O M O S E D TRANSPLANTS?
Wolff K.-D., Plath, T., Marks, C., Hoffmeister, B.
Department of Maxillofacial Plastic Surgery. Benjamin
Franklin Medical Centre, FU Berlin Germany
Larger facial defects often present borderline situations, in
which the decision to use local flaps or microsurgical flaps
can be difficult. The aim of our study was to establish the
differential indications by comparing both methods.
Grouped according to the aesthetic units: forehead, nose,
cheek, chin and scalp, defects of comparable sites were cov-
ered with either a microsurgical flap or local skin flap, in a
total of 34 patients. Results were evaluated according the
criteria: aesthetic appearance, complications, surgical com-
plexity and revision measures required. The results show
that even skin defects on the cheek and chin, which involve
almost the entire aesthetic unit can be closed with local skin
flaps in most cases. The kite, rhomboid and bilobed flaps as
well as cervical transposition or rotation flaps have proven
to be effective here. On the scalp and forehead, tissue
expanders should be used in defects of more than 25% of
the aesthetic unit. The results of local procedures were gen-
erally better than those of microsurgically anastomosed
flaps, which were often conspicuous because of their exces-
sive volume and lighter colour. Complications with local
skin flaps were wound dehiscence with infection (3) and
cicatricial ectropion (2), while necrosis occurred in two
microsurgically anastomosed flaps. Re-operations for aes-
thetic indications were twice as common with microsurgical
transplants as with local skin flaps; in two patients, the
microsurgical transplant was later replaced by local flaps In
our experience, microsurgical transplants should only be
used in deep or very large defects extending beyond the aes-
thetic unit.
RESULTS OF MANDIBULAR RECONSTRUCTION
W I T H M I C R O S U R G I C A L ILIAC CREST OR FIBULA
TRANSPLANTS IN CONNECTION W I T H I M P L A N T S
Wolff, K-D., Ervens, J., Khasim L., Hoffmeister, B.
Department of Maxillofacial Plastic Surgery, Benjamin
Franklin Medical Centre, FU Berlin, Germany
After tumour-related mandibular resection, the question
arises as to what procedure (transplant type, time of recon-
struction and implantation) will most reliably restore masti-
catory function depending on the patient's individual
EACMFS - Abstracts, Helsinki Congress 1998 211
situation. By clinical and radiological analysis of our
patient population (43 iliac crest transplants, 32 osteocuta-
neous fibula transplants), our aim was to establish the indi-
cations for these transplants and to compare the
complications of endosseal dental implants. According to
our results, the iliac crest transplant enabled optimal recon-
struction of areas equivalent to half a mandible, but it is dis-
advantageous due to the limited length of the vessel pedicle
and considerably voluminous skin-fat component. This
transplant is best used for purely osseous defects and where
there are good connecting vessels in the neck. If there are
combined bone and oral mucosa defects, the osteocuta-
neous fibula transplant offers not only an implantable bone
but also a thin skin component for intraoral coverage; a ves-
sel pedicle of up to 15 cm can be exposed during distal flap
raising. The success rate was about 95% in both transplant
types. While implantations into the fibula (54 implants in 15
patients) were always successful, 12 of 63 implants placed
into the iliac crest transplants showed early loosening and
had to be removed. As a result of pocket infection or false
positioning, a total of 16 other implants could not be used
prosthetically. After implantation, 6 patients had a tumour
recurrence; the mean interval until complete prosthetic
rehabilitation was 22.5 months These results show that
restoration of masticatory function after tumour-related
mandibular resection is one of the most difficult tasks in
maxillofacial surgery.
THE OXYGEN SUPPLY O F VENOUS SKIN FLAPS:
A CLINICAL AND EXPERIMENTAL STUDY
Wolff, K.-D., Hechler, M., Aimoufli, IV., Marks, C.
Department of Maxillofacial Plastic Surgery, Benjamin
Franklin Medical Centre, FU Berlin, Germany
Venous skin flaps are transplants which are exclusively per-
fused via their venous system. These flaps are applied in
reconstructive surgery, although knowledge on the type of
oxygen supply, especially capillary perfusion, is still incom-
plete We AI~A)clinically and 1~) experimentally studied the
capillary perfusion of venous flaps using the Erlangen
microlightguide spectrophotometer, with which relative
intracapillary haemoglobin oxygenation of the target tissue
can be determined on the basis of the different absorption
spectrums of oxygenated and deoxygenated haemoglobin.
~ l During conventional radial forearm flap transfers in 12
patients, the following Hb oxygenations were intraopera-
tively found on the forearm skin a) 51-74% with conven-
tional perfusion, b) 6.9-12.2% only pedicled to the cephalic
vein after 120 min., c) 0% without perfusion after 240 min
and d) a constant 6.0-11.8% after microsurgical anastomo-
sis to the cephalic vein only. 1~) The following intracapillary
Hb oxygenations were found in epigastric flaps (4x2.5 cm)
of 10 Wistar rats: a) 26.8-33.1% with conventional perfu-
sion, b) 0% (4h) without perfusion c) 10.6-19.4% with only
venous perfusion and d) 19.2-27.4% with arterialization of
the veins. In the Wilcoxon test (p=0.0024), there were signif-
icant differences in a) vs. d), d) vs. c) and c) vs. b)
(p=0.00001). Our results showed that the capillary system of
the skin is also reached by retrograde perfusion via the
venous system though to a lesser degree. If there is no
artery, exclusively venous perfusion can make an important
contribution to vital maintenance, for example, in the
replantation of traumatically amputated tissue. Venous
flaps may expand the spectrum of reconstruction
possibilities.
212 Journal of Cranio-Maxillofacial Surgery
RESORBABLE FIXATION IN PAEDIATRIC
CRANIOFACIAL SURGERY: A REVIEW OF 80
CONSECUTIVE CASES
RJ Wood, J Petronio
Aims/Study Design: Resorbable fixation has become the
modality of choice for fixation of craniofacial bone in our pae-
diatric patient population. We have reviewed our first eighty
consecutive patients. This extends over a 17 month period (9-
15-96 to 4-10-97). Our patient population involved midface
fractures (n=5), calvarial reconstructions (n=51), calvarial
fractures (n= 15), mandible reconstructions (I1=2). All children
were followed prospectively with serial examinations and radi-
ography as indicated. Patient ages ranged from 3 to 228
months (mean=40.2 months) with follow-up ranging from 12
to 90 weeks. All fixation was with plates and screws of a poly-
lactic acid and polyglycolic acid copolymer (Lactosorb, Walter
Lorenz, Inc.). The majority of the cases involved utilizing the
1.5 mm system, with 2.0 mm plates and screws utilized in some
midface applications. No titanium product was used.
Results: The majority of the cases were craniosynostoses
treated in infancy. There were 3 palpable plates between 6-9
months. All palpable plates had resorbed by the 12 month
follow-up. There were no plates visible. The quality of fixa-
tion and final results were judged to be at least equivalent to
our previously used titanium fixation. Two complications
(2.5%) were noted: erythema of the lower eyelid after fixation
of an orbital fracture that resolved with a short course of oral
antibiotics, and a subgaleal abscess after fixation of calvarial
fractures, which responded to drainage and antibiotics.
Conclusion: We feel that resorbable fixation provides equivalent
or superior results to titanium fixation in our experience. In the
paediatric age group where plate migration and growth restric-
tion is of significant interest, resorbable fixation should be
strongly considered and will likely become the standard care.
2) MULTIDIRECTIONAL INTRA-ORAL DISTRACTION
OSTEOGENESIS: THE DEVELOPMENT OF AN
ANIMAL MODEL AND REPORT OF TWO CASES
Wood, RJ
Atlanta, USA
Aims/Study Design: Distraction osteogenesis is a powerful
technique in craniofacial reconstruction, especially in chil-
dren with profound functional limitations. The technique has
been limited by uni- or bi-directional techniques of expansion
as well as external scars with externally placed expanders. We
report our experience in developing a multidirectional intrao-
ral expander and its clinical utilization in two cases.
Results: Serially modified curvilinear intraoral distractors
(KLS-Martin, Inc.) were placed in a series of eight mongrel
dogs. Infection or nonunion were not noted in any case. In
the expansion that was achieved there appeared to be good
bone formation. The limiting factor in the development of the
device was the activating arm. Progression through a series of
flexible cables to an articulated arm yielded a mechanism
strong enough to activate the device without malfunction.
The device has been used in two clinical cases. Both children,
ages 4 years, 11 months and 7 years, 1 month, had severe
micrognathia and were tracheostomy dependent. They had
undergone conventional expansion in the past without suc-
cessful decannulation. Successful expansion was achieved in
both cases. There were no infections and stable bone forma-
tion was achieved. The children have not yet been decannu-
lated, however their tracheostomies have now been success-
fully plugged.
Conclusion: Our early clinical experience suggests that a
multidirectional intraoral expansion is possible. This device
expands in a curvilinear fashion that may be customized
according to clinical needs. Refinement of this technique
may allow complex expansion in multiple dimensions, with-
out external scars.
RECONSTRUCTION OF THE TEMPOROMANDIBULAR
JOINT USING CALVARIAL BONE.
Worthington, P.
Department of OMFS, Universityof Washington, Seattle, USA
Teflon/Proplast Implants, formerly used in the repair of the
temporomandibular joint, are known to be associated with
erosive giant cell reactions in the tissues, with varying
degrees of bone destruction. A case is described with sub-
stantial erosions of the glenoid fossa as well as the mandibu-
lar condyle. The erosions extended into the middle cranial
fossa. The disk of calvarial bone removed during the cran-
iotomy approach proved useful in the reconstruction of the
joint. Good joint function was maintained. It is suggested
that this method of reconstruction might be used in other
destructive lesions of the temporomandibular joint.
A P P L I C A T I O N O F RHBMP 2 IN PREIRRADIATED
CALVARIAL DEFECTS
K.K. Wiirzler*, A.H. Reddi#, N.R. Kiibler*, J.F. Reuther*
*Klinik und Poliklinik fiir Mund-, Kiefer-, Gesi&tschirurgie,
Bayerische Julius-Maximilians-Universitgit, Wiirzburg,
Germany; #Center for Tissue Regeneration and Repai~
University of California, Davis, USA
Aims: The management of osteoradionecrosis of the facial
bones is an important clinical challenge in patients having under-
gone radiotherapy to head and neck tumours. We investigated
the potential of recombinant human BMP-2 to ameliorate the
impaired bone healing following irradiation of facial bones.
Methods" Irradiation with a single dose of 1200rad was car-
ried out 2 or 7 days preoperatively. Two parietal craniotomies
(3ram O) were created in 32 male LongEvans rats (35-42 days
of age). Defects were either left untreated or filled with solu-
ble collagen type I as a carrier for 25~tg or 35gg of rhBMP-2.
Unirradiated animals served as controls. Animals were sacri-
ficed 3, 7, 14, 21 days postoperatively. New bone formation
was assessed by computerized quantification of radiographs
of the calvaria. Histological evaluation was performed on
decalcified sections stained with Masson's trichrome.
Results: Within 14-21 days, untreated and unirradiated
defects showed a spontaneous osseous regeneration of
90_+7% of the defect area. Irradiation of the site (1200 rad, 2
days prior to OP) resulted in a profound decrease in the bone
filling of the untreated defect (5_+2%). rhBMP-2 in 1.5 mg
soluble collagen type I delivered to the defect significantly
increased new bone formation (34_+14%, p<0.01 for 25gg
rhBMPs-2; 77+19% for 35gg rhBMP-2 p<0.01). Type I col-
lagen carrier alone resulted in only 7_+2% healing. In animals
irradiated 7 days prior to craniotomy 25gg rhBMP-2 in
1.5mg soluble collagen type I achieved a 68+12% filling of
the defect. The untreated control side showed significantly
less regeneration (32_+23% defect fill, p<0.01).

Conclusions: Radiation-induced impairment of calvarial
repair can be overcome by recombinant human BMP-2.
BMP-2 induced regeneration of pre-irradiated bone
defects has potential applications in reconstructive bone
surgery.
BLOW-OUT FRACTURE OF THE ORBIT IN
CHILDREN:REVIEW OF 137 CASES.
Wyszygtska, G.*, Bartkowski, S.B., Zapala, J.
Department of Maxillo-Facial Surgery, the Jagiellonian
University, Krak6w, Poland
The aim of this study was to evaluate the efficiency of estab-
lished methods of surgical treatment of blow-out fractures
of the orbit in 137 children.
Subject: The group analysed consisted of 113 boys and 24
girls aged from 4 to 15 yrs. (average age 10.7 yrs.),treated
for pure blow-out fractures of the orbital floor from 1971
to 1997.The children comprised 46.1% out of 297 patients
operated on in our Department due to isolated fracture of
the floor or medial wall of the orbit with an intact orbital
rim. In the diagnosis of blow-out fractures of the orbit in
children, neurological examination was mandatory. If pos-
sible, radiology was limited to a radiograph of the maxil-
lary sinuses in Water's view. Ophthalmological examination
comprised: type of diplopia, visual acuity, enophthalmos,
active and passive eyeball motility, presence of squint.
Surgery was performed by the transconjunctival rather
than subciliary approach. In linear fractures entrapped tis-
sues were released. In fractures with defects, releasing of
entrapped tissues was followed by reconstruction of the
orbital floor by autogenous bone graft harvested from pari-
etal, temporal, illiac or maxillary bone. Surgical treatment
was supplemented by orthoptic rehabilitation and, in cases
with persistent diplopia, by eye muscle surgery.
Results were evaluated on the basis of opthalmological
examination. The criteria of recovery were: full eyeball
motility, single binocular vision, correct eyeball position in
the orbit. Full recovery was obtained in 79(57.7%) of
patients, improvement in 43(31.4%), slight improvement in
15(10.9%) of patients.
CONCLUSIONS:
1) Surgical treatment of blow-out fracture of the orbit in
children is indicated in cases with persistent diplopia, posi-
tive forced duction test and enophthalmos.
2) Transconjunctival approach is aesthetically preferable.
Autogenous bone grafting for reconstruction of the orbital
floor defects is the most reliable method.
3) Eye muscle training following surgery is indicated.
C O M P U T E R AIDED THREE-DIMENSIONAL
ANALYSIS OF NOSTRIL FORMS WITH FACIAL
SURFACE SCANNER
Yamada, T*., Kinoshita, F., Mori, Y., Minami, K., Sakuda, M.
Dept. of Dentistry & Oral Surgery, Tenri General Hospital,
Nara, Japan, and Dept. of OMFS II, Faculty of Dentistry,
Osaka University, Osaka, Japan
Aims: The appearance of the nostril of cleft patients is a
very important factor for patients' satisfaction. To improve
EACMFS- Abstracts, Helsinki Congress 1998 213
the outcome of plastic operations, we developed computer
aided system for diagnosing nostril forms.
Method: Facial forms were measured with three-dimensional
optical scanner (OGIS RANGE FINDER RFX-IV). XYZ
coordinates (256x240) and RGB image (512x480) data sets
were obtained with the apparatus. Nostril area was determined
by discriminant analysis of RGB data, and 19 landmarks of
the nostrils were extracted automatically with geometric condi-
tions. The stability of the coordinates obtained by this tech-
nique was assessed, and normal data of 37 volunteers was
collected. Subsequently, this system was applied to cleft lip
patients who had undergone secondary nasal correction.
Results: Landmark stability was approximately within 1
ram. Applied to cleft patients, quantitative evaluation of
nostril deformities was possible; nasal asymmetries in uni-
lateral cases and wide and flat nostrils in bilateral cases were
greatly improved after surgery, but conversely the volume of
the nasal tip decreased.
Conclusions: This system was a great help for diagnosis of the
nostril deformities. Because of the objectivity of this tech-
nique, it was suggested to be suitable for multi-center studies.
COMPARATIVE STUDY OF PEDICLED FLAPS
AND FREE FLAPS FOR ORAL AND
MAXILLOFACIAL RECONSTRUCTION
Yamashiro, M.1, Kobayashi, J. 1, Nagasawa, H. 1, Negishi,
A. 1,Fujii, E. 1, Ishii, J. 1, Iwaki, H. 1, Yoshimasu, H. 1,
Amagasa, T. 1, Hasegawa, K 2,
1 The 1st Department of OMS, Tokyo Medical and Dental
University, Tokyo, 2 Department of OMS, Shizuoka City
Hospital, Shizuoka, Japan
Aims: We reviewed 161 cases of oral and maxillofacial
reconstructions with vascularized or pedicled flaps retro-
spectively to evaluate the incidence and the cause of flap-
related complications.
Patients and Methods: A total of 87 cases was reconstructed
by pedicled flaps; 52 pectoralis major myocutaneous
(PMMC) flaps, 25 deltopectoral (DP) flaps, six combina-
tions of PMMC and DP flap, two latissimus dorsi myocu-
taneous (LD) flaps and one forehead flap. Free flaps
were used in 74 cases; 38 rectus abdominis myocutaneous
flaps, 32 forearm flaps, three scapular osteocutaneous flaps
and one free LD flap.
Results: In 87 pedicled flaps, total flap loss occurred in eight
cases (9.2%), six major flap loss (6.9%), eight minor flap
loss (9.2%), and 14 wound dehiscences (16.1%). In 74 free
flaps, total flap loss occurred in one case (1.4%), one minor
flap loss (1.4%) and 10 wound dehiscences (13.5%).
Free flaps surpassed pedicled flaps in success rate (98.6%
versus 83.3%, p=0.0017 by Fisher's exact probability test).
Flap necrosis tended to occur in the pedicled flap, and total
flap loss was mainly attributed to technical errors. Two of
three free flaps which developed venous thrombosis (4.1%)
were salvaged by re-exploration.
Conclusion: In view of the low morbidity, we conclude that
free flaps are more suitable than pedicled flaps as the first
choice for oral and maxillofacial reconstruction.
PLATYSMA W I T H O U T SKIN - A SIMPLE
RECONSTRUCTION FLAP
Yates, C.*
214 Journal of Cranio-MaxillofacialSurgery
Dept. of O.M.FS., Wexham Park Hospital, Slough,
England
Aim: To demonstrate the use of a platysma flap (without skin)
in oro-pharyngeal reconstruction after tumour resection.
Method: A series of cases is presented, using platysma with-
out skin to reconstruct oral lining.
Conclusions: The platysma myocutaneous flap is a well estab-
lished but little used method of oro-pharyngeal reconstruction
after tumour resection. Its advantages are ready availability
and technical simplicity. Possible disadvantages have been
listed as a tenuous blood supply, difficulties in closure of the
donor site and hair on the donor skin. Many of the flaps for
oral reconstruction which were described originally in the
myocutaneous or fasciocutaneous forms are now routinely
used without skin, relying on secondary epithelialisation to
produce a superior oral lining. Absence of a skin paddle will
usually increase the versatility of a flap and there are obvious
advantages at the donor site. In this series, the technique is illus-
trated and attention drawn to its advantages and limitations.
EXPERIMENTAL STUDY O F O S S E O U S AND
M U S C U L A R CHANGES AFTER MANDIBULAR
R A M U S E L O N G A T I O N IN MONKEYS.
lYi CIC, 2Chang HH, 3Kim HJ,, 4Fukuda J, 4Hirashima S,
1. Departmentof OMFS, Collegeof Dentist~ YonseiUniversity,
Seoul, Korea
2. Departmentof OMFS, Asan Medical Center, Collegeof
Medicine, Ulsanumversity,Seoul, Korea
Department of Anatomy, Collegeof Dentistrjz, YonseiUniversity,
Seoul, Korea, Departmentof OMFS, KyushuDental College,
Kitakyushu, Japan
Aims : When we attempt to lengthen undergrown bony areas
by one stage operation, the stress of surrounding soft tissues
will create unfavorable effect on post-op, stability. This
study is to investigate post-op, stability by observing osseous
and muscular changes after two different ramus lengthening
procedures(EVRO, IVRO) in which pterygomasseteric
slings have different stress respectively.
Methods : Mandibular ramal elongations were done in mon-
key by two different methods. The osseous changes were
evaluated by lateral cephalogram and muscular changes
were evaluated by histochemical method. Histologic evalua-
tion on operation site in each group was also done. The ser-
ial changes(1Mo, 3Mo, 6Mo) in experimental groups were
compared with each other and control group.
Results : In both experimental groups, the decrease of verti-
cal distances between specific landmarks were noted in lat-
eral cephalogram. But the decrease or bone resorption
pattern is somewhat different between two groups. Fiber
type in masseter muscle identified by histochemical study
can be a clue in explaining above phenomena.
r~ CASE PRESENTATION O F M A L I G N A N T
CHANGE AND RESEARCH INTO VAPORIZATION
1N A PRECANCEROUS M O D E L "IS IT EFFECTIVE
OR DOES IT P R O M O T E CANCER ACTIVITY'?"
Kenji Yoshida, DDS
First Department of Oral and Maxillofacial Surgery, School
of Dentistry, Aichi-Gakuin University, Nagoya, Japan
Recently, many different kinds of laser therapy have been
used for various diseases in the field of oral and maxillofa-
cial surgery. Laser vaporization and resection therapy have
been adopted clinically to treat oral precancerous lesions
such as oral leukoplakia. However, some recent cases of
malignant transformation after CO 2 laser therapy for oral
precancerous lesions have been reported in the follow-up
periods.
Given the reports of fundamental studies on laser ther-
apy, it would be difficult at present to say that laser therapy
is an established treatment for oral precancerous lesion, and
forthcoming studies have to be investigated radically into
the safety of laser therapy.
Therefore, studies were attempted to determine the can-
cer promoting or inhibiting effects of laser irradiation in
experimentally-induced oral precancerous lesions. On the
basis of these experimental studies, when oral precancerous
lesions were not completely removed by laser vaporization,
it was suggested that there was a risk of cancer promotion
from the surviving epithelium.
NERVE REGENERATION A N D ACCELERATION
OF LOW P O W E R LASER THERAPY -
M A N A G E M E N T OF THE PARESTHESIA D U E TO
INFERIOR ALVEOLAR NERVE INJURY A N D FACIAL
PALSY -
Kenji Yoshida, DDS
First Department of Oral and Maxillofacial Surgery, School
of Dentistry Aichi-Gakuin University, Nagoya, Japan
Various low power output lasers are used frequently in the
oral region. Recently, low power output lasers have been
widely used in clinics, and successful application has been
reported in the acceleration of wound healing and pain con-
trol. The author have demonstrated therapeutic effects of
low power Nd:YAG laser and diode laser irradiation of
patients with neurological disease such as lower lip paralysis
and facial palsy.
For the treatment of these patients, the author have tried
to substitute the conventional stellate ganglion block injec-
tion with low power output laser irradiation on the stellate
ganglion.
in the previous study, the remarkable findings were
observed from thermographical images that facial cuta-
neous temperature rises bilateraly during Nd:YAG laser
irradiation under 300-500m W output power, while temper-
ature rises only one one side when giving a conventional
stellate ganglion block injection. These findings lead to the
conclusion that blood flow rises by laser irradiation and
activates the damaged peripheral nerve because of the ame-
lioration of ischaemia even when there is a provisional
remission during irradiation.
Although many aspects of the mechanism of action in
low-power laser therapy are unknown, clinical applications
is gaining popularity. Future studies will be needed to fur-
ther clarify these mechanisms.
SURGICAL T E C H N I Q U E D E S I G N E D FOR THE
REPAIR OF I N C O M P L E T E CLEFT LIP
Yoshimura, E * Nakajima, T., Nakanishi, II.
Department of Plastic and Reconstructive Surgery, Fujita
Health University. Toyoake. Japan

Aims: We have already reported our technique for unilateral
cleft lip repair in 1993 (B.J.P.S. 46:616). However, use of the
same technique which can achieve good results in complete
cleft lips, for incomplete clefts resulted in postoperative
drooping on the affected side. Therefore, we have introduced
a new technique specially designed for the incomplete cleft
lip.
Method: The main cause of postoperative drooping of the
cleft side lip seen in the cases of incomplete cleft is that the
tissue volume on the cleft side in the incomplete cleft lip is
greater than that in the complete cleft lip. The skin incision
is the same as reported in Cronin's method, with the excep-
tion of the triangular flap. At the white skin roll, a incision
perpendicular to the vermilion border is added to the
straight incision. This makes the approximation of the ver-
milion border precise, and prevents an acute peak of the
Cupid's bow. A triangular flap is raised at the alar base on
the cleft side to be advanced to the columella base. This cre-
ates the nostril sill and prevents flaring of the alar base. The
resulting suture line is completely straight, and runs along
the philtrum column.
Results: From our two-year experience, postoperative elon-
gation of the cleft-side white lip is prevented and a fine
structure of the Cupid's bow can be created by this method.
Conclusions: We can say that the incomplete cleft lip should
be treated differently from complete cleft lip.
AN INVESTIGATION O F THE EFFECTS O F
DIRECT AND INDIRECT TRAUMA ON M A S S E T E R
MUSCLE: "A H I S T O P A T H O L O G I C A L STUDY"
Biirkan, U., Yiicel, E*., Sarisoy,fi., Mollaoglu, N., Erkmen, E.
Department of Oral & Maxillofacial Surgery. Faculty of
Dentistry, Gazi University, Ankara, Turkey
Aims: The aim of this study was to investigate the changes
which occur on the masseter muscle by the direct and indi-
rect trauma.
Methods: In this study 32 young adult Rattus Norvegicus
Albinus weighing 180 to 200 gr were used. Animals were
divided into direct and indirect trauma groups. The special
trauma apparatus designed by Luz, Jaeger de araujo and
Rezende is used for this experiment. The direct force was
applied to the masseter muscle bilaterally while indirect
force applied to the symphyseal junction of the rat
mandible.
Results: The rats were killed after 24 hours, 7, 15 and 45
days. Masseter muscles were completely removed and exam-
ined histopathologically.
ULTRASONOGRAPHIC ASSESSMENT OF
R E S P O N S E O F CERVICAL L Y M P H NODE
METASTASIS TO R A D I O T H E R A P Y AND
CHEMOTHERAPY
Yusa, H. * 1, Yoshida, H. 1, Ueno, E. 2, lwasa, S. 3, Watanabe, T.3
1Department of Oral and Maxillofacial Surgery, Institute of
Clinical Medicine, University of Tsukuba, Tsukuba, Japan
2 Department of Metabolic and Endocrine Surgery, Institute
of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
3 Department of Pathology, Institute of Basic Medical
Science, University of Tsukuba, Tsukuba, Japan
EACMFS - Abstracts, Helsinki Congress 1998 215
Aims: To ultrasonographically evaluate the response to pre-
operative radiotherapy (RT) and chemotherapy (CT) of cer-
vical metastatic lymph nodes and squamous cell carcinoma
in the oral and maxillofacial region.
Method: The correlation between US findings before RT
and CT, and response to these therapies was analyzed in 36
metastatic nodes obtained from 19 patients who underwent
neck dissection; the response was evaluated according to the
change in nodal size and histological grading system.
Results: Seventy-one % of hypoechoic nodes and 70% of
nodes with color flow signal in US showed reduction in size,
and 82% of hyperechoic and 89% of nodes with a peripheral
fusion pattern showed no change or progessive disease.
Seventy % of the nodes with smooth margin and 70% of
those with color flow signal had histologic changes of
Grade 2b, Grade 3 or Grade 4, and 67% of nodes with a
peripheral fusion pattern showed Grade 1 or Grade 2b.
Conclusion: US findings may offer valuable information for
predicting the response of cervical lymph node metastasis to
RT and CT.
LATE RESULTS OBTAINED T H R O U G H
OSTEOARTHRECTOMY AT BONY ANKYLOSIS OF
THE TMJ
Zvone Zajdela,
Department of OMFS, University Clinic Centre, Ljubljana,
Slovenia
To present are two patients, a young female patient of 17,
with unilateral bony ankylosis of the TMJ, and a young
man, 19, with bilateral bony ankylosis of the TMJ.
In the young lady asymetrical appearance of the face was
present, this because of the hypoplastic mandible the bony
mass filled out the joint space, thus causing the condyle to
grow together with the bony mass.
As to the young man, profile deformity was present as a
result of the bilateral bony ankylosis and hypoplastic
mandibula.
By setting free the mandibula by performing the
osteoarthrectomy, full mobility of the mandible as well as a
regular month function were regained, free of any distur-
bances.
In the second phase, the aesthetic appearance was put to
correction.
" O P E N SURGERY" O F INTERNAL T M J
DYSFUNCTIONS
Zanetti 1_7.,Burlini D., Ferrari Parabita S.
Department of Maxillo Facial Surgery Civic Hospital of
Brescia Italy
(Head." Prof. Ferrari Parabita G)
AIMS:
To verify if the treatment of condylomeniscal dysfunctions
(internal derangement) by "open surgery" allows gradual
improvement in functions and pain symptoms.
METHOD:
Over a two-year period (1995-97) we operated 44 patients
(52 TMJs): the criteria for admission to surgery were func-
tional weakness, oral aperture inferior to 3 cm and prevent-
216 Journal of Cranio-Maxillofacial Surgery
ing normal social life. Before admission to the surgical pro-
tocol, all patients were required to undergo suitable
orthopaedic and functional treatment. Surgical treatment
always involved the repositioning of articular disc, possibly
its repair, and the reshaping of articular bone surface.
RESULTS:
The percentage of surgically operated patients ( 6-7% of
those admitted), is comparable to that reported in the litera-
ture.
Post-op N M R checks showed a satisfactory recovery (in
80% of cases) of the joint's morphology and functions. Pain
symptoms were also affected: they vanished in 80 treated
cases, remained unchanged in 15% and increase in 5%.
CONCLUSIONS:
This shows above all that the principle where by surgery
employed only in strictly chosen cases, and above all for
patients who can benefit from an operation, re-establishes
the importance of traditional surgery in the treatment of
internal disorders of the temporomandibular joint.
PATHOLOGY AND MANAGEMENT OF
TRAUMATIC OPTIC NERVE DAMAGE.
RETROSPECTIVE STUDY OF 100 PATIENTS WITH
POST-TRAUMATIC BLINDNESS
Zapala, J*., Bartkowski, S.,B., Szuta, M.
Department of Maxillofacial Surgery, the Jagiellonian
University, Krak6w, Poland
The aim of this paper is to assess causes of failure of the
treatment of patients with posttraumatic blindness in 100
cases with serious injuries of the facial skeleton.
The main problem was the efficiency of diagnostics at the
reversible stage of the optic nerve injury. Also the mistakes in
decision making in the management of the optic nerve injuries
were analysed. Direct cause of the optic nerve injury was
assessed in all cases on the basis of ophthalmological and radi-
ological examination. Out of 100 patients with posttraumatic
blindness, in 18 cases decompression of the optic nerve was per-
formed, in 16 patients by transethmoid approach, in 2 cases
with concomitant nasal liquorrhea, by frontal craniotomy.
In majority of patients the diagnosis of blindness and
admission to our Department were significantly delayed.
Results: In the group of 18 patients operated on, in 2
(11.1%) cases progressive reduction of visual acuity was
stopped. Despite surgical treatment, 16 (88.9%) patients
remained blind.
CONCLUSIONS:
1) Ophthalmological examination is obligatory in patients
with serious injuries of the facial skeleton and should be
performed as soon as possible after injury.
2) Progressive reduction of the visual acuity with concomi-
tant radiological symptoms of the fracture of the optic
nerve canal is indication for surgical decompression of
the optic nerve.
3) Immediate steroid therapy should follow confirmed diag-
nosis of posttraumatic blindness.
TREATMENT CONCEPTS 1N THE SECONDARY
THERAPY OF CRANIO-SYNOSTOSIS
Zeilhofer HF*, Horch HH, Miihlbauer W,,Fairley J, H6pner F,,
Dpt. of Oral and Maxillofacial Surgery, University of
Technology, Munich, Germany
The pathological growth patterns of syndromatic facio-
cranio synostoses is influenced only limitedly by a bilat-
eral fronto-orbital advancement performed in the time
of infancy. Severe functional restrictions like seizures,
bulbus luxations and stenoses of the oro- and nasopha-
ryngeal pathways make further surgical interventions
inevitable. The necessary extent of the midface advance-
ment, often combined with a frontoorbital mobilisation
or a monobloc operation and a total craniectomy,
accompanied by a remodelling of the skull lead to the
borderlines of today's surgical potential. The surgical
concepts are even more complicated by asymmetries that
are manifest already at the time of the treatment as well
as by persistant growth anomalies in the skull base
region.
Individualized treatment strategies and various
remodelling techiques resulting out of these concepts are
presented in selected, exemplary cases from more than 35
treated patients performed from the Munich
Craniofacial Workgroup. Possibilities and limits of
surgery planning and simulation with medical rapid pro-
totyping models will be demonstrated, the correct indi-
cation for the application of osteosynthesis systems,
sphere reconstructions using alloplastic implants, e.g.
carbon fiber compound materials, and distraction osteo-
genesis of the midface are discussed, looking especially
at the specific risk factors.
METHYLPREDN1SOLONE (URBASONE®) IN A
MEGADOSE-REGIMEN SHOWS A NEURO-
PROTECTIVE EFFECT IN EXPERIMENTAL BLUNT
OPTIC NERVE TRAUMA
ZerfowsM M ~, Gellrich NC, Babiili M, Heisig N, Eysel UT
Dept. of Oral and Maxillofacial Surgery and Dept. of
Neurophysiology of the Ruhr-University Bochum, Bochum;
Dept. of Oral and Maxillofacial Surgery of the Albert-
Ludwigs-University, Freiburg, Germany
Aims: The efficacy of megadose methylprednisolone (MP)
as a neuro-protective agent in experimental blunt optic
nerve trauma is to be demonstrated.
Methods: A port system for intravenous (jugular vein)
access was implanted subcutaneously. The retrobulbar part
of the rat right optic nerve was exposed and crush-injured
by a standardized and reproducible trauma. Eight rats, serv-
ing as control, were sham-operated, received the optic nerve
crush and received iv.-saline injections in 9 doses (C). Eight
rats underwent the same procedure, but received MP
intravenously in a megadose regimen (285 mg /kg body
weight/48 h in 9 doses) starting 10 rains after the crush-
injury (T1). Eight rats received the same MP-regimen but
the first dose was given 20-25 mins before the crush-injury
(T2). After 30 days, the rats were sacrificed, the retinas of
both eyes whole-mounted, stained and morphometrically
evaluated.
Results: The neuronal count within the retinal ganglion cell
layer (RGC) of the control rats was reduced by 25% on the
crushed side as corn-pared with the non-crushed, left side.
The Tl-group showed only a 16% reduction in the average
neurone count, the T2-group even only a 13% reduction.
The reduction of neuronal cell numbers in the RGC layer
was significantly less pronounced in those rats having been

given methylprednisolone in a megadose regimen (P<0.05).
Conclusion: For the first time a neuroprotective effect of
megadose MP (Urbasone®) in a calibrated experimental
model of blunt optic nerve trauma was demonstrated. This
strongly supports the clinical use of megadose MP in
patients with blunt optic nerve trauma as is widely used in
analogy to the National Acute Spinal Cord Injury Study II
but without as yet an experimental basis.
TMJ AND LATERAL PTERYGOID MUSCLE
PATHOLOGICAL IMAGES BEFORE AND AFTER
EXTRA ARTICULAR REARRANGEMENT
OPERATION: A PRELIMINARY MRI REPORT
Yang XJ,* MD, MMFS; Hong M AID, PbD, DDS;
Maxillofacial Surgery Dept., General PLA Hospital,
Beijing, China
An MRI study is reported in the evaluation of a new opera-
tion for Temporomandibular Joint Dysfuction(TMJd):
TMJ Extra Articular Rearrangement (EARe) operation.
This operation attempts to rearrange the internal derange-
ment of the TMJ and associated masseteric muscle disorder
without opening the capsule of the joint. Magnetic
Resonance Imaging (MRI) is used before operation for the
diagnosis and after operation to evaluate the results.
Twnty six cases (40 joints) are reported on. Twenty cases
(32 joints) with recurrent disc displacement and flat condy-
lar surfaces, without severe degenerative imaging changes in
the condyles ; 6 cases (8 joints) with recurrent disc displace-
ment and degenerative imaging are shown in the condyle.
Hypertrophy of the lateral pterygoid muscle (35 joints);
effusion (25 joints) and dystrophy of the muscle (6 joints)
are noted on MRI. The pathological images are also found
in the anterior attachment and posterior bilaminar zone of
the disc. On the MRI of 3 months to 14 months postopera-
tion, 22 cases (35 joints) symptoms of TMJd are improved
and with MRI changes in the lateral pterygoid muscles.
Eighteen cases (20 joints) with improved disc replacement; 4
cases (5 joints) are improved in regard to degenerative
changes in condyles; 3 cases (4 joints) with relief of pain
symptoms but without evidence of imaging changes after 5
months. One case(1 joint) without evidence improvement in
both symptoms and images.
*CORRESPONDING:
Dr. Xiao-Jiang Yang ,Beijing Kofta Medical Institute, 123
Rm. Science Center ;
11, Bei San Huan Xi Lu;100088, BEIJING C H I N A
EFFICACY AND TOLERABILITY OF A
SELECTIVE, PERIPHERALLY ACTING, K-OPIOID-
AGONIST AFTER EXTRACTION OF W I S D O M
TEETH
C.M. Ziegle6 S. Hoelzer*, J.E. Z611er, J. Jacob, U. Miinster
Dep. of Oral & Maxillofacial Surgery University of
Heidelberg, Germany
Background Opioids have been used as highly potent anal-
gesics for thousands of years. The analgesic effect, but also
the side effects of morphine, are mediated on m-, ct- and k-
receptors. The strong, centrally acting opioids mostly work
on m-receptors. Besides strong analgesia k-receptors also
mediate sedation, dysphoria and diuresis as side effects,
EACMFS - Abstracts, Helsinki Congress 1998 217
which are ascribed to the CNS and should not appear with a
peripherally acting substance. An analgesia mediated
through peripheral k-receptors represents a new therapeutic
approach which has not yet been examined on patients.
Asimadoline has been developed by the Merck Co. as a
selective, peripherally acting k-opioid- receptor- agonist.
Method: Sixty out- patients (aged between 18 and 47 years)
were randomized double-blind in four treatment groups
during a period of 11 months. Three of these groups took
Asimadoline in a concentration of either 0.5, 2 or 5mg post-
operatively after wisdom tooth-extraction, as a single dose,
the fourth group received a placebo. Paracetamol was a per-
mitted concomitant-medication. The main interest was pain
intensity on a visual analog scale (VAS). Further the onset
of response, the pain intensity scale (PIS), the pain relief
scale (PRS), the amount of Paracetamol used, the global
assessment of the analgesic effect by patient and investiga-
tor and finally the postoperative swelling. To obtain an
impression of the tolerance, type and frequency of adverse
events, blood pressure and heart rate, laboratory findings
and the assessment of global tolerance were documented.
Results Significant differences concerning the analgesic
effect have only been found at certain times and confined to
single pairwise comparisons of two doses at single times.
Equally the final assessment of the analgesic effect from the
point of view of the investigators and patients and the mea-
sure of swelling did not show any statistical significant dif-
ferences between the single doses and the placebo group.
Adverse events however only occurred in 5 cases which
could be connected with the study medication. Only 14
patients reported "medium" adverse events. In no case did
an adverse event lead to study exclusion. Only one patient
reported a "serious" adverse event, which afterwards proved
to be a simultaneously acquired EBV- infection.
Conclusion This study showed that Asimadoline is a periph-
erally-acting opiate, which could, because of the kind and
frequency of adverse events, be designated as very good or
tolerable, but which did, in the study design chosen referring
to the analgesic effect, not show satisfying results. Further
investigations will have to prove, whether by changing the
doses, the frequency of application or maybe the indication
(e.g. chronic pain, visceral pain) sufficient analgesia can be
attained by maintaining the advantages concerning the tol-
erability.
PRECISION AND PREDICTABILITY OF
MAXILLARY MOVEMENTS IN BIMAXILLARY
SURGERY
Zimmermann A.P. *, Haers P.E., Sailer H.F., Eyrich (7,.
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland
Introduction: In contrast to conventional simulation tech-
niques used in orthognathic surgery, the 3 D orthognathic
surgery simulator (3D OSS) developed by Krenkel allows
simulation and metric measurement of linear displacements
and rotations in the three dimensions. This prospective clin-
ical study evaluates the precision and predictability of surgi-
cal repositioning of the maxilla when using this system, by
comparing repeated pre- and postoperative face-bow regis-
trations and cephalograms.
Material and method: This study was done in a consecutive
series of seventeen patients (14 females, 3 males, mean age
22 y 8 m) undergoing bimaxillary orthognathic surgery. A
face-bow registration of the maxilla was performed preop-
218 Journal of Cranio-Maxillofacial Surgery
eratively in order to plan the maxillary displacement in the
orthognathic simulator. A face bow registration of the
maxilla in its new position in the simulator was then made
and compared to a clinical registration made six weeks
postoperatively. The displacement as planned in the simula-
tor was transferred during surgery by using the Face-O-
Meter in combination with an intermediate wafer in
intermaxillary fixation. Lateral and posterio-anterior
cephalograms were made 10 days preoperatively, 5 days and
6 weeks postoperatively. Relevant skeletal and dental land-
marks were digitized and the surgical movements analyzed.
The linear displacements of the I-point in the three dimen-
sions served as reference for the planning and for the evalu-
ation.
Results: For sagittal, horizontal and vertical move-
ments, the precision of the surgical execution based
u p o n the 3D OSS simulation was extremely high. The
mean simulated sagittal displacement was 4.8 + 2.5 mm
and the displacement measured in the cephalogram was
5.5 + 2.8 mm. In the vertical dimension, an average
movement of 1.6 + 1.0 mm was planned and a move-
ment of 1.4 + 1.0 mm measured. Transversally, a mean
discrepancy of 0.25 m m between model and real
surgery was detected.
Discussion: A very high precision and metric control of
model surgery and transfer during surgery can be achieved
when using the 3D OSS in combination with the Face-O-
Meter. The regular use of this device should be recom-
mended especially for complex threedimensional
movements of the maxillomandibulary complex.
CLOSURE OF MAXILLARY ALVEOLAR DEFECTS
BY MEANS OF NARROWING SEGMENTAL
OSTEOTOMIES AND BONE GRAFTING
Zimmermann A.P.*, Haers P.E., Oechslin C.K., Griitz K. W.,
Sailer H.F.
Department of Cranio-Maxillofacial Surgery, University
Hospital Zurich, Switzerland
Introduction: Defects in the maxillary alveolar process with
otherwise an intact dental arch demand for optimal aesthetic
and functional repair. An implant supported prosthesis is
preferred in cases where the neighbouring teeth are intact.
Material and method: Seventeen patients (average 25 years at
surgery, eleven female and six male patients) with defects
involving the anterior maxilla were included in this study.
Ten of these presented with posttraumatic defects and in
seven cases these were due to surgical removal of benign
tumours. The bone defect was either filled with autologeous
bone grafts (8 cases) or, prior to this, the gap was narrowed
by performing a segmented Le Fort I osteotomy with
approximation of the segments and ensuing bone grafting (9
cases). In all cases, delayed insertion of fixtures was done 8-
12 weeks postoperatively (42 implants).
Indication and treatment results of both treatment
modalities were compared (maximum follow up of 36
months).
Results: Implant success rates were similar in both groups
(95,2%). An algorithm for deciding to perform a segmented
Le Fort I osteotomy or not was based on the site of the
defect in the dental arch, its width (number of teeth
involved), size (height and depth), the occlusion, the avail-
ability of a graft, the age of the patient as well as his/her aes-
thetic expectations.
A segmented Le Fort I-osteotomy was done in cases of
major defects exceeding 4 tooth units and extending into the
basal bone. Other factors leading to this treatment option
were open bite deformities or other types of dysgnathia and
highest aesthetic demands. Bone grafting alone was pre-
ferred in cases in which the height of the bone defect was
less than the heigth of the alveolar process and its width
limited to 3 teeth or less and in cases with normocclusion.
Discussion: The application of methods established for clos-
ing diastema in secondary cleft surgery is also valid for the
reconstruction of tumour and trauma related alveolar max-
illary defects. The more elaborated surgery related to the
segmented Le Fort I-osteotomy allows to reduce the defect
as well as the volume of the transplant and the number of
implants needed. Consequently primary closure was facili-
tated. Moreover, in cases of malocclusion and dysgnathia a
global treatment plan is available, which can be combined
with preoperative orthodontic coordination.
LATERAL CEPHALOMETRIC ANALYSIS OF THE
MANDIBLE IN YOUNG WHITE PATIENTS
Zb'llner B*, Ehmer A, Smolka K, Ehmer U, Joos U
Cranio-MaxilloJacial Surgery, University of Muenster,
Germany
Aims: The aim of this longitudinal study was to define
female and male cephalornetric standard values for sagittal
growth of the mandible and the mandibular symphysis in
eugnathic probands.
Method: Lateral cephalometric radiographs at the age of 9,
12, 15 and 18 years were digitized with a reflex metrograph
to determine the development of the bone extension of the
mandibular ramus, the mandibular body and the symphysis
of the mandible. 36 male and 41 female white patients with
an Angle Class I and no history of facial trauma, facial
surgery or orthodontic treatment were randomized selected
from the Bolton Brush Growth Study Cleveland, Ohio.
Results: The length of the mandibular ramus increased from
a mean of 59.7 mm at the age of 9 years to 71.5 mm at 18
years of age in men, and stagnated at the age of 15 years at
a mean of 65.5 mm in women. The sagittal extension of the
mandibular ramus increased in men gradually to a mean of
33.9 mm at the age of 18 years and stagnated in women with
30.7 mm average at the age of 15 years. In men and in
women the sagittal dimension of the symphysis increased
from the age of 9 to 18 years by 1 to 1.5 ram. The mean of
the sagittal dimension of the symphysis was 15 mm at the
age of 18 years in women ranging from 10 mm to 18 ram.
Conclusions: The standards reported proved to be useful as
a yardstick for planning and treatment in orthognathic
surgery and might be a keystone in timing of early genio-
plasty.
[~ H I G H FREQUENCY ULTRASOUND IN
DETERMINATION OF EXPANSION IN DEPTH OF
T U M O U R S OF THE SKIN OF THE FACE
Pesic, Z.*, Mihailovic, D., Ojordjevic, B., Milosavljevic, M.,
Department of Maxillofaeial Surgery, Institute of Pathology,
Clinic for Dermatovenerology, Medicine University, Nis,
Yugoslavia.

The aim of this study is to estimate the validity of highfre-
quencis ultrasound determination the depths of the expres-
sion of tumors located in the face skin.
The depth of tumors expansion was first determined by
20 MHz ultrasound equipment (Dermascan, Cortex
Technology, Hadsund, Denmark). Tumors of face skin were
surgically excised and patohistologicali analyzed. Depth of
tumors invasion was measured on patohistological samples.
By this procedure 39 tumors of face skin were examined.
Results obtained by ultrasound measurements and mea-
surements on patohistological samples were compared by
linear regression analysis.
Comparising results obtained by ultrasound and pato-
histological determination show statistically significant cor-
relation, R = 0.64.
High frequencies ultrasound gives objective picture of
skin tumors expansion in depth and facilities proper surgi-
cal procedure.
LASER TREATMENT O F FACIAL VASCULAR
LESIONS
Barry L. Eppley, MD,. DMD
Indiana University, Division of Plastic Surgery, Indianapolis,
Indiana, USA
The use of pulsed, wavelength-specific laser energy offers
the potential for improvement for a variety of facial vascu-
lar lesions. When property applied to appropriately selected
lesions, clinical benefit can be achieved with very minimal
morbidity. Those facial vascular lesions which are most
responsive, however, await reports of large clinical series.
Over a five year period, a series of infants, children, and
adults were treated with the pulsed dye laser (PDL) at a
wavelength of 585nm for port wine stains (PWS) and hae-
mangiomas (HG). Seventy-eight (78) patients (31 PWS, 47
HG) were studied for color clearance, lesion regression,
number of treatments for maximal effectiveness, and post-
treatment skin complications. In addition, the safety of vas-
cular laser therapy in infants under one year of age was
studied by haptoglobin blood levels and the presence of uri-
nary pigments immediately after treatment.
The result of this clinical series will provide therapeutic
insight into which facial vascular lesions should be treated
with PDL and what clinical outcomes can be reasonably
expected.
ANALYSES OF PRIMARY I N F E C T I O N S O F
H E R P E S SIMPLEX VIRUS TYPE-1 IN M A X I L L O -
FACIAL R E G I O N
Tadamitsu, K., Jingo, K., Yoshihumi, K., Shin-ichiro, T.
Department of Oral Surgery, Kurume University School of
Medicine, Fukuoka, Japan
Aims: To define the recent clinical behavior of primary
infection with herpes simplex virus type-1 (HSV-1) in max-
illo-facial region.
Method: The clinical behavior between 66 patients with pri-
mary infection of HSV-1 treated from 1975 to 1981 (the first
period: FP) and 86 patients treated from 1982 to 1991 (the
second period: SP), as well as between child and adult
groups of the SP was compared.
EACMFS Abstracts, Helsinki Congress 1998 219
Results: 1. The male to female ratio is 1.0 : 1.28 in FP and
1.0 : 1.69 in SP, showing an increase of females from FP to
SP. The tendency of the increase in cases in their thirties is
especially apparent.
2. As for the infection path way within each family, infec-
tion between children was mainly in the FP while that
between parents, especially the mother, and children was
mainly in the SP.
3. As for patients condition, children tended to show
more severe symptoms than adults. Most prodromes were
fever greater than or equal to 38°C, and most physical con-
ditions at the first examination were fever and / or painful
swelling of the submandibular lymphnode.
Conclusions: Primary infection with HSV-1 in maxillo-facial
regions was not the disease of young children.
QUANTITATIVE EVALUATION O F M I C R O N U C L E I
IN ORAL S Q U A M O U S CELL E P I T H E L I A AND
P E R I P H E R A L LYMPHOCYTES IN PATIENTS WITH
ORAL CANCER
Eckardt, A.*, Barth, E. and Fokas, K.
Department of Oral and Maxillofacial Surgery, Hannover
Medical School, Hannover/Germany
Aims: Measuring micronuclei might be helpful in quantifi-
cation of genomic damage: Micronuclei are defined as
microscopically visible cytoplasmic masses next to the
nucleus. Five criteria were established to identify micronu-
clei: 1. it has an area < 1/5 of the nucleus, 2. its intensity is
equal to that of the nucleus, 3. the number of micronuclei
must not be more than 2 per cell, 4. it is completely sepa-
rated from the nucleus and 5. it is round or oval with no
indented margins.
Results concerning exposure to ionizing radiation, tobacco
products, alcohol consumption showed a strong dose-
response relationship. The possibility of using the presence
of micronuclei in precancerous lesions to estimate the risk of
cancer development or as a biomarker in the follow-up of
patients with oral cancer is controversial.
Method: Our study population consisted of 137 patients
with oral cancer (age 30 - 79 years) and 38 normal controls
(age 16 - 55 years). For comparison of micronuclei in lym-
phocytes and epithelia, peripheral lymphocytes were iso-
lated from heparinized blood by centrifugation. Exfoliated
epithelia from the buccal mucosa were collected with a
wooden spatula, suspended in 0.9 % saline and washed.
Cells were placed on dry clean slides. Following fixation and
hydrolization cells were stained with Acriflavin, a fluores-
cent dye. Micronuclei were then counted in 1000 cells under
a fluorescent microscope.
Results: The samples taken from healthy control persons
gave a mean value of 1.73 micronuclei per 1000 cells (lym-
phocytes) and 1.42 micronuclei per 1000 cells (exfoliated
epithelia). In contrary samples taken from tumor patients
gave a mean value of 4.63 micronuclei per 1000 cells (lym-
phocytes) and 2.68 micronuclei per 1000 cells (exfoliated
epithelia). The difference in micronuclei count was statisti-
cally significant for both lymphocytes ! epithelia in tumor
patients versus non-tumor control persons (p < 0.02).
Conclusion: The investigation demonstrated a clear differ-
ence of the micronucleus assay in tumor versus non-tumor
patients. Whether this test is a valuable "biomarker" to
detect patients at high risk for developing second primary
tumors needs to be further clarified in this ongoing study.
220 Journal of Cranio-MaxillofacialSurgery
5 YEAR F O L L O W UPS OF HORSESHOE LE FORT I
OSTEOTOMIE
S. G6ssweiner*, F. Watzinger, G. Sudash, J. Luksch, R.
Ewers
Clinic of Oral and Maxillofacial Surgery, AKH Vienna,
Waehringer Guerte118-20, A- 1090 Vienna, Austria
Tel.." 01-4040014259; Fax.: 4253 e-mail." r.ewers@akh-
wien. ac. at
Subject: The Horseshoe Le Fort I osteotomy with interposi-
tional bone grafting is a method for reconstruction of the
severely atrophied maxilla. 23 patients were treated with this
regimen at our clinic. It is the aim of this study to determine
the rate of osteointegration of the interpositional bonegraft
and the resorption of the residual alveolar ridge. The sur-
vival rate of the implants in patients who underwent a
horseshoe Le Fort I osteotomy was also evaluated.
Material and methods: Dental CT was used for radiological
evaluation of osteointegration of the interpositional bone
grafts.
1) The alveolar ridge was measured in the area of the
nasal floor, and in the frontal and posterior area of the max-
illary sinus,
2) The quality of the bone graft was evaluated and
3) The reaction of the maxillary sinus was determined.
Lateral cephalogram was performed pre- and postopera-
tively and in a yearly follow up. Vertical relapse and sagittal
relapse were evaluated.
Results: In 18 patients 121 endosteal implants have been
placed. 9 were lost and 3 had to be removed in spite of
osseointegration. The medium height of the osteointegrated
bone was 12 mm in the molare region and 15 mm in the pre-
molare region, 16 mm in the frontal region. Concerning
postoperative vertical relapse an average of 6 mm was mea-
sured within a five years follow up period, sagittal relapse
caused by resorption of the anterior alveolar ridge showed
an average of 1 ram. 3 patients had radioopaque maxillary
sinuses, 3 patients showed resorption of the bone inside the
graft.
B I O M E C H A N I C A L EVALUATION O F
DISTRACTION OSTEOGENESIS: AN
EXPERIMENTAL STUDY ON CANINES, A
PRELIMINARY REPORT
Sariso~; S*, Yiicel, E., Erkmen, E., Mollao~lu, N., Biirkan,
0., Sarisoy, L.
Department of Oral & Maxillofacial Surgery, Faculty of
Dentistry, Gazi University, Ankara, Turkey
Aims: To perform mandibular lengthening by distraction
osteogenesis in dogs and to investigate the resistance of the
new bone formed under compression forces.
Method: Mandibular lengthening was performed by means
of a modified intraoral orthodontic expansion device
(hyrax) adjusted by screws, in the right side of the mandibles
of three beagle dogs. The activation of the appliance was
started five days postoperatively and continued for 10 days
with a rate of 1 mm/day. The follow up perigd was 3
months. Compression forces were applied to the right and
left mandibular segments.
Results: A uniform, new bone was observed in the gap cre-
ated by distraction, after three months. The breaking
threshold values of the bones under compression forces of
the D O G (distraction osteogenesis) sites were found to be
close to the non D O G sites.
Conclusion: The new bone formed by D O G shows similar
resistance to the normal healthy bone under compression
forces. The results lead us to new studies of longer duration.
H I S T O L O G I C EXAMINATIONS ON ALGIPORE@,
A PHYCOGENIC HYDROXYAPATITE
(7. Lagogiannis*, C. Schopper, R. Ewers, F. Wanschitz, D.
Moser
Clinic of Oral and Maxillofacial Surgery, AKH Vienna,
Waehringer Guerte118-20, A- 1090 Vienna, Austria
Tel.: 01-40400/4259; Fax.: 4253 e-mail: r.ewers@akh-
wien. ac. at
Creation of sufficient bone is a basic condition for dental
implantation. One solution is the use of xenogenic materials
for bone augmentation, for example in preprosthetic surgery
of the extremely atrophied maxilla. Algipore® was devel-
oped as a temporary bone substitute. It is a phycogenic,
granular and resorbable hydroxyapatite with an intercon-
necting microporosity.
At our clinic Algipore® was administered in 402 cases
for different indications, mostly in preprosthetic procedures.
In 47 cases or 11.7 % we were able to harvest specimen for
histologic examination. These were processed by a grinding
technique, stained with toluidine blue and evaluated under
light microscopy. Because of its porosity, Algipore® is easily
penetrable for fluids at the recipient sites. Due to its unique
microarchitecture, it provides a bone-equivalent matrix for
osseoconduction.
With microradiographs we demonstrate the subsequent
stages of osteoblastic transformation, osseoid formation
and mineralisation. Woven bone is transformed into lamel-
lar bone, resulting in complete osseointegration of the gran-
ules. Furthermore, these are resorbed by cellular and
enzymatic processes and replaced by newly formed bone. We
provide clinical and histological data and demonstrate the
different stages of bone formation and osseointegration of
Algipore®.
A NOVEL MANUFACTURING TECHNIQUE FOR A
LONG FIBRE COMPOSITE FOR CRANIOFACIAL
BONE REPAIR
McDougall, K.E. *, Downes, S., Corden, T.J.+, Jones, LA.+,
Fisher; S.E. ++
School of Biomedical Sciences, Medical School, Queen's
Medical Centre, Nottingham, NG7 2 UH, United Kingdom
+ Department of Mechanical Engineering, University of
Nottingham, NG7 2RD, United Kingdom
++ Maxillofacial Unit, 30 The Ropewalk, Nottingham, NG1
5DW,, United Kingdom
Aim: To produce poly-E-caprolactone (PCL) as a matrix
material in a bioabsorbable composite and to use human
craniofacial bone cells (CFC) to assess the biocompatibility.
Methods: PCL was produced using a novel in-situ polymeri-
sation technique. This process, in which the monomer is
polymerised after injecting into a tool cavity, allows PCL to
be used as a matrix material in long fibre composite materi-

als produced by resin transfer moulding (RTM). PCL of
varying molecular weights has been produced using proper-
ties compared to that of commercially available PCL.
Biocompatibility of PCL was assessed by seeding CFC onto
polymer discs and culturing for 48 hours. Cell activitiy was
assessed by the alamar Blue assay as a measure of mito-
chondrial activity and cell morphology was viewed by light
microscopy and scanning electron microscopy (SEM).
Results: High quality PCL with a narrow molecular weight
distribution and properties comparable to commerically
available PCL can be produced by this novel manufacturing
process. Cell morphology and activity was good on PCL of
varying molecular weights. It was noted that activity was
lower on gamma-irradiated than non-irradiated PCL.
Conclusions: PCL can be produced in the manner detailed
and is biocompatible with CFC. This technique may be used
with stereo lithography to produce individually tailored
bioabsorbable implants for craniofacial bone repair.
BENIGN NEUROGENIC T U M O R S O F THE
MAXILLOFACIAL R E G I O N
Antoniades K*, Toliou T, Psimopoulou M, Kesaridou D,
Thanoulis P, Giannouli T, VahtsevanosK.
Department of OMFS, Theagenion Cancer Hospital of
Thessaloniki, Greece.
Neurilemmoma and neurofibroma are uncommon benign
nerve sheath tumors with a predilection for the head and
neck region. Both types may be solitary or may be part of
the clinical presentation of von Recklinghausen's disease.
They are slow growing, well circumscribed and often with
the associated nerve attached peripherally. The purpose of
this paper is to demonstrate the detailed clinical and histo-
logical features and to present the method of treatment of
three very unusual maxillofacial neurogenic tumors (two
cases of neurofibroma and one of neurolemmoma).
Case 1 was a 70-year-old female patient with
Recklinghausen neurofibromatosis who presented with a
rapidly growing skin neurofibroma over the left cheek. The
lesion was widely excised and the pathologic examination of
the specimen revealed a Merkel cell carcinoma of the cheek
arising at a neurofibroma. We believe that the patient is the
first to be described a Merkel cell carcinoma associated with
neurofibomatosis, in the literature.
Case 2 was a 20-year-old male who presented with a huge
tumor at the right floor of the mouth. The lesion was slow
growing with a long year history, painless and a CT-scan
disclosed a well circumscribed soft tissue mass with hetero-
EACMFS - Abstracts, Helsinki Congress 1998 221
geneous density. The lesion was completely excised intrao-
rally and the histologic examination disclosed a neurolem-
morea of the hypoglossal (XII) nerve. Although the
neurolemmoma of the floor of the mouth is a very rare
tumor it should be included in the differential diagnosis of
tumor lesions in and around the mouth.
Case 3 was a 51-year-old female who presented with a
mass in the left maxilla. A CT-scan revealed a very extensive
lesion filling the left maxillary sinus with bone destruction
and extending to the inferior nasal turbinate. The patient
underwent a total left maxillectomy and the histologic
examination of the specimen demonstrated neurofibro-
matosis. Benign neurogenic neoplasms are considered very
rare tumors of the nasal and paranasal sinuses.
ANALYSIS O F CHANGES O F THE OCCLUSAL
P L A N E F O L L O W I N G BIMAXILLARY
OSTEOTOMIES.
Novak J.B.*, Haers P.E., Sailer H.F.
Department of Cranio-MaxillofaciaI Surgery, University
Hospital Zurich, Switzerland
Aims: This study aims to analyse the changes of angulation
of the occlusal plane following bimaxillary surgery.
Method: Cephalograms taken preoperatively and 1 year
postoperatively in a series of 50 consecutive cases of bimax-
illary surgery were analysed. Subgroups were made accord-
ing to the underlying types of dysgnathia. The
corresponding pre- and postoperative profile views of the
patients were analysed for changes of the paranasal volume
and nasolabial angle, whereas incisor exposure at rest and
during smiling were studied on en face pictures. Planning of
changes of the occlusal plane was based on these aesthetic
parameters.
Results: The preoperative angulation of the occlusal plane
was different for the underlying types of dysgnathia (with
mean values for the subgroups ranging from 5 ° to 13 °) and
was corrected such that postoperatively, the differences were
not significant anymore (ranging from 9 ° to 12°), although
standardisation of the angulation of the occlusal plane had
not been a parameter for planning. The clinical relevance of
changes of angulation of the occlusal plane shall be demon-
strated with clinical and radiological illustrations.
Conclusions: There is a relevant influence of changes of
angulation of the occlusas plane on the aesthetic charac-
teristics of the paranasal area and smile line. This should
be taken into account when planning bimaxillary
procedures.