Mund-, Kiefer- und Gesichtschirurgie : MKG
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Mund Kiefer Gesichtschir · Sep 1999
Review[Clinical studies on the pathophysiology of odontogenic abscesses].
In 26 patients with abscesses in the maxillofacial area, the electrolyte concentrations, pH and osmotic and hydrostatic pressures of the pus fluid were measured and calculated. The main cations identified were sodium (134 +/- 38 mmol/l) and potassium (37 +/- 16 mmol/l) and as anions chloride (183 +/- 46 mmol/l) and bicarbonate (10 +/- 4 mmol/l). The pH value of the pus liquid was 6.164 +/- 0.233. ⋯ After penetration of virulent microorganisms into the tissue space, the area of acute inflammation is walled off by the collection of inflammatory cells. Destruction of tissue by products of the polymorphonuclear leucozytes takes place and results in liquefactive necrosis and a hypertonic abscess cavity. The inwards-directed flow of tissue fluids into the cavity via the abscess membrane causes volume expansion and generates pressure, two facts that can explain the swelling dynamics and typical symptoms of abscesses in the maxillofacial area.
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Mund Kiefer Gesichtschir · May 1998
[Obliteration of the frontal sinus with lyophilized cartilage in frontal fractures].
Obliteration of the frontal sinus is frequently necessary in the appropriate treatment of major craniofacial trauma of the upper third of the face. Successful frontal sinus obliteration requires (1) meticulous removal of the frontal sinus mucosa, (2) permanent occlusion of the nasofrontal duct and (3) obliteration of the denuded cavity. The current techniques include implantation of autologous fat, bone or muscle. ⋯ The present study reviews 51 patients with obliteration of the frontal sinus due to craniofacial trauma. In none of the patients were there clinical or radiological signs of postoperative mucocele formation. Progressive ossification of the implanted cartilage was verified in most of the patient population.
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Mund Kiefer Gesichtschir · May 1998
Case Reports[Modifications of fronto-orbital osteotomy as an approach to the anterior and middle skull base].
Various extracranial, intracranial and combined extra-intracranial approaches have been described for the surgical therapy of tumours of the anterior and medial cranial base. A combined extra-intracranial approach is indicated in cases in which the cranial base tumour spreads out intracranially and at the same time into the main nasal cavity, the paranasal space and/or the orbits. ⋯ Generally, additional transfacial incisions are unnecessary. The operative techniques are described and the results of 108 cases of tumours of the skull base shown.
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Mund Kiefer Gesichtschir · Mar 1998
[Quality of cardiopulmonary resuscitation by dentists in dental emergency care].
The crucial factor deciding the success of cardiopulmonary resuscitation is a sufficient oxygen supply. At about 4 min after cardiac arrest, cerebral death results because of hypoxia, and cardiopulmonary resuscitation has to be started regardless of the pathogenesis of the cardiac arrest. The purpose of the study was to assess the application of guidelines for cardiopulmonary resuscitation by participants at a dental surgery congress (n = 96) and to evaluate previous knowledge in cardiopulmonary resuscitation and knowledge after instruction. ⋯ The participants were, however, found to be in need of further education and training in diagnostics and certain cardiopulmonary resuscitation measures. Knowledge should be improved concerning recognition of the emergency (42.7%), checking the carotid pulse (22.9%), the correct order of primary insufflation and closed-chest cardiac massage (9.4%), correct implementation of compression (21.8%) and ventilation (36.4%), and the correct ratio of compression and ventilation (21.9%). Regular courses should be targeted at these specific aspects.
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Mund Kiefer Gesichtschir · Jul 1997
[Microneural reconstruction after iatrogenic lesions of the lingual nerve and the inferior alveolar nerve. Critical evaluation].
As microneural repair techniques of the sensory mandibular branches enter the third decade of their clinical use, there are but a few long-term investigations into the value of these procedures in the treatment of iatrogenic injury to the lingual (LN), inferior alveolar (IAN) or mental (MN) nerve. To establish the efficacy of microneural repair in lesions of the LN, IAN or MN with loss of continuity, the outcome of sensory recovery was evaluated in a series of 92 patients (LN: direct coaptation n = 39, coaptation + sural nerve grafting n = 23; IAN: direct coaptation n = 11 coaptation + sural nerve grafting n = 10; MN: direct coaptation n = 11). The minimum duration of follow-up was 14 months postoperatively. ⋯ In the LN coaptation group low scores and improved taste perception were convincingly associated with short periods since injury (i.e. timing of repair). In conclusion, we feel there is sufficient justification to optimize the potential results of microneural repair by immediate (LN/MN) or early (IAN) reexposure of the injured site in order to clarify the precise nature of the underlying nerve damage and prevent delay, if patients present with complete loss of sensory function subsequent to dentoalveolar or oral surgery. However, clinical and electrophysiologic findings suggesting impairment or partial loss of sensory function are considered a contraindication to microneural intervention, in view of the limited prospects of sensory recovery after surgical repair.