PubMed Health⌕ Search

Biomedical subjects

A Bremerich

Publications and source records attributed to A Bremerich.

At least 19 recordsLinked to original sources
PubMed2006

Outcomes after surgical treatment of facial skin basal cell carcinomas.

BACKGROUND: Missing recurrences and the aesthetic outcomes after reconstructions of the face are preoccupations in the surgical treatment of basal cell carcinomas. Hence, the different reconstructive techniques in particular and the rate of recurrence are evaluated in this study. PATIENTS: 205 patients receiving resections of basal cell carcinomas and facial skin reconstructions were included and data were analyzed. RESULTS: The rate of recurrence was 7.3% after follow-up at an average of 2.5 years (0.5-5 years). Local flaps, full-thickness skin grafts and skin extension closures were carried out most often; indications for split-thickness skin grafts were rare. Sensitivity disturbances occurred in only 3.6% of skin extension closures and in 11.7% of local flaps, but in 22.7% of full-thickness skin grafts and in 38.7% of split-thickness skin grafts. The aesthetic outcomes were evaluated through clinical inspection and by using patients' scale. They were classified as "unobtrusive" and "excellent or good" in 88.4% of local flaps and in 92.6% of skin extension closures, but in only 66.4% of full-thickness skin grafts and in 54% of split-thickness skin grafts. CONCLUSION: Local flaps and skin extension closures provide better aesthetic and neurological outcomes after facial skin reconstructions. However, skin grafts are alternative procedures for critical indications of local flaps.

Adult↗
PubMed2005

[Experiences with surgical management of facial basal cell carcinoma and procedures for plastic reconstruction].

BACKGROUND: No recurrences and optimal aesthetic outcomes after R0 resection and plastic reconstruction of the face are the goals in the surgical treatment of basal cell carcinoma. The aim of this study was to evaluate recurrence rates and to evaluate different reconstructive techniques. PATIENTS AND METHODS: This study included 205 follow-up patients undergoing R0 resection of primary basal cell carcinoma and facial skin reconstruction between 1998 and 2002; data were analyzed retrospectively. RESULTS: The most frequent locations of basal cell carcinoma were the nasal (40.5%) and orbital (22.9%) regions. The rate of recurrence after 2.5 years (6 months-5 years) was 7.3%. Local flaps, full-thickness skin grafts, and sliding flaps were usually performed; indications for split-thickness skin grafts were rare. Disturbances of sensation were found in only 3.6% of the sliding flaps and in 11.7% of the local flaps, but 22.7% in full-thickness and 38.7% in split-thickness skin grafts. The aesthetic outcome, evaluated by clinical inspection and a patient satisfaction score, was classified as "unobtrusive" and "good or excellent" for 88.4% of local flaps, 92.6% of sliding flaps, but only for 66.4% of full-thickness and 54% of split-thickness skin grafts. CONCLUSION: Local flaps and sliding flaps result in better aesthetic and neurological outcomes after reconstruction of facial skin regions. Skin grafts have their indications as an alternative procedure in cases of critical indications for flaps.

Adult↗
PubMed2005

[Pierre Robin sequence: postoperative complications following cleft palate surgery. A retrospective study covering 25 years].

BACKGROUND: In a 25-year retrospective review of 1976-2000, the postoperative course after cleft palate surgery and pharyngeal flap surgery in 87 children with Pierre Robin sequence was studied. PATIENTS AND METHODS: The study comprised 114 interventions with 87 primary palatoplasties; 17 patients required palatal fistulae repair and 10 children were treated with secondary pharyngoplasty procedures. All children were divided into three postnatal risk groups according to the severity of their symptoms at birth and in the course of the early months of life. RESULTS: A direct correlation was seen between the incidence of early postnatal difficulties and the postoperative obstructive complications after cleft palate surgery and pharyngeal flap surgery. Thus, children experiencing obstructive problems at birth (high postnatal risk group) displayed more severe complications at the time after cleft palate repair. In children undergoing pharyngeal flap surgery not only early postoperative obstruction but also late obstructive sleep apnea can occur.

Abnormalities, Multiple↗
PubMed2003

Stability of bone grafting and placement of implants in the severely atrophic maxilla.

A severely atrophic maxilla can be restored by bone grafts to allow the insertion of implants. We present 30 consecutive patients treated with autogenous inlay and onlay bone grafts from the iliac crest to the floor of the maxillary sinus and the alveolar crest. A total of 200 implants were inserted 4-6 months after bone grafting. A mean vertical increase in bone thickness of 14mm was achieved. After a mean bone loss of 1.3mm during the first year after bone grafting only minimal resorption was observed during the second and third year. Seven implants failed to integrate and a further four implants were lost during follow-up.

Alveolar Bone Loss↗
PubMed2001

[Frey syndrome].

AIMS: The incidence of Frey's syndrome after parotidectomy as cited in the literature varies distinctively. Strategies for successful treatment are also assessed differently. PATIENTS: Between 1980 and 1994 a total of 372 parotidectomies were performed in 364 patients at the Bochum University Hospital. RESULTS: After an average of 18 months following parotidectomy, 86 patients (23.5%) developed Frey's syndrome. Thirty-five patients were treated with scopolamine ointment. The symptoms improved in nine cases after an average of 25 months of therapy. Of the patients receiving no treatment (n = 20), seven improved after an average follow-up of 20 months. Therapy with scopolamine ointment did not elicit significantly better results compared to no treatment at all. CONCLUSION: Gustatory sweating after parotidectomy still has to be regarded as an unpleasant complication which is difficult to cure.

Adolescent↗
PubMed2001

Reasons for patients' discontent and litigation.

Introduction: Discontent and litigation among patients is a problem which increasingly preoccupies the medical profession. Aim: We aim to analyse the origin of discontent and litigation and to help avoiding these claims. Material: One hundred and seventy-eight medical expert opinions were evaluated, all made following examination of the complainant. Methods: Depending on the results of the clinical examination and the study of the files it was determined whether there was either a case of malpractice or insufficient informed consent, or no fault at all in a legal sense. In addition the patient and the surgeon were questioned as to their point of view regarding the procedure and their communication and relationship before and after treatment. Results: Frequent complaints were pain (either during treatment or afterwards), major swelling or bleeding, disturbances of trigeminal or facial nerve function, poor scar formation, loss of teeth or fixtures, faulty occlusion and discrepancies between the expected and the actual result of treatment. In 26 cases actual faults made during medical treatment were discovered. In 49 further cases, poor explanation of the proposed procedure was the reason for complaint. In the majority of remaining cases, neither faulty treatment nor insufficient information given to the patient lead to the complaint but the patient's expectations were unrealistically high. Conclusion: A considerable proportion of lawsuits originate from misunderstandings, and not treatment errors: The surgeons often concentrate on the legal requirements of informed consent and neglect to explain the practical consequences of the operation; the patients in turn tend not to ask about possible complications. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed2000

[Methods of pain therapy in mouth, jaw and facial surgery].

Pain therapy in the oral and maxillofacial region is still a problem. Before starting therapy, the genesis of pain has to be carefully clarified. The article presents the most important syndromes, aspects concerning diagnosis and differential diagnosis as well as therapeutic schemata.

Diagnosis, Differential↗
PubMed2000

[Associated anomalies in lip-maxillopalatal clefts].

BACKGROUND: Retrospective studies of cleft lip and palate patients suggest a multifactorial aetiology for this condition. Many patients exhibit multiple defects, often removed from the orofacial region. The frequency and location of such coexistent abnormalities vary between studies. PATIENTS: A retrospective case-note study of 1,737 individuals with orofacial cleft, treated between 1974 and 1998 at our centre, was undertaken to assess the frequency of associated malformations and syndromes. RESULTS: Associated malformations were found to be present in 33% of all cases investigated. In nearly one half of these individuals (48%), defects could be attributed to recognisable syndromes. Patients with isolated palatal clefts (45.6%) and those with bilateral clefts of the lip and palate (35.3%) were particularly well-represented. The following problems were observed relatively frequently: Cerebral anomalies (16%), facial anomalies (14%), heart malformations (15%), anomalies of the extremities (9%) and urogenital tract abnormalities (8%). In contrast, endocrine aberrations were identified sporadically (0.5%). A partial situs inversus was found only in one case. CONCLUSION: As clefts of the lip and palate are frequently associated with additional malformations, the importance of thorough interdisciplinary neonatal screening cannot be over emphasised.

Abnormalities, Multiple↗
PubMed2000

[Complications following piercing in the oral and facial region].

The increasing distribution and social acceptance of body piercing induced us to investigate the nature and rate of complications brought about by this fashionable injury of the unscathed body. All dentists, maxillofacial surgeons and clinics within the region of the association of dentists of Bremen were asked to register all patients presenting between June and October 1998 in whom piercings of the head and neck area were visible. Response was good; 699 piercings in 273 persons were recorded and some exemplary photographs made. Some 47 persons showed local complications which ranged from keloid formation and temporary infections to cartilage necrosis and disturbances in sensibility. General diseases were described as well, mainly allergies and hepatitis. In accordance with the seriousness of the complication the medical treatment required varied. Nine persons had to be treated in hospital. In 14 cases patients suffered permanent damage. Piercings cause severe complications and considerable expense to the public health service.

Adolescent↗
PubMed2000

[Clinical manifestations of CHARGE association in the area of the mouth, jaw and face].

Clinical experience of 11 patients with CHARGE association is reviewed. The study comprised six girls and five boys. All presented with congenital heart disease. Eight had bilateral choanal atresia. Coloboma affecting either one or both eyes was detected in nine children. Nine patients suffered abnormal pinnae or deafness. In addition to major abnormalities, further anomalies of the orofacial region and the upper airways occurred in all patients. All children exhibited velopharyngeal incoordination and swallowing problems often resulting in recurrent aspiration pneumonia. Three patients had cleft lip and palate. Both micrognathia and high-arched palate were present in two patients. Facial palsy was observed in six patients. Optimal management requires a multidisciplinary approach with active coordination and cooperation between the appropriate specialties. The anatomical repair of bilateral choanal atresia should be performed as early as possible. In our experience, the transpalatal approach is far more satisfactory than the transnasal. It gives the surgeon the opportunity of direct access and anatomical repair. After the child has grown stronger, a long-term management is desirable including developmental and feeding training.

Abnormalities, Multiple↗
PubMed1999

[Follow-up studies of 3-dimensional osteoplastic reconstruction of the extremely atrophied maxilla combined with implants].

In the severely resorbed maxilla, a 10-year success rate of only 49-74% of implants in combination with autogenous bone grafts has been reported. We developed a modified technique of antral inlay grafting and lateral and vertical onlay grafting of the severely resorbed maxilla for inserting implants to retain dentures. The clinical and radiologic results are presented. In 21 patients with severely resorbed edentulous maxillae, a total of 20 bilateral and one unilateral antral inlay graftings and lateral and vertical onlay graftings were performed after a prosthodontic setup. 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 corticocancellous iliac crest bone grafts. The maxilla was also augmented in the lateral and vertical direction. The bone grafts were fixed by osteosynthesis. After a median of 5 months, a total of 134 implants (Brånemark) were placed and later loaded by prosthodontic rehabilitation. Computed tomography (CT) scans were taken before the grafting procedure, immediately after grafting, after 4 months, and every year thereafter. A total of 94.8% of the implants were successful at the time of the abutment operation. After loading, two additional failures were seen in an average follow-up period of 2.5 years. Most patients were provided with implant-borne dentures. CT scans showed an average initial gain of vertical bone height of 3.7-17.7 mm. One year after grafting, a loss of 1.3 mm or 7% 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. We observed undisturbed healing and obtained large vertical bone heights, a high success rate, minimal resorption, and fully satisfactory prosthodontic rehabilitation; we can thus recommend our modified technique of reconstruction of the severely resorbed maxilla for routine use.

Alveolar Bone Loss↗
PubMed1998

Facial trauma in children and adolescents.

Most studies on facial trauma in the pediatric age group focus on special subgroups. This investigation encompasses all traumatic facial injuries, minor and major, of children and adolescents. Epidemiological data of the type and pattern of injury of trauma patients less than 19 years of age, treated during a 3-year-period in a large metropolitan trauma centre were reevaluated. Of the 1385 patients, 68% had soft tissue injuries, 24% had dental trauma, and 8% fractures of facial bones. More than 90% suffered from minimal or minor trauma. The leading cause of injury was a fall, predominantly at the toddler stage. In adolescents an adult mechanism of trauma prevailed: over 60% of injuries were sequelae of an assault or altercation. The male sex predominated through all age groups and for all types of injuries. The bulk of soft tissue injuries are located within a small falling zone, extending from the nose to the mental area. There was a rising incidence of fractures of facial bones towards older age groups, mandibular fractures being the most common. Condylar fractures, with their potential impact on further growth of the mandible, are seen frequently in children and adolescents, making up 80% of the fractures of the lower jaw.

Adolescent↗
PubMed1996

[Thermographic quantification of sensory and sympathetic nerve lesions in mandibular fractures--a prognostic criterium?].

As a rule, damage to segmental afferent nerves by trauma is accompanied with local impairment of sympathic functions. Standardized quantification of subjective items concerning the deficit of sensibility is quite problematical. Investigation by electrophysiological means yield not more than qualitative issues. In contrast, changes of sympathetic status and reaction of dependent dermatomas are quantitatively measurable by thermography. -26 patients with unilateral mandibular fractures complained of different posttraumatic or postoperative sensible impairment of the third branch of the trigeminal nerve. In the course of onto 3 years area and quality of the concerned neural defect were correlated to skin temperature that was measured by contact thermography and compared to the opposite reference region.- In all cases the early posttraumatic period showed a difference in temperature of the corresponding skin areas (delta T = 0.43 +/- 0.24 C). In 20 of 26 cases a relation between the changes of temperature concerning time and area and the sensible improvement could be seen. There was an individual time-lag between these developments. Side-comparing thermography was able to forecast improvement in 17 of 26 cases. Thus, the issued device provides statements about the amount and the course of posttraumatic loss of sensibility.

Follow-Up Studies↗
PubMed1996

[Mandibular fractures. An epidemiological study of a 10-year cohort].

From 01-01-1981 to 12-31-1990 512 patients with isolated mandibular fractures, 161 patients with combined midfacial-/mandibular fractures and 15 patients with combined frontobasal-/midfacial-/mandibular fractures were treated. During that period the number of isolated mandibular fractures doubled, whereas the frequency of combined mandibular fractures was nearly constant. The male/female ratio was 3.1 to 1. The more severe the combined mandibular fractures had been, the less female patients were concerned. Most of the patients were between 16 and 30 years old followed by 31 to 45 year old patients. The main reason for isolated mandibular fractures had been assaults, followed by falls and road traffic accidents, whereas most of the combined mandibular fractures were caused by road traffic accidents. The numbers of single and double fractures of the mandible were nearly equal. Certain and uncertain signs of fractures are mostly unreliable, so that an X-ray is needed. A combined conservative and surgical treatment shows the best results and guarantees the reintegration of the patient in the every-day life as early as possible.

Accidental Falls↗
PubMed1995

Speech results and velopharyngeal morphology following 151 cranially based velopharyngoplasties.

151 velopharyngoplasties (VPP) are evaluated for velopharyngeal insufficiency (VPI) and quality of spontaneous speech, conspicuous scarring or asymmetry of the pharyngeal flap and upper airway obstruction. VPP improves speech effectively in all patient groups, although poorer results are found in patients older than 6 years or with primary VPI. Postoperative morphology does not seem to affect these results, and upper airway obstruction is related to hypertrophic tonsillar tissue.

Adolescent↗
PubMed1995

Conscious midazolam sedation in third molar surgery--aspects of post-operative patient evaluation.

This study was conducted on 426 patients undergoing third molar surgery to evaluate their opinion on surgery and the follow-up period concerning postoperative behaviour, pain, and complaints. Two groups were formed as patients had to choose between local anaesthesia only or additional conscious sedation by means of intravenous midazolam (0.1 mg/kg). Women and younger patients preferred conscious sedation. Surgery was described as significantly less distressing by the sedated group. No difference in the evaluation of the follow-up period between both groups existed. Patients of the midazolam group took more analgesics, tended to stay longer in bed and reported on protracted cooling. Non-sedated persons older than 30 years complained about a slower decrease in postoperative pain. According to these findings, sensitive, cautious patients tend to prefer conscious sedation which is reflected in their behaviour. No relationship between the evaluation of surgery itself and the follow-up period could be found.

Adolescent↗