Biomedical subjects
Publications and source records attributed to D Wiesenfeld.
The indications and operative technique of various procedures commonly used to provide or increase access to the central skull base, anterior and middle cranial fossae, nasopharynx, infratemporal fossa and retromaxillary space are discussed with illustrative cases.
Maxillofacial osteosarcoma is a rare tumour. Curative treatment strategies have evolved to include chemotherapy in addition to definitive surgical resection. To review and report our experience in eight patients with maxillofacial osteosarcomas, we retrospectively reviewed eight patients with high-grade maxillofacial osteosarcoma seen over the last decade at our institution. Our results suggest that a combined surgical and chemotherapy approach provides excellent local disease control and high cure rates.
This paper focuses on how patients with oral squamous cell carcinoma (SCC) are assessed and managed once they have been referred for specialist care. Current and future treatment options are presented and basic management principles are discussed. It is our hope that this will enable the general dental practitioner to gain insight into the process and reasoning behind the multidisciplinary treatment of these complex cases.
Necrotising fasciitis is a severe soft tissue infection which spreads rapidly through fascial planes, is characterised by soft tissue necrosis and is potentially life-threatening. It is a rare entity in the head and neck region. The management of this condition is difficult and early diagnosis and aggressive surgical and medical management are essential. This paper reports two cases of necrotising fasciitis as a result of ascending odontogenic infection involving the temporalis muscle.
We review 72 midfacial tumours managed during the 10-year period between 1985 and 1995. We describe presenting features, sites of lesions and histology, treatment regimens and outcomes, as well as the various surgical approaches for the resection of midfacial tumours, and their indications and contraindications. The choice of approach should be based on type of tumour, its site, and extent.
A series of 21 patients, who were selected for primary mandibular stabilisation with titanium plates following excision of advanced malignant tumours, is reported. Success was defined as a plate that did not have to be removed due to fracture, exposure or infection. The overall success rate was 71%, with follow-up ranging from 7-53 months. The majority of plate losses were experienced when either anterior or large lateral defects which included the condyle were bridged and when patients were subjected to either pre- or postoperative radiotherapy.
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The development of osteolytic bone lesions in patients with chronic lymphocytic leukaemia (CLL) is extremely rare and has not been reported to involve the mandible. A case of bilateral pathologic fracture of the mandible extensively involved with multiple bony deposits of CLL is reported.
A combined surgical and orthodontic technique for management of transverse maxillary deficiencies in mature patients is described and discussed. Special references are made to the surgical release of several circummaxillary articulations to facilitate the use of a fixed expansion device, and to the authors' addition of an osteotomy below the nasal spine, to ensure that the nasal septum remains independent of the maxillary segments. Indications for the use of this surgically-assisted maxillary expansion technique, and its advantages when compared with segmented surgical expansion, are also presented.
Our knowledge of the entry and spread of oral cell carcinoma (SCC) into the mandible is increasing, making an impact on surgical planning. Fourteen resection specimens of mandibular bone and adjacent SCC were radiographically (CT) and histologically investigated. In six cases there was no involvement of mandibular bone; a continuous periosteal layer separated the tumour from bone. The remaining eight specimens showed bony involvement with good correlation between corresponding CT and histological slices in the five edentate cases. The site of entry of the tumour into the bone was usually through the alveolar crest with additional spread through the lingual cortex in tumours that lay lingual to the mandible. Although limited, our data shows that the main site of entry of SCC is through the alveolar crest. It also highlights the usefulness of CT in the identification of bone involvement in edentate cases. This information may assist in the planning of operations to preserve as much bone as is consistent with complete excision of the tumour.
The authors report on a retrospective study of 205 consecutive patients at the Maxillofacial Unit of The Royal Melbourne Hospital to assess if adherence to Champy's principles in placement of miniplates in mandibular fractures minimises morbidity. 205 well documented cases of mandibular fractures treated with internal fixation, January 1985 to April 1990 were studied. The patients were assigned into three groups according to the type of fixation; 83 patients had miniplate fixation according to Champy's principles, 40 patients had miniplate fixation ignoring Champy's principles, 82 patients had transosseous wire (TOW) fixation. Outcome was measured by preoperative variables (age, gender, mechanism of fracture, site and number of fractures, nerve function, associated injuries and treatment delay) and postoperative variables (duration of admission, duration of intermaxillary fixation (IMF), malocclusion, infection, dehiscence, union, removal of fixation and nerve function which were assessed and compared. The results show that the preoperative variables were statistically similar in all groups. The postoperative variables indicated a statistically higher complication rate for the transosseous wire group compared with the miniplate groups, and morbidity was reduced in the group following Champy's principles. The morbidity rates in this study compare favourably with other studies even though the patients in this study had a much higher incidence of multiple fractures. Titanium miniplates appear as effective as miniplates constructed of other materials used in previous studies, especially when Champy's principles are followed.
The case of a primary intraosseous carcinoma occurring in the maxilla is presented. The classification; clinical, radiologic, and light microscopic features; and treatment are described. These rare lesions should be considered among the diagnostic possibilities when patients present with atypical cysts of the jaws.
General dentists are frequently called upon to manage maxillofacial infections. Such infections are usually well localized in their initial stages but can spread to become severe and potentially life-threatening. This paper discusses the anatomical basis of the spread of these infections and techniques relevant to the rational management of these serious conditions.
Rebuilding of the alveolar ridge is part of oral rehabilitation for the postoperative cancer patient. Consideration should be given to immediate or delayed reconstruction, the use of fixed or removable prostheses, and most importantly the patient's prognosis and expected outcome.
Ameloblastoma is uncommon in the maxilla, comprising about 15% of all reported ameloblastomas. Ameloblastomas are locally aggressive and, when involving the maxilla, potentially lethal. The long term outcome of 13 patients with ameloblastoma in the maxilla for whom surgery was the primary treatment between 1951-1990 was studied. Patient records from both private and public practices in Melbourne, Australia were examined as were those cases reported to the Bone Tumour Registry at the University of Bristol, England. The study showed that control of disease was achieved in all patients where the tumour was limited to the confines of the maxilla (10 cases). The mean follow-up period in this group was 7 years (range 2-20 years). In the three cases that recurred all had preoperative radiological evidence of posterior maxillary sinus wall destruction and/or pterygoid plate erosion. Two patients died of extensive local recurrence and one has persistence of the disease. Histopathological examination confirmed the diagnosis of ameloblastoma in each case with a variety of histological patterns being noted. It is concluded that notwithstanding histological type, the extent of the tumour at presentation and the adequacy of the surgical approach and removal were the main factors in successfully managing the disease.
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A review of 107 cases of acute maxillofacial infections managed at the Royal Melbourne Hospital was undertaken, and details of the presentations, demography, management, and outcomes of these patients are presented. The results indicated that many of the patients had sought treatment from dentists in general practice, and that a significant proportion had received sub-optimal management prior to referral. Thus a review of the principles of management and guidelines for the referral of patients with maxillofacial infections is also presented.