Biomedical subjects

E Reinhart

Publications and source records attributed to E Reinhart.

At least 19 recordsLinked to original sources

PubMed2003

[Bimaxillary osteotomy with and without condylar positioning--a 1981-2002 long-term study].

PURPOSE: The introduction of the four-splint technique in our hospital in 1997 made possible the reproducible centric condyle positioning in bimaxillary osteotomies, while taking the auto rotation of the mandible into consideration and avoiding steps in the mandibular osteotomy line. PATIENTS AND METHODS: From 1981 to 2002 a total of 622 patients underwent bimaxillary osteotomy surgery. During 1981-1997 a total of 395 patients (63.5%) underwent surgery without or only with centric condyle positioning in sagittal ramus osteotomy of the mandible. During 1997-2002 a total of 227 patients (36.5%) underwent surgery with continuous centric condyle positioning with the four-splint technique. RESULTS: In patients with preoperative functional disorders, surgery with continuous centric condyle positioning resulted in statistically significant (p<0.05) improvement compared to those who underwent surgery without continuous centric condyle positioning. CONCLUSION: The results confirm the indication for continuous centric condyle positioning in bimaxillary osteotomies.

Dental Occlusion, Centric↗

PubMed2003

[Typical features of craniofacial growth of the FGFR3-associated coronal synostosis syndrome (so-called Muenke craniosynostosis)].

BACKGROUND: The FGFR3-associated coronal synostosis syndrome (Muenke craniosynostosis) is caused by a point mutation (C749G) on the FGFR3 gene resulting in a Pro250Arg substitution. METHODS: To characterize this malformation, the neuro- and viscerocranium were analyzed by axial CT scans of the skull and cephalometric radiographs of up to 13 affected children before and in part after fronto-orbital advancement. RESULTS: Preoperative analysis of the intracranial volume of four patients showed a mean decrease of 3.6%, indicating a compensatory growth pattern of the skull in cases of coronal synostosis. The typical brachycephaly could be verified by the significant shortening of the skull length of 13.2% on average and by the significant reduction of the anterior cranial base length of maximal 5.9% on average. The anterior part of the skull was characterized by a significant mean increase of the intercoronal distance of 8.6%, which indicates a compensatory transversal growth in this malformation. The widened bilateral interorbital and anterior interorbital distances were increased by 7.3 or 9.0%, respectively, confirming a hypertelorism typical for this syndrome. The "frontal bossing" frequently found in brachycephaly was characterized by the preoperatively increased sagittal extension of the forehead (about 112.9% above the norm) and by the increased height of the frontal prominence (about 47.8% above the norm). Following surgery, both variables defining the morphology of the forehead were reduced and appeared to be constant throughout the follow-up. Hypoplasia of the midface described by Muenke et al. (1997) was confirmed in the present study only by the significant reduction of the sagittal length of the maxillary base, which was decreased by 6.8%. CONCLUSION: In accordance with the current literature, the skull configuration described for Muenke craniosynostosis shows similarities with the Saethre-Chotzen syndrome.

Amino Acid Substitution↗

PubMed1999

[Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue].

In 63 patients, 82 elevations of the maxillary sinus were performed. As augmentation, materials autografts from the iliac crest (combined with alveolar ridge augmentations in 16 sinus lifts) were transplanted in 39 cases and osteoinductive, allogeneic bone powder (AAA bone (autolyzed, antigen-extracted, allogeneic bone): n = 8, DFDBA (demineralized freeze-dried bone allograft) and/or Grafton (demineralized bone matrix gel): n = 35) were used in 43 cases. Some 4-6 months after implantation, osteoinductive, allogeneic (demineralized) bone implants showed radio-opaque areas as an equivalent of bone formation. Histological examinations revealed that osteoinductive implants were completely transformed into patients' own bone tissue. The average augmentation height after autograft transplantations was 14 (+/- 3) mm in comparison with 9 (+/- 3) mm after allograft implantations. Histologically as well as radiologically no differences of the bone quality could be determined between the two augmentation materials. Endoscopic controls showed, in both groups, nonirritated mucous membranes. On an average 2 endosseous implants (Bone Lock or ITI-screw implants) were inserted into the augmentated maxillary sinus floors in both groups. No osseointegration was achieved in 4 out of 67 dental implants when bone autografts were used and in 2 out of 74 dental implants of the allogeneic bone group. Patients with bone autografts suffered from postoperative complaints on an average of 19 (+/- 9) days (without consideration of 2 patients with postoperative complaints persisting for more than 90 days). The average postoperative complaints of recipients of allogeneic bone implants continued for 3 (+/- 5) days. The 13 patients who underwent an ambulant sinus lift procedure with allogeneic bone powder were already symptom-free several hours after the operation. Under critical consideration of all investigated parameters, osteoinductive bone implants are preferable to iliac bone autografts for maxillary sinus augmentations in those cases in which no additional alveolar ridge augmentation is required.

Alveolar Bone Loss↗

PubMed1999

[Low energy extracorporeal shockwave therapy (ESWT) for treatment of myogelosis of the masseter muscle].

Patients with functional disorders of the temporomandibular apparatus often show painful myogelosis, especially of the masseter muscle. The cause is hypertonia of the affected muscle. The aim of the presented single-blinded clinical trial was to analyze the effects of low-energy extracorporeal shock waves on patients with pain sensitivity in this region. Participating in the trial were 50 patients with painful, palpable and sonographically evident myogelosis of the masseter muscle. Half of the patients received a single application of 250 impulses of 0.04 mJ/mm2. The second half received an equivalent placebo treatment with the shock-wave impact being inhibited by a neopren insert. It was shown that in 64% of the patients significant alleviation of pain with palpable and sonographically evident softening of the myogelosis could be achieved. In 40% of the patients the therapeutic result could be conserved over a period of 2 weeks. The difference from the placebo group was statistically highly significant. ESWT is thus an easy-to-use, non-invasive method of initial pain therapy for patients with functional disorders. To preserve the long-term therapeutic result, additional functional therapy is nevertheless necessary.

Adult↗

PubMed1998

[Clinical application of osteoinductive implants in craniofacial surgery].

Autolyzed, antigen-extracted, allogeneic bone (AAA bone) is prepared from cortical bones of human organ donors. AAA bone possesses osteoinductive properties as it delivers BMPs from its bone matrix. Within a prospective study, 37 cranial defects were reconstructed using AAA bone implants over a period of more than 7 years. The patients were followed-up at standardized intervals. Roentgenographic assessments and bone scintigraphies revealed osseous integration and remodelling of the AAA bone implants. In one quarter of the cases re-entry was performed 10 to 18 months after the cranioplasty (removal of osteosynthesis material, recurrence of tumor). All nine AAA bone reconstructions showed bleeding surfaces and bony integrations. A bone biopsy was taken from the center of one of these AAA bone implants and this showed new bone formation originating from the surface of the implant. In one case an AAA bone implant was lost due to infection. This is noteworthy as in approximately one third of the cases the bone implants were in direct contact with the frontal sinus. The clinical results clearly emphasize the therapeutical benefit of AAA bone for cranioplasties. Large AAA bone chips from human skull bones facilitate the reconstruction of the skull's convexity, especially when sterolithography-based operation planning is performed.

Adolescent↗

PubMed1998

[New hydroxylapatite cement for craniofacial surgery].

A new stoechiometric mixture of 27% dicalcium-phosphate (DCPA) and 73% tetra-calcium-phosphate (TTCP) can be prepared with water intraoperatively to a paste that subsequently sets to a structurally stabile implant composed of hydroxyapatite (HA). Primary setting time is about 20 min; pH during setting ranges from 6.5 to 8.5. There is no relevant curing heat or expansion or contraction. Compressive strength is about 50 MPa, tensile strength about 8 MPa. Over a period of about 4 h in physiological milieu, the cement converts to hydroxyapatite. This product is no longer redissolvable in normal body fluid. This cement can be used for non-load-bearing applications especially in craniofacial bone surgery. Cranial defects due to tumour or trauma as well as deficits in the facial skeleton may be reconstructed using this new biomaterial. In nine of ten patients we used the hydroxyapatite cement successfully for reconstructions in the craniofacial area. Fluid control of the operation field and implant site is extremely important and sometimes difficult to achieve. Further applications could be all non-load-bearing augmentations such as filling of blocked paranasal sinuses, of dentoalveolar cysts and defects following dental apectomy or fixation of implanted hearing-aid electrodes. The perspectives for the hydroxyapatite cement include its application as a carrier for osteogenic protein preparations, especially because of its isothermic reaction and intrinsic osteoconductive characteristics.

Bone Cements↗

PubMed1998

[Long-term outcome after corrective surgery of the neuro- and viscerocranium of patients with simple and syndrome-related premature craniosynostosis].

A retrospective and partly prospective study was conducted to analyse both clinically and cephalometrically the craniofacial growth pattern of patients with isolated and syndrome-related premature craniosynostosis after standardized fronto-orbital and midface advancement. The file data of 293 children with fronto-orbital advancement were evaluated over an average period of 4.4 years. In addition, lateral teleradiographies of 117 patients from this group were cephalometrically analysed. Moreover, late results of 36 children and 8 adults with midface-advancement with an average follow-up period of 4.5 years were assessed. In contrast to linear craniectomy and so-called lateral canthal advancement, in only 8.2% of cases (24 out of 293 patients) were relapses requiring reoperation found in this study after fronto-orbital advancement. The evaluations indicate that with simple forms of craniosynostosis such as trigonocephaly and plagiocephaly predominantly very good or good growth can be observed. Cephalometric evaluation confirmed the limited potential of growth in the area of the anterior skull base and in the midface in the presence of syndrome-related faciocraniosynostoses. In such cases the cephalometrically confirmed maxillary hypoplasia, which increases in severity in the following order of syndromes 'Saethre-Chotzen-Crouzon-Apert-Pfeiffer', could be influenced only to a limited degree by fronto-orbital advancement. For this reason midface advancement is of secondary importance in children with very severe anomalies. In the present evaluation, a high rate of relapse of midfacial hypoplasia was to be found in children and adolescents after this operation in accordance with other references. Therefore, the indication for Le Fort III osteotomy in the growth period should be limited.

Adult↗

PubMed1998

[Results of surgical therapy of orbital abnormalities].

Dystopies of the bony orbit are caused mainly by craniosynostosis, facial clefts and encephaloceles. This article presents the results of the surgical correction of orbital hypertelorism in 24 patients. Using this operation technique, the bony interorbital distance was decreased from an average of 47.6 mm to 22.8 mm. However, the distance between the soft tissues was not reduced by the same amount as the distance between the bony orbits. The intercanthal distance decreased from an average of 58.5 mm to 44.5 mm, whereby an additional refixation of the medial palpebral ligament resulted in a reduction of the intercanthal distance to 40.8 mm. A strabismus divergens was seen preoperatively in 18 patients, postoperatively only in 8 patients. Four of the latter had to undergo operative correction of the diplopia. We conclude that the operative technique is not reserved only for complex cases of hypertelorism because it shows satisfactory functional and aesthetic results with a low complication rate.

Adolescent↗

PubMed1998

[Perioperative antibiotic prophylaxis in orthodontic bone operations of the facial skull].

Intraoral orthognathic surgical procedures are clean-contaminated operations because of the facultative pathogenic flora of the oral cavity. Without antibiotic prophylaxis in this kind of operation a postoperative wound infection can be expected in 20-31% of cases. Therefore, a retrospective analysis of the clinical course of 545 patients with various dentofacial deformities was performed to evaluate the importance of perioperative antibiotic prophylaxis. The total rate of wound infections was 2.8% and lower than rates published in other comparable studies without antibiotic prophylaxis. The rate of wound infection after single mandibular osteotomy (4.1%) was significantly higher than the analogous amount after single maxillary osteotomy (0.8%) because of the mechanical strain of the surgical wound in the region of the mandibular angle and because of the high retention of food particles and other decay products in this area. The recognized rise in the wound infection rate by increasing the length of operation demonstrates that the extent of bacterial contamination of the surgical wound depends on the dimension and duration of surgery. Bacterial flora caused the noticed wound infections in 61.5% of cases aerobic-anaerobic mixed infections, which is in accordance with the results of similar publications. With increasing length of antibiotic prophylaxis, an increase in the incidence of antibiotic-associated side effects and in the wound infection rate could be observed. Therefore, an antibiotic prophylaxis which exceeds 3 days does not seem to be useful. In this study, in which cephalosporins were mostly used, the total rate of antibiotic-associated side effects (4.6%) was lower than analogous amounts of other groups of antibiotics. The analysis demonstrates that a short-term prophylaxis with broad-spectrum cephalosporins such as cefatoxime of 48 h is very effective and useful.

Adolescent↗

PubMed1997

[Outcome of profile-improving operations in craniofacial abnormalities].

In 52 children with craniosynostosis, we studied the effect of fronto-orbital advancement onto the forehead profile and the growth tendency of the forehead and midface. As a reference, the following kephalometric data were used: SN line. N-Spna line, SNA angle, N-tf line (as an indicator of the forehead profile) and the tf-TF line (as an indicator of the forehead size). The operation was carried out at an mean age of 10.5 months. Follow-up with X-ray control covered a period of 37.2 months on average. In patients with brachycephalus the SNA line was reduced and the post-operative growth tendency was the most unfavorable. Also the forehead profile (N-tf-line) did not become normal after the operation in patients with brachycephalus. Besides this, the increase in the forehead size indicated a new growth-tendency disorder. In all children with brachycephalus as well as in most children with oxycephalic growth tendency, sagittal midface growth was inhibited (NSA angle) while vertical midface growth was normal (N-Spna line). The success of fronto-orbital advancement was dependent on the kind of growth disorder, the location, and the age when the operation was carried out. Only early operative treatment could interrupt the pathological growth tendency even in cases with a major development disorder.

Cephalometry↗

PubMed1996

Craniofacial growth characteristics after bilateral fronto-orbital advancement in children with premature craniosynostosis.

The standardized bilateral fronto-orbital advanced method of osteotomy established at the University of Wuerzburg is applied in all forms of craniosynostosis except scaphocephalus. The intention behind early operation is to halt progression of the disorder and to institute the physiological direction that growth should take. The preoperative severity of the disorder, the particular symptoms of the various malformations concerned, and the postoperative course of growth were analyzed and assessed both clinically and cephalometrically using the retrospective evaluations of the file data of 131 children with various forms of craniosynostosis. In contrast to linear craniectomy and so-called lateral canthal advancement, which have sometimes been thought to lead to undesirable postoperative growth development, only 11 relapses requiring renewed operation were found postoperatively in our own study of 131 children. It became evident that the greater the severity of the malformation, the more probable it was that a relapse would occur. Fronto-orbital advancement can only affect the pathological growth pattern to a limited degree, especially when craniosynostosis is related to a syndrome. Cephalometric evaluation confirmed the limited potential for growth in the area of the anterior skull base and in the mid-face in the presence of syndrome-related brachycephaly and severe facio-craniosynostoses. In such clinical cases, compensatory growth of maxillary hypoplasia cannot be expected after fronto-orbital advancement.

Cephalometry↗

PubMed1996

[Treatment outcome and complications of surgical and conservative management of mandibular fractures].

Retrospective analysis of 712 patients with 1166 mandibular fractures and follow up-study of 374 patients with 593 fractures was performed for discrimination of differences in wound- and bone-healing as well as late results between operative and conservative fracture treatment. 46.1% (328) of all patients have been treated conservatively, 53.9% (384) have been treated by operation. The follow up was performed on 255 patients with operative fracture treatment and 119 patients with conservative treatment. In 3.0% of the operatively treated patients bacterial infections occurred, in comparison to 8.7% of conservatively treated patients. From the viewpoint of functional aspects, such as occlusion, articulation and mandibular movement as well as radiological signs in the fractured region patients after operative treatment have shown partly significantly better results during the follow up compared to the group of conservatively treated patients. Neurological testings of inferior alveolar nerve and mental nerve have shown significantly better results in the group of conservatively treated patients. Since the functional results are much better after operative treatment, osteosynthesis with miniplates should be performed if there are no contraindications. The more precise reconstruction and stabilization of the fragments shortens time of hospitalization and leads to sooner functionality of the mandible.

Bone Plates↗

PubMed1996

[Therapeutic concept in comminuted and defect fractures of the mandible].

Immediate live-saving emergency treatment of patients with heavily communited and partially defective mandibles by airway intubation, control of haemorhage and primary treatment of wounds necessarily must be followed by a staged concept of treatment for the functional and aesthetic rehabilitation of hard and soft tissue in order to enable the patient to survive not only biologically but also socially. Out of 384 patients with surgically treated mandibular fractures, 120 had multiple fractures, 24 heavily comminuted fractures and 6 sustained vast defects. All multiple and communited fractures could be treated successfully by an intraoral approach using function-orientated miniplate-osteosynthesis and in 30 cases functionally stable plates. In patients having sustained vast avulsions of soft and hard tissue, immediate emergency-revascularisation was well to the fore. In cases of tissue destruction, primarily the position of the jaw stumps was secured by plates and reconstruction was done in the early secondary stage using composed microvascularly transferred scapular flaps.

Adult↗

PubMed1995

[Comparative studies with apicoectomy using various surgical techniques and filling materials].

Follow-up examinations were made retrospectively on 799 apicoectomized teeth from a group of patients with a total of 3,524 apicectomies, the mean postoperative interval of observation being 4.2 years. An intraoperatively orthograde root-canal filling was performed in 51.3%, an intraoperatively retrograde in 23.7% and a preoperative filling in 25.0% of the patients. Apart from 126 teeth that had already been extracted, a further 160 teeth had been clinically and/or radiologically conspicuous, so that a total of 286 failures was to be recorded. The dentally related success graphs computed according to Kaplan and Meier (1958) showed a significantly worse success probability for the preoperative filling compared to the two other techniques. With regard to the different materials employed in orthograde application, the silver filling had a higher and the guttapercha filling a less favourable success quota compared to a titanium filling. Moreover, in the retrograde method, amalgam resulted in a significantly higher success probability than glass ionomer cement. With an attendant cyst there was a significantly improved success quota over apical parodontitis or a renewed operation. With regard to the localization of apicectomies, maxillary front teeth attained the highest success rate. The present results point unequivocally to an unfavourable outcome after preoperative endodontics and underscore the good prognosis of an intraoperatively orthograde filling. Due to the fact that biocompatibility is in the forefront today, time-tested materials, such as silver and amalgam, are clearly being used less.

Adult↗

PubMed1994

[Microsurgical scapula transplants for reconstruction of the facial skull--experiences with 44 patients].

Great versatility gives composed scapular flaps a particular significance for the reconstruction of defects in face and skull: According to individual requirements one up to five separate elements may be transferred with one vascular pedicle. Anatomical studies of 120 scapulas measured a mean length of 13.4 cm and a mean diameter of 1.2 cm of the lateral margin offering sufficient bone for most indications in the visceral skull. Up to three cutaneous flaps may cover nearly every defect in the head. 44 patients were treated in the years 1989 to 1993 using scapular flaps, most of them combinations consisting of bone and skin elements. In two patients a so called 4-in-1-flap was transferred including the latissimus-dorsi-flap. All donor sites could be closed primarily. Venous thrombosis caused one loss of a flap. Infections healed without sequelae. Medical gymnastics brought full rehabilitation of the donor site within 6 months.

Bone Transplantation↗

PubMed1992

Combined nitrofurantoin toxicity to liver and lung.

Nitrofurantoin is an antibiotic commonly used for prophylaxis and treatment of urinary tract infections. Pulmonary and hepatic toxicity are rare side effects of this agent. The simultaneous occurrence of pulmonary fibrosis and chronic active hepatitis in a patient undergoing long-term nitrofurantoin therapy is reported. The presence of pulmonary toxicity was evidenced by infiltrates on chest radiographs and impaired diffusion capacity during pulmonary function tests. Prolonged elevation of liver enzyme concentrations together with the presence of increased antibody titers (anti-smooth muscle antibody, antinuclear antibody) was suggestive of chronic hepatitis, a diagnosis corroborated by liver biopsy findings. After discontinuation of nitrofurantoin therapy, the patient had a full recovery. The infiltrates initially found on chest radiographs disappeared, and laboratory parameters normalized without the need for corticosteroid therapy.

Aged↗

PubMed1991

[The diagnostic assessment of enlarged lymph nodes by the qualitative and semiquantitative evaluation of lymph node perfusion with color-coded duplex sonography].

Perfusion of enlarged lymph nodes by colour-coded sonography was studied prospectively in 105 benign and 115 malignant lymph nodes. The diagnosis was confirmed histologically in 158 and clinically in 62. Spectral analysis in the benign lymph nodes provided normal values for pulsatility and resistance indices. A pulsatility index greater than = 1.8, or a resistance greater than = 0.9 indicate lymph node metastases with positive prediction of 93% and specificity of 97%. In addition, subjective, semiquantitative classification of lymph node perfusion in relation to the surrounding fat or connective tissue improves the diagnosis of lymph node metastases and of malignant lymphomas.

Axilla↗

PubMed1991

[Various factors influencing the local anesthetic effect of articaine].

In a field study, the reduction in the anaesthetic effectiveness of Articain was investigated in relation to various influencing parameters. Both in the ZMK-Klinik (Dental Hospital) of Würzburg as well an in various independent practices, the local anaesthetic Articain was given to over 2000 patients in the course of dental treatment. With 12.1% of all test-subjects, inspite of the initial positive effectiveness upon application of the nerve-blocking anaesthetic, touch sensitivity and/or painfulness was established in the area concerned. Statistical evaluations of the recorded data of the test-subjects investigated showed a significantly higher quota of anaesthetic failure in the case of heavy cigarette consumption, chronic exposure to inhaled toxins as well as in the case of the intake of medicines of certain pharmaceutical types. Apart from that, a connection was also established between reduction in the effectiveness of the local anaesthetic and various treatments as well as the way in which the local anaesthetic was applied and the site of injection. Possible causes will be presented and discussed in relation to information from the literature on the subject.

Anesthesia, Dental↗