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Biomedical subjects

H A Merten

Publications and source records attributed to H A Merten.

At least 19 recordsLinked to original sources
PubMed1992

A new condylar positioning technique in orthognathic surgery. Technical note.

In two-jaw surgery, special importance must be attached to the maintenance of the condylar position, particularly in combination with rigid fixation, not only to enhance the stability of the post-operative result but also to avoid iatrogenic temporomandibular joint complications. The new positioning method reported herein is based on a mini fragmentation plate, which can be easily adapted to the bone surface. Reinforcement of the plate by autopolymerizing acrylate, injected into a silicone tube which is pushed over the plate, prevents any unnoticed deformation of the positioning device during surgery. In clinical use, this positioning method has proved to be more versatile and technically less difficult to perform than previous techniques, without any decrease in reliability.

Bone Plates↗
PubMed1992

Clinical and radiological findings in Gardner's syndrome: a case report and follow-up study.

Gardner's syndrome is characterized by colorectal adenomas, multiple osteomas, especially of the skull, and various soft-tissue tumours. The disease is inherited as an autosomal dominant disorder and all untreated patients will develop colorectal adenocarcinomas. Since the clinical and radiological stigmas in the maxillofacial area, such as exosteal and endosteal osteomas, skin cysts, atypical skin pigmentation and abnormal dental findings or radiopaque lesions can precede the often symptomless adenomas for many years, dentists, maxillofacial surgeons and radiologists should be familiar with the manifestations of this disease. A case is reported to illustrate the dentist's role in the diagnosis of Gardner's syndrome. In a follow-up study of 11 patients with colorectal adenomas, the typical triad of features of Gardner's syndrome was found in eight. In six patients, bony changes were demonstrated by panoramic radiography. It is proposed that radiography of the jaws may serve as a valuable tool for the early detection of carriers of Gardner's syndrome.

Adenomatous Polyposis Coli↗
PubMed1992

[Bleomycin emulsion for intralesional instillation in advanced oropharyngeal carcinomas. A case report on local bleomycin application].

Local therapy of head and neck cancer using a special bleomycin emulsion as an intratumoral applicarted cytotoxic agent is not established in regular antitumor therapy. It's use only is supposed to be regarded as an "ultima ratio" possibility when other usual methods like surgery, radiotherapy or systemic cytostatic therapy have failed. The procedure of intralesional bleomycin emulsion application will be described and the advantages and disadvantages will be discussed by means of a long-term case report.

Adult↗
PubMed1992

[The bacteriological and clinical aspects of odontogenic soft-tissue infections].

The antibiotic treatment is proved to be an effective supplement for the surgical therapy of odontogenic soft-tissue infections. For the use of antibiotics the knowledge of the oral bacterial flora and its state of resistance is very essential. In a catamnestic study the clinical records of 250 patients with orofacial infections, who were under stationary treatment in the Dept. of Maxillofacial Surgery, University Clinic Göttingen, were analyzed. The results show, that the bacterial flora has not changed basically during the last decade. Predominantly mixed aerobic and anaerobic infections can be found. Increasing importance must be attached to penicillin-resistant Staphylococci and anaerobic pathogens. Penicillins must be further considered as antibiotics of the first choice. For an extension of the antimicrobial activity the combination with a betalactamase inhibitor is useful.

Abscess↗
PubMed1992

[The treatment results in the differential therapy of mouth carcinomas. A retrospective study of the patient population of the Oral Surgery Department (1978-1986) of the University of Göttingen].

In a retrospective observational study on malignomas of the oral and maxillofacial region a data material of 157 patients has been analyzed. Results of the therapy and the course of disease are presented. The average delay between the appearance of the first symptom respectively the beginning of a therapy and the treatment in a specialized department for maxillofacial surgery runs up to 4.3 month and 2.8 month respectively. This dissatisfying situation is corroborated by the results for TNM categories with more advanced tumors. Only 16.6% of the patients belong to the T1 category, 42% to the T2 category and 35.7% to the T3 category. In 30.5% of cases tumor cells are found in cervical lymph nodes. Correlations between the size and the localisation of the primary tumor and metastases are obviously. The results of treatment are presented in form of survival curves and curves for times of no recurrence. There is no advantage in a combination of chemotherapy and surgery instead of single surgical therapy. In cases of more advanced tumors in T2 and T3 category there is no recurrence after 2 years in 70% of surgical treatment and in 69% of combined surgical treatment and chemotherapy. The censored estimated survival rate after 5 years in cases of surgical treatment comes to 63%, in cases of combined therapy to 62%. The consistent radical neck dissection is of distinctive signification. Recurrencies in the neck dissection region appear in 8.2% of patients.

Adult↗
PubMed1992

[The refusal to consent to blood transfusion. Legal and medical aspects using Jehovah's Witnesses as an example].

The limited understanding of a patient, such as a Jehovah's Witness, who has consented to an operation but refuses a blood transfusion for personal or religious reasons, places the physician in a moral dilemma. According to Article 2 II of the German Constitution, the fact that the patient has withheld or expressly refused his consent, i.e., in writing, mandates that the legal right of physical integrity be upheld with final legal effect, even in the case of an emergency. If this right to self-determination is abused, the person giving treatment is guilty of bodily harm in the sense of section 223 of the German Penal Code. Intraoperative haemodilution, the cell-save procedure, and colloidal and crystalloid volume replacement represent alternative methods of blood transfusion for Jehovah's Witnesses.

Blood Transfusion↗
PubMed1992

[Effect of pin-point surface osteosynthesis plates in comparison with conventional osteosynthesis plate surfaces on the sub-implant bone tissue. Preliminary communication].

Treatment of bone fractures with compression plates requires contact surfaces between the implant and bone. Because of this, there is a major nutritional disturbance in bone as a result of surgery. In an animal study of minipigs, this investigation proved that the reduced contact surfaces of periosteal bone vitality and that contact aids in the prevention of osteoporosis. Our work substantiates the conclusion that the osteoporosis underneath the smooth surface plates in the vicinity of implants is a result of cortical remodeling. This effect is believed to be induced by necrosis rather than by unloading effects.

Animals↗
PubMed1991

Stereotactic removal of foreign bodies in the maxillofacial area.

A technique is described for making it possible to localize any deep-seated radiopaque foreign body in the soft tissues and skeleton of the maxillofacial area. Using a stereotactic guide system, any point in the facial skeleton can be reached exactly, with precalculated precision, from any point outside the face. Thus, a foreign body can be exposed and subsequently removed by a surgical approach that gives minimal discomfort and carries low risk. The target probe serves the surgeon as a guide bar whilst the tissue is dissected. A precondition of successful stereotactic operations in the head and neck area is close cooperation between neurosurgeons and maxillofacial surgeons.

Aged↗
PubMed1991

[Mandibular condyle fractures in childhood: effects on growth and function].

Long-term follow-up findings in 29 patients having had childhood condylar fractures and 13 patients having had childhood mandibular body fractures combined with condylar fractures are presented. In only 12% of all cases moderate to severe mandibular growth abnormalities were observed. About 2/3 of these patients showed growth retardation on the condylar fracture side. 1/3 of this group, however, demonstrated more pronounced growth on the fracture side compared to the nonfracture side. Cephalometric measurements proved to be the most effective method for evaluation of growth disorders, whereas clinical examination and photographs were less efficient. Although function and anatomical remodelling was good, the probability of complete remodelling and functional rehabilitation is higher in younger children.

Child↗
PubMed1991

[Prophylaxis of the bacterial endocarditis in dental surgery].

Bacterial endocarditis is a disease with high morbidity and lethality. Bacteremia following diagnostic or therapeutic procedures in oral surgery may cause bacterial endocarditis. Patients with certain kinds of heart diseases are at higher risk to develop bacterial endocarditis. Especially these patients have to be protected by means of systemic and local prophylactic regimens.

Anti-Bacterial Agents↗
PubMed1991

[Intraoral transpositional plastic surgery of coronoid process in treatment of recurrent TMJ luxation. Preliminary report].

As a preliminary communication, we introduce a surgical procedure not previously described--intraorally performed ventrocaudal transpositional plastic surgery of the coronoid process for the treatment of recurrent TMJ luxation. The aim is to provoke an early stretch reflex of the temporal muscle and tendons by surgically shifting its insertion when the mouth is opened to an extreme position. Physiologically, this limits the extent to which the mouth can be opened and counteracts luxation. We report on initial clinical results of the intraoral transposition of the coronoid process after on observational period of 9 months.

Adult↗
PubMed1991

[Anaesthesia and spontaneous return of sensation following resection of the mandibular continuity with primary alloplastic materials].

Resection affecting the continuity of the mandible and the mandible nerve leads to complete anaesthesia of the lower lip and mental area, furthermore to deformity and functional disturbance like uncontrolled salivation. In our long term follow up study on multimodal neurological investigation sensibility is reported to have uncomplete regenerated spontaneously often already after one year. Complete sensory, however, could not be found; the incomplete sensory return was to be measured in individually different degrees of hypaesthesia. Furthermore the axonal qualities of the mandible nerve show different regenerative potential: the receptor function for pressure and contact sensitivity could be demonstrated in the most of cases, whereas the heat- and painreceptor qualities could not be revealed in all cases.

Adult↗