[The extraction of retained mandibular wisdom teeth (I). The indications and preoperative diagnosis].
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Contraindications↗
Biomedical subjects
H F Sailer
Publications and source records attributed to H F Sailer.
[The extraction of retained mandibular wisdom teeth (II). The surgical technic, follow-up and complications].
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Anesthesia, Dental↗
[The surgical removal of the lower wisdom teeth. Is open follow-up care still up-to-date?].
The removal of lower wisdom teeth is one of the most common procedures in oral surgery. Postoperative complications have been reported in over 10% of the cases, of those being 8.5% due to infection. In our Department, the open wound healing method has been used routinely for more than 50 years. In this article we present a retrospective and a prospective study comparing the open and closed wound healing techniques after lower third molar removal. The retrospective study dealt with 908 consecutive cases of the year 1991 in which all postoperative complications were analysed. The prospective controlled randomized study dealt with 300 cases in which the open and the half closed wound treatment was compared. Preoperative data including the papillary bleeding index and the postoperative incidence of infections were analysed. In the open wound healing group, a complication rate of 3%, with less than 1% being infectious, was observed. In the group where a semi-closed procedure was performed, a complication rate of more than 13% with 6% infections was found. It could be demonstrated that poor oral hygiene influences the postoperative infection rate, especially in cases where the semi-closed wound healing was used, whereas open wound healing is less affected by the status of oral hygiene. In both methods approximately three postoperative consultations were necessary. Based on these results, the open wound healing method after surgical removal of lower wisdom teeth is advocated.
Adolescent↗
[Orbital volumetry as a planning principle for reconstruction of the orbital wall].
Before reconstruction of the orbital walls and other surgical procedures concerning the orbits leading to a modification of pathologically altered orbital volumes, it is useful to measure these volumes in order to allow preciser correction. Orbital volumetric studies on 22 patients and 6 dry skulls were performed using high resolution computer tomography. 14 patients presented enophthalmos of various origin, 3 patients fibrous dysplasia involving the orbits and 5 patients showed no orbital pathology. In 10 patients with unilateral posttraumatic enophthalmos an increase of the bony orbital volume of 20.1% in the average was found corresponding to an enophthalmos of 3.5 mm in the average. Correlation between the severity of the enophthalmos and the increase in orbital volume was found. Enophthalmos could not be correlated to the intraorbital fat volume, especially no atrophy of orbital fat could be demonstrated in these patients. Normal orbital volume measurements of patients and dry skulls were compared to those found in the literature. Planning of the surgery was therefore facilitated before correction of enophthalmos, reconstruction of bony orbital contour after tumor resection and in patients with fibrous dysplasia. Results suggest that the bony orbital enlargement, followed by a change in soft-tissue shape and position is the usual cause for posttraumatic enophthalmos. Changes in volume of soft-tissues themselves are less significant.
Cephalometry↗
[Mandibular reconstruction with calvarial bone and temporalis flap].
Eleven patients with reconstruction of a massive mandibular defect with a vascularized full-thickness calvarian bone flap or a free full-thickness calvarian bone flap together with a temporalis muscle flap are reported. In six cases the resection was done because of squamous cell carcinoma, in four cases because of radioosteomyelitis and in one case because of gun shot trauma. In one case we lost the whole calvarian bone because of necrosis and in another case a permanent palsy of the frontal branch of the facial nerve remains. An advantage of using full-thickness calvarian bone flaps is that the donor area is in the same operation field and that the thickness of bone allows insertion of titanium osseointegration posts, which was done in five patients. The transplantation of full-thickness calvarian bone and temporalis muscle is a real alternative to an osseomyocutaneous microvascularized free flap for reconstruction of the mandible in cases where the neck was operated and radiated before, and anastomosis may be critical. Further advantages are virtual absence of postoperative pain in the donor area and an invisible scar. With this method we can reach satisfying functional and esthetic results.
Adult↗
Should titanium miniplates be removed after bone healing is complete?
A prospective study of 32 patients was performed to analyze black pigmentation in the soft tissue covering titanium miniplates. This soft tissue was compared with the soft tissue covering Champy stainless steel plates. All plates were removed 8 months after application. Macroscopically visible pigmentation was found in 25.6% of the soft tissue covering titanium miniplates and in none of the soft tissue covering Champy stainless steel plates. Microscopically visible pigmentation was found in 71.8% of the soft tissue covering titanium miniplates and in 65.3% of the soft tissue covering Champy stainless steel plates. Energy-dispersive x-ray analysis of the soft tissue covering titanium miniplates revealed only the presence of titanium dioxide. In the soft tissue near Champy stainless steel plates, chromium, nickel, iron, and molybdenum were found. Electron microscopy showed titanium dioxide to be mainly deposited between the collagen fibers, whereas stainless steel particles were mainly found in giant cells.
Adolescent↗
Cranioplasties for congenital and acquired skull defects in children--comparison of new concepts with conventional methods.
From 1974 to 1992 fifty-two patients with congenital or acquired skull defects were operated at the Department of Pediatric Surgery of the University Children's Hospital of Zurich. By 1988, in 26 patients conventional methods with PMMA (polymethyl methacrylate) plasties or rib plasties were performed. After 1988, in 26 patients skull reconstruction was done by skull splitting, application of lyophilized bone or cartilage or a combination of both. In the latter period, stabilization and fixation was always provided by biodegradable screws and bands. The results of the different techniques were compared in a retrospective fashion. PMMA plasties provided immediately full stability and good cosmetic results. Another advantage was their availability. In one patient (= 4.8%), a wound infection required the removal of the plasty. In two other patients (9.5%), an increasing mobility of the plasty could be observed during skull growth. Rib plasties were not satisfying. Skull splitting or reconstruction with lyophilized bone or cartilage showed good results with a stable integration within 3-4 months. In one patient (4%), a superficial wound infection occurred, but it did not affect the plasty. From the present study, we conclude that skull splitting or the reconstruction of skull continuity by means of lyophilized bone or cartilage with fixation through biodegradable screws and bands are the methods of first choice in children, because they are fully integrated, avoid foreign material and might have a slightly lower risk of infection. In addition, removal of the implants may be avoided.(ABSTRACT TRUNCATED AT 250 WORDS)
Biodegradation, Environmental↗
[Comparative results of tertiary repair with the Boyne flap or with the vestibular mucoperiosteal rotational flap].
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Adult↗
The use of the Cell Saver in transoral maxillofacial surgery: a preliminary report.
In a prospective study with 18 patients, the Cell Saver was used in transoral operations. Blood cultures were taken immediately before retransfusion, 15 min, 2 and 24 h after retransfusion. As a clinical consequence we noticed a higher increase in temperature because of the transient bacteraemia. Other negative clinical consequences were not observed. If adequate antibiotic prophylaxis is used with careful patient selection, we think that the Cell Saver can even be used in transoral operations, although the number of observations is too small to allow definitive conclusions.
Adolescent↗
[Osteomyelitis in congenital analgesia].
Presentation of a case of a congenital analgia, who showed as a complication a chronical osteomyelitis of the mandible with formation of sequester and fracture. Partial resection of the mandible and immediate reconstruction was done performing simultaneously a rebuilding of the atrophied alveolus by the use of split ribs and fixation with a long miniplate.
Humans↗
[Mandibular sandwich technique build up with lyophilized cartilage].
High resorption rates of onlay bone grafts for augmentation of the atrophic mandible led to the invention of the sandwich technique. In Zurich the first sandwich augmentation procedure with homologous lyophilized cartilage was performed in 1982. 50% of our examined patients were operated on 5 to 8 years ago. We describe the longterm results concerning resorption (23.8% after 4.65 years) and the even integration of the lyophilized cartilage with radiologic evidence of calcification and bony incorporation, even in patients with preoperative severely compromised tissues, as in cases after osteomyelitis or radiotherapy.
Adult↗
[Pathological changes in face and skull in acromegaly].
31 patients (mean age 52.7 years) suffering from persistent symptoms of a growth hormone producing pituitary adenoma underwent both clinical and roentgenological examinations. The results of standardized x-ray analysis of the viscero- and neurocranium were compared with those of a group of 25 healthy subjects (mean age 42.1 years): Although several remarkable changes were observed, statistically significant changes of the facial skeleton could be found only in the lower jaw. The main contribution to its elongation was given by the chin prominence and the condyle. The findings in the neurocranium could be divided in symptoms of first and symptoms of second choice. With the help of these parameters, a score was established to facilitate interpretation of early signs of acromegaly in lateral skull radiographs. Two clinical symptoms found in our patient sample have not been mentioned before in literature about acromegaly: the so-called "hanging columella" and marked changes in diameter of the canalis mandibularis.
Acromegaly↗
Malignant melanotic schwannoma of the oral cavity.
Intraoral malignant melanotic schwannoma is an extremely rare tumor. Two cases are presented, one occurring in the mandible of a 62-year-old man, the other in the maxilla of a 79-year-old man. The clinical presentation, light microscopic findings and immunohistopathological features are described. The difficulty of diagnosing this special tumor at initial presentation correctly, is discussed.
Aged↗
[The ameloblastic fibro-odontoma].
The ameloblastic fibro-odontoma is a rare nonagressive mixed odontogenic tumor. Most of these lesions occur in patients under 20 years. There is no sex predilection. They are located more often in the mandible, usually in the posterior segment. Painless swelling in the most common clinical sign. Radiologically, ameloblastic fibro-odontomas show a circumscribed radiolucency which contains radiopaque foci of various sizes and shapes. Histological examination reveals fibrous soft tissue and islands of odontogenic epithelium. The tumor produces enamel or enamel matrix, dentin and cementum. Treatment of ameloblastic fibro-odontomas usually consists of enucleation or surgical curettage. Eight cases of ameloblastic fibro-odontoma are reported and the clinical features, radiographic and histo-pathologic findings will be discussed along with the 67 cases found in the literature.
Adolescent↗
[New methods of oral rehabilitation. Combination preprosthetic surgical operations with endosseous screw implants].
New methods developed in 1987 by the author are described which make the setting of titanium screw implants also possible in extreme cases of mandibular and maxillary atrophy. We describe the first time the posterior mandibular sandwich procedure after lateralization of the alveolar nerve which is a new preprosthetic method even without setting of implants. The anterior mandibular sandwich procedure is a new combination of the Schettler-method 1976 and the placement of titanium implants with interpositioning of autologous as well as lyophilized sterilized bone or lyo-cartilage. A new development is the Le Fort I-osteotomy of the extremely atrophic maxilla with total removal of the mucosa from the floor of the sinus and its obliteration using bicortical iliac crest bones fixed by titanium screw implants (Sailer, 1989). Simultaneously the intermaxillary relation is corrected and a submucous vestibuloplasty performed. Another new method is the vertical maxillary sandwich procedure designed for the extreme narrow alveolar ridge; the method fills a gap of conventional preprosthetic procedures and can be used with bank bone and bank cartilage, but also together with titanium screw implants placed extraorally into iliac crest grafts which are squeezed between the maxillary alveolar lamellae. The bucco-labial bony lamella is pedicled to the submucous tissues and to the periosteum, a submucous vestibuloplasty is always performed. The new methods are a breakthrough in preprosthetic surgery which allow the setting of long implants in cases of severe mandibular and maxillary atrophy. Fixed and hybrid suprastructures are now possible in these cases. The aesthetic aspects are convincing.(ABSTRACT TRUNCATED AT 250 WORDS)
Alveolar Bone Loss↗
[Application of endosseous screw implants. Indications and planning].
To achieve long term positive results for endosseous dental implants, three points have to be considered: the osséointegration, the correct indication and the suprastructural planification designed for the spécific type of implant. If the surgery part is done by a different practitioner as the prosthetic part, tight coworking for planning is necessary and the responsibility in each step has to be cleared in advance. The planification in implant cases is divided into three stages: clearing of contraindications, choice of the suprastructure, and the surgery planning. Aids for exact localisation of the implants are presented.
Aged↗
[Long-term results of surgical-orthodontic treatment of open bite deformity by a Le-Fort-I osteotomy].
One year after the surgical correction of open bite deformity by a Le-Fort-I osteotomy, which in all cases was combined with presurgical orthodontic treatment, the stability was examined using clinical and computer assisted cephalometric methods. The results show that long term stability were obtained. The Le-Fort-I osteotomy, in combination with orthodontics, gives more stable and more predictable results when compared with results obtained after mandibular osteotomy.
Female↗
[Results of resection and simultaneous reconstruction of the mandible in osteomyelitis and radioosteomyelitis].
Results after simultaneous resection and reconstruction of the mandible in odontogenic osteomyelitis and in radio-osteomyelitis are reported from the Department of Maxillofacial Surgery, University Hospital Zurich. In addition a comparative study is presented in cases of radioosteomyelitis of simultaneous resection and reconstruction and of resection and secondary reconstruction after an interval free of infection. The results after simultaneous reconstruction in cases of odontogenic osteomyelitis are identical to those achieved in non-infected cases. The results after simultaneous reconstruction in cases of radioosteomyelitis seem to be superior to those of secondary reconstruction after an infection free interval. In both groups a high rate of complications is found; their management need extensive experience in reconstructive maxillofacial surgery. Whenever possible we perform nowadays the replacement of hard and soft tissues in severe cases of radioosteomyelitis, f.i. using the pedicled temporalis muscle flap plus a free bone graft or the osteomyocutaneous pectoralis major flap. The use of free microvascular tissue transfer in high dose irradiated patients with uni- or bilateral neck dissection seems less suitable than expected.
Humans↗