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Biomedical subjects

H P Freihofer

Publications and source records attributed to H P Freihofer.

At least 19 recordsLinked to original sources
PubMed1992

Long-term results on the quadrangular osteotomy.

The results of a follow-up study of 17 patients who underwent a quadrangular osteotomy, are presented. The indication for a quadrangular osteotomy includes a hypoplastic maxilla with retruded infra-orbital rims and infra-orbital area, but with normal nose projection. Almost all patients were satisfied with the result. Relapse in a horizontal direction appeared to be approximately 12%; however, considerable relapse was seen in the vertical direction (61.7%-158%). A major problem during operation appeared to be the high rate of fractures of the infra-orbital wing. Sensory loss in the area of the infra-orbital nerve occurred in 79% of the operated sides. Four patients needed surgical correction of conditions that should be considered complications resulting from the osteotomy, including a case of partial ischaemic necrosis of the premaxilla in a BCLP patient.

Adolescent↗
PubMed1992

The chin as a donor site in early secondary osteoplasty: a retrospective clinical and radiological evaluation.

26 unilateral cleft palate patients received an autogenous bicortical chin bone graft for early reconstruction of the alveolar process. In the evaluation of the donor site, 4% of the anterior teeth showed a negative pulpal sensibility, less than 1% a peri-apical granuloma and 12% pulp canal obliteration. The tooth buds of the canines showed developmental disturbances in 6%. Exposure of unerupted canines should be avoided, and a 5 mm safety margin is advised. Based on its architecture, topographic accessibility, minimal post-operative morbidity and absence of visible scars, the chin can be considered to be a very useful donor site in bone grafting procedures.

Alveolar Process↗
PubMed1991

Early secondary osteotomy-stabilization of the premaxilla in bilateral clefts.

Using the same arguments as for early bone grafting of the alveolar process in unilateral clefts, the cleft team of the University of Nijmegen started about 10 years ago to apply early osteotomy-stabilization of the premaxilla to bilateral clefts. A series of 13 cases with a minimum follow-up of 15 months is presented. The patients were operated on at the age of 8 2/12 to 12 5/12 years. The results are considerably better than when doing the same operation in the adult. More than 90% are successful. In comparison with adults we additionally register more favourable eruption of the canine, the possibility of closing the dental arch without prosthetic appliances and in some cases also the elimination of a psychological handicap. The inhibition of growth by this operation seems not to be important. If need be, Le Fort I osteotomies are possible after completion of growth. They will be in one piece which is technically easier than the usual three-segment Le Fort I. In conclusion we prefer early secondary osteotomy and stabilization of the premaxilla to the tertiary operation.

Alveoloplasty↗
PubMed1991

Restricted opening of the mouth with an extra-articular cause in children.

Restricted opening of the mouth with an extra-articular cause (ROMEC) can have very different aetiologies. A series of 6 children, who have been operated on under 4 different diagnoses, are presented. Excluded are common problems such as recent trauma and posttraumatic scarring, craniomandibular dysfunction or elongated coronoid process, and also tumours. Problems of establishing the diagnosis, surgical treatment, postoperative physiotherapy and timing are discussed. It is shown that none of the cases is a perfect result, some outcomes are even very disappointing. It is therefore concluded that absolute trismus should be treated independently of age. The result expected will be mediocre. For final correction it is suggested that the operator should wait preferably until the second growth spurt has passed. The same goes for children presenting primarily with a mouth opening greater than 20 mm.

Child↗
PubMed1990

Early secondary bone grafting of alveolar cleft defects. A comparison between chin and rib grafts.

Since 1981 in cleft lip and palate patients a combined surgical-orthodontic procedure has been performed to eliminate the residual alveolar cleft. For early secondary bone grafting (before the eruption of the canine tooth) initially the graft tissue of choice was rib. Since 1984 chin bone has also been used. Sixty one patients with complete unilateral clefts were reviewed (mean age 9.5 years). 15.7% of the rib graft cases showed resorption of the graft of 50% and more. Such resorption was not found in any of the chin graft cases. No complications such as wound dehiscence, sequestration, excessive resorption of bone or recurrence of an oro-nasal fistula were found in the chin graft group. This leads to the conclusion that if enough bone is available in the chin region to bridge the defect, this graft is preferable to a rib graft.

Adolescent↗
PubMed1990

Sensibility and cutaneous reinnervation of pectoralis major myocutaneous island flaps. A preliminary clinical report.

The cutaneous sensibility of 13 pectoralis major cutaneous island flaps has been investigated retrospectively. Although in raising the pectoralis major myocutaneous island flap sensory denervation of the skin is produced, after a mean follow-up period of 29 months (range 5 to 71 months), 68% of the cutaneous portion of the flap revealed sensibility to touch, suggesting a reinnervation from the surrounding intact oral mucosa or skin. The rate of reinnervation was found to be related to the sensibility present in the surrounding tissue.

Adult↗
PubMed1990

[Transposition of the temporal muscle in the surgical treatment of cleft palate].

The use of the temporalis muscle flap presents a great interest for the surgical repair of cleft palate. The simplicity of the technical procedure, the absence of cosmetic and functional sequelae, and the excellent morphological results lead us to affirm its efficacy in the reconstructive surgery of the palatine region. The Authors report a clinical case and describe the surgical procedures utilized.

Adult↗
PubMed1990

Four-step mandibular lengthening to correct a bird face deformity. A case report.

A technique for extreme lengthening of the mandible is presented. In one operation it combines several procedures already known, modifying some of them. Its advantage is that the movement is subdivided in 4 steps. Thereby the need for grafting is reduced or even absent and the amount of relapse is probably less important than if fewer but bigger movements were applied.

Adolescent↗
PubMed1989

Stability after osteotomy of the edentulous maxilla.

The results after advancement and lowering of the edentulous maxilla after a mean follow-up of 21 months are presented. Eight cases were stabilized with wire osteosyntheses, eight others with miniplates. In contrast to earlier reports considerable variation of the results after a longer follow-up was found, although the means of the whole group do not differ very much from other series. It is concluded that the Le Fort-I operation is more reliable for the augmentation of the edentulous maxilla than onlay grafting. Better results are achieved after stabilization with miniplates than with wiring.

Adult↗
PubMed1988

Replacement of the damaged interarticular disc of the TMJ.

Meniscectomy should be abandoned and the removed, damaged disc of the TMJ should be replaced in patients suffering from internal derangement of the TMJ. In seventeen patients the disc which was removed, was replaced with fresh autogenous auricular cartilage. The follow-up period ranged from one to six years with a mean of almost three years. From the analysis of the results we concluded that all patients showed a postoperative improvement in their symptoms and joint function and that the use of intermaxillary fixation for a short period postoperatively had a significant effect on the subsequent increase in mouth opening.

Adult↗
PubMed1987

Secondary post-traumatic periorbital surgery. Incidence and results.

Over a 6 year period 20 patients presented for secondary corrections of the periorbital region after trauma. Corrections after isolated fracture of the zygoma were necessary in 6 cases, mainly comprising re-osteotomies and contour corrections. A tertiary correction was needed only once (17%). Secondary treatment was indicated in 6 patients after fracture of the midface, necessitating mainly re-osteotomies of the zygoma, corrections of the nose and canthopexies. Tertiary corrections were performed in 3 cases (50%). In 8 patients the results of treatment of fronto-orbito-nasal fractures required further improvement. Again, osteotomies of the zygoma, corrections of the nose as well as corrections of scars and bony contours were often indicated. Four cases (50%) needed tertiary surgery. It is concluded that the more serious the primary trauma the greater the necessity for further secondary surgery. Independently of the kind of primary trauma the indication for secondary treatment was, in most cases, aesthetic. Not only was the number of re-osteotomies and nasal corrections high, but also the number of tertiary revisions. While this might not be very surprising for the nose, it is for the zygoma and proves the difficulties which arise for perfect positioning when there are no clear landmarks. Forty percent of all patients underwent tertiary and one patient needs a quaternary correction.

Adult↗
PubMed1986

The reaction of the periodontium to different types of splints. (I). Clinical aspects.

To study the influence of splints on the periodontia over a period of time, Obwegeser and Merkx splints were applied on beagles. Clinical evaluation using different periodontal parameters was carried out before, and 48 h, 3 weeks and 6 weeks after splinting. It was shown that both splints act as plaque-retentive devices and provoke gingival inflammation. A statistically significant difference between both splints could, however, only be demonstrated for the plaque index.

Animals↗
PubMed1986

The reaction of the periodontium to different types of splints. (II). Histological aspects.

To study the influence of splints on periodontal tissues, Obwegeser and Merkx splints were applied to beagles. Histological evaluation was performed after splinting periods of 48 h and 6 weeks. After 48 h, gingivitis had developed when using both types of splints. After 6 weeks, the adverse effects of the splints were more predominant. Gingivitis had become severe and mild periodonitis had developed. In the case of Merkx splints, the periodontal ligament appeared to be somewhat less affected but the condition of the gingiva appeared to be somewhat worse than in the case with Obwegeser splints. For both types of splints, it is important that clinical application should be attended by measures not only to reduce plaque accumulation, but also to minimize trauma due to their application and continuous mechanical irritation of the tissues.

Alveolar Process↗