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Biomedical subjects

H P Freihofer

Publications and source records attributed to H P Freihofer.

At least 37 records · Page 2Linked to original sources
PubMed1998

Successful surgical repair of progressive exophthalmos caused by a meningocele in a patient with neurofibromatosis Type 1. Case report.

A case of surgical repair of progressive exophthalmos of the right eye in a 43-year-old woman with neurofibromatosis Type 1 (NF1) is presented. Preoperatively, the patient's ocular movements and visual fields were intact. Visual acuity was 20/30 on the right side and 20/20 on the left. Computerized tomography scanning demonstrated complete absence of the superolateral orbital wall on the right side with a large meningocele protruding into the right orbit. Intraoperatively, a new superolateral wall was constructed using the inner table of the left frontal bone as a bone transplant. A free galeoperiosteum flap was used for water-tight dural reconstruction. A few weeks postoperatively the patient's exophthalmos showed remarkable resolution. Her ocular movements, visual acuity, and visual fields remained unchanged. In conclusion, reconstruction of the superolateral wall and repair of a meningocele in a patient with NF1 is worthwhile and can be followed by excellent cosmetic results. More important, the patient's visual functions remain preserved.

Adult↗
PubMed1998

[Syndromes. 1. Cleidocranial dysplasia].

Dysostosis cleido-cranialis is mainly characterized by a pathognomonic deformity of the skull, a hypoplastic midface, lack of eruption of permanent teeth, supernumerary teeth, defects in the clavicles, short stature and multiple other skeletal deformities. The inheritance is autosomal dominant, but there is a considerable number of new mutations.

Cephalometry↗
PubMed1998

[Syndromes 6. Crouzon's disease].

Morbus Crouzon is a syndrome with craniosynostosis. Besides a deviating form of the skull this causes a retropositioned middle third of the face. Therefore pseudo-exophthalmos, strabismus and an Angle Class III relation of the jaws are usually seen. The eyes are especially vulnerable. Since the symptoms are rather symmetrical, a good result of the corrections can usually be achieved. The form of the skull will be corrected in very early childhood, while the deformities of the face are by preference operated after completion of growth. However, different reasons can be found to start correction in an earlier stage.

Craniofacial Dysostosis↗
PubMed1998

[Syndromes 2. Pfeiffer syndrome].

Acrocephalosyndactylias are syndromes characterized by abnormalities of the head (craniosynostosis), the face (hypertelorism, retromaxillism), hands and feet (cutaneous or bony syndactyly). Inheritance is autosomal dominant, but spontaneous cases are described also. The group is divided into several syndromes with varying penetrance and expressivity. As an example of an acrocephalosyndactylia is the Pfeiffer syndrome presented.

Abnormalities, Multiple↗
PubMed1998

Stability of transverse maxillary dental arch dimensions following orthodontic-surgical correction of anterior open bites.

A sample of 130 patients with vertical maxillary hyperplasia; mandibular hypoplasia with a high mandibular plane angle; narrow, tapered maxillary dental arch form; and anterior vertical open bite were collected from three different institutions to evaluate the stability of transverse maxillary arch dimensions after correction of the open bite. Surgical treatment consisted of Le Fort I or bimaxillary osteotomies. Intermolar, interpremolar, and anterior arch widths were measured three-dimensionally on dental casts using a Reflex microscope, and transverse stability after orthodontic or surgical maxillary expansion was analyzed. Orthodontic expansion followed by a one-piece Le Fort I intrusion osteotomy was performed in 77 patients, and surgical maxillary expansion by a multisegment Le Fort I intrusion osteotomy was performed in 53 patients. The increase of transverse arch width and the relapse after orthodontic or surgical expansion were not significantly different. The transverse arch width in these two groups did not relapse in 20% of the patients after a mean follow-up of 69 months. An additional bilateral sagittal split osteotomy had no detectable effect on stability. Patients who underwent a multisegment Le Fort I osteotomy stabilized with rigid internal fixation showed better transverse stability than those with intraosseous wire fixation and maxillomandibular fixation. Maxillary intermolar and interpremolar arch width relapses were not correlated with tongue interposition or loss of interdigitation. The relapse of these arch widths showed significant correlations with clockwise rotation of the mandible but not with changes of overbite or overjet.

Adolescent↗
PubMed1997

Ectodermal dysplasia, cleft lip/palate, and severe cutaneous and osseous syndactyly in a mentally retarded girl: a new multiple malformation syndrome.

A 13-year-old mentally retarded girl with severe cutaneous and osseous syndactyly of the hands and feet, cleft lip/palate, and ectodermal dysplasia is presented. We conclude that the pattern of malformations described represents a new multiple malformation syndrome. A comparison with Zlotogora-Ogür syndrome is presented.

Abnormalities, Multiple↗
PubMed1997

Skeletal and dento-alveolar stability of Le Fort I intrusion osteotomies and bimaxillary osteotomies in anterior open bite deformities. A retrospective three-centre study.

A sample of 267 patients with maxillary hyperplasia, a Class I or Class II/I occlusion and anterior vertical open bites, collected from three different institutions, was analysed regarding stability after surgical corrections. Skeletal and dento-alveolar stability of the maxilla, and positional changes of the mandible and of the incisors were evaluated. All patients underwent Le Fort I intrusion osteotomies and in 92 patients segmentation of the maxillae was performed. An additional bilateral sagittal split advancement osteotomy was performed in 123 patients. Intraosseous wire fixation was used in 153 patients and rigid internal fixation in 114 patients. Cephalometric radiographs were collected before orthodontic treatment, before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). It can be concluded that patients with anterior open bites, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy, exhibited good skeletal stability of the maxilla. Rigid internal fixation produced the best maxillary and mandibular stability. The mean overbite at the longest follow up was 1.24 mm and a lack of overlap between opposing incisors was present in 19%. The overbite did not differ significantly between the different treatment procedures, probably due to compensatory movements of the mandibular and maxillary incisors.

Adolescent↗
PubMed1997

Three-dimensional morphometric analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

A prospective longitudinal study in 75 growing cats was conducted to evaluate palatal soft-tissue expansion in cleft lip and palate surgery. In 31 cats, palatal scars were induced by simulated Langenbeck surgery at the age of 8 weeks. At the age of 14 weeks, custom-made tissue expanders were inserted in 61 animals. Tissue expansion was performed by weekly inflation in 33 cats (16 without and 17 with scars) for an 8-week period. The remaining 28 cats (14 without and 14 with scars) served as sham groups. A control group was formed by 14 animals (without scars and without tissue expander). The effects of the experimental interventions were evaluated on a series of dental casts during the inflation period and until 8 weeks after removal of the tissue expander. The results indicate that soft-tissue expansion of the palatal mucoperiosteum is feasible. Until 20 weeks of age, no differences were found between both expansion and sham groups. Thereafter, significant soft-tissue surface-area gain was quantified in relation to the base surface and base diameter of the tissue expander. Iatrogenic side-effects of active tissue expansion consisted of significant transversal growth retardation in the anterior part of the bony palate and dentoalveolar structures. After removal of the tissue expanders, some accelerated growth in the tissue-expansion, scarred-tissue group was seen. It is concluded that palatal soft-tissue expansion is possible in growing cats, with and without the presence of palatal scars; however, this technique, like other kinds of palatal surgery, impairs dentomaxillary growth and development.

Age Factors↗
PubMed1997

Improvement in oral function following tumour surgery by a combination of tongue plasty by the Steinhäuser technique and osseointegrated implants.

Oral functions such as speaking, chewing and swallowing are often reduced after ablative tumour surgery in the mouth and oropharynx. For restoration of at least a part of these functions, stable dentures and satisfactory mobility of the tongue are necessary. Dental implants can be used to achieve stable dentures. Pre-implant surgery, however, is often needed to reduce the amount of bulky tissue when myocutaneous flaps have been used for reconstruction, and to achieve adequate mobility of the tongue. A combination of tongueplasty by the Steinhäuser technique and osseointegrated implants will be described and discussed. Twelve patients have been treated by this technique between 1992 and 1995, with a mean follow up of 11.6 months. All patients reported an improved tongue mobility and ability to chew. Tongueplasty by the Steinhäuser technique with secondary epithelialization, in combination with osseointegrated implants, is a simple and effective means of improving oral function.

Deglutition↗
PubMed1997

Profiloplasty: variations in personal views.

There is sometimes controversy among colleagues over treatment plans in orthognathic surgery. This is because there are differing ideas about which part of the facial skeleton should be moved to give an optimal result. A study was therefore set up to obtain insight into the differences between surgeons. Ten unbalanced profile drawings were given to seven experienced surgeons with the request that they draw the profile line which they would like to give these patients. It was acceptable either to draw the profiles 'artistically' off the cuff or to use additional construction lines as long as this was not the profile planning according to Brons and Mulié (1993). The evaluation showed that some surgeons drew profiles which resembled each other to some extent in proportions and inclinations, while others produced variations without any evident regularity and basic concept. The variability per profile was very important in almost all cases. Such discrepancies are not acceptable in a teaching centre.

Attitude of Health Personnel↗
PubMed1997

Tooth eruption through autogenous and xenogenous bone transplants: a histological and radiographic evaluation in beagle dogs.

The effect of implanting autogenous and xenogenous (Bio-Oss) bone transplants into metabolically active sites within beagle dog mandibles during permanent premolar tooth eruption was examined. Ten 14-week-old beagles were used. Before commencing the radiographic experiments, metal bone markers were placed in the caudal margin of the mandible at the age of 10 weeks. The deciduous first and third molar teeth were extracted and their sockets over the permanent second and fourth premolars were implanted with autogenous particulate enchondral iliac crest bone, autogenous particulate membraneous mandibular body bone, xenogenous bovine anorganic bone mineral spongiosa granules (1-2mm3) (Bio-Oss, Geistlich Pharma, Switzerland) of left empty. The third premolar served as control site. Standardized oblique lateral radiographs were taken once a week. A number of coordinates of defined points and structures were determined by means of a coordinate digitizing system. Animals were killed 4, 10 and 16 weeks after bone transplantation for histological examination of the transplantation sites. All premolars showed no delay in eruption or disruption of crown and root development. On histology, the Bio-Oss particles were not resorbed or integrated in the alveolar bone but were pushed forward into the gingiva. We have demonstrated that there is on difference in the eruption curve of the permanent premolars in the four groups (ANOVA P > 0.5) and that bone transplantation has no inhibitory effect on eruption (ANOVA P > 0.3) and crown development of the underlying permanent premolar but that Bio-Oss does not have the same resorbable or integrating capability as autogenous bone grafts.

Alveolar Process↗
PubMed1997

Osseointegrated oral implants in head and neck cancer patients.

After cancer treatment in the head and neck area, mastication and speech are often affected. Some of the problems encountered can be solved by adequate dental rehabilitation. However, dental rehabilitation is often compromised for various reasons. The change in anatomy due to surgery often results in lack of denture-bearing mucosa. The effects of radiotherapy on the salivary glands and the mucosa result in dry oral tissue and diminished retention of removable dentures. Osseointegrated oral implants can help to solve these problems. Although implant treatment for patients with cancer of the head and neck is covered by the Dutch national health insurance, and there is therefore no financial obstacle, implants have not, so far, been widely used with these patients. In order to establish the possible reasons for this, an analysis was performed. Retrospective data on 95 consecutive patients were collected from records. The indication for the use of oral osseointegrated implants was reviewed. Analysis of the data showed that 45% did not need specific prosthetic rehabilitation. An indication for the use of osseointegrated implants was found in 25% of the patients. For various reasons, only 3% actually received implants. In striving to completely rehabilitate a cancer patient, the possible use of osseointegrated oral implants should be evaluated before the initial oncological treatment begins. The insertion of implants during the initial surgical procedure should be considered more often, with a view to reducing the number of surgical procedures.

Adult↗
PubMed1997

Variations in the correction of Treacher Collins syndrome.

A new combination of basically known techniques is described for the correction of Treacher Collins syndrome. The patients are treated in two to three operative sessions beginning early in the second decade of life. The main components are a chin advancement simultaneously with malar osteotomies in a first operation. In the second operation, the chin prominence is moved further forward by a simultaneous vertical movement of the maxilla, sagittal split osteotomy and body osteotomy of the mandible, together with a further chin advancement. Additional finishing touches may ask for a third intervention. Since there is a large variability of expression of the different signs, the techniques have to allow for a good deal of flexibility. The study of 10 patients reflects the considerable variations in the condition at the outset and the adequacy of the basic treatment protocol. The results of malar osteotomies are better than those of pure onlay augmentation. Despite the complexity of the maxillomandibular osteotomies, occlusal results are reasonably stable, and aesthetic improvement is considerable. The adaptation of the treatment to the individual patient resulted in modifications of direction of movement for different segments but also in omission of parts of the standard osteotomies. As a consequence, a modified treatment plan will be used as often as the standard program. The causes for the two not satisfying results are explained, and they demonstrate the limitations of the concept.

Adolescent↗
PubMed1997

Two-dimensional cephalometric analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

The feasibility and possible effects of palatal soft-tissue expansion in palatal repair were studied. A prospective longitudinal animal experiment was performed in 75 growing cats assigned to 5 groups. In 31 cats, a midline defect was made, and bipediced flaps were raised at the age of 8 weeks (stimulated Langenbeck operation) in order to create palatal scars. At the age of 14 weeks, custom-made tissue expanders were inserted palatally in 61 animals. Tissue expansion was performed by weekly inflation in 33 cats (16 without and 17 with scars) for an 8-week period. The remaining 28 cats (14 without and 14 with scars) served as sham groups. A control group was formed by 14 animals (without scars and without tissue expanders). Soft-tissue gain and its effects on maxillofacial growth and development were measured in the midsagittal plane on tracings from standardized lateral radiographs. The effects of the experimental interventions were evaluated for 8 weeks after removal of the tissue expanders. Not all the cats yielded results at all time periods. This study showed that soft-tissue expansion of palatal mucoperiosteum is feasible. The surgically induced scars did not cause significant differences between the different groups in the midsagittal plane, and the data from both expansion and sham groups could be pooled. Significant soft-tissue gain was achieved by the tissue-expansion technique. Iatrogenic side effects were significant anteroposterior growth retardation at the level of the bony palate and an increase in vertical growth of the anterior nasomaxillary height and the posterior skull height during active tissue expansion. After removal of the tissue expanders, some accelerated growth was found in the tissue expansion in the scarred tissue group, with initial correction of the abnormal growth at the cranial base level. It is concluded that palatal soft-tissue expansion is possible in growing cats. This technique, however, impaired maxillofacial growth and development.

Analysis of Variance↗
PubMed1997

[Secondary posttraumatic correction of the face].

Any part of the face may present residual deviations in form and/or function after trauma, even if primary treatment has been executed optimally. Secondary corrections may be indicated as a consequence. The techniques are usually the same as for primary treatment. However since secondary corrections quite often are a consequence of complicated primary problems, it does not surprise, that frequently complex deformities present for secondary surgery. Depending on the nature of the lesion percentages of success between 60 and almost a 100% may be expected. This indicates that additional treatment after primary care may be a way out for quite a number of residual deformities.

Esthetics↗
PubMed1996

Transmandibular implant versus intramobile cylinder implants: a randomized, prospective clinical trial.

A randomized, controlled clinical trial was conducted to compare two different implant treatment modalities for edentulous patients with severely resorbed mandibles. In one modality (the IMZ group), two intramobile cylinder implants were placed, connected by a Dolder bar and provided with an overdenture, and in the other (the TMI group), a transmandibular implant with a triple bar and cantilever extensions was placed, likewise provided with an overdenture. The conditions of the overdentures, the peri-implant tissues, and the implants were evaluated. Orthopantomograms were taken for radiologic evaluation. An overall complication scale which took account of all aspects was devised to compare the results. The follow-up period was 2-4 years, with a mean follow-up of 3 years. The condition of dentures and oral hygiene aspects were comparable for both groups. The complication rate in the TMI group was significantly higher than that in the IMZ group. The scores on the complication scale resulted in a significant difference between the TMI and the IMZ groups (Wilcoxon, P = 0.0044).

Alveolar Bone Loss↗
PubMed1996

Neurofibroma in the articular disc of the temporomandibular joint: a case report.

In classical Von Recklinghausen neurofibromatosis (Type I), skeletal defects occur as a result of abnormalities of derivatives of the neuroectoderm and mesoderm. Temporomandibular joint (TMJ) disorders caused by neurofibroma in the joint capsule or disc have not been reported previously in the English language literature. A case of neurofibroma in the TMJ articular disc in a 29-year-old woman with neurofibromatosis Type I is presented.

Adult↗