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Biomedical subjects

H P Howaldt

Publications and source records attributed to H P Howaldt.

At least 19 recordsLinked to original sources
PubMed1997

[Lateral orbitectomy for correction of endocrine ophthalmopathy].

Grave's disease is often associated with various symptoms summarized as endocrine orbitopathy. A surgical procedure is presented which reduces the exophthalmos by approximately 4.5 mm by resecting the caudal and lateral orbital wall through a subciliar incision. The surgical intervention regularly leads to an amelioration of the functional symptoms of endocrine orbitopathy, such as diplopia, corneal exposure and lid irregularities. In one case an acute reduction of vision on both eyes significantly ameliorated immediately after surgery. The operation described also improves the aesthetic appearance of the patients, who often suffer psychologic impairments associated with Grave's disease.

Decompression, Surgical↗
PubMed1996

Mandibular distraction osteogenesis as first step in the early treatment of severe dysgnathia in childhood.

The sole orthodontic treatment of severe dysgnathias in childhood often leads to unsatisfactory results. On the other hand, standard surgical procedures are very difficult and due to their high risks not practicable in early childhood. The distraction osteogenesis enables us to correct hypoplastic mandibles, so that secondary malformations of the midfacial complex can be avoided. During the operation the hypoplastic site of the mandible is osteotomized behind the last visible tooth bud and a bidirectional distractor is inserted. Following the principles of Ilizarov the new callus is lengthened gradually until the required length of the mandible has been achieved. Out of a total sample of 27 patients 3 case reports of young children are presented. The new surgical concept describes new treatment perspectives.

Adolescent↗
PubMed1996

Correction of mandibular hypoplasia by means of bidirectional callus distraction.

The method of gradual callus distraction proved to be very useful in augmenting hypoplastic mandibles. When performing our first series using a unidirectional distractor, we faced some problems in determining the direction of lengthening. Moreover, postoperative adjustments were not possible. On the basis of this experience, we developed a bidirectional lengthening device consisting of two limbs and a variable angulation piece. This allows distinct control of the vertical and horizontal components of the distraction. The method proved effective and reliable in 18 patients with various degrees of mandibular hypoplasia. The median follow-up period was 10 months (range, 1-19 months).

Adolescent↗
PubMed1996

[Mandibular micrognathism as a sequela of early childhood capitulum fractures and their treatment using distraction osteogenesis].

We report about our experience in five patients who suffered from a mandibular micrognathia after ancylosis of the temporomandibular joint. At first the ancylosis was removed using a costochondral graft. About one year later, the mandible was cut by an osteotomy behind the last visible toothbud and a distractor was inserted. The mandible was to a slide overcorrection. This has to be taken into account to compensate a certain relapse. At first we used an unidirectional device, for one and a half years we have used a bidirectional device (Normed from Tuttlingen/Germany) which enables us to correct mandibular hypoplasias more adequately. Up to now our experience shows, that gradual callus-distraction leads to stable normalization of mandibular hypoplasias. Functional problems concerning chewing and speech are solved, the dramatical improvement of the profile of the face may avoid psycho-social problems for these patients.

Adolescent↗
PubMed1995

[Standardized documentation of patho-anatomic findings using ADT (Association of German Tumor Centers) tumor forms for malignancies of the mouth, jaw and face (version III)].

The documentation form for pathohistologic findings (version III) for tumors of the maxillofacial region is presented. It is part of the site-specific documentation of the German Association of Tumor Centers (ADT). Its handling is explained by instructions which are based on the ICD-O classification and the TNM system. The prognostic relevance of the standardized documentation has already been proven by various histomorphologic investigations concerning oral and oropharyngeal cancer. By means of a multicentric observational study the German Austrian Swiss co-operative group DOSAK will develop a new prognostic model for oral and oropharyngeal cancer.

Documentation↗
PubMed1995

Lengthening of the hypoplastic mandible by gradual distraction in childhood--a preliminary report.

Uni- or bilateral mandibular hypoplasia can be associated with various syndromes or is acquired after early traumatic or inflammatory disease in the temporomandibular joint (TMJ). Early treatment is necessary to avoid consequent impairment of midfacial growth. The standard treatment of these malformations consists of the application of bone grafts which can lead to unpredictable growth. Furthermore, these procedures often require intermaxillary fixation and sometimes blood transfusions. Lengthening of the mandible by gradual distraction, according to the method of Ilizarov, opens new perspectives for interceptive therapy. This paper reports on this method applied in 9 cases of mandibular hypoplasia. Out of 3 bilateral and 6 unilateral mandibular distractions the average amount of bone lengthening was 21 mm, ranging from 15 to 25 mm. In order to facilitate ossification, the mandibles were maintained in external fixation for an average of 9 weeks subsequent to the period of active lengthening. Thereafter, immediate postoperative orthodontic treatment is necessary to avoid a relapse. No complications were noted during the follow-up period (max 17 months).

Adolescent↗
PubMed1995

Three years of experience with the free vastus lateralis flap: an analysis of 30 consecutive reconstructions in maxillofacial surgery.

Free vastus lateralis flaps for maxillofacial reconstruction were used in 30 patients. On the basis of its anatomy, this flap can be inserted as a musculocutaneous or musculofascial transplant in slim or normal-weight patients if extensive defects exist. The microvascular transfer is facilitated and accelerated by the long and high-caliber vascular pedicle and flap raising, which can be performed at the same time as tumor resection. We see indications for the musculocutaneous transplant in almost all sections of the oral cavity, particularly for tongue reconstruction; the vastus lateralis flap can be inserted in a purely muscular form for defect coverage on the scalp in connection with split skin. The donor defect is minimal functionally and aesthetically, and the success rate is approximately 90% for all flap transfers.

Adult↗
PubMed1994

Transnasal approach to the orbit, the interorbital space, and the nasopharynx.

We present a surgical procedure that provides exposure to the medial part of the orbit, the interorbital space, and the nasopharynx. A midline incision of the nose is followed by a pedicled osteotomy of the lateral nasal wall and the medial wall of the orbit in one piece. This transnasal approach provides good exposure to the medial parts of the craniofacial junction to remove foreign bodies or benign tumors.

Angiofibroma↗
PubMed1994

[Orbital reconstruction with tabula externa for correction of post-traumatic enophthalmos].

In general the posttraumatic enophthalmos results from an enlargement of the orbit mainly in its dorsal part. The surgical correction must be performed in this particular part and calvarian bone grafts are very suitable for the procedure. In 20 patients the aesthetic appearance could significantly be approved. Anyhow functional aspects, mainly the binocular vision, must not be neglected.

Bone Transplantation↗
PubMed1994

[High caloric parenteral nutrition in patients with mouth and oropharyngeal cancers--a clinical study].

Patients with carcinomas of the oral cavity and oropharynx often show signs of malnutrition. This is caused by reduced intake in patients due to chronic alcoholism resulting in suppressed appetite and disturbed gastrointestinal functions. Also the growth of the tumor can cause painful swallowing. The effects of chronic malnutrition reduce patients tolerance regarding surgical treatment, chemotherapy and radiation. A pretherapeutic parenteral balanced nutrition should achieve an anabolic metabolism. Changes in body cell mass (bcm) as a parameter of total protein synthesis can be estimated by bioelectrical impedance analysis in order to prove the success of this management. Twenty-eight patients participated in this study, divided into three groups: group 1 = 18 male subjects and group 3 = 3 female subjects, all able to be operated upon, and group 2 = 7 male subjects, not able to be operated. High caloric nutrition in group 1 lead to a higher increase of bcm than in group 2. The review of single cases showed that in both groups one part of the patients failed increasing bcm despite nutrition. The therapeutic response was correlated to survival by means of a Kaplan-Meier analysis and a Cox-model. Survival probability could positively be correlated to an increased bcm.

Adult↗
PubMed1993

A comparison of radical and conservative neck dissection.

A review is presented of the confusing terminology applied to the various types of neck dissection. It is recommended that the terms "conservative" and "radical" be based on clear definitions. The fourth prospective, randomized DOSAK therapy study deals with the controversial issue of radical as compared with conservative neck dissection. Patients with squamous cell carcinoma (SCC) of the oral cavity who had not been treated before were randomized and stratified according to the DOSAK treatment-dependent prognostic index (TPI). At present, 104 patients have been evaluated, of whom 48 had radical neck dissection, and 56 conservative neck dissection. Tumor location and patient age and sex are equally divided in both therapy groups. After an average follow-up time of 460 days, the relative mortality for both therapy groups is 23%. At this stage, there is no difference between the two groups in the percentage of patients with complete remission or in the percentage of patients alive. At this stage, there appears to be no difference between the two groups with regard to patient survival or recurrent disease.

Carcinoma, Squamous Cell↗
PubMed1993

Proposal for a modified T-classification for oral cancer. The DOSAK.

The UICC plans to publish a modification of the TNM system. A proposal for a T category is calculated out of the data from the DOSAK tumour registry containing more than 3000 cases of primary squamous cell carcinomas of the oral cavity & oropharynx. By adding tumour thickness as a factor of the T component, the prognostic relevance of the classification is enhanced.

Carcinoma, Squamous Cell↗
PubMed1993

A novel technetium-99m labeled monoclonal antibody (174H.64) for staging head and neck cancer by immuno-SPECT.

A novel murine monoclonal antibody (MAb 174H.64) was labeled with 99mTc by a direct method. MAb 174H.64 detects a cytokeratin-associated antigen which is expressed by over 90% of all squamous cell carcinomas. Panendoscopy, sonography and computerized tomography scan were performed in all cases as well as magnetic resonance imaging (in selected patients). Pre-operative immunoscintigraphy was performed in 21 patients with histologically proven primary carcinomas (18 with remaining primary tumors and 3 with lymph node recurrences). Scintigraphic images were obtained 4-6 h after injection of 1.1 GBq of the 99mTc-labeled antibody (2 mg). Late images were acquired 18 to 24 h after injection. Single-Photon-Emission-Computed Tomography (SPECT) of the head and thorax was performed in all patients. The primary tumors were immunoscintigraphically visualized in all 18 patients with remaining primary tumor. Fifteen of 18 loco-regional lymph node metastases were visualized by immunoscintigraphy (the smallest lesions had a diameter of < 1 cm), in one patient lymph node metastases were detected by immunoscan only. Two metastatically involved lymph nodes were identified by histology only (micrometastases). Distant metastases were present in 3 patients, of which two were identified by immunoscintigraphy. Immuno-SPECT according to this method was a sensitive and specific imaging modality for preoperative staging of patients with squamous cell carcinoma of the head and neck and detected lymph node metastases with higher accuracy than conventional clinical and imaging modalities.

Animals↗
PubMed1992

[Fiberoptic intubation as a safe method for the treatment of odontogenic abscesses].

Infections caused by dental disease may result in severe swelling of the throat and whole neck. In an operation for opening an abscess, the initial phase of general anaesthesia is often critical due to obstructions of the airway and trismus. Therefore the wide use of a fibre-optic intubation is advocated in order to avoid an emergency tracheostomy or other complications.

Airway Obstruction↗