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Biomedical subjects

H Schierle

Publications and source records attributed to H Schierle.

7 recordsLinked to original sources
PubMed2004

Ortho- and heterotopic bone grafts in bifocal transport osteogenesis for craniofacial reconstruction--an experimental study in sheep.

Bifocal transport osteogenesis (BTO) is a promising technique for the reconstruction of extended osseous craniofacial defects. Aim of this study was to determine the potential of this technique related to various donor sites of the transport segment. In 10 adult sheep critical size defects of the calvaria were treated by gradual movement of a transport segment consisting either of autogenous regional free calvarial bone grafts (n=5) or autogenous illiac free bone grafts (n=5). Latency period was 5 days; the rate of distraction was 1mm per day and extended approximately 40 days. The consolidation period was 28 days. After harvesting, specimens were investigated by conventional radiography, CT-scans, histologically and by fluorescence. In both groups transport osteogenesis resulted in a complete closure of the critical size defect. Membranous bone formation and remodeling occurred during the entire period of distraction and consolidation. The volumes and thickness of newly formed bone at the defect site were increased significantly when calvarial bone grafts were used (P<0.05). Iliac bone grafts became progrediently smaller during distraction, while the volume of calvarial grafts remained relatively constant (P<0.05). In conclusion, transport segments consisting of calvarial and iliac bone resulted in a reliable closure of craniofacial critical size defects in adult organisms; the application of calvarial bone grafts resulted in an increased extend of bone formation.

Animals↗
PubMed2001

Craniofacial distraction osteogenesis: a review of the literature: Part 1: clinical studies.

A review of the literature dealing with distraction osteogenesis (DO) of the craniofacial skeleton, provided by a PUBMED search (National Library of Medicine, NCBI; revised 3 April 2000) from 1966 to December 1999 was conducted. Key words used in the search were distraction, lengthening, mandible, mandibular, maxilla, maxillary, midface, midfacial, monobloc, cranial, craniofacial and maxillofacial. This search revealed 285 articles. One hundred and nine articles were clinically orientated and were analysed in detail in this study. The type of distraction, indications, age, type of surgery, distraction rates and rhythms, latency and contention periods, amount of lengthening, follow-up period, relapse, complications and the nature of the distraction device were analysed. This review revealed that 828 patients underwent DO of the craniofacial skeleton; 579 underwent mandibular DO, 129 maxillary DO, 24 simultaneous mandibular and maxillary DO and 96 midfacial and/or cranial DO. Craniofacial DO has proven to be a major advance for the treatment of numerous congenital and acquired craniofacial deformities. Treatment protocols and success criteria for craniofacial DO are suggested on the basis of these results. There is still, however, a lack of sufficient data, especially on follow-up and relapse, so that treatment strategies have to be validated by long-term studies in the future.

Adolescent↗
PubMed2000

Maxillary distraction osteogenesis: a two-dimensional mathematical model.

Patients with cleft lip and palate with severe maxillary retrusion usually have a mandible with anterior-superior autorotation and subsequent overclosure and loss of the vertical facial dimension. Maxillary distraction osteogenesis can correct the sagittal maxillomandibular relationship and should simultaneously reestablish vertical dimension through maxillary vertical height increase and clockwise rotation of the mandible to restore facial balance. We present a two-dimensional mathematical model in the sagittal plane, which reestablishes sagittal and vertical skeletal deficiencies and proper occlusal alignment for planning maxillary advancement with distraction osteogenesis in patients with cleft lip and palate. The model is illustrated in a case of a 13-year-old boy with a complete bilateral cleft lip and palate and severe maxillary retrusion. The two-dimensional mathematical model described in this article allows the surgeon and orthodontist to calculate in a simple and accurate way the ideal distraction vector to advance the maxilla to its desired position.

Adolescent↗
PubMed1999

[Complex reconstruction of the area of the maxilla and mid-face after radical tumor surgery].

The esthetic and functional restoration of facial defects is always a daunting challenge. The advent of free vascularized tissue transfers in combination with oral implants enables the surgeon to attain a high level of flexibility in the treatment of such defects. Due to its anatomical properties, the osteocutaneous scapula flap qualifies to a high degree for reconstruction purposes in the midfacial area. From July 1990 to February 1997, reconstruction of complex facial defects after oncologic surgery was performed in 17 patients using free vascularized tissue transfer. In four cases, a free scapula flap was used. Advantages and disadvantages of this technique are illustrated in these patients. Complete oral rehabilitation requires bony continuity of the jaws and stable dentition. To attain this goal, additional grafting procedures are required in most cases when insertion of oral implants is planned. As for the soft tissues, the problem of measuring the amount of tissue needed often leads to an overcorrection, requiring several debulking procedures.

Adult↗
PubMed1998

[Reconstruction of severe facial defects due to noma].

Noma is an ulcerative-necrotizing gingivo-stomatitis eventually leading to severe destruction of the midface, including lips and cheek, maxilla/mandible, nose and rarely the orbit. The defects are usually unilateral. Children from economically underdeveloped countries are predominantly affected. Medically untreated the disease has a high mortality rate, which can be dramatically lowered by adequate antibiotic therapy started in time. Predisposing factors include malnourishment, immunosuppression, and poor oral hygiene. Forty-eight noma patients were surgically treated in Sokoto, Nigeria during October 1997 by an Interplast Germany team sponsored by AWD Stiftung Kinderhilfe. Interdisciplinary surgical strategies and results, e.g. ankylosis release, local flap coverage and 12 pedicled musculocutaneous latissimus dorsi island flaps, as well as a noma classification (NOMAC), are presented.

Adolescent↗
PubMed1997

[Facial asymmetry after vascular pedicled muscle transfer. Additional criterion for evaluating outcome in managing chronic facial paralysis].

Today neurotization and muscle transplantation are considered an ideal method of reconstructing the function of the facial nerve and the mimetic muscles in long-established facial palsy. Transplantation of the gracilis muscle as a segmental muscle provides an appropriate size for the face; however, determining the amount of muscle is difficult in order to obtain the desired dynamic and symmetric results. Prompted by the question of an "ideal" transplant size, a retrospective study was undertaken. Since 1991, 11 microneurovascular gracilis muscle transfers have been performed in 10 patients with long-established facial palsy (one patient underwent an additional transfer due to excessive scarring in a severe case of neurofibromatosis). Computed axial tomography scans were performed on six patients using a method for obtaining muscle-volume measurements of corresponding areas in each individual by using bony landmarks for reference. Cross-section area measurements by a digitalized mode were obtained from each scan, determining 20-70 Hounsfield units as appropriate for muscle tissue. Muscle-volume measurements ranged on the transplantation sites between 3.85 and 62 cm3 compared to 1.4 and 22.3 mm3 for the corresponding sites. The increments in muscular tissue by a factor between 2 and 3 are due to an increase in each single scan of the corresponding sides: when comparing the corresponding operated and unoperated sides in each patient, soft-tissue volumes were significantly (P < 0.005) elevated on the operated side. The findings presented in this study demonstrate not only encouraging functional results, but also show significant improvement of facial symmetry at rest. The results of our investigation support those of other authors, who also saw the main difficulty as determining the appropriate graft size. Secondary corrective procedures of the muscle puts the pedicle at risk of vascular and neural damage. Meticulous shaping of the graft and proper fixation and suspension technique cannot be overemphasized.

Chronic Disease↗