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Biomedical subjects

H Schliephake

Publications and source records attributed to H Schliephake.

At least 73 records · Page 4Linked to original sources
PubMed1996

[2.7 mm (AO) or 2.0 mm miniplate osteosynthesis in mandibular fractures].

In a retrospective study on 302 patients, miniplate osteosynthesis (n = 236) and rigid internal fixation (n = 66) in patients with fractures of the mandible were investigated. The total complication rate following miniplate osteosynthesis was 6.5% compared to 12.7% following rigid internal fixation. Additional intermaxillary immobilisation did not avoid postoperative complications. In patients with multiple or comminuted fractures of the mandible, rigid internal fixation demonstrated a lower complication rate compared to miniplate osteosynthesis.

Adult↗
PubMed1996

[Incidence and regeneration time of disorders of the inferior alveolar nerve in osteosynthesis of mandibular fractures--a prospective clinical study].

In a prospective study posttraumatic and postoperative sensitivity disturbances after mandible fractures in the region of osseous course of the inferioralveolar nerve were assessed. The study contains 28 patients with 31 mandible fractures. For assessment somato sensoric evoked potentials and computer assisted pain and thermal sensitivity testing was used. A rate of 32% posttraumatic and 52% nerve disturbances resulting from osteosynthesis was found. In 81% the sensitivity disturbances lasted only 6 months post-operatively. In 19%, mainly cases of fracture dislocation of 5 mm minimum, anesthesia and hypesthesia lasted for more than half a year.

Adolescent↗
PubMed1996

[Bone SPECT of the jaws after fracture, onlay osteoplasty of insertion of implants].

AIM: The aim of this study was early differentiation between uncomplicated and complicated processes of healing in the jaw using bone SPECT. METHODS: Investigations were performed in 40 mandibular fractures and 26 jaws after onlay osteoplasty as well as secondary insertion of implants. Bone SPECT was carried out within 1-2 months and after approximately 4-5 months. The uptake in the jaw was assessed semi-quantitatively using ROI analysis. RESULTS: Fractures with uncomplicated healing showed a decrease of uptake in follow-up, whereas fractures with an infection in the later course showed an increase, resulting in a significantly higher uptake at the follow-up investigation for the latter group. 1-2 months after onlay osteoplasty significantly lower uptake was found in regions with later occurrence of sequestration. In regions with implants in which osseointegration failed, there was significant reduction of uptake initially and significant elevation at the follow-up investigation. CONCLUSION: These results indicate a prognostic relevance of bone SPECT in the evaluation of processes of healing in the jaw.

Adolescent↗
PubMed1995

Experimental transplantation of hydroxylapatite-bone composite grafts.

PURPOSE: This study was undertaken to determine if autogenous bone can be cultivated in vivo in a porous hydroxylapatite (HA) matrix by ingrowth from underlying bone and if this autogenous HA-bone composite graft can then be transplanted. PATIENTS AND METHODS: Five Göttingen minipigs received subperiosteal implantation of one HA block each (40 x 10 x 10 mm), covered by a polylactic membrane, on the ascending ramus of the mandible. After 5 months, half of each implant was harvested and transplanted as an onlay graft to the horizontal ramus of the mandible with simultaneous insertion of a titanium implant. Polychrome fluorescence labeling was done 1, 2, 4, and 8 weeks postoperatively. After 3 months, the vascular system of the animals was filled with BaSO4 for microangiographic examination, and all blocks were retrieved. RESULTS: Fluorescence microscopy showed that there was a significant decrease in deposition of the label in the grafted blocks at 1 week when compared with later labels. After the second week, there were no significant changes. A 20% to 30% decrease in the frequency of fluorochrome staining was noted in the upper third of each block. In this region, microangiography demonstrated highly vascularized tissue and limited bone resorption. CONCLUSION: It was concluded that cultivation of mandibular bone in a porous matrix under guided bone regeneration is possible and that this autogenous HA-bone composite graft can be transplanted at a later date.

Angiography↗
PubMed1995

The use of basic fibroblast growth factor (bFGF) for enhancement of bone ingrowth into pyrolized bovine bone.

This pilot study aimed to investigate whether in vivo cultivation of bone in porous scaffolds can be enhanced by the use of growth factors. Four adult Göttingen minipigs received subperiosteal implantation of a block of pyrolized bovine bone on either side of the mandible. The blocks were covered with polylactic membrane. On one side, the implants were loaded with 240 micrograms of lyophilized basic fibroblast growth factor (bFGF). After 5 months, bone ingrowth was found throughout the whole block into the peripheral pore layers regardless of whether or not the scaffolds had been loaded with bFGF. Fluorescence labels likewise showed no significant differences in bone formation.

Animals↗
PubMed1995

Long-term quality of life after ablative intraoral tumour surgery.

The aim of the present retrospective study was to determine the long-term quality of life of patients who had undergone intraoral tumour resection. 135 patients with a malignant tumour located in the floor of the mouth and the adjacent area were enrolled in the study. A standard questionnaire was used to determine the physical functional status, the psychological status and social functioning of cancer patients (Schipper et al., 1984). The results were related to the T-stage, the size and the location of the intraoral soft tissue defect, the mode of reconstruction and the postoperative interval. The results showed a significant correlation of the Functional Living Index-Cancer (FLIC) score with the Karnowsky-Index. The values were significantly lower in the higher T-stages. The location of the soft tissue defect, the type of soft tissue reconstruction and discontinuity resections of the mandible were crucial for postoperative quality of life, inasmuch as bilateral defects with loss of mandibular continuity and myocutaneous flap reconstructions showed significantly lower FLIC values. Reconstruction of mandibular continuity did not contribute to an increase in FLIC values. Dysphagia, reflux of food through the lips and nose during meals, decreased appetite and persistent pain significantly decreased the FLIC scores. It is concluded, that the FLIC is suitable for the determination of life quality in cancer patients since the score has shown the potential to reflect differences in postoperative life quality with regard to surgical procedures and functional sequelae.

Adult↗
PubMed1995

[Clinical and roentgenologic evaluation of the outcome of therapeutic tooth movement for occlusal adjustment].

The indication of therapeutic tooth luxation in partly impacted teeth as the only method of occlusal adjustment has up to the present been rare. It was therefore the aim of this retrospective, long-term study to include clinical and X-ray results following therapeutic molar luxation (OK 6, UK 7). After an average observation period of 5.3 years, all teeth (7) with incomplete root formation at the time of luxation were rated "successful" following molar luxation. On the other hand, only 2 out of 4 teeth were hand, only classified as "successful" following molar luxation with complete root formation. The results have shown that therapeutic tooth luxation for occlusal adjustment of partly retained molars has a high rate of success when the indication is correctly handled. Because the prognosis is determined according to the stage of root formation, the surgical approach of tooth luxation should be used solely in teeth whose root development has the 1/2 to 3/4 of the expected definitive root length and whose Foramen apicale is open at the time of operation. When an atraumatic operation technique is used, further root formation and a maintained sensibility of the pulp can be reckoned with.

Adolescent↗
PubMed1994

Enhancement of bone ingrowth into a porous hydroxylapatite-matrix using a resorbable polylactic membrane: an experimental pilot study.

The objective of this pilot study was to study bone ingrowth into porous hydroxylapatite (HA) blocks using a polylactic membrane for guided tissue regeneration. Porous HA blocks were placed on both sides of the mandible and of the ilium in five Göttingen minipigs. On one side a polylactic membrane was used to cover the blocks. After 5 months, the blocks with the membrane covering showed complete bony penetration of the HA matrix both in the mandible and the ilium. The blocks without the membrane covering showed substantially less and irregular bone ingrowth after placement on the mandible and poor ingrowth after placement on the ilium. The newly formed bone in the blocks from the ilium showed a cancellous structure while bone tissue inside the blocks from the mandible exhibited a dense cortical appearance. The polylactic membrane was nearly completely degraded at the time of investigation.

Animals↗
PubMed1994

Long-term results of blood flow and cutaneous sensibility of flaps used for the reconstruction of facial soft tissues.

PURPOSE: The aim of this study was to determine the blood flow and the cutaneous sensibility of flaps after the repair of tumor-related defects of the facial skin. PATIENTS AND METHODS: Fifty restorations (27 local flaps, 6 island flaps, 7 free skin grafts, and 10 microvascular grafts) were examined using laser Doppler flowmetry, two-point discrimination, and a pain and thermal sensibility testing device. The average postoperative interval was 62 months. Measurements were performed on the flap surface, the donor site, and the contralateral areas corresponding to the donor site and the former defect. Paired t-tests were used to assess statistically significant differences between the sites of measurement. RESULTS: Results showed a rate of both blood flow and two-point discrimination on the surface of local flaps and island flaps that was not statistically different from the corresponding area of the unoperated side. Free skin grafts exhibited incomplete restoration of thermal sensibility and increased blood flow rates compared with the donor site. Large microvascular flaps showed complete loss of cutaneous sensibility in six cases, whereas partial restitution without reproducible two-point discrimination was found in the remaining patients after an average interval of 39 months. Flowmetry rates of microvascular flaps corresponded to those of the donor site and were significantly lower than those of the recipient site in the head and neck area.

Face↗
PubMed1994

Experimental study by fluorescence microscopy and microangiography of remodeling and regeneration of bone inside alloplastic contour augmentations.

Five female Göttingen minipigs received unilateral subperiosteal implantation of a block of porous hydroxyapatite covered by a polylactic membrane. Five months later, biopsies were taken from the blocks, which were left in place for another 3 months. The biopsies showed bone formation in all pores, indicating complete penetration of the blocks after 5 months. Highly vascular tissue with radiographic signs of bone resorption was found in the upper third of the augmentation 3 months later. Fluorescence microscopy showed that all sequential labels were present throughout the whole block. However, a significant decrease in the frequency of the 1-week label was recorded, showing that elevation of the overlying soft tissue may lead to temporary impairment of vascular supply.

Angiography↗
PubMed1994

Reconstruction of facial soft tissues after resection of skin tumors.

The aim of the present study was to analyse the results of various reconstruction techniques of the facial skin with regard to general parameters such as the patients' age and health condition and to surgical parameters such as defect size, contamination of surgical fields and the type of reconstruction. 273 cases were evaluated, comprising local flaps (217), island flaps (21), free skin grafts (22) and cutaneous or myocutaneous distant flaps (13). The overall rate of major complications was 13.5%. No correlation was found with the age or impaired health of the patients nor did contamination by oral/nasal bacterial flora or the type of restoration show any significant correlation. The size of the defect turned out to be the only variable significantly related to the occurrence of complications (p = 0.0108). The complication rate observed following the repair of defects smaller than 30 mm in diameter was 7.5% while it rated 19.1% following the repair of defects larger than 30 mm. The overall rate of partial or total flap necrosis was low (2.9%). Secondary corrections and further surgical re-entry were required in 4.7% of all patients.

Age Factors↗
PubMed1994

[Defect bridging and augmentation of the mandible by transplantation of locally cultured bone in a porous matrix].

In the present study, 9 Göttingen Minipigs received one porous hydroxylapatite block each on the buccal cortex of their mandibles. Autogenous bone was gained inside these blocks by using a polylactic membrane covering for guided tissue regeneration. The blocks showed thorough penetration by bone tissue after 5 months and were transplanted as onlay grafts and for restoration of mandibular defects. The onlay grafts were fixed by titanium fixtures and miniplates respectively. Histologic examination 3 months after transplantation showed maintenance and remodelling of the transplanted bone inside the pores of the blocks in most specimens. There war a soft tissue free contact between the transplanted bone and the inserted fixtures and screws. Results indicate that autogenous bone may be gained inside a porous matrix of calcium phosphate and be transplanted for reconstruction of contour and discontinuity defects.

Animals↗
PubMed1994

[Microsurgical reanastomosis of scapula transplants for maxillofacial bone reconstruction].

Between 1989 and April 1993 29 grafts from the scapula region have been harvested for reconstruction in the head and neck area. 7 out of 20 osteocutaneous grafts have been used for reconstructions in the maxillary/midface area. In this area, one graft was completely lost due to venous congestion and another loss of the soft tissue component of one graft occurred. The complication rate in the maxilla seems to be higher than in application of the flap for mandibular reconstruction. Reconstruction in the maxillary/midface area most often requires several surgical steps. In special situations, as for example when unfavorable conditions regarding the recipient vessels exist, primary soft tissue reconstruction with a technically less demanding flap and a longer vascular pedicle (for example m. latissimus dorsi) and secondary free bone grafting may be indicated.

Bone Transplantation↗
PubMed1993

Determination of the 3-D morphology of degradable biopolymer implants undergoing in vivo resorption.

A technique is presented that allows the visualization of the degradation process of biopolymers. Serial thick-section specimens containing cross-sections of polydioxanone implants (PDAs) were realigned for 3-D reconstruction using a double-embedding technique. The outlines of the cross-sectioned implants were traced using an automatic image analysis system and converted into x, y, and z coordinates. The reconstruction of the implant body was achieved by the stepwise analysis of vertical relationships between two adjacent section levels. The surface was approximated by triangulation and calculated from the surface triangles. Visualization was achieved by introducing the data into commercially available software using z-buffering and Gouraud shading. The geometric precision of the reembedding technique was found to be 0.8-1.5% of the screen width; recovering experiments showed a good approximation to the actual physical volume of unresorbed implants (+/- 2.6%). The error of volume determination due to the limited resolution in the z direction was calculated to be acceptable (< 5.0%) in isotropic objects where the ratio between the radius of the surface curvature and the distance between the sections is > 4. Results indicate that large devices of PDAs are degraded in vivo in a fashion similar to that previously described for in vitro degradation of PLA molded screws by a surface/center differentiation with formation of hollow residuals after 17 weeks and complete degradation with phagocytosis of microparticles after 26 weeks.

Animals↗
PubMed1993

Ultrastructural findings in soft tissues adjacent to titanium plates used in jaw fracture treatment.

The present study was conducted on biopsies from soft tissues overlying titanium miniplates that were used for the treatment of jaw fractures. The aim was to investigate the morphology of liberated titanium particles and cellular or ultrastructural changes in tissues adjacent to the miniplates. Conventional transmission electron microscope (TEM) images were used for ultrastructural investigation and identification of metal-dense particles. The presence of titanium was proved by an increase in the intensity of element-specific, inelastically scattered electrons from the primary beam. The results showed that 5-8 months after insertion of the plates and screws, there was weak cellular activity within the scar tissue overlying the plates without inflammatory cells. Most of the titanium particles were located extracellularly. The ultrastructural appearance of most of these particles suggested that titanium may be shaved off the plates or screws and may undergo cellular uptake and lysosomal degradation. The partially degraded titanium particles are then left in place after the phagocytic cells have been isolated by collagenous fibers and have finally perished.

Bone Plates↗
PubMed1993

Metal release from titanium fixtures during placement in the mandible: an experimental study.

Titanium screw taps and titanium fixtures were investigated by SEM before and after experimental use. Peri-implant bone surfaces were examined immediately after surgery and 5 months after implantation by SEM using the SE mode, backscattered electron imaging, and EDX analysis to detect titanium contamination of the bone specimens. The Ti content of the livers, kidneys, and lungs of six Göttingen minipigs, which had received two screw implants each, was determined using flameless atomic absorption spectroscopy and compared to a control group with no implants. Results showed that Ti particles were abraded and deposited on the bone surface during the preparation of implant beds. Five months after placement, particles were no longer observed on the bone surface next to the implants. Determination of the Ti concentration of the inner organs showed that the lungs contained the highest amount of titanium. The Ti content of the kidneys and livers was much lower. All values differed significantly from those of the control group (P < .01).

Alveolar Process↗