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Biomedical subjects

J E Zöller

Publications and source records attributed to J E Zöller.

At least 19 recordsLinked to original sources
PubMed2007

[A vascular pedicled duplicated fibula transplant for treatment of lumbar instability following tuberculous spondylodiscitis].

Operative treatment of tuberculous spondylodiscitis is still an important part of the treatment for lumbar spine instability. We report on a patient who suffered an extensive relapse with microbiological confirmation of tuberculous spondylodiscitis following operative spinal treatment for unspecific spondylodiscitis. X-Ray examination showed development of pronounced lumbar instability, which was first treated with the aid of an external fixateur and later by means of a doubled fibular bone graft with a vascularised stem with no dorsal instrumentation, which led to bony consolidation.

Aged↗
PubMed2006

Lateral femoral cutaneous nerve and iliac crest bone grafts--anatomical and clinical considerations.

This study investigates the topographical relationship of the lateral femoral cutaneous nerve (LFCN) to the anterior iliac crest and its clinical relevance in the context of bone graft harvesting. In the anatomical part of the study, LFCN was dissected and its course investigated in 34 human formalin-embalmed cadavers. In the clinical part, data of patients who underwent an iliac crest bone grafting procedure were collected and analysed. The obtained results were then compared with the results of other investigators published in the medical literature. From 34 nerves, the lateral branch of 1 LFCN (2.9%) crossed the anterosuperior iliac spine (ASIS) prominence at a distance less than 5mm superolaterally from the most anterior point of the spine. All other nerves ran below the inguinal ligament with an average distance of 14.6mm in the inferomedial direction from the spine. In 4 out of 298 patients (1.3%) who underwent harvesting of monocortical bone grafts from the inner table of the ilium, sensory disturbances in the dermatome of LFCN were observed. After a maximum period of 12 months all sensory disturbances resolved so that no case of permanent sensory impairment was recorded. The relatively low incidences of iatrogenic LFCN damage can be attributed to a standardized surgical concept which employs a lateral incision and layer by layer dissection to the periosteum/iliacal fascia level in order to identify the nerves potentially crossing the iliac crest above the ASIS.

Adolescent↗
PubMed2006

Comparison of static and dynamic computer-assisted guidance methods in implantology.

The planning of dental implant position and its transfer to the operation site can be considered as one of the most important factors for the long-term success of implant-supported prosthetic and epithetic restorations. This study compares computer-assisted fabricated surgical templates as the static method with intro-operative image guided navigation as the dynamic method for transfer of three-dimensional pre-operative planning. For the static method, the systems Med3D, coDiagnostix/ gonyX, and SimPlant were used. For the dynamic method, the systems RoboDent und VectorVision2 were applied. A total of 746 implants were inserted between August 1999 and December 2005 in 206 patients. The static approach was used most frequently, accounting for 611 fixtures in 168 patients. The failure ratios within the first 6 months were 1.31% in the statically controlled insertion group compared to 2.96% in the dynamically controlled insertion group. Complications related to an incorrect position of the implants have not been observed so far in either group. All computer-assisted methods included in this study were successfully applied in a clinical setting after a certain start-up period. The indications for application of computer-assisted methods in implantology are currently given in difficult anatomical situations. Due to uncomplicated handling and low resource demands, the static template technique can be recommended as the method of choice for the majority of all cases falling into this category.

Adult↗
PubMed2005

[Chemodenervation with botulinumtoxin in masseteric hypertrophy].

BACKGROUND: Masseteric hypertrophy is a unilateral or bilateral enlargement of the masseteric muscle of various aetiologies. The therapeutic options range from solely conservative measures, especially in functionally induced abnormalities, up to surgical ablation of the muscle. The presented study evaluates the application of botulinum toxin serotype A for the treatment of masseteric hypertrophy. PATIENTS AND METHODS: Between June 2000 and August 2004 seven patients with a unilateral and one patient with a bilateral manifestation of the condition were treated by an injection of botulinum toxin. RESULTS: A significant improvement of facial asymmetry caused by chemodenervation and following reduction of the hypertrophic muscle mass could be achieved in all cases. Complications during the injection, side effects, signs of intoxication, and therapy failure were not observed. CONCLUSION: The results of this treatment series show in agreement with the reports in the literature that the application of botulinum toxin can be currently considered as the therapy of choice in masseteric hypertrophy.

Adolescent↗
PubMed2005

[Endosonographic imaging of tumor thickness in oral squamous cell cancer and its effect on the incidence of lymph node metastases].

BACKGROUND: The correlation between increasing tumor thickness and lymph node metastases as well as reduced survival in oral cancer has been proven by several studies. In most investigations the tumor thickness was assessed in histological sections. The aim of our prospective study was to assess tumor thickness in oral squamous cell carcinoma (OSCC) by intraoral ultrasonography and to evaluate the predictive value of tumor thickness for incidence of cervical lymph node involvement and survival. PATIENTS AND METHODS: A total of 64 patients with primary carcinomas of the oral cavity (stage I-IV) were included. Endosonographic assessment of patients was carried out using a 7.5-mHz probe (Hitachi EUP F334). The primary tumor could be visualized in all cases as a hypoechoic, sometimes irregular mass. RESULTS: The average tumor thickness in all tumors was 14+/-7 mm. The N+ patients showed a greater tumor thickness (15+/-7 mm) than N0 OSCCs with 12+/-6 mm (p =0.032, t -test). Less advanced T1/T2 carcinomas revealed a tumor thickness of 10+/-5 mm in contrast to T3/T4 carcinomas with 16+/-7 mm (p <0.001, t-test). The overall survival was reduced in patients with tumors thicker than 14 mm (48.9 versus 28.3 months, p =0,0102 log rank test). CONCLUSION: Although this technique facilitates the accurate assessment of tumor thickness in OSCC, only in less advanced tumors could endosonography provide additional information, since these tumors were not visible on CT or MRT scans. Nonetheless endosonography is a fast, cost-effective, and reliable technique for assessment of tumor extent in oral cancer.

Aged↗
PubMed2004

Chemoprevention of oral squamous cell carcinomas.

Among individuals with a history of head and neck cancer and tobacco abuse the risk of second primary cancers in the upper aerodigestive tract is high. Chemoprevention of oral squamous cell carcinomas is based on two conditions: Premalignant mucosa lesions are treated with chemopreventive agents in order to prevent malignant conversion (primary prevention). In secondary prevention of oral cancer, after curative therapy patients are treated by chemoprevention in order to reduce the rate of second primaries. This paper presents a comprehensive clinical review of oral cancer prevention studies, highlighting the agents mostly used, such as beta-carotene, alpha-tocopherol, ascorbic acid, and retinoids. Although most intervention trials showed good overall response with these substances, high relapse rates and serious side effects, in most cases related to the retinoid compounds were noticed. In addition, in all prospective randomized chemoprevention trials (CARET, ATBC and PHS) no significant evidence of benefit for supplementation with alpha-tocopherol, beta-carotene or retinyl palmitate was reported.

Antineoplastic Agents↗
PubMed2003

[Mucocele of the chin area. A rare complication after genioplasty with osteocartilagenous nasal bone transplant. Review of the literature and case report].

BACKGROUND: This paper describes an infrequent case of an intraosseous mucocele after chin augmentation using a nasal osseocartilaginous graft. Diagnostics, therapy, and clinical course of this rare complication are discussed based on our own experience and a review of the current scientific literature. CASE REPORT: Radiological examination of a 22-year-old patient revealed an oval lucent area approximately 3x1 cm in size with sclerotic rim. Cartilaginous material directly fused to the cyst wall was detected during surgery. The results of histological examination indicated parts of a cyst wall lined with respiratory epithelium located over normally maturing cartilaginous tissue. Postoperative long-term drainage with consecutive reduction of the cyst lumen was followed by cystectomy and concurrent osteoplasty and onlay graft. DISCUSSION: This case presented here is-as far as we know-one of three manifestations of a respiratory implantation cyst published. Its origin is most likely based on epithelium-like cells that have been incompletely removed from the resected nasal hump. Although severe complications of this technique have rarely been described, the surgeon must be aware of possible long-term side effects and should meticulously remove adherent nasal mucosa from the graft.

Adult↗
PubMed2003

[Evaluation of her-2/neu amplification/overexpression in OSCC with fluorescence in situ hybridization (FISH) and immunohistochemistry].

INTRODUCTION: The human epidermal growth factor receptor ( her-2/ neu) protooncogene encodes a membrane tyrosine kinase with homology to the epidermal growth factor receptor (EGFR). Amplification and protein overexpression have been identified in various solid tumors and a significant association with poor clinical outcome was reported. This investigation was performed to assess the frequency of her-2/ neu overexpression and to compare these results with clinical outcome in OSCC. MATERIAL AND METHODS: Archival biopsy specimens from 97 untreated OSCCs were evaluated using a polyclonal antibody A0485 (Dako). Only membrane staining intensity and pattern were evaluated according to the guidelines of the clinical trial assay recommendations (0-3+) for breast carcinoma. Score 0 and 1+ were interpreted as negative for HER-2/NEU protein overexpression and 2+ and 3+ as positive. FISH analysis with directly labeled probes for her-2/ neu and chromosome 17 was performed on the same specimens. The ratio between her-2/ neu and chromosome 17 signals was calculated after selection of 20-40 non-overlapping tumor cells. The tumor was considered amplified if the ratio was above 2. RESULTS: In 11 out of 97 biopsies (11.3%) membranous overexpression (score 2+ and 3+) of her-2/ neu was shown by immunohistochemistry. FISH analysis in 42 cases revealed amplification in 14 cases. Concordance between immunohistochemistry and FISH was found in 86%. Clinical-pathological data as well as survival revealed no correlation with her-2/ neu status. DISCUSSION: In spite of missing correlation between survival and her-2/ neu overexpression in our study, the predictive value of the her-2/ neu protooncogene in adjuvant therapy in OSCC needs further investigation.

Adult↗
PubMed2002

[The central odontogenic fibroma. A rare tumor].

This case report deals with the case history of a 45-year-old male patient who presented with an unusual case of a central odontogenic fibroma which destroyed and replaced the bone mass of the right maxilla. After clinical examination a biopsy was performed and histopathology was consistent with a central odontogenic fibroma with destructive growth. The treatment plan consisted of a surgical resection of the right maxilla. The histopathological evaluation showed a subtotal destruction of the maxillary bone mass by the odontogenic fibroma. Obvious problems concerning the differential diagnosis of odontogenic fibromas as well as current concepts regarding their exact designation and classification are discussed.

Diagnosis, Differential↗
PubMed2001

The fronto-orbital osteotomy as plastic-reconstructive approach to the anterior and middle skull base.

Introduction: A combined extra-intracranial access for the operative exploration of tumours of the anterior and middle skull base is indicated when the tumour extends intracranially and simultaneously into the nasal cavity, the paranasal sinuses or the orbit. Methods: Two standardized modifications of the fronto-orbital osteotomy, the fronto-orbito-nasal and the fronto-orbito-zygomatic osteotomy, allow safe removal of skull base tumours in these locations. In extensive skull base tumours, a modified bilateral fronto-orbital-zygomatic osteotomy can be used. Results: Between February 1993 and July 2000 skull base tumours in 111 patients were resected using the presented methods. The most frequent tumour type was meningioma in 29 cases. Complications were encountered in 13 cases (11.7%). Conclusion: The advantages over other approaches are good extra- and intracranial overview and minimal cerebral trauma. Additional transfacial incisions are not usually necessary. Exact repositioning of the fronto-orbital segments leads to optimal aesthetic results. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed2001

Use of an image-guided navigation system in dental implant surgery in anatomically complex operation sites.

INTRODUCTION: Recent developments in computer assisted surgery have brought major improvements to maxillofacial surgery. Computer systems for intra-operative navigation have been introduced enabling the surgeon to locate the continually updated position of the instruments and the operation site on the patient's three-dimensional reconstructed image data set displayed on a monitor in the operating room. Complex surgical procedures can be performed according to the preoperative plan based on CT and/or MRI data minimizing surgical risks and optimizing clinical results. Nowadays computer-assisted-surgery has also proved effective in dental implantology. AIM: The objective of this study was to compare the accuracy of conventional and computer-assisted dental implantation planning and surgery. Analyzing our early experiences, we aimed to evaluate the benefit from utilising computer assisted surgery (CAS). PATIENTS: Five patients were treated with the aid of CAS, a total of 18 dental implants being placed. Only difficult operation sites, e.g. following bone augmentation or anatomically malformed jaws were included in this study. METHOD: An infra-red light based navigation system (Vector Vision 2, BrainLAB, Munich, Germany) including a three-dimensional planning approach for maxillofacial surgery was used. Placement of dental implants in the maxilla included direct visualization when drilling the implant socket according to the axis previously planned on radiographs and CT scans. RESULTS: In two cases the conventionally planned implant location had to be changed due to insufficient bone being available. With four implants, it proved possible to insert longer fixtures after the CAS system had evaluated all parameters of the surgical region. In one case a shorter implant was installed due to insufficient bone at the designated location. CONCLUSION: The use of an image-guided navigation system provides a valuable tool in implant dentistry and proved superior to conventional implant surgery especially in difficult anatomical regions.

Alveolar Ridge Augmentation↗
PubMed2001

Image guided surgical navigation for removal of foreign bodies in the head and neck.

INTRODUCTION: The removal of foreign bodies in the head and neck area is often a surgical challenge due to a combination of difficult access and a close anatomical relationship of the foreign body to vital structures. Recent developments in computer-assisted surgery (CAS) have brought major improvements to the operating rooms for maxillofacial surgeons. The purpose of this paper is to report our experience in computer assisted removal of foreign bodies from the head and neck area, based on various clinical cases. PATIENTS: Computer assisted removal of foreign bodies from the head and neck area was performed in 11 patients. Three patients sustained gun shot wounds with remaining projectiles or fragments in the soft tissue. In six cases, objects related to a preceding surgical intervention were removed. Two patients presented with dislocated teeth in the facial or cervical soft tissues after 3rd molar surgery. METHOD: For surgical planning and intra-operative navigation, a computer based image guided surgery system (VectorVision(2), BrainLab) was used. RESULTS: In 10 of 11 cases the foreign bodies could be removed without major complications by a minimal invasive manner. More than 40 % of surgery time could be saved compared to similar interventions operated upon using conventional methods. CONCLUSION: In our opinion, the use of a computer based image guided surgical system is of great benefit when removing foreign bodies from the head and neck area. The minimally invasive access helps to prevent major complications such as injury to vital structures and allows a quicker operation.

Adolescent↗
PubMed2001

Photodynamic therapy of head and neck cancer.

Photodynamic therapy (PDT) is an alternative treatment option for tumours of the head and neck. The principle of PDT is based on a photochemical reaction which is initiated by light activation of a photosensitizing drug causing tumour cell death. PDT damage heals mainly by regeneration rather than scarring. Due to this organpreserving principle of PDT, important structures are maintained with very good functional and cosmetic outcome. This article will review the principle of PDT and the different indications for PDT of tumours of the head and neck, focusing on small and advanced tumours of the oral cavity and the larynx as well as papillomatosis of the larynx. A critical review on the literature will be accomplished.

Carcinoma, Squamous Cell↗
PubMed2000

[Current status and prospects of chemoprevention in oral squamous epithelial carcinomas and precancerous lesions].

Second primary tumors in initially cured patients remain the greatest challenge in therapy for oral squamous cell carcinomas. The concept of field concerization is the most accepted hypothesis for the cellular and subcellular damages resulting in neoplastic transformation in the upper aerodigestive tract by risk factors such as chronic alcohol and tobacco abuse. Recent studies investigated several agents and regimens with benefit for chemoprevention of oral squamous cell carcinomas. In our review, the results of the most promising agents were studied. Despite discouraging results from recent intervention trials, studies in oral squamous cell carcinomas reported response rates up to 92%. In our investigation, two groups of patients were treated daily with 100 mg alpha-tocopherol, 75 mg beta-carotene, and 1000 mg ascorbic acid per os. The first group consisted of 24 patients with leukoplakia of the oral cavity. The second group included 24 patients with premalignant lesions after R0-resection of primary oral squamous cell carcinoma. Biopsies were taken from both groups prior to therapy and after 12 weeks follow-up. Flow cytometry analyses were performed and nucleolar organizing regions (NOR) were examined. An overall histological response rate of nearly 98% was noticed. Additionally, the pretherapeutic regimen increased cell kinetic parameters, such as the S-phase portion, and the average number of NOR per cell nucleus decreased. These results indicate that the chosen combination has substantial activity in oral premalignant lesions. Nevertheless, basic research is required in investigating valid biomarkers for chemoprevention studies.

Anticarcinogenic Agents↗
PubMed2000

[Micro- and macrodistraction of the jaw. A sure method of adding new bone].

Vertical distraction osteogenesis (VDO) has been developed by our study group to move dentulous and edentulous segments of the alveolar process vertically with a device in microplate-design. Besides these techniques of vertical distraction of the atrophic alveolar crest some further modifications as Micro- and Macro-distraction are available. Micro-distraction can be used in localised small defects of the alveolar crest with microplates and screws of 1.0 mm in diameter. In a pilot study we could treat 6 patients especially after traumatic bone loss of the alveolus. The lengths of the segments were 12.6 mm, the vertical distraction rate was 9.2 mm in average. Macro-distraction we call the distraction of the severely resorbed mandible in order to rebuild the vertical dimension of the weakened mandible. Vertical distraction osteogenesis of 13.6 mm was completed successfully in five patients with large segments of 119 mm lengths in average in a sandwich-technique. With a solid 2.3 basic plate a secure stability of the weakened mandible could be achieved. In contrast to bone transplantation an earlier mineralisation in the vertically distracted area could be seen by radiological examination and biopsy. We could insert dental implants in both pilot groups 3 months after distraction procedure. Main advantages of vertical distraction osteogenesis are: 1. No bone harvesting, 2. decreased resorption, 3. lower morbidity compared with conventional techniques, 4. lower infection rate and 5. feasibility to insert dental implants 3 months after distraction procedure, 6. gain of soft tissue.

Adolescent↗
PubMed1999

[Initial outcome of vertical distraction osteogenesis of the atrophic alveolar ridge].

Besides several conventional therapeutic regimens to treat severe forms of alveolar ridge atrophy the distraction osteogenesis is an alternative method. We introduced a new technique for the treatment of alveolar ridge atrophy encouraged by the advantages of distraction osteogenesis in the last decade. A new technique called "vertical distraction osteogenesis (VDO)" has been developed by our study group to move dentolous and edentolous segments of the alveolar process vertically with a device in microplate-design. Vertical distraction osteogenesis was completed successfully in nine patients with segments length ranging from 6.5 mm to 43 mm with an average of 23.7 mm. The vertical distraction rate was 9.9 mm on average in seven mandibular and two maxillar segments. In all cases we found good stability and the predicted movement of the segments. In contrast to bone transplantation an earlier mineralization in the vertically distracted area could be seen by radiological examination and biopsy. Five patients were treated with dental implants 12 weeks after distraction procedure. Main advantages of vertical distraction osteogenesis are: 1. No bone harvesting, 2. decreased resorption tendency, 3. lower morbidity compared with conventional techniques, 4. lower infection rate and 5. feasibility to insert dental implants 12 weeks after distraction procedure, 6. gain of soft tissue.

Adolescent↗