Biomedical subjects
Publications and source records attributed to K W Bütow.
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The aim of this clinical research project was to evaluate histopathologically the zone of thermal effects along the cut margin of tissue specimens with the use of CO2 laser surgery regarding laser artifacts and diagnostic biopsy.
Pain and swelling are two of the most common problems experienced by patients who have undergone surgical removal of impacted third molars. The purpose of this research project was to ascertain which of two surgical techniques was judged by patients to cause the least pain and swelling. The survey comprised 20 patients with bilaterally symmetrical impacted third molar teeth. In each patient, the third molars on one side were removed using a standard mucoperiosteal flap, while on the opposite side, a smaller access incision was used. The results of this survey show conclusively that when a small incision was used, with minimal reflection of the mucoperiosteum, the subjective evaluation of patients is that there is significantly less postoperative pain and swelling than when the larger standard incision is used.
The titanium/titanium nitride temporomandibular joint (TTN-TMJ) prosthesis, for the combined replacement of both the joint and the glenoid fossa, was developed in 1992 and introduced clinically in 1994. This joint prosthesis is manufactured from pure titanium and the condylar surfaces, as well as the fossa, are coated with titanium nitride for hardening of the contact surfaces. In two different research projects, the joint were first placed in experimental animals, before they were successfully placed in human subjects. Twenty seven joint prostheses used in human subjects have been analysed for this review.
Over a period of 18-48 months, the bone resorption, or bone deposition (osteogenesis) of the mandible, in the supero-inferior dimension, was evaluated in patients who had had implanto-orthognathic reconstructive surgery (IORS). It entails the combination of three different types of surgical involvement for the reconstruction of the atrophic (class V), and severely atrophic (class VI) mandibular alveolar ridge (Bütow and Duvenage, 1993). This type of surgical reconstruction combines orthognathic osteotomy, interpositional bone grafting and the immediate placement of osseointegrated implants by means of a trans-mucoperiosteal approach. Evaluation of the mandibular IORS over the long-term, has proven that not only is there minimal resorption, but that osteogenesis of the alveolar ridge occurs.
Implanto-orthognathic reconstructive surgery (IORS) entails a combination of three different types of surgical involvement for the reconstruction of the atrophic mandibular or maxillary alveolar ridge. The surgery combines an orthognathic procedure with interpositional bone grafts and placement of osseointegrated implants by means of a transmucoperiosteal technique. The above-mentioned modified orthognathic technique includes three maxillary and two mandibular procedures. The osseointegrated compression screw implant (OCSI) is particularly suitable for this type of implanto-orthognathic reconstructive surgery as it may be placed transmucoperiosteally during this pre-prosthodontic reconstructive technique, thereby eliminating a second stage intervention.
The patient is often left with an oro-nasal fistula after the intravelar veloplasty procedure for the primary closure of the hard and soft palate cleft. The junction between the hard and soft palate is submitted to maximal tension during this procedure and is where the fistula most often occurs. The primary intravelar veloplasty procedure is discussed and 7 surgical modifications are introduced. The aim of these modifications is the prevention of an oro-nasal fistula and each is specifically adapted according to the existing anatomical form and defect of the cleft palate. The surgical modifications are divided into 2 main groups: those based on localised swivel flaps and those based on distant flaps.
The high incidence of middle ear effusion in cleft lip and/or palate infants and children led to the development of a tension sling for the tensor veli palatini muscle for better Eustachian tube function after intravelar veloplasty.--The surgical technique is outlined in this paper and an audiometric examination was conducted to determine the influence of this surgical modification, performed in the same procedure as the intravelar veloplasty, on the Eustachian tube function. The intra- and intergroup comparisons indicate that this surgical technique has a positive influence on the tube function.
A pharyngostomy is an alternative feeding method for patients with severe facial trauma where prolonged feeding is indicated. Oro- and nasogastric feeding are the other more well-known methods. A special intubation instrument has been developed to facilitate blunt dissection of cervical tissue and placement of the feeding tube. This particular technique and instrument has been used in 11 cases. The main aim and advantage of this technique is that the nasal and oral cavity can be kept clear of tubes which are a source of irritation and discomfort postoperatively in areas of extensive facial trauma.
A primary unilateral functional lip-plasty has been developed to improve the appearance of the asymmetrical nasal deformity and that of the lip scar in the cleft lip. A triangle is dissected from the lesser segment with the base located at the nasal alar base. The latter is rotated superior-horizontally and positioned at a semicurved release incision which is inferior to the columella. This C-junction of the nostril sill allows an alignment of the nasal structure without a primary rhinoplasty.
The purpose of this study was to create craniofacial growth disturbances via synostoses of sutures of the cranial base, as well as of other various selected sutures of the anterior cranial and posterior facial structures. Twelve sutures, single or in combination, were obliterated by means of autogenous bone transplantation in twenty-five baby baboons (Papio ursinus). The data obtained from the sacrificed animals were qualitatively analyzed. The results indicated that synostosis of any of the selected sutures does lead to craniofacial growth disturbances. Furthermore, no specific synostosed suture could be identified that might cause a specific type of craniofacial dysostosis, although unilateral facial deformities always occurred after unilateral suture synostosis.
The oblique facial cleft may present as a cutaneous and/or an osseous cleft, with or without a cleft lip, and with or without a cleft palate. This particular case was born with complete bilateral cutaneous-osseous oblique facial clefts which extended from the oral cavity to the eye sockets with anophthalmia on the right side. The first surgical intervention included a midline nasal skeleton alignment and bilateral cleft lip and alveolus reconstruction. Urinary Foley catheters were used as facial tissue expanders and inserted adjacent to the oblique facial clefts. The second surgical procedure consisted of a partial pyramidal Le Fort II osteotomy for an inferiorly displaced nasal maxillary skeleton and a rotation and advancement of the cheek as a flap for reconstruction of the palpebral cleft and inner canthus.
In general, it is not easy to make the correct clinical diagnosis of a specific internal derangement of the arthralgias. The ten types of internal derangements, with desynchronisation between the meniscus and the condyle, may present clinically with localised sounds, such as clicking, grating and grinding, or without any sounds. Computerised tomography is one of the few non-invasive aids used for obtaining a more accurate diagnosis of arthralgia or anatopathological problems of the joint. The sagittal and coronal alignment of the skull and joint in the gantry, the specific highlighting of the meniscus and use of different types of occlusal splints, are all necessary for the accurate diagnosis of an internal derangement. The examination of 118 such joints is presented in this paper.
Thirteen patients with nasomaxillo-acrodysostosis are described. Some have the facial appearance of this syndrome only, although the others are more severely affected, with skull, eyes, ears, vertebrae and peripheral extremity involvement. The features of the 13 patients were studied and compared with those described in the literature as belonging to 'maxillonasal dysostosis' and 'acrodysostosis'. It seems certain that there is in fact only one syndrome, which differs only in extent of involvement.
A bilateral cleft lip and palate case received ornithine-vasopressin intra-operatively in preparation for a vasoconstricted field of the various lip segments prior to the repair of the cleft lip. A cyanotic tinge appeared immediately. This eventually led to total necrosis of the upper lip. Various relevant blood tests were done and a mild thrombocytosis was found. Surgical reconstruction of the upper lip was performed by means of a forked cross-lip flap--the main blood supply coming from the columella--as well as by means of an inferiorly pedicled cheek flap from the para-nasal area.
Oro-nasal fistulae often occur after the primary closure of the hard and soft palate cleft and in particular at the junction between the hard and soft palate. This is the area where maximal tension is exerted during the intravelar veloplasty closure procedure. Six surgical modifications of the primary intravelar veloplasty technique are described and each is specifically adapted according to the existing anatomical form and defect of the cleft soft palate, so that the occurrence of an oro-nasal fistula may be prevented. The surgical procedures may be divided into two main groups, namely those which are based on a localized swivel flap and those where remote flaps are used.