Biomedical subjects

S Reinert

Publications and source records attributed to S Reinert.

At least 19 recordsLinked to original sources

PubMed2006

[The influence of the Tübingen soft palate plate and early cleft closure on swallowing and Eustachian tube function in children with Pierre Robin sequence].

CURRENT KNOWLEDGE: Children with Pierre Robin sequence (PRS) typically have difficulty with bolus transport and swallowing. Due to velopharyngeal insufficiency caused by the cleft palate, a high percentage of the children affected also have impaired Eustachian tube function. AIMS OF THE STUDY: In the literature, substantial information may be obtained on conductive hearing loss in PRS patients; however, no study has yet been performed to investigate whether wearing a soft palate plate and relatively early surgical cleft palate closure positively influence Eustachian tube function. In the present study this question was investigated. METHODS AND RESULTS: A total of 41 PRS children, 27 girls and 14 boys, were included in the study and were examined for hearing ability prior to and after surgical cleft palate closure. All of the children had been wearing a Tübingen soft palate plate until surgical cleft palate closure, which occurred at an age of 3-13 months (mean age 7.3 months). Based on data obtained prior to surgery by BERA, otoacoustic emissions and tympanometry, a hearing loss of more than 30 dB was diagnosed in 68.4% of the children. After 3-6 months, normal hearing ability was found in 70%. CONCLUSIONS: Wearing the Tübingen soft palate plate, and the improved swallowing function resulting from this, as well as early surgical cleft palate closure had a very positive impact on the hearing ability of the children included in the study.

Auditory Threshold↗

PubMed2006

The effect of dose reduction on the detection of anatomical structures on panoramic radiographs.

OBJECTIVES: The aim was to evaluate the effect of dose reduction on diagnostic accuracy using different screen-film combinations and digital techniques for panoramic radiography. METHODS: Five observers assessed 201 pairs of panoramic radiographs (a total of 402 panoramic radiographs) taken with the Orthophos Plus (Sirona, Bensheim, Germany), for visualization of 11 anatomical structures on each side, using a 3-point scale -1, 0 and 1. Two radiographs of each patient were taken at two different times (conventional setting and setting with decreased dose, done by increasing tube potential settings or halving tube current). To compare the dose at different tube potential settings dose-length product was measured at the secondary collimator. Films with medium and regular intensifying screens (high and low tube potential settings) and storage phosphor plates (low tube potential setting, tube current setting equivalent to regular intensifying screen and halved) were compared. The five observers made 27 610 assessments. Intrarater agreement was expressed by Cohen's kappa coefficient. RESULTS: The results demonstrated an equivalence of regular screens (low tube potential setting) and medium screens (high and low tube potential settings). A significant difference existed between medium screens (low tube potential setting, mean score 0.92) and the group of regular film-screen combinations at high tube potential settings (mean score 0.89) and between all film-screen combinations and the digital system irrespective of exposure (mean score below 0.82). There were no significant differences between medium and regular screens (mean score 0.88 to 0.92) for assessment of the periodontal ligament space, but there was a significant difference compared with the digital system (mean score below 0.76). The kappa coefficient for intrarater agreement was moderate (0.55). CONCLUSIONS: New regular intensifying screens can replace medium screens at low tube potential settings. Digital panoramic radiographs should be taken at low tube potential levels with an exposure equivalent at least to a regular intensifying screen.

Alveolar Process↗

PubMed2005

The role of intraoperative ultrasonography in zygomatic complex fracture repair.

Intraoperative assessment of the zygomatic arch is very important in achieving adequate repositioning. The correct alignment of the zygomatic arch indicates the proper position of the zygomatic bone and ensures adequate prominence of the lateral midfacial aspect. The aim of this study was to estimate the value of ultrasonography as an intraoperative repositioning control. In a clinical study of 25 patients, ultrasonography was employed for intraoperative visualization of the zygomatic arch before and after fracture repositioning. Twelve patients presented with isolated zygomatic arch fractures and 13 with combined fractures of the zygomatic bone and arch. The ultrasonographic findings were compared to the radiological and clinical findings. Ultrasonography was able to detect all fractures and dislocations of the zygomatic arch. It was possible to assess the repositioning in 24 out of 25 cases using ultrasonography. The ultrasound images were concordant with the radiographs. Clinical assessment by palpation only succeeded in isolated zygomatic arch fractures with an m-shaped impression, whereas it remained uncertain in nearly all cases with a different dislocation pattern. Ultrasonography was rapid and easy to perform, and is recommended as an intraoperative visualizing tool in all midfacial fractures with displacement of the zygomatic arch.

Adult↗

PubMed2005

[Oral manifestation of miliary tuberculosis].

CASE REPORT: We report on the clinical course of a 40-year-old patient with an oral manifestation of miliary tuberculosis. In addition to oral mucosa and lung, the colon and ileum were also infested. The oral lesions may resemble malignant tumors and are difficult to diagnose, especially because tuberculosis has become a rare disease in industrialized countries. DISCUSSION: Oral lesions and concomitant pulmonary complaints can be a sign for existing tuberculosis. Patients with these problems should undergo a chest X-ray and a biopsy from the oral mucosa. In addition, tests should be conducted to determine if mycobacteria are present in the sputum, gastric fluid, and urine and cultures grown. In cases with negative results PCR may detect DNA of Mycobacterium tuberculosis.

Adult↗

PubMed2005

[Value of color-coded duplex sonography in preoperative visualization of lower leg arteries for microsurgical fibula transfer].

BACKGROUND: In patients being considered for a microsurgical fibular transfer, thorough examination of the vascular supply to the lower leg is indisputably necessary. The aim of this study was to evaluate the validity of color-coded duplex sonography (CCDS) in the assessment of the arteries of the lower leg. PATIENTS AND METHODS: In 13 patients needing bony reconstruction of the jaw 22 legs were examined using CCDS. The three arteries of the lower leg were visualized and traced from the ankle to the popliteal fossa. At every arterial segment Doppler sonographic examination was also performed. All 13 patients underwent digital subtraction arteriography (DSA) of the lower extremities, additionally. RESULTS: We were able to visualize and to assess all but one of the arteries using CCDS. In 13 extremities of 9 patients CCDS exhibited a normal vascular supply to the lower leg provided by three regular arteries. DSA confirmed this and the patients underwent fibular transfer. In the other 4 patients a regular vascular situation could not be shown by CCDS because of nonvisualization of arterial segments or pathological findings. Two of these patients received alternative bony transplants. In the remaining two patients angiography exhibited one leg to have a normal three vessel supply, respectively. Fibular transplants could be raised from this leg. In all patients CCDS was able to localize between 3 and 7 perforators branching off the peroneal artery. Their position determined the placement of the skin paddle to be raised with the bone. Further advantages of CCDS were the universal applicability to all patients and the possibility of performing it at our own department. The time required for the examination and the necessity of having adequate technical equipment were the disadvantages. CONCLUSION: In patients being considered for a microsurgical fibular transplantation, we recommend CCDS of the lower leg as a screening tool for the vascular supply of the lower leg. DSA and MRA are predominantly advocated for those patients, in whom CCDS reveals pathological or uncertain findings.

Adult↗

PubMed2005

Factors contributing to acute rejection in renal transplantation: the role of noncompliance.

Early episodes of acute rejection after renal transplantation reflect inadequate immunosuppression at a time of heightened immune challenge. Late acute rejection episodes, however, are less likely related to inadequacy of immunosuppression and may be due to patient noncompliance or overzealous weaning of immunosuppression. We evaluated 443 consecutive renal transplant recipients to determine the incidence and etiology of acute rejection. All episodes were confirmed by ultrasound-guided biopsy. The cause of each acute rejection was determined by chart review. Medication compliance was determined by history at the time of admission for biopsy. Over a follow-up period of 42 +/- 22 months, 87 patients (20%) suffered acute rejection. There was a trend toward fewer episodes of acute rejection with thymoglobulin induction and tacrolimus-based immunosuppression. Younger recipients had an increased risk of acute rejection (odds ratio 0.47, range 0.24-0.91, P = .027). Patient noncompliance with immunosuppression was associated with late acute rejection (P = .0002). Acute rejection increased the risk of allograft failure (P < .0001). Modifiable factors, including the choice of immunosuppression, reduce the risk of acute rejection. More importantly, the transplant recipient plays a substantial role in the maintenance of their allograft health through compliance with immunosuppressive drug therapy. Future strategies to improve compliance, including increased vigilance in high-risk patient groups, frequent medication review, and laboratory testing, should be encouraged.

Acute Disease↗

PubMed2005

[Assessment of precision and accuracy of digital surface photogrammetry with the DSP 400 system].

The objective of the present study was to evaluate the precision and accuracy of facial anthropometric measurements obtained through digital 3-D surface photogrammetry with the DSP 400 system in comparison to traditional 2-D photogrammetry. Fifty plaster casts of cleft infants were imaged and 21 standard anthropometric measurements were obtained. For precision assessment the measurements were performed twice in a subsample. Accuracy was determined by comparison of direct measurements and indirect 2-D and 3-D image measurements. Precision of digital surface photogrammetry was almost as good as direct anthropometry and clearly better than 2-D photogrammetry. Measurements derived from 3-D images showed better congruence to direct measurements than from 2-D photos. Digital surface photogrammetry with the DSP 400 system is sufficiently precise and accurate for craniofacial anthropometric examinations.

Algorithms↗

PubMed2004

[Image-guided navigation for the control interstitial laser therapy of vascular malformations in the head and neck region].

Laser-induced interstitial thermal therapy (LITT) is a proven minimally invasive surgical technique for the treatment of haemangiomas and vascular malformations, and various tumours. The intra-lesion application of thermal energy destroys regional tissue. The percutaneous placement of the laser fibre for photocoagulation is done without the benefit of direct visual control. Image-data-based LITT was performed in patients (five procedures) with extensive venous malformations in the maxillofacial area. The system comprised a specially developed Nd:YAG laser fibre introducer set used in conjunction with fused high-resolution computed tomography, and magnetic resonance image-data--based surgical navigation. In all cases, follow-up examination clearly showed a diminishment in tumour volume, and all patients reported significant subjective improvement. The results suggest that navigation-guided LITT can be performed safely, preserving vital structures from collateral thermal damage.

Head and Neck Neoplasms↗

PubMed2003

[Hemangiomas and vascular malformations in the area of the head and neck].

The treatment of paediatric patients with extended vascular anomalies in the head and neck requires a multidisciplinary approach involving paediatricians, maxillofacial surgeons, dermatologists and radiologists. Therapeutic strategies are based on an internationally accepted classification of vascular anomalies, which distinguishes haemangiomas and vascular malformations. Whereas haemangiomas are endothelial proliferations, vascular malformations are considered to be developmental anomalies which are classified into high-flow or low-flow lesions and, according to their vascular channels, into capillary, lymphatic or venous malformations. In this review we present guidelines for the diagnostic assessment of paediatric patients with vascular anomalies in the head and neck region. The indications for treatment are discussed and therapeutic options are outlined.

Adolescent↗

PubMed2003

Stability of bone grafting and placement of implants in the severely atrophic maxilla.

A severely atrophic maxilla can be restored by bone grafts to allow the insertion of implants. We present 30 consecutive patients treated with autogenous inlay and onlay bone grafts from the iliac crest to the floor of the maxillary sinus and the alveolar crest. A total of 200 implants were inserted 4-6 months after bone grafting. A mean vertical increase in bone thickness of 14mm was achieved. After a mean bone loss of 1.3mm during the first year after bone grafting only minimal resorption was observed during the second and third year. Seven implants failed to integrate and a further four implants were lost during follow-up.

Alveolar Bone Loss↗

PubMed2003

[Registration using three-dimensional laser surface scanning for navigation in oral and craniomaxillofacial surgery].

INTRODUCTION: Recent innovations in laser scanning technology provide a potentially useful tool for three-dimensional surface registration for image-guided surgery. The purpose of this study is to evaluate the clinical reliability of this technique in oral and maxillofacial surgical procedures using image-guided navigation. METHODS: In an experimental step, a stable anthropomorphic skull model with prelabeled markers was scanned and registered with laser surface scanning (z-touch, BrainLAB) and marker- based algorithms. The registration protocol was then repeated 25-times. Root mean square error (RMSE) and target difference values were compared for their suitability for this application. Twelve patients with different indications for oral and maxillofacial surgery were planned for image-guided surgery using a passive infrared surgical navigation system (VectorVision, BrainLAB). Preoperative computed tomography (CT) scans were carried out with newest 16-line multisclice CT-scanner (Siemens Somatom Sensation 16). The new markerless laser surface scanning technique was applied in all intraoperative patient registrations. Registration error was noted. The clinical application accuracy was determined for anatomical landmark localization deviation. RESULTS: In the experimental protocol a mean registration error (RMSE) or target difference of 1.3 (0.14) or 2.08 (0.49) mm for laser scanning and 0.38 (0.01) or 0.99 (0.15) mm for marker registration was found. The differences for RMSE and target localization were statistically significant (p < 0.005). Furthermore, a strong correlation between RMSE and target difference was found for laser scanning (r = 0.96) and marker registration (r = 0.95). During various clinical procedures involving oral and maxillofacial surgery, the overall error of the registration procedure determined as RMSE was 1.21 (0.34) mm. Intraoperatively, the mean clinical application accuracy was found to be 1.8 (0.5) mm. CONCLUSION: Three-dimensional laser surface scanning technique may be a interesting and useful approach to register the patient for image-guided procedures, particularly during oral and craniomaxillofacial surgery.

Cephalometry↗

PubMed2002

[Interdisciplinary concept for classification and treatment of vascular anomalies in the head and neck].

PURPOSE: In patients with extended vascular anomalies in the head and neck, therapeutic decisions may pose a challenge to maxillofacial surgeons, dermatologists, and interventional radiologists. We analyzed the value of an interdisciplinary classification and treatment concept. PATIENTS AND METHODS: The classification distinguishes hemangiomas and vascular malformations. Whereas hemangiomas are endothelial proliferations, vascular malformations are considered to be developmental anomalies, which are further classified into high-flow or low-flow lesions and according to the vascular channels into capillary, venous, or lymphatic malformations. Since 2000 we have provided interdisciplinary consultation for patients with vascular anomalies. In patients with hemangiomas and venous malformations, the clinical diagnosis is confirmed by color-coded duplex sonography and magnetic resonance imaging; angiography is performed as part of the treatment planning for patients with arteriovenous malformations. Patients with hemangiomas are treated surgically by cryosurgery or laser surgery or conservatively according to lesion size and behavior. In patients with venous malformations, percutaneous sclerotherapy is combined with surgical reduction; patients with arteriovenous malformations undergo transarterial embolization prior to surgical excision of the nidus. RESULTS: A total of 73 patients attended the interdisciplinary consultation. This group included 53 patients with facial hemangiomas, 7 with venous malformations, 2 with capillary malformations, 5 with lymphatic malformations, and 6 with high-flow arteriovenous malformations. CONCLUSIONS: The interdisciplinary protocol increases diagnostic accuracy and helps to establish individual treatment plans for patients with extended vascular anomalies.

Adolescent↗

PubMed2002

[Value of panendoscopic examinations within the scope of diagnosing the extent of carcinoma of the mouth cavity].

BACKGROUND: In our department panendoscopic examinations of the tracheobronchial system, the epi-, meso,- and hypopharynx, and the upper gastrointestinal tract are obligatory with regard to the staging of oral squamous cell carcinomas, the main interest being the exclusion of synchronous secondary carcinomas. The aim of this study was to present the pathological findings in 160 panendoscopies of patients with previously untreated oral squamous cell carcinomas. STUDY: A total of 17 synchronous carcinomas were found in 13 (8.2%) of all cases studied. They were situated in the esophagus (n = 9), the stomach (n = 1), the duodenum (n = 1), the hypopharynx (n = 1), the trachea (n = 1), and the lung (n = 4). Multiple carcinomas were found in three patients. The survival time of patients with a secondary carcinoma proved to be significantly worse than that of the other patients. The abuse of alcohol and tobacco causes a high amount of inflammatory changes in the aerodigestive system. In 27 cases (17%) ulcers of the stomach or duodenum were found, although the majority of the patients had large inflammatory mucosal alterations. In 49 cases (34.5%) a chronic tracheobronchitis could be found. DISCUSSION: In our opinion there is an absolute indication for panendoscopic examinations of patients with oral squamous cell carcinomas. In cases with dysplastic mucosal findings these endoscopies have to be repeated on a regular basis.

Carcinoma, Squamous Cell↗

PubMed2002

[Cystic neck lymph node metastases as an indication of occult tonsillar carcinoma].

BACKGROUND: Cystic carcinomas of the neck without evidence of a primary tumor are diagnostically challenging lesions. Differentiation between a cystic lymph node metastasis of an occult primary tumor and a carcinoma arising in a branchiogenic cyst is frequently not possible even with histological examination. In order to clarify the diagnosis, an intensive search for a primary lesion in the upper aerodigestive tract must be carried out. DIAGNOSIS: An occult carcinoma might be situated in Waldeyer's ring, especially in the tonsillar crypts. These tumors tend to produce cystic metastases in the jugulodigastric region. Therefore, multiple biopsies have to be taken from the tissue of Waldeyer's ring. In the case of a positive histological result, adequate therapy of both the primary and the metastasis can be carried out. The diagnosis of a malignant branchiogenic cyst is only permissible after a primary lesion has been thoroughly excluded.

Aged↗

PubMed2002

[3-dimensional image acquisition for analysis of primary, cleft-induced facial deformity with an optoelectronic surface scanner].

BACKGROUND: Anthropometric analysis of the face has been performed with direct facial measurement and photogrammetry. Both methods have disadvantages. The aim of our investigation was to create a three-dimensional image of the primary cleft nasal deformity with a video scanner and to carry out linear measurements. MATERIAL AND METHODS: Facial plaster casts of 19 patients with uni- and bilateral cleft lip and palate before primary lip repair were scanned with digital surface photogrammetry DSP 400. The width of the nose and of the nostril floor, the distance of the alar bases, the length of the ala, and the nasal tip protrusion were measured. RESULTS: Imaging was possible without problems in all models. Direct measurements of the model correlated well with the results of the three-dimensional image. Significant dimensional differences of the nasal parameters examined were noted, depending on the cleft type. DISCUSSION: A video-supported surface scanner allowed immediate three-dimensional imaging of the face. The computer software analyzed the generated surface exactly. The data measured with the presented system resembled other previously published results.

Casts, Surgical↗

PubMed2002

[Feasibility of intraoperative diagnosis with a mobile computed tomography scanner].

AIMS: The possibility of performing intraoperative computed tomography may add to the safety and efficiency of some maxillofacial procedures. It would be preferable for intraoperative image data acquisition to be available to a surgeon on demand for immediate control of therapy results. METHODS: In a pilot study, the use of a mobile computed tomographic scanner (Philips Tomoscan M, Philips Medical Systems, Eindhoven, Netherlands) was evaluated in our unit. The scanner is equipped with wheels, draws power from wall outlets in combination with batteries, and has a translating gantry. RESULTS: Experience to date with six patients has confirmed the feasibility of intraoperative CT. All patients operated on were treated for craniofacial trauma. The CT images showed good spatial resolution. In all cases, visualization of the correct fragment position was excellent without causing significant delay of the operative procedure. CONCLUSIONS: Intraoperative computed tomography could be the new state-of-the-art method for direct control of treatment results in maxillofacial traumatology. Nevertheless, the high expenses for installation of such technical infrastructure has to be pointed out; therefore, the routine use of this technique might be questioned.

Equipment Design↗

PubMed2002

Carcinosarcoma of the mandibular mucosa: the first report.

A 67-year-old man was referred with a squamous cell carcinoma of the left mandibular alveolar ridge verified elsewhere by an exploratory excision. After extensive staging and preoperative irradiation, a radical surgical attempt was performed. Histopathological examination and immunohistochemical analysis revealed the first case of a carcinosarcoma of the mandibular alveolar ridge. Clinical and histopathological features are presented, and treatment and prognosis are discussed.

Aged↗

PubMed2002

Endoscopically assisted zygomatic fracture reduction and osteosynthesis revisited.

In comminuted fractures of the zygoma open reduction of the malar arch is essential for correct anatomic repair. Avoiding exposure of this landmark may result in severe functional and aesthetic impairment. Exposure of the malar arch necessitated traditionally a coronal incision. However, recently several authors reported good results in malar fracture repair with minimal incisions and endoscopic assistance. To establish this technique a cadaver study was performed. Different approaches to the malar arch, fracture reduction and internal fixation were evaluated. After establishment of a satisfactory technique 12 patients with comminution of the zygoma were treated with endoscopic assistance. Repositioning of the fragments was excellent in nine cases, minimal remaining dislocation was seen in two cases and in one case revision was necessary. Postoperatively the frontal branch of the facial nerve was intact in all patients. Scarring was minimal. In three patients plating of the malar arch on a side table resulted in arch necrosis and resorption in the long-term follow-up. Operating time was remarkably longer than in conventional procedures due to the difficult technique.

Adolescent↗