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Biomedical subjects

S Reinert

Publications and source records attributed to S Reinert.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Dental MRI. Phantom study and clinical results].

Magnetic resonance imaging (MRI) is used as a diagnostic tool for special indications in oral and maxillofacial surgery. We describe a new MRI technique that presents images in a panoramic view analogous to orthopantomography. This technique is based on three-dimensional T1- and T2-weighted sequences. The familiar panoramic view in MRI provides better orientation and makes diagnosis faster and easier. However, the acquisition time is long (6-12 min per sequence), with a correspondingly high risk of motion artifacts. Moreover, the final workup is also time-consuming. These restrictions could be overcome by progress in hardware and software. There are promising indications for dental MRI.

Adult↗
PubMed1999

[Follow-up studies of 3-dimensional osteoplastic reconstruction of the extremely atrophied maxilla combined with implants].

In the severely resorbed maxilla, a 10-year success rate of only 49-74% of implants in combination with autogenous bone grafts has been reported. We developed a modified technique of antral inlay grafting and lateral and vertical onlay grafting of the severely resorbed maxilla for inserting implants to retain dentures. The clinical and radiologic results are presented. In 21 patients with severely resorbed edentulous maxillae, a total of 20 bilateral and one unilateral antral inlay graftings and lateral and vertical onlay graftings were performed after a prosthodontic setup. We opened the maxillary sinus by removing a bony window from the anterolateral wall and, after elevation of the sinus lining, grafted the sinus floor with corticocancellous iliac crest bone grafts. The maxilla was also augmented in the lateral and vertical direction. The bone grafts were fixed by osteosynthesis. After a median of 5 months, a total of 134 implants (Brånemark) were placed and later loaded by prosthodontic rehabilitation. Computed tomography (CT) scans were taken before the grafting procedure, immediately after grafting, after 4 months, and every year thereafter. A total of 94.8% of the implants were successful at the time of the abutment operation. After loading, two additional failures were seen in an average follow-up period of 2.5 years. Most patients were provided with implant-borne dentures. CT scans showed an average initial gain of vertical bone height of 3.7-17.7 mm. One year after grafting, a loss of 1.3 mm or 7% occurred. In the following 2 years, no major atrophy was observed. Statistical analysis showed no correlation between sex, bone height before augmentation, augmented bone height, and resorption of the grafted bone. We observed undisturbed healing and obtained large vertical bone heights, a high success rate, minimal resorption, and fully satisfactory prosthodontic rehabilitation; we can thus recommend our modified technique of reconstruction of the severely resorbed maxilla for routine use.

Alveolar Bone Loss↗
PubMed1999

[Tracheobronchial perforations--a complication after mouth, maxillary and facial surgery].

After difficult endotracheal intubation in oral and maxillofacial surgery, esophageal or tracheal injuries can cause mediastinal, pericardial or cervicofacial soft tissue emphysema. If a patient has of thoracic pain after general anesthesia, mediastinal emphysema should be taken into consideration because of the possibility of subsequent life-threatening complications. Diagnosis can be established with computed tomography and fiber-endoscopy. We present the diagnostic and therapeutic management of two patients.

Adult↗
PubMed1999

The value of magnetic resonance imaging in the diagnosis of mandibular osteomyelitis.

Our aim was to evaluate the accuracy of magnetic resonance imaging (MRI) and bone scintigraphy in the diagnosis of mandibular osteomyelitis. Twenty patients with mandibular osteomyelitis were prospectively investigated by conventional radiography, bone scintigrams and MRI. All diagnoses were verified either by surgery or by the clinical course. There was no significant difference between bone scintigraphy and MRI in the detection of osteomyelitis or the assessment of its extent. MRI was significantly better than scintigraphy at detecting the presence and assessing the extent of extraosseous inflammation. We always use MRI to diagnose osteomyelitis. For long-term follow-up of patients with mandibular osteomyelitis, we recommend MRI and bone scintigraphy.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1998

[Interdisciplinary diagnosis and therapy of traumatic optic nerve damage].

Traumatic optic nerve lesions (TONL) still pose a large clinical problem concerning early detection and treatment. Neuro-ophthalmology provides reliable tests to detect afferent lesions but these methods are limited to just 30% of the severely injured patients. Especially in the patient with multiple injuries, optic nerve injuries are hardly predictable. In the latter group we established well-known neurophysiological methods for early detection of afferent disorders of the visual pathway, i.e. flash-VEP ERG. Apart from these diagnostic problems of TONL, controversy still surrounds the appropriate treatment of TONL--whether conservative or surgical or even combined treatment should be advocated. Our aim was to establish a reliable diagnostic schedule, based on the combination of neuro-ophthalmological, spiral-CT and clinical findings, and a treatment plan, so that in any patient there is a distinct guideline as to whether there is a need for early treatment of the peripheral visual pathway or not. In 52 patients who were assessed by the above-mentioned schedule, we could detect any of the 20 afferent disorders of the peripheral visual pathway. Although it is difficult to prove therapeutic effects on the injured optic nerve, immediate combined conservative treatment plus optic nerve decompression helped in three patients, who reported unilaterally no light-perception at admission, to regain at least partial recovery of afferent function of the visual pathway. Most of the trauma units still handle the problem of optic nerve trauma with a 'wait and see' policy. This is not regarded as an up-to-date option, since there are alternatives, and these will be outlined.

Afferent Pathways↗
PubMed1998

[Problems in diagnosis and therapy of carcinoma in stroma-abundant pleomorphic adenoma of the parotid gland].

The case is reported of a 27-year-old patient who developed multiple recurrences of a carcinoma arising from richly stromal pleomorphic adenoma of the parotid gland over 13 years. Originally the tumor was classified as a benign pleomorphic adenoma because there were no cytological characteristics of malignancy. Later on the diagnosis had to be modified to that of a carcinoma arising from a pleomorphic adenoma because of the infiltrating growth pattern of the tumor. A multicentric local recurrence and metastases on the left side of the neck supported the correct diagnosis. This case demonstrates that, beside the classic cytological criteria of malignancy invasion and penetration of the capsule can be decisive for the diagnosis of malign transformed pleomorphic adenoma. Treatment and prognosis of salivary gland tumors assume a clear determination of their diguity. The unusual course in this case of a pleomorphic adenoma originally diagnosed as benign demonstrates the importance of regular follow-up.

Adenoma, Pleomorphic↗
PubMed1998

[Pigmented villonodular synovitis of the temporomandibular joint with invasion of middle cranial fossa].

A 63-year-old man is presented in whom a tenosynovail giant-cell tumor destroyed the right temporomandibular joint and fossa and showed extensive intracranial growth. Because of uncharacteristic complaints, a symptomatic treatment was performed elsewhere. The lesion was finally resected under endotracheal anesthesia. After 20 months free of recurrence the patient's outcome is very satisfying. Differential diagnosis and therapy are discussed.

Diagnosis, Differential↗
PubMed1996

[Late outcome and complications of mandibular compression osteosynthesis with intraoral approach--a 10-year study].

Late results and complications following rigid internal fixation of mandibular fractures-a 10 year survey. From 1984 to 1993 541 fractures of the mandible in 332 patients have been treated by rigid internal fixation with the mandibular compression system (MCS). In 0.8% we saw serious complications like pseudarthrosis or osteomyelitis. In a retrospective study 105 patients with 171 fractures of the mandible could be examined 4.1 years after osteosynthesis. In case of preoperative normesthesia of the inferior alveolar nerve in 74.1% of the fractures nomesthesia was still present, 18.1% of the fractures showed hypesthesia and 4.2% showed complete anesthesia. In case of already preoperatively existent hypesthesia in 81.8% of the fractures normesthesia and in 8.2% hyp- or paresthesia were seen. There were no anesthesias seen in this group. 3.6% of the fractures showed mild occlusal disharmonies.

Adult↗
PubMed1996

[Principles of surgical treatment of obstructive sleep apnea by interventions on the facial bones].

The clinical picture of the obstructive sleep apnea syndrome is caused by a multifactorial etiology. Therefore a lot of different conservative as well as surgical therapeutic approaches are discussed. In approximately 40% of the patients an obstruction of the pharyngeal airway is combined with an abnormal sagittal morphology of the skull. In these cases a simultaneous maxillomandibular advancement by at least 10 mm seems to be a causal therapy, leading to an enlargement of the pharyngeal airways. The current therapeutic results are roughly stable up to a period of approximately 3 years. Requirement of this therapy is the exclusion and/or the prior therapy of an extreme obesity, which can favour the manifestation of an obstructive sleep apnea syndrome.

Airway Obstruction↗
PubMed1994

Microvascular anastomosis of interpositional vein grafts with sutures and a new mechanical device--a histologic and scanning electron microscopic study.

In an experimental study, a new mechanical device for microvascular anastomosis was compared with suture anastomosis. In 14 rabbits, seven end-to-end and seven end-to-side anastomoses of the jugular vein to interpositional vein grafts were done with a ring-pin device and by the conventional suture method. There was no significant difference between the patency rates of mechanical and suture anastomoses. The completion of mechanical anastomoses took one-third the time required for suture anastomoses. After 10 days, histologic and scanning electron microscopic examination revealed an uneventful reparative process at the anastomotic site with media atrophy and a continuous endothelial layer. At 4 weeks, occasional foreign body giant cells were seen between the polyethylene rings and surrounding connective tissue. The study confirms that the ring-pin device is safe and provides a faster way to do microvascular anastomoses than by suturing.

Anastomosis, Surgical↗
PubMed1994

[Results and special aspects of secondary microsurgical bone transfer in the area of the facial skull].

Results and significance of secondary reconstruction of mandibular and maxillary defects. The results of 14 patients with 12 mandibular and 2 maxillary defects following tumour surgery with irradiation and/or chemotherapy, osteomyelitis, osteoradionecrosis or trauma, which were reconstructed secondarily, are presented. 12 flaps survived, 1 flap showed a partial and 1 flap a complete necrosis due to venous thrombosis. The major differences of secondary reconstruction of bone defects in the facial skeleton in comparison to primary reconstruction are the scar formation in the defect region and above all the reduced number and quality of recipient vessels in the neck area. The design of the flap should be exactly determined preoperatively. Of great importance is the examination of the recipient vessels in the neck area. Non-invasive methods are preferred.

Bone Transplantation↗
PubMed1992

[The value of 2- and 3-dimensional computed tomography in the diagnosis and classification of midfacial and orbital fractures].

The value of 2D- and 3D-computed assisted tomography in detecting and classifying midfacial fractures and craniofacial deformities acquired by gunshot injuries was assessed in 123 resp. 26 patients and compared with the postoperative results. In a comparative study 37 patients were prospectively examined by pluridirectional tomography. Examinations of a macerated skull were performed to optimize 3D investigation technique. High resolution CT proved to be the most reliable technique in detecting midfacial fractures and associated soft tissue injuries. 3D-imaging of bony surfaces allowed clear demonstration of fraction extent and fragment displacement without offering additional detail information. 3D-based computer-assisted manufacturing of individual models facilitated surgical planning of complex midfacial injuries.

Adolescent↗
PubMed1990

[The microplate system: a new armamentarium for osteosynthesis in the child skull].

In certain ares of the craniofacial skeleton the plate systems commonly used for rigid internal fixation seem to be over-dimensioned. The newly developed Micro System for internal fixation with extremely tiny plates and screws provides a firm three-dimensional fixation of segments with minimal interference with the overlying soft tissues. Fields of application are traumatology and craniofacial surgery in infants, fractures of the naso-ethmoidal region and the orbit, reconstruction of the skull, and the fixation of cartilage and bone grafts.

Adolescent↗