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PubMed2002

[Pharyngeal reconstruction after salvage pharyngolaryngectomy in recurrent tumors].

BACKGROUND: Total pharyngeal reconstruction after salvage pharyngolarynectomy in recurrent tumors after primary surgery or radiation therapy may be performed by ENT surgeons in the oncologic field. PATIENTS: We report on six patients that underwent salvage pharyngolaryngectomy and total pharyngeal reconstruction. METHODS: In three cases pharyngeal reconstruction was performed as a two-stage procedure with deltopectoral flaps. One of these patients died before the completion of reconstruction. In three other patients the reconstruction was performed with a tubed pectoralis major myocutaneous flap including one patient after a failed reconstruction with a jejunum segment. or fistula prevention we applied silicon stents in three patients and self-expanding Nitinol stents in three other patients. RESULTS: Of five successfully reconstructed patients two fed orally, one fed combined orally and via PEG and two fed via PEG. CONCLUSIONS: Summarizing our experiences the use of silicon tubes and nitinol stents has proved its worth. Experiences with a larger number of patients must be collected in the future.

Adult↗

PubMed2005

[Pitfalls in ossicular chain reconstruction].

Today, the reconstruction of the ossicular chain is standard in middle ear surgery. It is performed as a one step procedure in cases of non-inflamed middle ears, as well as in cases of chronic ear diseases. In contrast to the past, a large tympanic cavity is today regularly reconstructed, which contributes to a normally ventilated middle ear. Reconstruction of the ossicular chain is necessary to keep the tympanic membrane in its normal position.However, many modern prostheses are available with different designs and material properties. This article aims to give an overview of the acusto-mechanical and surgical aspects of ossicular chain reconstruction. After a description of normal middle ear vibration, the biomechanical background of the reconstructed middle ear (incus reconstruction, stapes reconstruction) is discussed.

Ear Diseases↗

PubMed2001

[Diagnosis of acute lung embolism with spiral CT and 3D reconstruction. Development of an animal model and technical probe in an ex-vivo experiment].

PURPOSE: To develop a model for simulation the CT morphologic situation of acute pulmonary embolism, to evaluate the accuracy of spiral CT and 3D reconstruction in the detection of artificial emboli and to investigate the influence of the orientation of emboli depending on z-axis orientation. MATERIALS AND METHODS: Standardized artificial emboli made of wax and of defined size and shape were positioned into the pulmonary arteries of porcine lungs. Castings of the embolized pulmonary arterial trees were made by injection of a special opaque resin. After performance of spiral CT the data sets of the emboli and the pulmonary arteries were post-processed. The 3D segmentations were compared with the anatomic preparation to evaluate the accuracy of spiral CT/3D reconstruction-technique. Technical specimens simulating CT-morphology of acute embolized vessels underwent spiral CT in six different positions with respect to the z-axis. The CT data were reconstructed using a standardized and a contrastadapted method with interactive correction. The 3D emboli were analysed under qualitative aspects, and measurements of their extent were done. RESULTS: In nearly 91%, there was complete agreement between CT and the corresponding findings at the anatomical preparation. Measurements of the 3D reconstructed technical specimens showed discrepancies of shape and size in dependence of the size of the original preparation, orientation and reconstruction technique. Overestimation up to 4 mm and underestimation to 2.2 mm were observed. Measurements of preparations with heights from 14 to 26 mm showed variances of +/- 1.5 mm (approximately 6-11%). CONCLUSION: The presented models are suitable to simulate CT morphology of acute pulmonary embolism under ex-vivo conditions. Accuracy in the detection of artificial emboli using spiral CT/3D reconstruction is affected by localization, size and orientation of the emboli and the reconstruction technique.

Acute Disease↗

PubMed2005

3D kinematic in-vitro comparison of posterolateral corner reconstruction techniques in a combined injury model.

With the variable injury pattern to the posterolateral structures (PLS) of the knee, a number of reconstructive procedures have been introduced. It was the aim of the present study to evaluate the resulting 3D kinematics following three different surgical techniques of reconstruction in a combined posterior cruciate ligament (PCL)/PLS injury model. In nine human cadaveric knees, 3D kinematics were recorded during the path of flexion-extension using a computer based custom made 6-degree-of-freedom (DOF) testing apparatus. Additional laxity tests were conducted at 30 and 90 degrees of flexion. Testing was performed before and after cutting the PLS and PCL, followed by PCL reconstruction alone. Reconstructing the posterolateral corner, three surgical techniques were compared: (a) the posterolateral corner sling procedure (PLCS), (b) the biceps tenodesis (BT), and (c) a bone patellar-tendon bone (BTB) allograft reconstruction. Posterior as well as rotational laxity were significantly increased after PCL/PLS transection at 30 and 90 degrees of flexion. Isolated PCL reconstruction resulted in a remaining external rotational deficiency for both tested flexion angles. Additional PLS reconstruction closely restored external rotation as well as posterior translation to intact values by all tested procedures. Compared to the intact knee, dynamic testing revealed a significant internal tibial rotation for (b) BT (mean=3.9 degrees, p=0.043) and for (c) BTB allograft (mean=4.3 degrees, p=0.012). (a) The PLCS demonstrated a tendency to internal tibial rotation between 0 and 60 degrees of flexion (mean=2.2 degrees, p=0.079). Varus/valgus rotation as well as anterior/posterior translation did not show significant differences for any of the tested techniques. The present study shows that despite satisfying results in static laxity testing, pathological 3D knee kinematics were not restored to normal, demonstrated by a nonphysiological internal tibial rotation during the path of flexion-extension.

Aged↗

PubMed2005

Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles.

A decrease of deep knee flexion torque after anterior cruciate ligament (ACL) reconstruction, using a semitendinosus (and gracilis) tendon, has been reported. However, the cause of this weakness remains controversial. Architectural and functional differences in the knee flexor muscles influence this weakness. the fiber length of the semitendinosus, gracilis, semimembranosus, and biceps femoris were directly measured in six human cadavers. The flexion torque and EMG of the hamstrings were measured in both limbs of 16 patients (23+/-5 years) after ACL reconstruction (12-43 months post-operation), using ipsilateral semitendinosus tendon. Magnetic resonance imagings were taken, over both the thighs of those patients, to measure muscle volume and to confirm a state of semitendinosus tendon regeneration. The position of the musculotendinous junction of the semitendinosus was also analyzed. The fiber length of the semitendinosus and gracilis were three to four times longer than that of the semimembranosus and biceps femoris. The difference of flexion torque between the normal and ACL reconstructed limbs significantly increased as the knee flexion angle increased. The EMG value for the semimembranosus and biceps femoris of both limbs as well as the semitendinosus of the ACL reconstructed limbs, significantly reduced as the knee flexion angle was increased. The volume of the semitendinosus in the reconstructed limb was significantly smaller than in normal limbs. The regeneration of the semitendinosus tendon was confirmed in all subjects, and the musculotendinous junction position of the reconstructed limb in almost all subjects was found in further image from the knee joint space than that for the normal limb. The decrease of deep knee flexion torque, after ACL reconstruction, could be due to the atrophy and shortening of the semitendinosus after its tendon has been harvested, as well as the lack of compensation from the semimembranosus and biceps femoris, due to the architectural differences between the semitendinosus and the semimembranosus and biceps femoris.

Achilles Tendon↗

PubMed2006

Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction?

The clinical implications of using irradiation to sterilize allograft bone-patellar tendon-bone (BPTB) remains unknown. The purpose of this study was to compare the clinical outcome of anterior cruciate ligament (ACL) reconstruction with irradiated allograft versus autograft BPTB. We hypothesized that patients undergoing ACL reconstruction with irradiated BPTB allograft would have no significant differences in patient-reported and objective parameters compared to those undergoing autograft BPTB reconstruction. Patients who underwent ACL reconstruction with either irradiated allograft or autograft BPTB from 1996 to 2002 were eligible for this study. One hundred and two patients (39 allograft, 63 autograft) met the study criteria and were available for follow-up. The BPTB allografts were obtained from a single tissue bank and were sterilized with 2.5 Mrad of irradiation prior to distribution. Participants completed the International Knee Documentation Committee (IKDC) subjective knee form and returned for physical and radiographic examinations, instrumented measurement of laxity, and functional testing. Patients were evaluated at an average follow-up of 4.2 years (range 1.8-8.4). Those undergoing allograft reconstruction were older (44+/-8.4 vs. 25.3+/-9.3 years, p<0.001) and had a longer median time from injury to surgery (17.1 weeks vs. 9.7 weeks, p=0.04). There was no difference in IKDC Subjective Knee Scores between groups (86.7 allograft vs. 88.0 autograft, p=0.65). The average maximum manual KT-1000 side-to-side difference was 1.3 and 2.2 mm for allograft and autograft, respectively (p=0.04); however, after adjusting for age, this difference was no longer significant. 90.6% of the allograft and 82.8% of the autograft had normal/nearly normal overall IKDC physical examination rating (p=0.37). 66.7% of the allograft and 77.8% of the autograft returned to the same or more strenuous level of sports (p=0.25). Patients undergoing ACL reconstruction with irradiated allograft BPTB had similar clinical outcomes compared to those reconstructed with autograft BPTB. These data suggest that irradiation can be used to sterilize BPTB allograft without adversely affecting clinical outcome.

Activities of Daily Living↗

PubMed2006

Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction.

A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament (ACL) injury and reconstruction. The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction. Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction. Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft. All the patients performed a test battery of three strength tests for each leg in a randomised order. The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test (open kinetic chain) and lower-extremity muscular power in a leg-press test (closed kinetic chain). There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually. Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery. Thus, this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side, both in patients with an ACL injury and in patients who have undergone ACL reconstruction. It is concluded that a test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction. Only a minority of the patients had restored leg muscle power. The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction.

Adult↗

PubMed1998

Blood flow measurement in reconstructed anterior cruciate ligaments using laser Doppler flowmetry.

Laser Doppler flowmetry (LDF) was used to measure blood flow in anterior cruciate ligaments (ACL) reconstructed using a bone-patellar tendon-bone autograft. Thirty-five patients (17 men, 18 women) undergoing second-look arthroscopy for a reconstructed ACL were selected at random for postoperative participation in the study at 6, 12, and 18 months. Eight patients with an intact ACL had their blood flow measured arthroscopically for a control. Under arthroscopic visualization, a 3 mm probe was placed through a trocar sleeve into the ACL. Functional flow was evaluated using LDF, for which the output signal, the blood cell flux (BCF), is expressed in terms of volts. These patients also underwent magnetic resonance imaging (MRI); MRI, IKDC final evaluation, and second-look arthroscopic findings for each patient were compared with the others. In normal ACL, the BCF value ranged from 120 to 130 mV, and synovial blood flow, 90-132 mV. Significantly high BCF values for the reconstructed ACL were noted at 6 and 12 months, but there was no change in synovial BCF postoperatively. There was a gradual return to near normal BCF values for the reconstructed ACL 18 months after surgery. Significantly abnormal BCF values (580 +/- 20 mV) were seen in cases with a severely abnormal IKDC final evaluation; there were few differences in BCF values between normal, nearly normal, and abnormal. LDF is easy to use and appears to be a reproducible technique for evaluating blood flow in the reconstructed ACL, offering distinct advantages for evaluating its maturation. Six months after surgery, there was a decrease in MRI with a high signal intensity, whereas the BCF values in the reconstructed ACL generally needed 18 months to return to near normal; the return was gradual. We believe the blood supply of the reconstructed ACL may originate from the synovium of posterior joint capsule within 6 months after surgery.

Adolescent↗

PubMed1999

Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete.

The objective of this study was to compare the function and activity level in patients with anterior cruciate ligament injuries, who participated in competitive sports (Tegner activity level > or = 7) and underwent a reconstruction of the anterior cruciate ligament, either subacute (2-12 weeks, group I) or late (12-24 months, group II) after the injury. The patients in group I (n = 97) were comparable with those in group II (n = 103) in terms of gender, age, preinjury activity level, and the reconstruction technique. At the final follow-up (2-5.5 years after the operation), the Lysholm score, the IKDC evaluation system and the one-leg-hop test revealed no differences between the groups. There were also no differences between the groups in terms of the patients' subjective evaluation or expectations. The Tegner activity level at follow-up was 8 (range 2-10) in group I and 6 (range 2-9) in group II (P = 0.0001). The same thing was found in terms of the desired Tegner activity level, which was 9 (range 4-9) in group I and 7 (range 3-10) in group II (P = 0.0002). The KT-1000 laxity meter revealed a total side-to-side difference of 1.5 mm (-3.5-8.5) in group I and 1.5 mm (-3.5-7) in group II (NS). Associated meniscal surgery between the index injury and the reconstruction, or during the reconstruction, was performed in 37/97 (38%) of the patients in group I and 59/103 (57%) of the patients in group II (P < 0.01). This study revealed that competitive athletes who underwent reconstruction at a subacute stage after the anterior cruciate ligament injury had a higher activity level 2-5.5 years after the index operation, as well as a higher desired level of activity compared to athletes who had the reconstruction delayed by 12-24 months. Furthermore, meniscal injuries were significantly more frequent if the reconstruction was delayed.

Adolescent↗

PubMed1999

Proprioception after anterior cruciate ligament reconstruction with and without bracing.

In this investigation we evaluated the effect of ACL reconstruction and functional knee bracing on knee proprioception. Twenty subjects who experienced acute ACL disruption and underwent reconstruction with a bone-patellar tendon-bone graft participated in a controlled rehabilitation program and were studied at a mean follow-up of 2 years. A control group of ten subjects were also studied. In both groups proprioception was evaluated by measuring the threshold to detection of passive motion (TDPM) with the knee at 15 degrees of flexion with and without a functional knee brace applied. The Knee Osteoarthritis Outcome Score, Cincinnati knee score, and two functional knee tests were also used as outcome measurements. Anterior-posterior displacement of the tibia relative to the femur was evaluated with the KT-1000 arthrometer. There were no significant differences in TDPM between the ACL-reconstructed and contralateral knees, or between the ACL reconstructed group and the healthy control group. Bracing did not produce a significant change in the TDPM for the ACL-reconstructed group or for the control group. There were low to moderate correlations between TDPM and the other outcome measurements. This study indicates that there is no significant differences in proprioception between the ACL-reconstructed knee and the contralateral uninvolved knee 1 year or more after surgery. Functional knee bracing does not seem to improve proprioception in patients who have undergone ACL reconstruction and been followed up on average 2 years after surgery.

Adult↗

PubMed2003

Visuo-vestibular interaction in the reconstruction of travelled trajectories.

We recently published a study of the reconstruction of passively travelled trajectories from optic flow. Perception was prone to illusions in a number of conditions, and was not always veridical in the others. Part of the illusionary reconstructed trajectories could be explained by assuming that subjects base their reconstruction on the ego-motion percept built during the stimulus' initial moments. In the current paper, we test this hypothesis using a novel paradigm: if the final reconstruction is governed by the initial percept, providing additional, extra-retinal information that modifies the initial percept should predictably alter the final reconstruction. The extra-retinal stimulus was tuned to supplement the information that was under-represented or ambiguous in the optic flow; the subjects were physically displaced or rotated at the onset of the visual stimulus. A highly asymmetric velocity profile (high acceleration, very low deceleration) was used. Subjects were required to guide an input device (in the form of a model vehicle; we measured position and orientation) along the perceived trajectory. We show for the first time that a vestibular stimulus of short duration can influence the perception of a much longer-lasting visual stimulus. Perception of the ego-motion translation component in the visual stimulus was improved by a linear physical displacement, perception of the ego-motion rotation component by a physical rotation. This led to a more veridical reconstruction in some conditions, but to a less veridical reconstruction in other conditions.

Acceleration↗

PubMed1999

Computer-assisted 3D reconstruction of serial sections of cortical bone to determine the 3D structure of osteons.

The objective of this study was to create three-dimensional (3D) images for the histomorphological study of osteons. Medical imaging technology was used to register digitized 2D images of serial decalcified histological sections of bone, to segment the tissues of interest from the surrounding tissues, and to create 3D reconstructions from the segmented structures. Examination of the 3D reconstructions did not support suggestions in the literature that osteons have a spiraling organization. In contrast, the 3D reconstructions indicated that osteons have a complex pattern of organization that is dominated by branching. Examination of the reconstructions also suggested that osteons described in the literature as being dumbbell shaped are actually artifacts of the plane of sectioning. This study demonstrated the applicability of imaging and visualization technology developed for the 3D reconstruction of medical images to the reconstruction of digitized 2D images of serial sections of bone and additionally demonstrated the feasibility of using 3D reconstructions for the histomorphological study of osteons.

Animals↗

PubMed1997

Diagnostic value of 3D CT surface reconstruction in spinal fractures.

Our purpose was to evaluate the diagnostic value of three-dimensional (3 D) CT surface reconstruction in spinal fractures in comparison with axial and reformatted images. A total of 50 patients with different CT-proven spinal fractures were analysed retrospectively. Based on axial scans and reformatted images, the spinal fractures were classified according to several classifications as Magerl for the thoraco-lumbar and lower cervical spine by one radiologist. Another radiologist performed 3 D CT surface reconstructions with the aim of characterizing the different types of spinal fractures. A third radiologist classified the 3 D CT surface reconstruction according to the Magerl classification. The results of the blinded reading process were compared. It was checked to see in which type and subgroup 3 D surface reconstructions were helpful. Readers one and two obtained the same results in the classification. The 3 D surface reconstruction did not yield any additional diagnostic information concerning type A and B injuries. Indeed, the full extent of the fracture could be easier recognized with axial and reformatted images in all cases. In 10 cases of C injuries, the dislocation of parts of vertebrae could be better recognized with the help of 3 D reconstructions. A 3 D CT surface reconstruction is only useful in rotational and shear vertebral injuries (Magerl type C injury).

Humans↗

PubMed2004

Effects of reinforcement with the iliotibial tract flap in ACL reconstruction using bone-patellar tendon-bone.

INTRODUCTION: We attempted to reinforce the transplanted ligament by wrapping it with the iliotibial tract (ITT) flap to get more volume and to protect the graft from impingement in the intercondylar space postoperatively in reconstruction of the anterior cruciate ligament (ACL) using bone-patellar tendon-bone (BTB), and investigated the results in comparison with those of BTB alone. MATERIALS AND METHODS: The study included 88 cases (88 knees). Group A comprised 43 knees with the reinforcement and group B 45 knees with BTB alone. Both groups were evaluated by second-look arthroscopy, magnetic resonance imaging (MRI), manual testing, International Knee Documentation Committee (IKDC) score, and histopathological evaluation more than 2 years after the reconstruction. RESULTS: In the second-look arthroscopic findings, 84% of the reconstructed ACL in group A had good appearance, and no fibrous split was observed. The ratio of fibrous disorder was significantly less in group A in comparison with group B (p=0.0037). Distinct reduction of the tension of the reconstructed ligament was observed in 9% of group A and 36% of group B (p=0.0088). Regarding the results of the Lachman test, the ratio of the negative group was higher in group A (p=0.0067). In the MRI findings fulfilled pictures to the inside of the reconstructed ligament were observed in 77% of the patients photographed in group A. In contrast, the fibrous split was observed in 55% in group B. CONCLUSIONS: Reinforcement by wrapping with the ITT flap for the BTB autograft was effective in ACL reconstruction. The ratio of fibrous disorder and reduction of tension in the reconstructed ligament decreased.

Adolescent↗

PubMed1999

On the timing of soft-tissue reconstruction for open fractures of the lower leg.

The timing of soft-tissue reconstruction for severe open fractures of the lower leg is considered crucial to the later outcome, and yet pertinent publications are few. The purpose of this study was to add some based on evidence arguments for the choice of the most adequate timing in the management of these injuries. Twenty-nine consecutive open fractures of the tibia, including 24 grade 3B and 5 grade 3C fractures, were treated using a protocol of immediate debridement, early definitive skeletal stabilisation and early soft-tissue reconstruction. Fifteen lower legs were reconstructed after a mean delay of 4.4 days (range 1-9 days), while 14 lower legs were reconstructed immediately, i.e. as an emergency procedure on the day of admission. Both groups were comparable for sex, age, type of trauma, associated general injuries, type of fracture, associated arterial lesion, associated tendon rupture, type of soft-tissue reconstruction and duration of follow-up. All patients were reviewed at a mean follow-up of 47 months (range 15-89 months). In the delayed reconstruction group the time to full, unprotected weight-bearing (P = 0.0021), the time to definitive union (P = 0.0049), the number of reoperations (P = 0.0001) and the infection rate (P = 0.0374) were significantly higher. The data suggest that immediate reconstruction is, the general condition of the patient permitting, the timing of choice for soft-tissue coverage.

Adolescent↗

PubMed2000

Analysis of neural spike trains with interspike interval reconstruction.

As a method for the analysis of neural spike trains, we examine fundamental characteristics of interspike interval (ISI) reconstruction theoretically with a leaky-integrator neuron model and experimentally with cricket wind receptor cells. Both the input to the leaky integrator and the stimulus to the wind receptor cells are the time series generated from the Rossler system. By numerical analysis of the leaky integrator, it is shown that, even if ISI reconstruction is possible, sometimes the entire structure of the Rössler attractor may not be reconstructed with ISI reconstruction. For analysis of the in vivo physiological responses of cricket wind receptor cells, we apply ISI reconstruction, nonlinear prediction and the surrogate data method to the experimental data. As a result of the analysis, it is found that there is a significant deterministic structure in the spike trains. By this analysis of physiological data, it is also shown that, even if ISI reconstruction is possible, the entire attractor may not be reconstructed.

Action Potentials↗

PubMed2006

Colonic interposition and supercharge for esophageal reconstruction.

AIMS: We evaluated the techniques of colonic interposition and supercharge for esophageal reconstruction and discussed the main considerations related to these procedures. PATIENTS AND METHODS: In this study, we performed 51 esophageal reconstructions using colonic interposition. Twenty-eight of the 51 patients had synchronous or allochronic gastric malignancy. We selected colonic interposition for high anastomosis in 11 patients and also for esophageal bypass in 3 patients. This procedure was also selected to preserve gastric function in 5 patients. We recently performed the supercharge technique for colonic interposition in 41 patients. RESULTS: Despite the long duration and multistep nature of the operation procedure, no perioperative complications were noted. The patients returned to a good quality of life. The incidence of postoperative weight loss did not differ significantly between the colonic reconstruction group and the gastric reconstruction group. In terms of heartburn and dumping syndrome, the outcome was markedly better in the colonic reconstruction group (no cases of heartburn or dumping syndrome) than that in the gastric reconstruction group. CONCLUSION: For reconstruction of the esophagus, the colonic interposition and supercharge technique is advantageous and contributes to the patient's quality of life.

Adult↗

PubMed2004

[Long-term results following reconstruction of maxillary sinus wall defects with titanium micro-mesh: a CT-based study].

BACKGROUND: Extensive bony defects of maxillary sinus walls have to be reconstructed to prevent long-term complications. Different autogenous, allogeneic, and alloplastic materials, e.g., titanium mesh, are used for reconstruction. MATERIAL AND METHODS: In 26 patients large defects of the facial and laterodorsal walls of the maxillary sinus were reconstructed using titanium micro-mesh. The mean follow-up period was 49 months (5 months-10 years). All patients were examined with computed tomography applying multiplanar reconstruction techniques and three-dimensional volume rendering. RESULTS: In the CT scans stable scars of 3-6 mm thickness could be found on the antral surfaces of all titanium meshes bridging the defects. In 70% of the patients the volume of the reconstructed maxillary sinus reached 80-100% of the contralateral side. Volume losses were not due to poor adaptation of the titanium mesh but were caused by thickening of maxillary sinus walls or traumatic malpositions. In 77% of the patients ventilation of the maxillary sinus was undisturbed. After mesh removal neither facial contour disturbances nor changes of sinus volume were noted. Soft tissue invasion into the sinus was prevented by a stable scar which had formed underneath the mesh. Three-dimensional reconstruction confirmed symmetrical facial contours in all patients. CONCLUSIONS: The titanium micro-mesh offers a simple and effective alternative to autogenous tissue with stable long-term results for reconstruction of large maxillary sinus wall defects.

Adult↗