Publications (42) View all
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Article: Primary and Secondary Leiomyosarcoma of the Oral and Perioral Region-Clinicopathological and Immunohistochemical Analysis of a Rare Entity With a Review of the Literature.
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ABSTRACT: PURPOSE: Leiomyosarcoma (LMS) rarely occurs in the head and neck region. These tumors present with a wide range of clinical features, so the diagnosis is predicated on conventional microscopic findings coupled with immunohistochemical analysis. PATIENTS AND METHODS: Clinical and histologic data of 7 patients with LMS of the head and neck were recorded retrospectively. In addition to routine immunohistochemistry, staining for cell cycle regulator proteins p16 and p21 was performed. RESULTS: Five LMSs (4 intraoral, 1 dermal cheek) occurred primarily in the oral and perioral region. Two LMSs (parietal and sinonasal) were diagnosed as metastases originating from the uterus and pelvis. Treatment of the primary LMSs consisted of radical tumor resection with clear margins. Distant metastases from LMSs were irradiated or excised as palliative treatment. Three of 5 patients (60%) with primarily excised LMS developed recurrence after an average of 7 months, with lung metastases occurring after 17 months. In 1 patient, cervical lymph node metastases were detected after 10 months. Of all patients, 5 died after an average survival period of 2.4 years. The mean survival period of the 5 patients with primary LMS of the head and neck was 3.3 years. All tumors were positive for vimentin and α-smooth muscle actin, with 57% of tumors showing positive nuclear expression of p16 and 71% of p21. Lack of p16 nuclear expression was associated with a shorter mean survival time (1.3 vs 4.3 yr for p16 positivity). CONCLUSION: Lung and cervical lymph node metastases often occur in LMS of the head and neck. Presurgical staging, including gynecologic examination, whole-body computed tomography, and sometimes positron-emission or computed tomography, to rule out LMS metastasis is mandatory. Surgical resection of the tumor should be given top priority. Lack of p16 reactivity may have a prognostic value for LMS because it was related to a trend toward poorer survival.Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2013; · 1.58 Impact Factor -
Article: Secondary correction of posttraumatic orbital wall adhesions by membranes laminated with amniotic membrane.
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ABSTRACT: The objective of the study was to find out if human amniotic membrane could be used for corrective surgery after trauma to the orbital wall. Because of its proposed antiadhesive qualities, it seemed to be potentially suitable. We studied 8 men (mean age 37 (range 19-74) years) who had deficient ocular movement after fractures of the orbital floor. Five of them had already been operated on. Inclusion criteria were trauma dating back more than 4 months and a soft tissue stricture in the orbital floor diagnosed by magnetic resonance imaging. Patients were treated secondarily with lysis of adhesions and insertion of allogeneic human amniotic membrane laminated on to polyglactin 910/polydioxanone foil, which functioned as the carrier material. Patients were followed up for 3 months, by which time disorders of motility of the ocular bulb had disappeared completely in 5. Two patients had improved motility and a reduction in both their subjective and objective symptoms. One patient had no improvement. The considerable reduction in adhesions and scarring after insertion of the membrane confirms previous assumptions, according to which the epithelial side of the human amniotic membrane has an antiadhesive effect because of its smooth surface.British Journal of Oral and Maxillofacial Surgery 02/2013; · 1.95 Impact Factor -
Article: Comparison of outcome of microvascular bony head and neck reconstructions using the fibular free flap and the iliac crest flap.
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ABSTRACT: Several microvascular free flaps are available for reconstruction of the osseous components after resections for head and neck cancer. We have prospectively evaluated patients treated by bony microsurgical reconstruction to identify predictors of adverse outcomes for delayed wound healing and failure of free flaps. All patients from July 2007 to June 2011 who had reconstructions with microvascular fibular or iliac crest flaps immediately after resection of the tumour were evaluated. There were a total of 156 bony free flaps: 120 (77%) fibular and 36 (23%) iliac crest flaps. A total of 133 (85%) were successful. Delayed wound healing was more common with the iliac crest flap (p=0.01) at the intraoral site (p=0.04). Significantly more iliac crest free flaps failed (p=0.02). Anastomosis to the facial artery (p=0.05) and facial vein (p=0.04), and duration of overall operating time were associated with a significantly higher risk of failure of the flap. Patients with cancer of the head and neck who require microsurgical bony reconstruction are at increased risk of postoperative complications. Significantly more complications were found with the iliac crest flap, whereas the fibular flap was associated with a significantly longer operating time.British Journal of Oral and Maxillofacial Surgery 02/2013; · 1.95 Impact Factor -
Article: The innovative application of a novel bone adhesive for facial fracture osteosynthesis-in vitro and in vivo results.
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ABSTRACT: This study evaluates a novel adhesive fixation technique to affix cortical bone fragments to osteosynthesis plates using common PMMA cement. This technique utilizes a new amphiphilic bone bonding agent adhering with both hydrophilic bone and hydrophobic PMMA cement. After in vitro biomechanical testing of the bonding strength with explanted bovine and rabbit calvarian bone samples, osteosynthesis plates with screw holes of 1.3 and 1.5 mm were placed on the cranial bone of New Zealand white rabbits and the bond strength of these plates was determined through tension tests. In vitro bond strengths of 19.8-26.5 MPa were obtained. Control samples, prepared without a bone bonding agent, exhibited bone bonding strengths <0.2 MPa. In vivo respective bond strengths at the cranium of the white rabbits were 2.5-4.1 MPa 2 weeks post surgery and 1.9-2.5 MPa 12 weeks after implantation. This new innovative fixation method can be envisioned for cases in which conventional fixation techniques of screws and plates are insufficient or not possible due to the bone or trauma conditions. The observed bonding strengths support implementing this technique in nonload bearing regions, such as the central midface or frontal sinus, facilitating immobilization until bone reunion is complete. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2012.Journal of Biomedical Materials Research Part A 12/2012; · 2.63 Impact Factor -
Article: Eine klinisch prospektive Untersuchung zum Einfluss der Fokussanierung vor Herzklappenoperation auf den langfristigen zahnärztlichen Behandlungsbedarf
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ABSTRACT: Studienziel war die Evaluation des Einflusses einer nicht-radikalen Zahnsanierung vor einer geplanten Herzklappenersatzoperation auf den langfristigen postoperativen zahnärztlichen Behandlungsbedarf. 305 Patienten wurden vor einer Klappenersatzoperation hinsichtlich des zahnärztlichen Fokussanierungsbedarfs gescreent und notwendige Behandlungen eingeleitet. Nach 36 Monaten konnten 80 dieser Patienten klinisch reevaluiert werden. Bei 60 Patienten waren 155 Zähne behandlungsbedürftig, meistens aufgrund parodontaler Schädigungen. Gruppenunabhängig lag ein statistisch signifikanter Anstieg des Behandlungsbedarfs gegenüber dem initialen Erhebungsbefund vor. Darüber hinaus zeigte sich zum Nachbeobachtungszeitpunkt eine signifikant über der Erwartung liegende tatsächliche Therapienotwendigkeit, was möglicherweise auf nicht adäquate Therapiemaßnahmen während des Follow-up-Intervalls zurückzuführen ist. Eine Endokarditis war ungeachtet einer präoperativen Sanierung und einer meistens erfolgten prophylaktischen Antibiotikagabe im Gesamtkollektiv nicht aufgetreten. Nicht-radikale zahnärztliche Behandlungen vor einer Herzklappenersatzoperation können nur dann erfolgreich sein, wenn auch eine anschließende engmaschige Nachsorge unter standardisierten Nachbeobachtungsrichtlinien mit entsprechenden Erhebungsbögen gewährleistet ist. Die Gefahr einer von einem unbehandelten dentalen Fokus ausgehenden Ersatzklappenendokarditis wird wahrscheinlich überschätzt. The study objective was to evaluate the long-term influence of non-radical surgical and restorative dental treatment modalities prior to elective cardiac valve replacement on the subsequent dental treatment demand. A total of 305 patients preceding cardiac valve surgery were screened and the appropriate dental treatment was initiated. After 36 months 80 patients were re-evaluated clinically, of which 60 required dental restorations of 155 teeth, mostly due to periodontal pathology. Independent of the sub-group there was a statistically substantial increase of the treatment demand compared to the time of initial examination. In addition, at the time of final re-evaluation the definite treatment need significantly increased far beyond anticipation, potentially due to inadequate dental procedures during the follow-up interval. Irrespective of any dental treatment or antibiotic application, endocarditis did not occur in any patient. Non-radical dental restoration prior to cardiac valve replacement can only be successful, if a standardized dental follow-up with common monitoring forms is provided. The risk of prosthetic valve infective endocarditis based on a dental focus is probably overestimated. SchlüsselwörterHerzklappenprothesenendokarditis-Dentogener Fokus-Zahnsanierung-Antibiotika KeywordsProsthetic valve infective endocarditis-Dental focus-Surgical and dental restoration-AntibioticsWiener Medizinische Wochenschrift 04/2012; 159(23):608-619.
