Harald Essig

Publications of Harald Essig

• Advances and innovations in computer-assisted head and neck oncologic surgery.

  Authors: Majeed Rana, Harald Essig, André M Eckardt, Frank Tavassol, Martin Ruecker, Alexander Schramm, Nils-Claudius Gellrich

  The Journal of craniofacial surgery. 01/2012; 23(1):272-8.

  Over the past years, computer-assisted surgery has gained more importance in craniomaxillofacial surgery, especially in primary and secondary treatment of head and neck malignancies. The basis forOver the past years, computer-assisted surgery has gained more importance in craniomaxillofacial surgery, especially in primary and secondary treatment of head and neck malignancies. The basis for oncologic treatment of the head and neck region requires detailed planning using computed tomography, cone-beam computed tomography, or magnetic resonance imaging in combination with computer-assisted, infrared-based navigation system. These techniques allow a preplanned image-guided path to the tumor region for taking biopsies, resection, or reconstruction. The aim of this work was to show the advances and technical benefits for tumor surgery in a daily clinical routine from the view of the craniomaxillofacial surgeon. The target of our working group was to develop and clinically evaluate a novel three-dimensional planning and navigation software solution for treatment of craniofacial tumors. This work was carried out on 5 categories for oncologic surgical procedures in which computer-assisted surgery was applied from 2005 to 2011: preplanned trajectorial-guided tumor biopsy, intraoperative image-controlled tumor resection, tumor mapping, reconstruction after tumor surgery (true to original), and oral rehabilitation (backward planning). Successful preoperative planning, import of image data suitable for navigation, and intraoperative precise infrared-based navigation were obtained for all 5 categories without any complications. Image-guided navigation technique for head and neck oncologic surgery provides a precise, safe surgical method with real-time excellent anatomic orientation. Regarding the advantages of computer-assisted surgery, this technique will play a major part in craniofacial reconstructive surgery and will address widespread general methodologic solutions that are of great interest in multidisciplinary oncologic treatment.

• Increase in periosteal angiogenesis through heat shock conditioning.

  Authors: Majeed Rana, Constantin von See, Martin Rücker, Paul Schumann, Harald Essig, Horst Kokemüller, Daniel Lindhorst, Nils-Claudius Gellrich

  Head & face medicine. 11/2011; 7:22.

  It is widely known that stress conditioning can protect microcirculation and induce the release of vasoactive factors for a period of several hours. Little, however, is known about the long-termIt is widely known that stress conditioning can protect microcirculation and induce the release of vasoactive factors for a period of several hours. Little, however, is known about the long-term effects of stress conditioning on microcirculation, especially on the microcirculation of the periosteum of the calvaria. For this reason, we used intravital fluorescence microscopy to investigate the effects of heat shock priming on the microcirculation of the periosteum over a period of several days. Fifty-two Lewis rats were randomized into eight groups. Six groups underwent heat shock priming of the periosteum of the calvaria at 42.5°C, two of them (n = 8) for 15 minutes, two (n = 8) for 25 minutes and two (n = 8) for 35 minutes. After 24 hours, a periosteal chamber was implanted into the heads of the animals of one of each of the two groups mentioned above. Microcirculation and inflammatory responses were studied repeatedly over a period of 14 days using intravital fluorescence microscopy. The expression of heat shock protein (HSP) 70 was examined by immunohistochemistry in three further groups 24 hours after a 15-minute (n = 5), a 25-minute (n = 5) or a 35-minute (n = 5) heat shock treatment. Two groups that did not undergo priming were used as controls. One control group (n = 8) was investigated by intravital microscopy and the other (n = 5) by immunohistochemistry. During the entire observation period of 14 days, the periosteal chambers revealed physiological microcirculation of the periosteum of the calvaria without perfusion failures. A significant (p < 0.05) and continuous increase in functional capillary density was noted from day 5 to day 14 after 25-minute heat shock priming. Whereas a 15-minute exposure did not lead to an increase in functional capillary density, 35-minute priming caused a significant but reversible perfusion failure in capillaries. Non-perfused capillaries in the 35-minute treatment group were reperfused by day 10. Immunohistochemistry demonstrated an increase in cytoprotective HSP70 expression in the periosteum after a 15-minute and a 35-minute heat shock pretreatment when compared with the control group. The level of HSP70 expression that was measured in the periosteum after 25 minutes of treatment was significantly higher than the levels observed after 15 or 35 minutes of heat shock exposure. A few days after heat shock priming over an appropriate period of time, a continuous increase in functional capillary density is seen in the periosteum of the calvaria. This increase in perfusion appears to be the result of the induction of angiogenesis.

• Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy.

  Authors: Harald Essig, Majeed Rana, Andreas Meyer, André M Eckardt, Horst Kokemueller, Constantin von See, Daniel Lindhorst, Frank Tavassol, Martin Ruecker, Nils-Claudius Gellrich

  Radiation oncology (London, England). 11/2011; 6:159.

  The quality of the interdisciplinary interface in oncological treatment between surgery, pathology and radiotherapy is mainly dependent on reliable anatomical three-dimensional (3D) allocation ofThe quality of the interdisciplinary interface in oncological treatment between surgery, pathology and radiotherapy is mainly dependent on reliable anatomical three-dimensional (3D) allocation of specimen and their context sensitive interpretation which defines further treatment protocols. Computer-assisted preoperative planning (CAPP) allows for outlining macroscopical tumor size and margins. A new technique facilitates the 3D virtual marking and mapping of frozen sections and resection margins or important surgical intraoperative information. These data could be stored in DICOM format (Digital Imaging and Communication in Medicine) in terms of augmented reality and transferred to communicate patient's specific tumor information (invasion to vessels and nerves, non-resectable tumor) to oncologists, radiotherapists and pathologists.

• Orbital metastases as first sign of metastatic spread in breast cancer: case report and review of the literature.

  Authors: André M Eckardt, Majeed Rana, Harald Essig, Nils-Claudius Gellrich

  Head & neck oncology. 08/2011; 3:37.

  Intraorbital metastases of breast cancer is rare with only 3-10% of all ocular metastases. We report a case of orbital metastases as first sign of systemic metastatic spread in a female patient withIntraorbital metastases of breast cancer is rare with only 3-10% of all ocular metastases. We report a case of orbital metastases as first sign of systemic metastatic spread in a female patient with breast cancer. The patient had been diagnosed with breast cancer 3 years before. Her present complain was local pain, diplopia and periorbital swelling. A CT scan revealed extensive bony destruction of the orbital roof/anterior skull base. Bone scintigraphy demonstrated additional uptake at the level of the skull base, cervical spine, ilium and ribs suggesting metastatic spread to the skeleton. A navigation-assisted intraorbital biopsy from the orbital roof revealed a metastasis of breast cancer. With the confirmed diagnosis of metastatic breast cancer the patient was refered to the oncologist for further tumor staging. As further treatment she received systemic palliative chemotherapy in addition to intravenous treatment with bisphosphonates. In patients with a previous history of breast cancer who complain even of mild ophthalmologic symptoms such as local pain, periorbital edema, it is important to consider ocular or orbital metastatic disease. Adequate 3D-Imaging followed by a biopsy will usually confirm the diagnosis.

• A novel approach for studying microcirculation in bone defects by intravital fluorescence microscopy.

  Authors: Frank Tavassol, Andreas Kampmann, Paul Schumann, Daniel Lindhorst, Horst Kokemüller, Harald Essig, Jan-Helge Meemken, Martin Rücker, Nils-Claudius Gellrich

  Tissue engineering. Part C, Methods. 07/2011; 17(12):1151-9.

  Angiogenic and inflammatory responses to biodegradable scaffolds were previously studied using the dorsal skinfold chamber for testing different scaffold materials. In this model, the angiogenicAngiogenic and inflammatory responses to biodegradable scaffolds were previously studied using the dorsal skinfold chamber for testing different scaffold materials. In this model, the angiogenic response originates from the soft tissue of the skin. Herein, we introduce a new model that allows the study of developing microcirculation of bone defects for testing tissue-engineered constructs. A bone defect was prepared in the femur of Balb/c mice by inserting a pin for intramedullary fixation, and a custom-made observation window fixed over the defect allowed constant observation. This study included three different groups: empty defect (control), defect filled with porous poly(L-lactide-co-glycolide), and beta-tricalcium-phosphate scaffolds. Starting from 6 days after surgery, angiogenesis, neovascularization, leukocyte-endothelial cell interaction, and microvascular permeability were analyzed over 22 days by using intravital fluorescence microscopy. The empty defects showed no signs of angiogenesis during the observation period, but a distinct increase of capillary density was detected in the scaffold-containing defects. Surprisingly, the histological sections of the scaffold-treated defects showed new bone formation 22 days after implantation. We present a new bone chamber model for intravital long-term study of scaffold materials suitable for bone reconstruction in mice by using fluorescence microscopy.

• Endoscope-assisted transoral reduction and internal fixation versus closed treatment of mandibular condylar process fractures--a prospective double-center study.

  Authors: Horst Kokemueller, Vitomir S Konstantinovic, Enno-Ludwig Barth, Sabine Goldhahn, Constantin von See, Frank Tavassol, Harald Essig, Nils-Claudius Gellrich

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 06/2011; 70(2):384-95.

  The aim of this international AO-study was to compare the functional outcome after open versus closed treatment of mandibular condylar neck fractures. A prospective comparative study with twoThe aim of this international AO-study was to compare the functional outcome after open versus closed treatment of mandibular condylar neck fractures. A prospective comparative study with two follow-ups (FU) at 8-12 weeks and 1 year was undertaken in two clinics, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from clinic 1 (ENDO group) received endoscope-assisted transoral open reduction and internal fixation, whereas patients from clinic 2 (CONS group) were treated conservatively without surgery. Patients with unilateral condylar neck fractures showing one or more of the following conditions were included: displacement of the condyle with an inclination >30° and/or severe functional impairment such as malocclusion or open bite, with or without dislocation of the condylar fragment; severe pain upon palpation or movement, and/or vertical shortening of the ascending ramus. High or intracapsular condylar neck fractures were excluded. 75 patients (44 CONS and 31 ENDO patients) with condylar neck fractures were included in this study. The Asymmetric Helkimo Dysfunction Score (A-HDS) was slightly lower in the CONS group than in the ENDO group at the 8-12-week FU, corresponding to better function on the short-term. At the 1-year FU, however, there were slightly better values in the ENDO group. For the Clinical Dysfunction Index (Di) and the Anamnestic Dysfunction Index (Ai), CONS patients had a better outcome than ENDO patients at the 8-12 week FU, ie, a higher proportion of ENDO patients had severe symptoms due to the operative trauma. Yet these symptoms improved by one year, finishing with a significant higher proportion of symptom-free patients in the ENDO group. In addition, these patients had better values for the Index for Occlusion and Articulation Disturbance (Oi) at both FU examinations, ie, the proportion of patients without any occlusal disturbances was significantly higher in the ENDO group. On average, the duration of postoperative maxillo-mandibular fixation (MMF) was 3 times longer for the CONS group than for the ENDO group (33 vs. 11 days). Both treatment options may yield acceptable results for displaced condylar neck fractures. Especially in patients with severe malocclusion directly after trauma, however, endoscope-assisted transoral open reduction and fixation seems to be the appropriate treatment for prevention of occlusal disturbances during FU.

• Reconstruction of mandibular defects - clinical retrospective research over a 10-year period -.

  Authors: Majeed Rana, Riaz Warraich, Horst Kokemüller, Juliane Lemound, Harald Essig, Frank Tavassol, André Eckardt, Nils-Claudius Gellrich

  Head & neck oncology. 01/2011; 3:23.

  Functional and cosmetic defects in the maxillofacial region are caused by various ailments and these defects are addressed according to their need. Simplicity of procedure, intact facial function andFunctional and cosmetic defects in the maxillofacial region are caused by various ailments and these defects are addressed according to their need. Simplicity of procedure, intact facial function and esthetic outcome with the least possible donor site morbidity are the minimum requirements of a good reconstruction. Oro-mandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts. Reconstruction of trauma- or mandibular oncologic defects with bony free flaps is considered the gold standard. However the the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection and the timing of surgery. The purpose of this study was to determine the outcome of different osseous reconstruction options using autogenous bone grafts for mandibular reconstructions. This study was carried out on 178 patients with mandibular bone defects. They were reconstructed with autogenous bone grafts from different donor sites. At post operative visits they were evaluated for functional and cosmetic results. The success rate found in this study was around 90%. Only 7.6% of the cases showed poor results regarding facial contours and mouth opening. All other patients were satisfied with their cosmesis and mouth opening at the recipient sites was in the normal range during last follow-up visits. Donor sites were primarily closed in all cases and there was no hypertrophic scar. Based on this study, autogenous bone grafts are a reliable treatment modality for the reconstruction of mandibular bone defects with predictable aesthetic and functional outcomes. As the free vascularized fibular flap has the least resorption and failure rate, it should be the first choice for most cases of mandiblular reconstruction.

• Pre-operative planning for mandibular reconstruction - a full digital planning workflow resulting in a patient specific reconstruction.

  Authors: Harald Essig, Majeed Rana, Horst Kokemueller, Constantin von See, Martin Ruecker, Frank Tavassol, Nils-Claudius Gellrich

  Head & neck oncology. 01/2011; 3:45.

  Reconstruction of large mandiblular defects following ablative oncologic surgery could be done by using vascularized bone transfer or, more often, primarily with simultaneous or delayed boneReconstruction of large mandiblular defects following ablative oncologic surgery could be done by using vascularized bone transfer or, more often, primarily with simultaneous or delayed bone grafting, using load bearing reconstruction plates. Bending of these reconstruction plates is typically directed along the outer contour of the original mandible. Simultaneously or in a second operation vascularized or non-vascularized bone is fixed to the reconstruction plate. However, the prosthodontic-driven backward planning to ease bony reconstruction of the mandible in terms of dental rehabilitation using implant-retained overdentures might be an eligible solution. The purpose of this work was to develop, establish and clinically evaluate a novel 3D planning procedure for mandibular reconstruction. Three patients with tumors involving the mandible, which included squamous cell carcinoma in the floor of the mouth and keratocystic odontogenic tumor, were treated surgically by hemimandibulectomy. In primary alloplastic mandible reconstruction, shape and size of the reconstruction plate could be predefined and prebent prior to surgery. This study provides modern treatment strategies for mandibular reconstruction.

• Effects of VEGF loading on scaffold-confined vascularization.

  Authors: Daniel Lindhorst, Frank Tavassol, Constantin von See, Paul Schumann, Matthias W Laschke, Yves Harder, Kai-Hendrik Bormann, Harald Essig, Horst Kokemüller, Andreas Kampmann, André Voss, Rolf Mülhaupt, Michael D Menger, Nils-Claudius Gellrich, Martin Rücker

  Journal of biomedical materials research. Part A. 12/2010; 95(3):783-92.

  Adequate vascularization of tissue-engineered constructs remains a major challenge in bone grafting. In view of this, we loaded ß-tricalcium-phosphate (ß-TCP) and porous poly(L-lactide-co-glycolide)Adequate vascularization of tissue-engineered constructs remains a major challenge in bone grafting. In view of this, we loaded ß-tricalcium-phosphate (ß-TCP) and porous poly(L-lactide-co-glycolide) (PLGA) scaffolds via collagen coating with vascular endothelial growth factor (VEGF) and studied whether the VEGF loading improves scaffold angiogenesis and vascularization. Dorsal skinfold chambers were implanted into 48 balb/c mice, which were assigned to 6 groups (n = 8 each). Uncoated (controls), collagen-coated, and additionally VEGF-loaded PLGA and ß-TCP scaffolds were inserted into the chambers. Angiogenesis, neovascularization, and leukocyte-endothelial cell interaction were analyzed repeatedly during a 14-day observation period using intravital fluorescence microscopy. Furthermore, VEGF release from PLGA und ß-TCP scaffolds was studied by ELISA. Micromorphology was studied from histological specimens. Unloaded ß-TCP scaffolds showed an accelerated and increased angiogenic response when compared with unloaded PLGA scaffolds. In vitro, PLGA released significantly higher amounts of VEGF compared with ß-TCP at the first two days resulting in a rapid drop of the released amount at the following days up to day 7 where the VEGF release was negligible. Nonetheless, in vivo VEGF loading increased neovascularization, especially in ß-TCP scaffolds. This increased vascularization was associated with a temporary leukocytic response with pronounced leukocyte-endothelial cell interaction at days 3 and 6. Histology revealed adequate host tissue response and engraftment of both ß-TCP and PLGA scaffolds. Our study demonstrates that ß-TCP scaffolds offer more suitable conditions for vascularization than PLGA scaffolds, in particular if they are loaded with VEGF.

• Intraoperative navigation assisted reconstruction of a maxillo-facial gunshot wound.

  Authors: Constantin Stuehmer, Harald Essig, Alexander Schramm, Martin Rücker, André Eckardt, Nils-Claudius Gellrich

  Oral and maxillofacial surgery. 12/2008; 12(4):199-203.

  This case report describes a suicidal gunshot wound to the head using a handgun (9 x 19 mm). During mandibular penetration, the solid hollow point projectile (Aktion4) was deformed but did notThis case report describes a suicidal gunshot wound to the head using a handgun (9 x 19 mm). During mandibular penetration, the solid hollow point projectile (Aktion4) was deformed but did not fragment. The mandible, mid-face, orbit, and nasal complex were severely damaged. Here, the authors present, for the first time, a new approach for bilateral mid-facial fractures. For virtual reconstruction, a naso-orbito-ethmoidal complex of an unaffected skull (same age, sex, and ethnic group) was merged into the computed tomography (CT) data set. Based on this data set, a navigation assisted operation was performed. The favorable outcome leads us to recommend the technique of merging comparable CT data for reconstructive planning of bilateral mid-facial fractures.

• Computer-assisted navigation in craniomaxillofacial tumors.

  Authors: Alexander Schramm, Maria Mercedes Suarez-Cunqueiro, Enno-Ludwig Barth, Harald Essig, Kai-Hendrik Bormann, Horst Kokemueller, Martin Rücker, Nils-Claudius Gellrich

  The Journal of craniofacial surgery. 07/2008; 19(4):1067-74.

  Surgical procedures in the head and neck region require a detailed knowledge of this region's complex anatomy. Anatomic changes due to tumor growth present special challenges for the surgeon. InSurgical procedures in the head and neck region require a detailed knowledge of this region's complex anatomy. Anatomic changes due to tumor growth present special challenges for the surgeon. In addition to the clinical examination, which is still of fundamental importance, imaging procedures such as computer-aided surgical navigation technology are currently being used in the preoperative, intraoperative, and postoperative assessments of anatomic changes. For purposes of analysis, we have analyzed the application of navigation technology into 2 categories: 1) minimally invasive procedure and biopsy; and 2) resection of extensive tumors and reconstruction after tumor surgery. Navigation can make tumor surgery more reliable by specifying correct safety margins, protecting vital structures, and facilitating the reconstruction process.

• [Necrotizing sialometaplasia: diagnosis of a rare entity]

  Authors: Constantin Stühmer, Harald Essig, Henning Feist, Kai-Hendrik Bormann, Nils-Claudius Gellrich, Martin Rücker

  Schweizer Monatsschrift für Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia / SSO. 02/2008; 118(7):635-40.

  A differential diagnosis of an ulcer on the hard palate must consider a wide variety of diseases and conditions, among them rare entities such as necrotizing sialometaplasia. We report the case of aA differential diagnosis of an ulcer on the hard palate must consider a wide variety of diseases and conditions, among them rare entities such as necrotizing sialometaplasia. We report the case of a patient who presented with a painful ulcer on the hard palate. A biopsy taken at the initial presentation of the patient revealed a diagnosis of necrotizing sialometaplasia. Histology showed foci of eosinophilic granulocytes with lobular infarction or necrosis, bland-appearing nuclear morphology of squamous cells, simultaneous metaplasia of ducts and mucous acini. The ulcer resolved spontaneously within seven weeks and required no specific treatment. The case presented here shows that early diagnosis of necrotizing sialometaplasia is important in order to prevent unnecessary treatment.