Christian Freudlsperger

Heidelberg University, تيفين، أوهايو, Ohio, United States

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Publications (43)102.12 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Molding helmet therapy using an individual head orthosis presents a widely accepted treatment option for children with positional head deformities; however, studies addressing the incidence of complications during helmet therapy are rare.The current study evaluates the incidence of complications in 205 children with positional head deformity undergoing molding helmet therapy. Children were classified according to the severity of their deformity as presented by the Cranial Vault Asymmetry Index (CVAI) and the Cephalic Index (CI).Fifty-nine (28.8%) of our patients presented a moderate and 146 (71.2%) a severe form of a positional head deformity. Of these children, 166 (81.0%) were diagnosed for plagiocephaly, 19 (9.3%) were brachycephalic, and 20 (9.7%) showed a combination of plagiocephaly and brachycephaly.Overall, 54 children (26.3%) showed minor complications during their helmet molding including pressure sores (13.7%), ethanol erythema (2.9%), skin erosions/skin infections (4.3%), or deficient fitting (5.4%). Children with a combination of plagiocephaly and brachycephaly (n = 20) showed the highest risk for complications, which was significantly higher compared with children with plagiocephaly (50% vs 22.3%; P = 0.012). Irrespective of the type of positional head deformity, no statistical difference was revealed between the moderate and the severe form.Minor complications are a relatively frequent event during helmet molding therapy. Especially children with a combination of plagiocephaly-brachycephaly are at high risk for complications. A reduction of this rate might be reached by a close follow-up for a short period between helmet manufacturing adjustments.
    The Journal of craniofacial surgery 06/2015; 26(4):e299-302. DOI:10.1097/SCS.0000000000001649 · 0.68 Impact Factor
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    ABSTRACT: Craniofacial surgery in infants still harbors the risk of significant blood loss and the need for red blood cell (RBC) transfusion. Hence, the aim of the present study was to investigate the antifibrinolytic effect of tranexamic acid (TXA) on intraoperative blood loss and RBC transfusion rates during fronto-orbital advancement (FOA) in isolated metopic synostosis. A total of 33 children with metopic synostosis were operated on using standardized FOA, of which 16 patients (48.5%) were treated without intraoperative TXA (non-TXA group) and 17 patients (51.5%) received TXA intraoperatively (TXA group). To accurately evaluate the calculated blood loss (CBL) we analyzed the values for pre- and postoperative hematocrit and the volume of the RBC transfusion. The mean CBL and the mean weight-adjusted CBL was significantly lower for patients receiving TXA compared with the non-TXA group (158.8 ml vs. 198.5 ml, p = 0.0001; and 19.1 ml/kg vs. 22.3 ml/kg, p = 0.0293, respectively). In addition, the mean RBC transfusion and the mean weight-adjusted RBC transfusion was significantly lower for the TXA group (252.2 ml vs. 280.0 ml, p = 0.0001; and 27.9 ml/kg vs. 31.3 ml/kg, p = 0.0345, respectively). The mean duration of the surgical procedure did not differ statistically between the groups (132 min vs. 136 min, p = 0.4081), hence the lower CBL in the TXA-group was not related to a shorter cutting-suture time. As the use of intraoperative TXA minimizes blood transfusion volumes in children who undergo FOA, antifibrinolytics, such as TXA, should be considered for routine use in pediatric craniofacial surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
    Journal of Cranio-Maxillofacial Surgery 05/2015; DOI:10.1016/j.jcms.2015.05.004 · 2.60 Impact Factor
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    ABSTRACT: There is still disagreement regarding the intracranial volumes of patients with metopic synostosis compared with healthy patients. This study aimed to compare the intracranial volume of children with metopic synostosis before and after surgery to an age- and sex-matched control cohort using three-dimensional (3D) photogrammetry. Eighteen boys with metopic synostosis were operated on using standardized fronto-orbital advancement. Frontal, posterior and total intracranial volumes were measured exactly 1 day pre-operatively and 10 days post-operatively, using 3D photogrammetry. To establish an age- and sex-matched control group, the 3D photogrammetric data of 634 healthy boys between the ages of 3 and 13 months were analyzed. Mean age at surgery was 9 months (SD 1.7). Prior to surgery, boys with metopic synostosis showed significantly reduced frontal and total intracranial volumes compared with the reference group, but similar posterior volumes. After surgery, frontal and total intracranial volumes did not differ statistically from the control group. As children with metopic synostosis showed significantly smaller frontal and total intracranial volumes compared with an age- and sex-matched control group, corrective surgery should aim to achieve volume expansion. Furthermore, 3D photogrammetry provides a valuable alternative to CT scans in the measurement of intracranial volume in children with metopic synostosis, which significantly reduces the amount of radiation exposure to the growing brain. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
    Journal of Cranio-Maxillofacial Surgery 03/2015; 43(5). DOI:10.1016/j.jcms.2015.02.017 · 2.60 Impact Factor
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    ABSTRACT: As the most suitable approach for preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients undergoing surgical tooth extraction is still under discussion, the present study evaluates the incidence of BRONJ after surgical tooth extraction using a standardized surgical protocol in combination with an adjuvant perioperative treatment setting in patients who are at high-risk for developing BRONJ. High-risk patients were defined as patients who received intravenous bisphosphonate (BP) due to a malignant disease. All teeth were removed using a standardized surgical protocol. The perioperative adjuvant treatment included intravenous antibiotic prophylaxis starting at least 24 h before surgery, a gastric feeding tube and mouth rinses with chlorhexidine (0.12%) three times a day. In the follow-up period patients were examined every 4 weeks for the development of BRONJ. Minimum follow-up was 12 weeks. In 61 patients a total number of 184 teeth were removed from 102 separate extraction sites. In eight patients (13.1%) BRONJ developed during the follow-up. A higher risk for developing BRONJ was found in patients where an additional osteotomy was necessary (21.4% vs. 8.0%; p = 0.0577), especially for an osteotomy of the mandible (33.3% vs. 7.3%; p = 0.0268). Parameters including duration of intravenous antibiotic prophylaxis, the use of a gastric feeding tube and the duration of intravenous BP therapy showed no statistical impact on the development of BRONJ. Furthermore, patients currently undergoing intravenous BP therapy showed no higher risk for BRONJ compared with patients who have paused or completed their intravenous BP therapy (p = 0.4232). This study presents a protocol for surgical tooth extraction in high-risk BP patients in combination with a perioperative adjuvant treatment setting, which reduced the risk for postoperative BRONJ to a minimum. However, the risk for BRONJ increases significantly if an additional osteotomy is necessary, especially in the mandible. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
    Journal of Cranio-Maxillofacial Surgery 03/2015; 43(4). DOI:10.1016/j.jcms.2015.02.018 · 2.60 Impact Factor
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    ABSTRACT: Introduction: Head and neck squamous cell carcinoma (HNSCC) is frequently characterized by high resistance to radiotherapy, which critically depends on both altered signaling pathways within tumor cells and their dynamic interaction with the tumor microenvironment. Areas covered: This review covers EGFR-phosphoinositide 3-kinase (PI3K)-protein kinase B (AKT)-mechanistic target of rapamycin (mTOR) signaling in HNSCC. The role of each pathway node in radioresistance is discussed. Preclinical and clinical innovative aspects of targeting EGFR-PI3K-AKT and mTOR are demonstrated. Ongoing clinical trials and future perspectives are presented. Expert opinion: Different cellular signaling pathways seem to mediate radioresistance in advanced HNSCC and various molecular targeted therapies are currently being investigated to sensitize tumor cells to radiotherapy. Recently, new insights in the mutational landscape of HNSCC unraveled critical alterations in putative oncogenes and tumor suppressor genes and have emphasized the importance of PI3K and the corresponding upstream and downstream signaling pathways in pathogenesis and treatment response. The frequent activation of the EGFR-PI3K-AKT-mTOR pathway in HNSCC and its implication in the context of radiosensitivity make this pathway one of the most promising targets in the therapy of HNSCC patients. Clinical studies targeting EGFR and mTOR in combination with radiotherapy are under investigation.
    Expert Opinion on Therapeutic Targets 02/2015; 19(6):1-11. DOI:10.1517/14728222.2015.1012157 · 4.90 Impact Factor
  • Michael Engel, C. Freudlsperger, J. Hoffmann
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    ABSTRACT: Craniosynostosis belongs to the rare diseases with a prevalence of approximately one in 2500 live births and derives from a premature fusion of one or more of the cranial sutures. The most common types of craniosynostosis are isolated (= non-syndromal) forms where only a single suture is involved and which are not associated with further malformation. The characteristic clinical manifestations of single-suture craniosynostosis are pathognomonic for the affected suture and usually lead the experienced craniofacial surgeon to an accurate diagnosis. The standard diagnostics include a throughout clinical examination with cephalometric measurements and a sonography of the cranial sutures. With respect to the biological effects of ionizing radiation and risks of sedation especially in infants, preoperative imaging should be reduced to a minimum and should be reserved for complex craniofacial anomalies. The objective of the surgical treatment of isolated craniosynostosis using standardized surgical techniques, is to induce normal brain development, to prevent increased intracranial pressure (ICP) and to achieve an acceptable cranial morphology.
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    ABSTRACT: Head and neck squamous cell carcinoma (HNSCC) is frequently characterized by high resistance to radiotherapy, which critically depends on both altered signaling pathways within tumor cells and their dynamic interaction with the tumor microenvironment. This study evaluated the prognostic value of the phosphorylation status of AKT on Ser473 and Thr308 for the clinical outcome of patients with advanced HNSCC upon radiotherapy. Furthermore, we investigated the impact of AKT(Ser473) phosphorylation [p-AKT(Ser473)] in the context of radioresistance using ex vivo tissue cultures that resemble the complex tissue architecture and paracrine interaction with the tumor microenvironment. In a cohort of 120 patients with advanced HNSCC, who were treated with primary or adjuvant radiotherapy, a significant association was found between relative p-AKT(Ser473) levels and overall survival (p=0.006) as well as progression-free survival (p=0.021), while no significant correlation was revealed for relative p-AKT(Thr308) levels. In ex vivo tissue cultures p-AKT(Ser473) levels were increased upon irradiation and treatment with the PI3K inhibitor LY294002 inhibited both basal and irradiation induced AKT(Ser473) phosphorylation. Strikingly, pretreatment with LY294002 sensitized tissue cultures derived from primary and recurrent tumors to radiotherapy as determined by impaired tumor cell proliferation and enhanced DNA damage. In conclusion, phosphorylation status of AKT(Ser473) in tumor specimens serves as a novel biomarker to identify patients with advanced HNSCC at high risk for treatment failure following radiotherapy, and our data from ex vivo tissue cultures support the assumption that pharmacological inhibition of AKT(Ser473) phosphorylation might circumvent radioresistance to improve efficiency and reduce toxicity of current treatment modalities. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 11/2014; DOI:10.1002/ijc.29328 · 5.01 Impact Factor
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    ABSTRACT: Die Kraniosynostose ist ein vorzeitiger Verschluss einer oder mehrerer Schädelnähte aufgrund einer Störung innerhalb der osteogenen Prozesse, die während der Ossifikation des Schädels ablaufen. Diese bedingen ein für die jeweils betroffene Schädelnaht typisches klinisches Erscheinungsbild. Die Standarddiagnostik umfasst die klinische Untersuchung mit zephalometrischen Messungen (analog, 3-D-photometrisch) und eine Sonographie der Schädelnähte. Der Einsatz von ionisierender Strahlung innerhalb der Routinediagnostik sollte ebenso wie die MRT-Untersuchung in Sedierung vermieden und nur in Ausnahmefällen in Betracht gezogen werden. Für die operative Korrektur des Neuro- und Viszerokraniums stehen an das Alter der Patienten angepasste, standardisierte Verfahren mit guten, vorhersagbaren Ergebnissen zur Verfügung. Abstract Isolated single-suture craniosynostosis, which derives from a premature fusion of one of the cranial sutures, is the most common form of craniosynostosis with a prevalence of approximately 1 in 2,500 live births. As the characteristic clinical manifestations of single-suture craniosynostosis are usually sufficient for an accurate diagnosis and with respect to the biological effects of ionizing radiation and risks of sedation especially in infants, preoperative imaging should be reduced to a minimum and should be reserved for complex craniofacial anomalies. Each deformity requires a specific surgical procedure tailored to the individual case. Although the appropriate timing or method of surgical treatment is still controversially discussed, it is widely accepted that surgery before the age of 1 year results in minimal impairment of brain development and optimal bone regeneration. The objective of this treatment is to induce normal brain development, to prevent increased intracranial pressure and to achieve an acceptable cranial morphology.
    Der MKG-Chirurg 11/2014; 6(4):301-313. DOI:10.1007/s12285-013-0364-9
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    ABSTRACT: Orbital hypertelorism is defined as an increased distance between both medial and lateral sides of the orbits. Most common causes are frontonasal malformations, craniofacial fissures, encephalocele and a miscellaneous group of various syndromic or chromosomal disorders. Surgical correction of orbital hypertelorism is still challenging. The present report describes a case of severe orbital hypertelorism of an 11-year-old boy, where surgical correction was planned using three-dimensional printing modelling. This approach allowed reducing time of surgery, accurately planning the location of the osteotomies and precontouring the osteosynthesis material. Three-dimensional models are very helpful tools in planning complex craniofacial operative procedures.
    Oral and Maxillofacial Surgery 09/2014; 19(1). DOI:10.1007/s10006-014-0466-1
  • Christian Freudlsperger, Jens Philipp Bodem, Eva Engel, Jürgen Hoffmann
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    ABSTRACT: Because optimal reconstruction of maxillofacial defects requires functional rehabilitation, the current study demonstrates the successful secondary reconstruction of a large mandibular continuity defect using a fully digitally planned prefabricated free vascularized fibula with immediate implant-supported prosthodontic restoration.A 56-year-old man presented with a large mandibular continuity defect after resection of an enlarged squamous cell carcinoma arising from the floor of the mouth. For secondary reconstruction, the shape of the neomandible and implant position for support of the lower prosthesis were planned virtually. The combined cutting and drilling guide was printed in 3 dimensions.In a 2-step surgical approach, first, the implants were inserted into the fibula and covered with a split-thickness skin graft to form a neogingiva. In a second operation, the fibula was harvested, osteotomized, and fixed with the denture on the preinserted implants. The fibula was placed to its final position guided by the occlusion.Using three-dimensional virtual backward planning, it was feasible to perform a mandibular reconstruction with immediate prosthetic rehabilitation.
    The Journal of craniofacial surgery 03/2014; 25(3). DOI:10.1097/SCS.0000000000000551 · 0.68 Impact Factor
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    ABSTRACT: Resorbable osteosynthesis is a widespread tool in craniofacial surgery, however only a limited number of studies have focused on ultrasound-assisted pinned resorbable systems in the treatment of craniosynostosis. Thirty-eight children with various types of craniosynostosis including scaphocephaly, trigonocephaly, anterior and posterior plagiocephaly were treated using the Sonic Welding resorbable osteosynthesis system. All patients were evaluated for operation time, stability of the surgical results, rate of local infections and visibility or palpability of the osteosynthesis material in the follow-up ranging from 15 to 21 month. Mean operation time was not significantly higher compared to conventional osteosynthesis material and all remodelled cranial vaults showed immediate stability. Only one patient showed signs of an inflammatory skin reaction, which recovered spontaneously. The number of palpable or visible plates, respectively, increased during the first months with a maximum at 12 months (34 (89%) plates palpable, 26 (68%) plates visible). After this time point, the number decreased continuously until the end of the follow-up period at 21 months when 3 (20%) plates were palpable, 0 (0%) plates were visible). Ultrasound-assisted pinned resorbable systems seem to be a promising tool in craniofacial surgery providing a timesaving and stable osteosynthesis. An initial swelling of the plates during the first 12 months before the complete degradation might result in a palpable and visible bulge.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 09/2013; 42(5). DOI:10.1016/j.jcms.2013.07.016 · 2.60 Impact Factor
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    ABSTRACT: In the majority of the craniofacial literature, preservation of the supraorbital nerve during fronto-orbital advancement (FOA) is recommended. However, only a few studies have evaluated the incidence of sensory disturbance in the forehead after FOA during long-term follow-up. 57 children who underwent FOA in their first year of life because of isolated nonsyndromic craniosynostosis including trigonocephaly, anterior plagiocephaly or oxycephaly, were evaluated for sensory disturbance in the frontal region with a minimum follow-up of 27 months. An objective and repeatable measurement using the Semmes-Weinstein test was possible in 36 children older than 5 years at last follow-up. We revealed no sensory deficits in all patients, even in 3 patients, where one of the supraorbital nerves was transected during FOA. As previous reports have suggested a full recovery of sensation after transection of the supraorbital nerve during FOA I seen, the need to preserve the nerve has to be evaluated. However, as release of the nerve from the supraorbital rim is possible, we generally recommend preserving this structure, to minimize the risk of sensory deficits in the forehead region.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 08/2013; DOI:10.1016/j.jcms.2013.07.012 · 2.60 Impact Factor
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    ABSTRACT: Heat shock protein 90 (HSP90) is a chaperone protein that stabilizes proteins involved in oncogenic and therapeutic resistance pathways of epithelial cancers, including head and neck squamous cell carcinomas (HNSCCs). Here, we characterized the molecular, cellular, and preclinical activity of HSP90 inhibitor SNX5422/2112 in HNSCC overexpressing HSP90. SNX2112 inhibited proliferation, induced G2/M block, and enhanced cytotoxicity, chemosensitivity, and radiosensitivity between 25 and 250 nM in vitro. SNX2112 showed combinatorial activity with paclitaxel in wild-type (wt) TP53-deficient and cisplatin in mutant (mt) TP53 HNSCC lines. SNX2112 decreased expression or phosphorylation of epidermal growth factor receptor (EGFR), c-MET, v-akt murine thymoma viral oncogene homolog 1 (AKT), extracellular signal-regulated kinases (ERK) 1 and 2, inhibitor κB kinase, and signal transducer and transcription factor 3 (STAT3), corresponding downstream nuclear factor κB, activator protein-1, and STAT3 reporter genes, and target oncogenes and angiogenic cytokines. Furthermore, SNX2112 enhanced re-expression of TP53 and targets p21WAF1 and PUMA, while TP53 inhibitor Pifithrin or siRNA attenuated the antiproliferative activity of SNX2112 in wtTP53 HNSCC in vitro. Prodrug SNX5422 similarly down-modulated key signal targets, enhanced TP53 expression and apoptosis, and inhibited proliferation, angiogenesis, and tumorigenesis in a wtTP53-deficient HNSCC xenograft model. Thus, HSP90 inhibitor SNX5422/2112 broadly modulates multiple key nodes within the dysregulated signaling network, with corresponding effects upon the malignant phenotype. Our data support investigation of SNX5422/2112 in combination with paclitaxel, cisplatin, and radiotherapy in HNSCC with different TP53 status.
    Translational oncology 08/2013; 6(4):429-41. DOI:10.1593/tlo.13292 · 3.40 Impact Factor
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    ABSTRACT: Despite numerous studies, specific guidelines for cervical lymph node surgery in cutaneous malignant melanoma of the head and neck are still missing.In a retrospective study, the modalities of neck dissection (ND), the histologic results, and the outcome in 59 patients with cutaneous malignant melanoma of the head and neck were evaluated to verify the benefit of this therapy.Patients with proven lymph node metastasis often benefit from complete ND because about 50% of the patients showed more metastases in their ND specimen than before surgery. In addition, suspicious but not surely malignant lymph nodes often proved to be benign.This study reveals that patients with proven lymph node metastasis often benefit from complete ND because the number of infiltrated nodes is often higher than suspected; nevertheless, when planning the surgical therapy, the overall prognosis has to be kept in mind.
    The Journal of craniofacial surgery 03/2013; 24(2):483-7. DOI:10.1097/SCS.0b013e31827c7e67 · 0.68 Impact Factor
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    ABSTRACT: Craniosynostosis can be gene-linked, or caused by metabolic diseases, such as rickets, which results from a deficiency or impaired metabolism of vitamin D, magnesium, phosphorus or calcium leading to hypomineralization of the bone. X-linked dominant hypophosphatemic rickets (XLHR) is the most prevalent genetic type of hypophosphatemic rickets and is caused by germ line mutations in the PHEX-gene. In XLHR, only few case reports of craniosynostosis were described. Here, we present a clinical report of an 18 months old child with XLHR and bilateral coronal and sagittal synostosis who was treated by subtotal cranial vault remodelling with fronto-orbital advancement and right-angled Z-osteotomies. As a consequence of the child's diminished bone regeneration capacity, surgery that is performed after the age of 1 year requires more extensive craniectomy, multiple osteotomies and rigid fixation for calvarial vault remodelling to prevent extensive bone defects.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 02/2013; DOI:10.1016/j.jcms.2013.01.039 · 2.60 Impact Factor
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    ABSTRACT: Children with unilateral isolated coronal suture synostosis suffer from frontal plagiocephaly. In this retrospective study we analyzed 21 patients who were treated with an identical and standardized surgical technique of fronto-orbital advancement with hypercorrection with an average follow-up of 57.5 months. The median age at surgery was 12.1 months. The median average amount of blood loss during the operation was less than 188 ml. Not a single major complication was observed. According to the classification of Whitaker, 15 patients had a Class 1 outcome, with excellent surgical results. Three patients were defined as Class 2 outcome. One of our patients was Class 3 and two patients were Class 4 because of severe forehead retrusion and temporal hollowing. Re-operation rate was 14.3%. 67% of our patients showed a correction or an improvement of the typical C-shaped deformity in their follow-up examination. Aesthetic outcomes were excellent in 13, good in 5, and poor in 3 of cases, as judged by their families and the craniofacial team. Unilateral coronal synostosis can be successfully treated by fronto-orbital advancement with a low complication rate and an excellent clinical outcome. To minimize the need of re-operations, fronto-orbital advancement should be performed with an overcorrection on the affected side.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 02/2013; DOI:10.1016/j.jcms.2012.12.011 · 2.60 Impact Factor
  • J. Bodem, C. Freudlsperger, J. Hoffmann
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    ABSTRACT: Hämangiome sind die häufigsten Weichgewebstumoren im Kindesalter, circa 3–10% der unter Einjährigen sind betroffen. Infantile Hämangiome (IH) zeigen ein charakteristisches Wachstumsverhalten, das in Proliferations-, Ruhe- und Rückbildungsphase unterschieden wird. Unter Berücksichtigung des klinischen Verhaltens werden Hämangiome nach der International Society for the Study of Vascular Anomalies (ISSVA) zur Gruppe der vaskulären Tumoren gezählt und so eindeutig von der Gruppe der vaskulären Malformationen abgegrenzt. Die Ätiologie der Hämangiome ist bis heute noch nicht abschließend geklärt. Anhand der typischen Entwicklungsphasen und unter Berücksichtigung der klinischen Untersuchung ist i.d.R. eine recht eindeutige Diagnosestellung möglich, eine weitere bildgebende Diagnostik erübrigt sich meist. Aufgrund des gutartigen, selbstlimitierenden Wachstums der IH kann häufig auf ein interventionelles therapeutisches Vorgehen verzichtet werden. Abstract Infantile hemangiomas (IH) are the most frequent soft tissue tumors of early childhood and 3–10 % of children under 1 year old are affected. They exhibit a distinctive progression including an initial proliferation phase, an inactive period and a regression phase. With respect to the clinical characteristics of hemangiomas the Society for the Study of Vascular Anomalies (ISSVA) classified them as vascular tumors and therefore they are differentiated from the group of vascular malformations. The etiology underlying the development of hemangiomas is still unclear. Usually the diagnosis is based on the typical phases of development and with regard to the physical examination. Therefore, an additional medical imaging is mostly unnecessary. Due do the benign, self-limiting course of hemangiomas a non-invasive therapeutic strategy should be preferred.
    Der MKG-Chirurg 02/2013; 6(1):10-14. DOI:10.1007/s12285-012-0313-z
  • Dr. J. Bodem, C. Freudlsperger, S. Rohde, J. Hoffmann
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    ABSTRACT: Die Behandlung ausgedehnter vaskulärer Anomalien macht ein differenziertes interdisziplinäres Vorgehen notwendig. Hierfür ist die Kenntnis der Einteilung der Gefäßveränderungen nach der International Society for the Study of Vascular Anomalies (ISSVA) essenziell. Diese unterscheidet zwischen vaskulären Malformationen und vaskulären Tumoren. Die vaskulären Malformationen werden wiederum nach ihren hämodynamischen Eigenschaften in „Low-flow“- und „High-flow“-Malformationen unterschieden. Für diese Diagnosestellung spielt die Schichtbildgebung mittels Magnetresonanztomographie (MRT) eine Schlüsselrolle. Ergänzend hierzu ist in ausgewählten Fällen eine Magnetresonanzangiographie (MRA) sinnvoll. Die Therapieindikation ist primär vom klinischen Verhalten der vaskulären Malformation abhängig, die Behandlung sollte interdisziplinär geplant werden. Die interventionelle Radiologie mit der perkutanen Sklerosierung und transarteriellen Embolisation als Monotherapie oder in Kombination mit einem chirurgischen Vorgehen ist wesentlicher Bestandteil des interdisziplinären therapeutischen Konzepts.
    Der MKG-Chirurg 02/2013; 6(1). DOI:10.1007/s12285-012-0344-5
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    ABSTRACT: Tailoring the most suitable reconstructive approach to each patient remains challenging especially in the head and neck region. To compare the applicability of the latissimus dorsi (LD) and anterolateral thigh (ALT) flap, we retrospectively analyzed patients who had had reconstruction of extensive and/ or bulky composite tissue defects in the head and neck area. We performed 85 free tissue transfers (44 LD and 41 ALT flaps). LD mean flap surface was 115.8 cm2. ALT mean flap surface was 67.0 cm2. Pedicle length ranged from 8-16 cm in LD and 11-16 cm in ALT flaps. The survival rate was 93% in ALT and 91% in LD flaps. Donor-site morbidity occurred in 5% (ALT) and 7% (LD). A Two-team-approach was possible in 24% of the LD group, whereas all ALT flaps were raised in a Two-team-approach. Both flaps present excellent opportunities for the reconstruction of extensive and/ or bulky defects. They largely meet the requirements of an ideal soft tissue flap in terms of versatility, skin texture and tissue stock. Both flaps can be raised with a double skin paddle. The advantages and disadvantages of each flap have to be weighed up against each other and both flaps should be in the repertoire of every microvascular surgeon.
    Journal of Cranio-Maxillofacial Surgery 01/2013; DOI:10.1016/j.jcms.2013.11.017 · 2.60 Impact Factor
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    ABSTRACT: The reconstruction in case of large nasal defects, especially affecting the cartilaginous portion, is a surgical and aesthetic challenge. The result has to fulfill functional and aesthetic aspects concerning shape, texture, and nasal breathing, which requires accurate reproduction of nasal lining, support, and coverage. Here, we describe nasal reconstruction in a 36-year-old woman after near-total nasal resection due to a malignant peripheral nerve sheath tumor in the glabellar and nasal regions. After tumor resection, the cartilaginous and bone structures were reconstructed using a dynamic titanium mesh, which was precontoured on a three-dimensional-print model of the preoperative situation. Soft tissue defects were covered as a 2-stage procedure using a Converse scalp flap. We achieved an adequate long-term functional and aesthetic and oncological result. Titanium mesh in combination with Converse flap proved to be an alternative in extensive composite midfacial defects.
    The Journal of craniofacial surgery 09/2012; 23(5):e410-2. DOI:10.1097/SCS.0b013e31825cef78 · 0.68 Impact Factor

Publication Stats

161 Citations
102.12 Total Impact Points

Institutions

  • 2015
    • Heidelberg University
      تيفين، أوهايو, Ohio, United States
  • 2011–2015
    • Universität Heidelberg
      • Oral and Maxillo-Facial surgery
      Heidelburg, Baden-Württemberg, Germany
  • 2011–2013
    • National Institutes of Health
      • Branch of Surgery
      베서스다, Maryland, United States
  • 2012
    • Northern Inyo Hospital
      BIH, California, United States
  • 2008–2011
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 2008–2010
    • University Medical Center Hamburg - Eppendorf
      • Department Anatomy and Experimental Morphology
      Hamburg, Hamburg, Germany
  • 2006
    • University of Hamburg
      • Department of Anatomy and Experimental Morphology
      Hamburg, Hamburg, Germany