Nils-Claudius Gellrich

Publications of Nils-Claudius Gellrich

• Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial.

  Authors: Majeed Rana, Riaz Warraich, Salman Tahir, Asifa Iqbal, Constantin von See, Andre M Eckardt, Nils-Claudius Gellrich

  Trials. 04/2012; 13(1):36.

  ABSTRACT: BACKGROUND: The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequatelyABSTRACT: BACKGROUND: The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures at three points has continued to grow in response to observations of inadequate results from two point and one point fixation techniques. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with ORIF using 2 point fixation and ORIF using 3 point fixation and compare the outcome of two procedures. METHODS: 100 patients were randomly divided equally into two groups. In group A, 50 patients were treated by ORIF using two point fixation by miniplates and in group B, 50 patients were treated by ORIF using three point fixation by miniplates. They were evaluated for their complications during and after surgery with their advantages and disadvantages and the difference between the two groups was observed. RESULTS: A total of 100 fractures were sustained. We found that postoperative complication like decreased malar height and vertical dystopia was more common in those patients who were treated by two point fixation than those who were treated with three point fixation. CONCLUSIONS: Based on this study open reduction and internal fixation using three point fixation by miniplates is the best available method for the treatment zygomatic bone fractures.

• Designing the ideal model for assessment of wound contamination after gunshot injuries: a comparative experimental study.

  Authors: Constantin Von See, Majeed Rana, Marcus Stoetzer, Horst Kokemueller, Martin Ruecker, Nils-Claudius Gellrich

  BMC surgery. 04/2012; 12(1):6.

  ABSTRACT: BACKGROUND: Modern high-velocity projectiles produce temporary cavities and can thus cause extensive tissue destruction along the bullet path. It is still unclear whether gelatin blocks,ABSTRACT: BACKGROUND: Modern high-velocity projectiles produce temporary cavities and can thus cause extensive tissue destruction along the bullet path. It is still unclear whether gelatin blocks, which are used as a well-accepted tissue simulant, allow the effects of projectiles to be adequately investigated and how these effects are influenced by caliber size. METHOD: Barium titanate particles were distributed throughout a test chamber for an assessment of wound contamination. We fired .22-caliber Magnum bullets first into gelatin blocks and then into porcine hind limbs placed behind the chamber. Two other types of bullets (.222-caliber bullets and 6.5x57mm cartridges) were then shot into porcine hind limbs. Permanent and temporary wound cavities as well as the spatial distribution of barium titanate particles in relation to the bullet path were evaluated radiologically. RESULTS: A comparison of the gelatin blocks and hind limbs showed significant differences (p < 0.05) in the mean results for all parameters. There were significant differences between the bullets of different calibers in the depth to which barium titanate particles penetrated the porcine hind limbs. Almost no particles, however, were found at a penetration depth of 10 cm or more. By contrast, gas cavities were detected along the entire bullet path. CONCLUSION: Gelatin is only of limited value for evaluating the path of high-velocity projectiles and the contamination of wounds by exogenous particles. There is a direct relationship between the presence of gas cavities in the tissue along the bullet path and caliber size. These cavities, however, are only mildly contaminated by exogenous particles.

• Clinical evaluation of an autofluorescence diagnostic device for oral cancer detection: a prospective randomized diagnostic study.

  Authors: Majeed Rana, Antonia Zapf, Marco Kuehle, Nils-Claudius Gellrich, André M Eckardt

  European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP). 01/2012;

  The prognosis for patients with oral squamous cell carcinoma remains poor despite advances in multimodal treatment concepts. Early diagnosis and treatment is the key to improved patient survival. AThe prognosis for patients with oral squamous cell carcinoma remains poor despite advances in multimodal treatment concepts. Early diagnosis and treatment is the key to improved patient survival. A device (VELscope) that uses autofluorescence technology, allowing direct fluorescence visualization of the oral cavity, might be a useful tool for oral cancer detection or as an adjunct to standard clinical examination. A total of 289 patients with oral premalignant lesions were randomly divided into two groups for clinical examination of precancerous oral lesions. In group 1, 166 patients were examined conventionally with white light, and in group 2, 123 patients were examined with the autofluorescence visualization device (VELscope) in addition to the white light examination. Biopsies were obtained from all suspicious areas identified in both examination groups (n=52). In the first step, baseline characteristics of the two groups (only white light vs. white light and VELscope) were compared to exclude selection bias. In the second step, for the group examined with white light and VELscope (123 patients), the diagnostic strategies were compared with regard to sensitivity and specificity using biopsy as the gold standard. The results showed that using the VELscope leads to higher sensitivity (100% instead of 17%), but to lower specificity (74% instead of 97%). Thus, we can conclude that the VELscope is a useful new diagnostic device for detection of oral cancer diseases.

• 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.

• Myxolipoma in the tongue - a clinical case report and review of the literature.

  Authors: Shigehiro Ono, Majeed Rana, Masaaki Takechi, Ikuko Ogawa, Gaku Okui, Yoshitsugu Mitani, Nils-Claudius Gellrich, Nobuyuki Kamata

  Head & neck oncology. 12/2011; 3:50.

  In this article, we present our experience with a case of myxolipoma of the tongue. Lipoma is a mesenchymal benign tumor occurring with relatively high frequency. However, myxolipoma, one of theIn this article, we present our experience with a case of myxolipoma of the tongue. Lipoma is a mesenchymal benign tumor occurring with relatively high frequency. However, myxolipoma, one of the histological variant of lipoma characterized by mature adipose tissue and abundant mucoid substances, in the oral cavity is quite rare. The patient was a 52-year-old man who noticed a painless mass on the left border of tongue about 2 years ago. The lesion was noted at a complete medical checkup, and the patient was admitted to our institution for detailed examination. The mass was a palpable, soft and elastic nodule, 15 mm in diameter, covered with normal mucosa in the left inferior aspect of the tongue. The border of the tumor was well-defined, and computed tomography (CT) revealed a fat density within the mass. On the basis of these finding, the tumor was clinically diagnosed as lipoma and was excised under general anesthesia. Histopathologically, the tumor was a well-defined lobulated mass surrounded by a thin fibrous capsule within the muscle of the tongue. The tumor was diagnosed as myxolipoma because it was consisted of solid proliferation of mature adipocytes replaced by abundant mucoid substances. The post operative course was uneventful, and there was no evidence of recurrence 4 years after surgery.

• 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.

• Biomechanical evaluation of a microstructured zirconia implant by a removal torque comparison with a standard Ti-SLA implant.

  Authors: Kai-Hendrik Bormann, Nils-Claudius Gellrich, Heinz Kniha, Michel Dard, Marco Wieland, Michael Gahlert

  Clinical oral implants research. 11/2011;

  OBJECTIVES: The purpose of this study was to evaluate the biomechanical bone tissue response to novel microstructured zirconia implants in comparison to sandblasted and acid-etched (SLA) titaniumOBJECTIVES: The purpose of this study was to evaluate the biomechanical bone tissue response to novel microstructured zirconia implants in comparison to sandblasted and acid-etched (SLA) titanium implants through the analysis of removal torque (RTQ) measurements. MATERIALS AND METHODS: Ti-SLA implants with a sandblasted, large-grit and acid-etched surface were compared with zirconia implants with an acid-etched surface. All implants had the same shape, a diameter of 4.1 mm and a length of 10 mm. A total of 136 implants were placed in the maxillae of 17 miniature pigs. Six animals were sacrificed after both 4 and 8 weeks and five animals were sacrificed after 12 weeks, thus providing a total of 102 implants for RTQ testing (34 implants were reserved for future histological analysis). The RTQ analysis was successfully performed, using a mixed model regression with P-values calculated using the nonparametric Brunner-Langer method, on 100 of the 102 implants, two were excluded from the analysis. RESULTS: The adjusted mean RTQ values for Ti-SLA implants were 131 Ncm (95%CI: 107-155) at 4 weeks, 128 Ncm (108-148) Ncm at 8 weeks, and 180 Ncm (153-207 Ncm) at 12 weeks of healing, whereas RTQ values for the zirconia implants were 110 Ncm (86-134), 97 Ncm (76-118) and 147 Ncm (121-174) at the corresponding time intervals. A comparison of the implant materials resulted in P-values of P = 0.114 at 4 weeks, P = 0.034 at 8 weeks and P = 0.105 at 12 weeks (significance set at P < 0.05). CONCLUSIONS: Within the limits of the present study, it could be confirmed that the biomechanical bone-tissue response of the investigated zirconia implants is non-inferior to that of the well-documented, roughened titanium surface, at each time point, within the set tolerance. There were no statistically significant differences between the two materials after a healing period of 4 and 12 weeks. The RTQ values of both implant types increased significantly from the 8-week to the 12-week time point.

• An Evaluation of Face-Bow Transfer for the Planning of Orthognathic Surgery.

  Authors: Christoph Zizelmann, Beat Hammer, Nils-Claudius Gellrich, Rainer Schwestka-Polly, Majeed Rana, Peter Bucher

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 11/2011;

  PURPOSE: The purpose of this study was to evaluate the error magnitude in the clinical application of face-bow devices. Technical and methodologic inaccuracies, as well as deviations from referencePURPOSE: The purpose of this study was to evaluate the error magnitude in the clinical application of face-bow devices. Technical and methodologic inaccuracies, as well as deviations from reference planes, were determined. MATERIALS AND METHODS: The presented method is part of a 3-dimensional virtual planning procedure for orthognathic surgery and included 15 patients with dentoskeletal deformities. Cone beam computed tomography datasets obtained from patients with a referenced face-bow plane and a centric registration splint were matched with cone beam computed tomography datasets of the registered plaster model of the maxilla mounted in an articulator. To assess potential sources of methodologic errors, angulations were measured between the virtual face-bow plane and the horizontal cross bar of the virtual articulator. To evaluate the reproducibility of the anatomic reference plane, angulations between the Frankfort plane and the horizontal cross bar of the articulator were measured. Statistical significance was set at P < .05 and tested by univariate analysis of variance. RESULTS: Technical and methodologic errors showed a mean deviation of 3.5°, with a median of 3.6° and SD of 2.7°. The values did not reach statistical significance (P = .1). However, there was a significant error (P < .05) in determining the position of the anatomic reference plane by face-bow transfer. The mean deviation was 7.7° (values ranged between 1.2° and 18.9°), with a median of 6.7° and SD of 5.3°. CONCLUSIONS: In this study the traditional use of face-bow devices showed inaccuracies in model mounting as well as in assignment of anatomic reference planes. Three-dimensional virtual computer-assisted planning seems to be more accurate than conventional methods.

• Reconstruction of defects of maxillary sinus wall after removal of a huge odontogenic lesion using prebended 3D titanium-mesh and CAD/CAM technique.

  Authors: Marcus Stoetzer, Majeed Rana, Constantin von See, André M Eckardt, Nils-Claudius Gellrich

  Head & face medicine. 11/2011; 7:21.

  A 63 year-old male with a huge odontogenic lesion of sinus maxillaris was treated with computer-assisted surgery. After resection of the odontogenic lesion, the sinus wall was reconstructed with aA 63 year-old male with a huge odontogenic lesion of sinus maxillaris was treated with computer-assisted surgery. After resection of the odontogenic lesion, the sinus wall was reconstructed with a prebended 3D titanium-mesh using CAD/CAM technique. This work provides a new treatment device for maxillary reconstruction via rapid prototyping procedures.

• Calvaria bone chamber--a new model for intravital assessment of osseous angiogenesis.

  Authors: Branko Sinikovic, Paul Schumann, Meike Winkler, Julian Kuestermeyer, Frank Tavassol, Constantin von See, Carlos Carvalho, Rolf Mülhaupt, Kai-Hendrik Bormann, Horst Kokemueller, Andrea Meyer-Lindenberg, Matthias W Laschke, Michael D Menger, Nils-Claudius Gellrich, Martin Rücker

  Journal of biomedical materials research. Part A. 11/2011; 99(2):151-7.

  The faith of tissue engineered bone replacing constructs depends on their early supply with oxygen and nutrients, and thus on a rapid vascularization. Although some models for direct observation ofThe faith of tissue engineered bone replacing constructs depends on their early supply with oxygen and nutrients, and thus on a rapid vascularization. Although some models for direct observation of angiogenesis are described, none of them allows the observation of new vessel formation in desmal bone. Therefore, we developed a new chamber model suitable for quantitative in vivo assessment of the vascularization of bone substitutes by intravital fluorescence microscopy. In the parietal calvaria of 32 balb/c mice a critical size defect was set. Porous 3D-poly(L-lactide-co-glycolide) (PLGA)-blocks were inserted into 16 osseous defects (groups 3 and 4) while other 16 osseous defects remained unequipped (groups 1 and 2). By placing a polyethylene membrane onto the dura mater, the angiogenesis was mainly restricted to the osseous margins (groups 2 and 4). Microvascular density, angiogenesis, and microcirculatory parameters were evaluated repetitively during 22 days. In all animals, only a mild inflammatory reaction was observed with a climax after 2 weeks. The implantation of PLGA scaffolds resulted in a vascular growth directed towards the center of the defect as demonstrated by the significantly (p < 0.05) enhanced central microvascular densitiy from day 3 to day 22 when compared with unequipped chambers. The additional application of polyethylene membrane was found to reduce significantly the microvessel density mainly in the center of both scaffolds and defects. The present calvaria bone chamber allows for the first time to assess quantitatively the angiogenesis arising from desmal bone directly in vivo. Therefore, this chronic model may support the future research in the biological adequacy of bone substitutes.

• Modern surgical management of tongue carcinoma - a clinical retrospective research over a 12 years period.

  Authors: Majeed Rana, Asifa Iqbal, Riaz Warraich, Martin Ruecker, André M Eckardt, Nils-Claudius Gellrich

  Head & neck oncology. 09/2011; 3:43.

  In this retrospective study, we present a clinical review of our experience with tongue cancer in order to obtain valid criteria for therapeutic decision-making. Between August 1999 and June 2011, aIn this retrospective study, we present a clinical review of our experience with tongue cancer in order to obtain valid criteria for therapeutic decision-making. Between August 1999 and June 2011, a total of 398 patients with squamous cell carcinoma of the tongue were treated at the Department of Oral and Maxillofacial Surgery, King Edward Medical University Lahore Pakistan. Data concerning patient characteristics, clinical and pathologic tumour characteristics and treatment strategies and their results were obtained from a retrospective review of medical records. The average follow-up was 4.6 years. Statistical analysis for survival was calculated by the method of Kaplan and Meier. There were 398 total patients. The mean age at diagnosis was 49.5 years,. 224 (56.3%) were male and 174 (43.7%) female (male/female ratio = 1.3:1).332/398 patients received surgical treatment, whereas 66 patients were excluded from surgical treatment and received primary radio (chemo) therapy after biopsy. Tongue carcinoma patients treated by non surgical treatment modalities had 5 years survival rate of 45.5% and patients with surgical intervention had survival rate of 96.1%. We recommend categorical bilateral neck dissection in order to reliably remove occult lymph node metastases. Adjuvant treatment modalities should be applied more frequently in controlled clinical trials and should generally be implemented in cases with unclear margins and lymphatic spread. This study provides modern treatment strategies for the tongue carcinoma.

• 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.

• Bisphosphonate-associated osteonecrosis of the mandible: reliable soft tissue reconstruction using a local myofascial flap.

  Authors: Juliana Lemound, Andrè Eckardt, Horst Kokemüller, Constantin von See, Pit Jacob Voss, Frank Tavassol, Martin Rücker, Majeed Rana, Nils-Claudius Gellrich

  Clinical oral investigations. 08/2011;

  For the treatment of bisphosphonate-associated osteonecrosis of the jaw (BP-associated ONJ), poor cure rates are reported. In many cases, repeated osseous exposition and infection may occur. TheFor the treatment of bisphosphonate-associated osteonecrosis of the jaw (BP-associated ONJ), poor cure rates are reported. In many cases, repeated osseous exposition and infection may occur. The currently recommended management of affected patients is antibiotic treatment and bony decortication, which is often complicated by soft tissue deficits due to chronic infection. In severe cases osteonecrosis can be managed often only by continuity resections of the mandible. For this purpose, we developed a new surgical procedure, which allows an effective closure of difficult jaw wounds in the lateral mandible. In the last 3 years, 20 patients with BP-associated osteonecrosis of the lower jaw were treated successfully with a modified defect-covering method using a myofascial flap. A mylohyoid muscle flap was detached from mylohyoid line and used to cover the bony defect. During 19 months mean follow-up, 90% of patients were asymptomatic, the oral mucosa was intact, and no exposed bone was observed. In consequence, we are able to demonstrate that a mylohyoid muscle flap provides a reliable wound closure in the lower jaw in patients treated with BPs. Although there are still no consensual therapy guidelines for patients affected by BP-associated ONJ, the results of the presented study provide evidence for an effective surgical therapy with long-term success. Covering compromised bone with well-vascularized tissue, a muscle flap, increased healing chances by enabling and supporting the necessary nutrition and defense against opportunistic infections. This therapy concept showed a good clinical outcome.

• A Quantitative Approach to Orbital Decompression in Graves' Disease Using Computer-Assisted Surgery: A Compilation of Different Techniques and Introduction of the "Temporal Cage"

  Authors: Frank Tavassol, Horst Kokemüller, Corinna Müller-Tavassol, Alexander Schramm, Martin Rücker, Nils-Claudius Gellrich

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 07/2011;

  PURPOSE: Since 1911, when Dollinger first described surgical orbital decompression, many different techniques and approaches have been described, including 1-, 2-, and 3-wall decompressions withPURPOSE: Since 1911, when Dollinger first described surgical orbital decompression, many different techniques and approaches have been described, including 1-, 2-, and 3-wall decompressions with orbital fat removal. The indications for surgical treatment have been widened and include additional to optic neuropathy severe proptosis causing exposure keratopathy and disfigurement. Popular techniques for surgical decompression are the transantral or transpalpebral approach to the medial wall and orbital floor. Sometimes theses approaches are combined with lateral canthotomy incisions for access to the lateral wall ("3-wall decompression"). This report shows a compilation of different techniques using computer-assisted surgery for a 3-wall decompression with the introduction of the "temporal cage" in patients suffering from Graves' disease and the combination with zygomatic bone osteotomy. PATIENTS AND METHODS: Twelve patients suffering from Graves' disease presented for surgical treatment in our clinic. For surgical planning, a computed tomographic scan with navigation markers was carried out. The navigation was planned with voxel-based navigation software (VoXim or BrainLab). RESULTS: Of the patients, 1 had unilateral and 11 had bilateral decompressions. Of the 11 patients with bilateral procedures, 1 patient underwent simultaneous and 10 underwent sequential procedures. The 3-wall decompression in all cases was performed by transconjunctival approach. Temporary double vision could be observed in all cases. There was a significant reduction in proptosis. CONCLUSION: It was concluded that this approach and the computer-assisted surgery would be the operation of first choice when there is an indication for orbital decompression.

• 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.

• Three-dimensional evaluation of postoperative swelling after third molar surgery using 2 different cooling therapy methods: a randomized observer-blind prospective study.

  Authors: Majeed Rana, Nils-Claudius Gellrich, Alireza Ghassemi, Marcus Gerressen, Dieter Riediger, Ali Modabber

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 04/2011; 69(8):2092-8.

  In most cases, the removal of third molars leads to a significant degree of tissue trauma, resulting in common postoperative symptoms and signs of pain, facial swelling, dysfunction, and limitedIn most cases, the removal of third molars leads to a significant degree of tissue trauma, resulting in common postoperative symptoms and signs of pain, facial swelling, dysfunction, and limited mouth opening (trismus). The beneficial effects of cold treatment on postoperative swelling, edema, pain, and inflammation, as well as the reduction in bleeding and hematomas, have been described. The aim of the present study was to compare postoperative cooling therapy using cooling compresses with that using the water-circulating cooling face mask by Hilotherm. We recorded the beneficial effects on postoperative facial swelling, pain, trismus, and neurologic complaints. A total of 30 patients were scheduled to undergo third molar surgery and were divided randomly into 2 groups for treatment with either the Hilotherm or conventional cooling with cooling compresses. Cooling was performed one time for 45 minutes immediately after surgery. Facial swelling was quantified using a 3-dimensional optical scanning technique. The pain and neurologic scores and the degree of mouth opening were observed for each patient. Patients receiving cooling therapy using Hilotherm demonstrated less facial swelling, less pain, a tendency toward fewer neurologic complaints, and were more satisfied than the patients who had received conventional cooling. The results of our study have shown that the Hilotherm is more efficient for managing postoperative swelling and pain after the removal of third molars than conventional cooling using compresses.

• Comparably accelerated vascularization by preincorporation of aortic fragments and mesenchymal stem cells in implanted tissue engineering constructs.

  Authors: Paul Schumann, Constantin von See, Andreas Kampmann, Daniel Lindhorst, Frank Tavassol, Horst Kokemüller, Kai-Hendrik Bormann, Nils-Claudius Gellrich, Martin Rücker

  Journal of biomedical materials research. Part A. 04/2011; 97(4):383-94.

  The demanding need for tissue replacement resulted in manifold approaches for the construction of different tissues. One common problem which hampers the clinical usage of tissue engineeringThe demanding need for tissue replacement resulted in manifold approaches for the construction of different tissues. One common problem which hampers the clinical usage of tissue engineering constructs is a limited vascularization. In an attempt to accelerate the vascularization of tissue engineering constructs we compared the usage of bone marrow mesenchymal stem cells (bmMSCs) and fragments derived from the aorta in vivo. Tissue engineering constructs composed of PLGA scaffolds containing Matrigel (n = 8), aortic fragments embedded in Matrigel (n = 8), bmMSCs embedded in Matrigel (n = 8), and aortic fragments embedded in Matrigel combined with bmMSCs (n = 8) were implanted into dorsal skinfold chambers of balb/c mice and analyzed repetitively over 14 days. In all groups a weak inflammatory response was transiently apparent. Vascularization was significantly (p = 0.05) accelerated in bmMSC and aortic fragments containing constructs compared with Matrigel alone, demonstrated by a distinctly increased microvascular density throughout the whole experiment. The combination of bmMSCs and aortic fragments showed no additional effect compared with bmMSCs and aortic fragments alone. The accelerated vascularization and microvascular density of tissue engineering constructs triggered by bmMSCs and aortic fragments is comparable. Thus aortic fragments provide a new promising source for clinical relevant tissue engineering constructs.

• Prolongated survival of osteoblast-like cells on biodegradable scaffolds by heat shock preconditioning.

  Authors: Frank Tavassol, Andreas Kampmann, Daniel Lindhorst, Paul Schumann, Horst Kokemüller, Kai-Hendrik Bormann, Nils-Claudius Gellrich, Martin Rücker

  Tissue engineering. Part A. 03/2011; 17(15-16):1935-43.

  The implantation of tissue-engineered constructs leads to hypoxic and physical stress to the seeded cells until they were reached by a functional microvascular system. Preconditioning of cells withThe implantation of tissue-engineered constructs leads to hypoxic and physical stress to the seeded cells until they were reached by a functional microvascular system. Preconditioning of cells with heat shock induced heat shock proteins, which can support the cells to survive a subsequent episode of stress that would otherwise be lethal. Preconditioning of tissue-engineered constructs resulted in significantly higher number of surviving osteoblast-like cells (OLC). At the 6th and 10th day, angiogenic response was found comparative to poly(L-lactide-co-glycolide) (PLGA) scaffolds vitalized with either unconditioned or preconditioned OLC. However, they were significantly enhanced compared with the nonvitalized collagen-labeled PLGA scaffolds. This study demonstrates that vitalization of PLGA scaffolds with OLC accelerates the angiogenic response induced by the surrounding host tissue. In addition, heat shock preconditioning significantly enhances the survival rate of the OLC that are seeded on these scaffolds. Thus, vitalization of substitutes with adequately pretreated OLC may promise biologically adequate osseous restorations.