S. Swaid

Technische Universität München, München, Bavaria, Germany

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Publications (12)8.67 Total impact

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    ABSTRACT: Dental implants have played a part in rehabilitation of the jaws for more than 40 years, but in some cases they alone are inadequate because of extreme alveolar resorption. Correction may necessitate a two-stage procedure with additional interventions. We have made a preliminary study of the use of the Norian skeletal repair system (SRS), a carbonated calcium phosphate bone cement used to augment the alveolar ridge as a single-stage procedure, with the placement of implants. Ten edentulous patients with insufficient vertical bone in the interforaminal area were treated. After a horizontal osteotomy and crestal mobilisation of the alveolar ridge, implants were placed through the crestal part and fixed in the basal part of the mandible. Norian SRS was used to fill the gap created. The prostheses were inserted 3 months later. Forty implants were inserted. The follow up period was 60 months, and no fractures or dislocations developed. One of the implants was lost and there was one wound dehiscence, but no surgical intervention or revision was necessary. Radiographs showed good consolidation of the bony structure in all cases. We have described a reliable, single-stage procedure for augmentation and implantation in a highly atrophic alveolar crest. A 98% survival is comparable with those of other techniques. Further clinical trials are necessary to replicate these promising results.
    British Journal of Oral and Maxillofacial Surgery 10/2010; 49(7):542-5. · 2.72 Impact Factor
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    ABSTRACT: The radial forearm flap is a standard method for the reconstruction of intraoral defects of soft tissues. We report the case of a middle-aged man who developed ischaemia in three fingers after a fasciocutaneous radial flap had been raised. The preoperative Allen test to diagnose occlusion of radial or ulnar artery was satisfactory. Soon after the operation the patient resumed smoking and four weeks later he developed ulcers on the thumb, index, and middle fingers. Only after he had stopped smoking and been given acetylsalicylic acid and heparin did blood flow and capillary hemoglobin oxygenation increase. As a result, his radial fingers recovered completely.
    British Journal of Oral and Maxillofacial Surgery 03/2006; 44(1):57-9. · 2.72 Impact Factor
  • Journal of Cranio-maxillofacial Surgery - J CRANIO MAXILLOFAC SURG. 01/2006; 34:92-92.
  • S. Swaid, F. Hölzle, K.-D. Wolff
    Journal of Cranio-maxillofacial Surgery - J CRANIO MAXILLOFAC SURG. 01/2006; 34:124-125.
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    ABSTRACT: In the literature currently available monitoring devices are usually divided into two major groups: those for monitoring perfusion and those for measuring tissue oxygenation. The O(2)C (oxygen to see) system combines these two ways of monitoring free flap viability. The aim of this prospective study was to determine the necessity of flap revision and when unnecessary revision can be avoided. Another point of interest was the question of whether critical values for the successful course of free flaps could be defined and in addition whether such values would differ for different flap types. In a prospective study 82 free flaps (61 radial forearm flaps and 21 fibula flaps) were monitored with the O(2)C monitoring unit. Measurements were carried out intraoperatively and postoperatively up to 14 days. Perfusion compromise occurred in 12 (14.6%) of 82 monitored free flaps. Operative exploration was performed in seven cases, in five of them successfully. Five flaps (three radial forearm and two fibula flaps) were lost due to vascular compromise, which led to an overall success rate of 93.4%. Venous congestion was identified by a rapid increase in hemoglobin concentration of more than 30%. An abrupt decline of blood flow and hemoglobin oxygenation indicated arterial occlusion. Vascular complications were detected in all cases prior to clinical assessment with no false positive or negative results. For radial forearm flaps a hemoglobin oxygenation of 15%, a superficial flow of 10 AU, and a deep flow of 20 AU were identified as minimum values for flap viability. For fibula flaps a hemoglobin oxygenation of 10%, a superficial flow of 5 AU, and a deep flow of 15 AU were determined as minimum values. O(2)C combines laser Doppler flowmetry and tissue spectrophotometry and for the first time allows simultaneous measurement of the microcirculatory parameters including blood flow, flow velocity, hemoglobin concentration, and hemoglobin oxygenation. We found this new noninvasive technique to be a reliable and accurate method for evaluating flap viability and improving the success rate in free flap transfer.
    Mund- Kiefer- und Gesichtschirurgie 10/2005; 9(5):290-9.
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    ABSTRACT: This study reports on a modified approach to treat zygomatic fracture. For the surgical approach, a transconjunctival incision and, instead of a lateral canthotomy, a superficial incision of the skin and subcutaneous tissue was used, preserving the lateral ligament. The results are compared with those of previous techniques, especially the subciliary incision. In a prospective study, 30 patients (9 females and 21 males, mean age 32.1 years) with zygomatic fractures were operated using this approach. Mean follow-up time was 6 months after removal of the plates. Fractures were caused by trauma due to fighting, bicycle falls, or sport accidents. Follow-up radiographs were used to evaluate the position of the zygoma after reduction and rigid fixation. Reduction and rigid fixation of the fractures were possible to perform in all cases. The access to the orbital floor and the exposure of the inferior and lateral rim were satisfactory and an additional latero-orbital cut was not necessary. The disadvantage of the complete incision of the lateral ligament with the necessity of intraoperative refixation and possible ectropium of the eyelid could be avoided. Injuries or infections of the cornea or the bulbus did not occur. Postoperative complications such as scar formation resulting in entropium or ectropium were not seen. These results show that the transconjunctival approach with lateral superficial incision preserving the lateral ligament for treatment of zygomatic fractures is satisfactory in all cases of rigid fixation of both inferior and lateral rims. Because of its esthetic and functional advantages this approach has become standard in our department.
    Mund- Kiefer- und Gesichtschirurgie 10/2004; 8(5):296-301.
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    ABSTRACT: A carbonated apatite cement (NORIAN SRS) was used as a bone mineral substitute for the calvaria or viscerocranium in 27 patients. It has the consistency of a paste and hardens at physiologic pH and body temperature due to dahllite crystallization, which has the stoichiometric formula Ca(8.8)(HPO(4))(0.7)(PO(4))(4.5)(CO(3))(0.7)(OH)(1.3). The cement was used for posttraumatic bone defects in the orbital, periorbital or malar regions (nine patients), posttraumatic deformities of the frontal bone (six patients), tumour-dependent bony defects of the calvaria (two patients) and posttraumatic or cystic defects of the mandible (five patients). In another five patients, the material was used to augment the atrophic anterior mandible in combination with the insertion of dental implants. Follow-up varied between 6 and 40 months (mean: 29 months). There was no inflammatory reaction surrounding the implanted material. There was no sign of infection in any of the patients and only one case of partial wound dehiscence with superficially exposed material. The defect fillings and augmentations were successful in all patients. None of the 19 dental implants which were inserted in combination with the material showed any sign of infection or loosening. Also, there was no loosening of the implants after loading (mean follow-up: 15 months). From the check-up radiographs, the material could be seen as a dense, radio-opaque structure. There were no material fractures or dislocations. Radiologically, the material seemed to be completely replaced by bony tissue after 30 months. Our 5-year clinical experience suggests that the material is a suitable bone mineral substitute for cranio-maxillofacial surgery especially for moderate-sized defects of the calvaria and forehead bone. It has advantages over preformed, solid bone substitute materials, and, due to its initial plasticity and eventual great compressive strength, it can also stabilize dental endosseous implants in the atrophic mandible.
    Journal of Cranio-Maxillofacial Surgery 05/2004; 32(2):71-9. · 1.61 Impact Factor
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    ABSTRACT: ZusammenfassungFragestellung Es war das Ziel der vorliegenden prospektiven Untersuchung, Jochbeinfrakturen über einen transkonjunktivalen Zugang mit lateraler Kanthotomie unter Schonung des lateralen Lidbandes zu versorgen und diese Ergebnisse mit den herkömmlichen, an unserer Klinik üblichen Techniken, insbesondere dem subziliaren Zugang, zu vergleichen.Patientengut In einer prospektiven Studie wurden 30 Patienten (9 Frauen und 21 Männer, Durchschnittsalter 32,1 Jahre) mit Jochbeinfrakturen (ausgeschlossen Trümmerfrakturen) mit dem beschriebenen Zugang operiert. Die Nachuntersuchungszeit lag bei 6 Monaten nach Materialentfernung. Frakturursachen waren Traumata durch Rohheitsdelikte, Fahrradstürze und Sportunfälle. Eine röntgenologische Stellungskontrolle der osteosynthetisch versorgten Frakturen wurde regelmäßig durchgeführt.Ergebnisse Die Versorgung von Jochbeinfrakturen über diesen Zugang war in allen Fällen sehr gut möglich. Die Darstellung der Fraktur war übersichtlich, die Erweiterbarkeit des Zugangs ohne Durchtrennung des lateralen Lidbandapparates problemlos durchführbar und ein zusätzlicher lateroorbitaler Schnitt nicht nötig. Die Nachteile einer kompletten Durchtrennung des lateralen Lidbandes mit der Notwendigkeit einer intraoperativen Refixation und den möglichen Folgen einer Ektropiumbildung konnten vermieden werden. Hornhaut- oder Bulbusverletzungen bzw. -infektionen traten nicht auf. Postoperative Komplikationen wie Narbenstrikturen, eine Entropium- oder Ektropiumbildung wurden nicht beobachtet.Schlussfolgerung Die hier beschriebene und angewandte transkonjunktivale Schnittführung mit lateraler Kanthotomie ohne Durchtrennung des lateralen Lidbandes ist aus ästhetischer und funktioneller Sicht eine ausgesprochen zweckmäßige und übersichtliche Methode. Sie stellt in unserer Klinik mit wenigen Ausnahmen inzwischen den Standardzugang dar.
    Mund- Kiefer- und Gesichtschirurgie 01/2004; 8(5):296-301.
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    ABSTRACT: There are many reports on the versatility of the fibular flap, but only a few studies have reported on the morbidity, and none on the nutritive perfusion, of the donor site. This study describes for the first time the quantitative investigation of nutritive perfusion at the donor site after osteomyo-cutaneous fibula transfer. Tissue nutrition of the lower leg was measured in 25 patients by micro-lightguide spectrophotometry and laser Doppler flowmetry. In a standardized examination, hemoglobin oxygenation and blood flow of the donor leg and the contralateral leg (intraindividual control) were measured at the nutritive region of the peroneal artery (I), posterior tibial artery (II), and anterior tibial artery (III). In the operated leg, blood flow was significantly reduced in region I with the sacrificed peroneal artery, and significantly increased in region II and III, probably for compensation (P = 0.03). Decreased hemoglobin oxygenation and blood flow of the peroneal region at the donor site were without significance in comparison to the control leg (P = 0.55 and P = 0.35, respectively). Decreased nutritive perfusion at the donor site was below the threshold of clinical manifestation, and supports the low donor site morbidity following fibular grafting.
    Microsurgery 02/2003; 23(4):306-12. · 1.62 Impact Factor
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    ABSTRACT: The aim of the present study was to investigate the effects of the oxygen-carrying hemoglobin solution DCLHb (diaspirin-crosslinked hemoglobin) on microvascular perfusion and tissue oxygenation in striated skin muscle after the induction of critical ischemia followed by reperfusion. Using intravital fluorescence microscopy the functional capillary density was analyzed in the striated skin muscle of Syrian golden hamsters before the induction of a 4-h period of ischemia and again after 0.5 h, 2 h and 24 h of reperfusion ( n=8 in each group). In other animals ( n=8 in each group), the identical protocol was applied to determine tissue oxygenation by means of the multi-wire surface electrode (MDO, Eschweiler, Kiel, Germany). Animals in the treatment group ( n=8) received a bolus infusion of 5 ml of DCLHb per kg of body wt. (10 g/dl; Baxter, Ill., USA) 15 min before reperfusion. Control animals ( n=8) received equivalent volumes of isotonic saline (Braun, Melsungen, Germany). RESULTS. Functional capillary density was dramatically reduced in control animals, while in DCLHb-treated animals significantly higher values were observed. Efficient restoration of tissue PO(2) was also seen in DCLHb-treated animals and not in control animals. These results show that the oxygen-carrying solution DCLHb is significantly more efficient than the commonly used crystalloid solutions in restoration of tissue PO(2) after ischemia-reperfusion. The use of this solution therefore appears promising as a means of protecting the tissue put at risk by ischemia from reperfusion damage.
    Mund- Kiefer- und Gesichtschirurgie 02/2003; 7(1):31-5.
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    ABSTRACT: Fragestellung. Ziel der vorliegenden Untersuchung war, die Effekte der Sauerstoff tragenden freien Hämoglobinlösung (Diaspirin-crosslinked-Hämoglobin, DCLHb) auf die kapillare Perfusion sowie die Oxygenation im quergestreiften Hautmuskelgewebe nach kritischer Ischämiezeit und nachfolgender Reperfusion zu analysieren. Material und Methode. Die kapillare Gewebeperfusion wurde anhand der funktionellen Kapillardichte im Hautmuskel des syrischen Goldhamsters quantitativ vor der Induktion einer 4-stündigen Ischämie sowie nach 0,5 h, 2 h und 24 h Reperfusion mittels intravitaler Fluoreszenzmikroskopie erfasst (n=8 pro Versuchsgruppe). In separaten Tieren wurde nach demselben Versuchsansatz mit der Mehrdrahtoberflächenelektrode (MDO, Eschweiler, Kiel) die Gewebeoxygenation gemessen (n=8 pro Versuchsgruppe). Die Tiere der Testgruppe (n=8) erhielten 15 min vor der Reperfusion eine Kurzinfusion von 5 ml/kg KG DCLHb (Diaspirin-crosslinked-Hämoglobin, 10 g/dl, Baxter, IL, USA). Die Kontrolltiere (n=8) erhielten äquivalente Dosen einer isotonen Kochsalzlösung (Braun, Melsungen). Ergebnisse. Die funktionelle Kapillardichte als Maß für die Länge von erythrozytenperfundierten Kapillaren pro Beobachtungsfeld war bei den Kontrolltieren in der Reperfusionsphase dramatisch vermindert, während bei den mit DCLHb behandelten Tieren signifikant höhere Werte nachweisbar waren (p<0,05). Diese Beobachtung spiegelte sich in einer vollständigen Erholung des Gewebe-pO2 bei den Behandlungstieren wider, was in Kontrolltieren nicht erreicht wurde. Schlussfolgerungen. Die Ergebnisse dieser Studie zeigen, dass die Sauerstoff tragende Lösung DCLHb nach kritischer Ischämie und Reperfusion die nutritive Perfusion und Gewebeoxygenation gegenüber kristalloiden Lösungen verbessert. Die Anwendung derartiger Lösungen scheint unter den klinischen Bedingungen einer kritischen Ischämie daher als viel versprechender adjuvanter therapeutischer Ansatz. Aim. The aim of the present study was to investigate the effects of the oxygen-carrying hemoglobin solution DCLHb (diaspirin-crosslinked hemoglobin) on microvascular perfusion and tissue oxygenation in striated skin muscle after the induction of critical ischemia followed by reperfusion. Material and Methods. Using intravital fluorescence microscopy the functional capillary density was analyzed in the striated skin muscle of Syrian golden hamsters before the induction of a 4-h period of ischemia and again after 0.5 h, 2 h and 24 h of reperfusion (n=8 in each group). In other animals (n=8 in each group), the identical protocol was applied to determine tissue oxygenation by means of the multi-wire surface electrode (MDO, Eschweiler, Kiel, Germany). Animals in the treatment group (n=8) received a bolus infusion of 5 ml of DCLHb per kg of body wt. (10 g/dl; Baxter, Ill., USA) 15 min before reperfusion. Control animals (n=8) received equivalent volumes of isotonic saline (Braun, Melsungen, Germany). Results. Functional capillary density was dramatically reduced in control animals, while in DCLHb-treated animals significantly higher values were observed. Efficient restoration of tissue PO2 was also seen in DCLHb-treated animals and not in control animals. Conclusions. These results show that the oxygen-carrying solution DCLHb is significantly more efficient than the commonly used crystalloid solutions in restoration of tissue PO2 after ischemia–reperfusion. The use of this solution therefore appears promising as a means of protecting the tissue put at risk by ischemia from reperfusion damage. Ischämie Reperfusion Sauerstoff tragende Lösungen DCLHb Mikrozirkulation GewebeoxygenationIschemia-reperfusion Oxygen-carrying solution DCLHb Microcirculation Tissue oxygenation
    Mund- Kiefer- und Gesichtschirurgie 01/2003; 7(1):31-35.