Rainer Schmelzle

Publications of Rainer Schmelzle

• Donor site morbidity of the vascularized fibula: the Hamburg experience.

  Authors: Philipp Pohlenz, Artun Atac, Philip Catala-Lehnen, Pezhman Khakpour, Lei Li, Jan Klatt, Rainer Schmelzle

  Clinical oral investigations. 03/2012;

  OBJECTIVES: The postoperative complications following the harvesting of the fibula through the lateral or medial access have increasingly become a subject of controversy in the literature. As theOBJECTIVES: The postoperative complications following the harvesting of the fibula through the lateral or medial access have increasingly become a subject of controversy in the literature. As the surgical access, amongst other factors, was important for us, we hoped to achieve a meaningful comparison of the consequences of the surgical access. MATERIALS AND METHODS: Forty-two patients were examined after the removal of a fibula flap using the medial (n = 21) and the lateral approach (n = 19). When using the lateral approach, a skin island was included in nine patients. To evaluate the operation results, we applied the clinical classification of the "American Orthopaedic Foot and Ankle Society": the AOFAS score. General health and changes to it were documented and evaluated using the SF-36 questionnaire. RESULTS: The comparison of the surgical approaches showed disadvantages significantly more often in the group of patients with lateral access: functional (36 vs. 32 %), neurological (30 vs. 63 %), and circulatory and wound healing problems (17 vs. 37 %). CONCLUSIONS: The medial access to the fibula is associated with lower long-term morbidity and higher patient satisfaction, not least on cosmetic. CLINICAL RELEVANCE: For this reason, when a purely osseous microvascular fibula graft is required, we prefer the medial access, particularly in female patients.

• Long-Term Donor-Site Morbidity After Microsurgical Fibular Graft: Is There a Difference Between the Medial Approach and the Lateral Approach?

  Authors: Philip Catalá-Lehnen, Carsten Rendenbach, Max Heiland, Pezhman Khakpour, Johannes M Rueger, Rainer Schmelzle, Felix Blake

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 12/2011;

  PURPOSE: Microvascular fibula harvesting for osseous reconstruction is a valuable aid in maxillofacial surgery. We assessed whether the lateral and the medial harvesting techniques differed withPURPOSE: Microvascular fibula harvesting for osseous reconstruction is a valuable aid in maxillofacial surgery. We assessed whether the lateral and the medial harvesting techniques differed with respect to long-term donor-site morbidity. MATERIALS AND METHODS: We conducted a retrospective cohort study of patients who had undergone free fibula harvesting at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, between 1987 and 2008. The primary predictor variable was the surgical approach. The primary and secondary outcome variables were the American Orthopaedic Foot & Ankle Society score and the result of the Short Form 36 Health Survey on quality of life, respectively. Other variables were age, gender, harvest length, operation time, and specific impairments and surgical complications. Statistical analysis was performed with SPSS, version 14.0 (SPSS, Chicago, IL); P < .05 was considered significant. RESULTS: The 42 patients had a mean age of 55.5 years. The mean follow-up period was 81 months (range, 7-174 months). In the medial group, the mean American Orthopaedic Foot & Ankle Society score was 94.4 points and the total number of impairments was 34, as compared with 85.6 points and 46 impairments, respectively, in the lateral group. This tendency for less morbidity with the medial approach was only found in female patients. The Short Form 36 scores were not statistically different between the 2 surgical approaches. CONCLUSIONS: The medial approach led to less functional impairment of the foot and ankle. Our results support the medial approach as a viable alternative, especially in women, but only in cases when a skin paddle is not necessary.

• A series of complications after third molar osteotomy in a pancytopenia patient and spontaneous healing after bone marrow transplantation.

  Authors: Jan C Klatt, Alexander Gröbe, Rainer Schmelzle, Artun Atac, Max Heiland, Marco Blessmann, Philipp Pohlenz

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 05/2011; 69(10):2508-12.

• Leech therapy in reconstructive maxillofacial surgery.

  Authors: Alexander Gröbe, Andreas Michalsen, Henning Hanken, Rainer Schmelzle, Max Heiland, Marco Blessmann

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 05/2011; 70(1):221-7.

  Corrective plastic surgery is indicated after accidents, burns, cancer surgery, or postoperative wound healing disorders with large tissue defects. The range of reconstructive techniques includesCorrective plastic surgery is indicated after accidents, burns, cancer surgery, or postoperative wound healing disorders with large tissue defects. The range of reconstructive techniques includes local skin flaps, pedicle grafts, and microvascular anastomosed flaps in the case of large defects. Main complications such as arterial and venous insufficiency caused by a vessel collapse or a vascular spasm are reported regularly in the area of anastomosed vessels and are the concern of any surgeon. Today, leeches are used if wound healing is at risk because of hemodynamic imbalance or a venous insufficiency. A retrospective evaluation of 148 patients who underwent medical leech therapy in the case of local or pedicaled flaps and some patients who had undergone reconstruction with microvascular flaps from 2005 and 2010 was conducted. Our sample had the typical symptoms of venous congestions of their flaps, despite suture removal, relief of pressure on the flap, and the elimination of a hematoma beyond the flap after surgery. Medical leech therapy was used in these cases. Our series has confirmed the excellent and predictable healing after medical leech therapy for local and microsurgical anastomosed flaps in the case of venous congestion. Leech therapy should be considered as a reliable additional procedure and an advantage in maxillofacial and plastic reconstructive surgery to remedy complications resulting from a hemodynamic imbalance or venous insufficiency in the immediate postoperative period.

• Influence of lip closure on alveolar cleft width in patients with cleft lip and palate.

  Authors: Wolfgang Eichhorn, Marco Blessmann, Oliver Vorwig, Gerd Gehrke, Rainer Schmelzle, Max Heiland

  Head & face medicine. 01/2011; 7:3.

  The influence of surgery on growth and stability after treatment in patients with cleft lip and palate are topics still under discussion. The aim of the present study was to investigate the influenceThe influence of surgery on growth and stability after treatment in patients with cleft lip and palate are topics still under discussion. The aim of the present study was to investigate the influence of early lip closure on the width of the alveolar cleft using dental casts. A total of 44 clefts were investigated using plaster casts, 30 unilateral and 7 bilateral clefts. All infants received a passive molding plate a few days after birth. The age at the time of closure of the lip was 2.1 month in average (range 1-6 months). Plaster casts were obtained at the following stages: shortly after birth, prior to lip closure, prior to soft palate closure. We determined the width of the alveolar cleft before lip closure and prior to soft palate closure measuring the alveolar cleft width from the most lateral point of the premaxilla/anterior segment to the most medial point of the smaller segment. After lip closure 15 clefts presented with a width of 0 mm, meaning that the mucosa of the segments was almost touching one another. 19 clefts showed a width of up to 2 mm and 10 clefts were still over 2 mm wide. This means a reduction of 0% in 5 clefts, of 1-50% in 6 clefts, of 51-99% in 19 clefts, and of 100% in 14 clefts. Early lip closure reduces alveolar cleft width. In most cases our aim of a remaining cleft width of 2 mm or less can be achieved. These are promising conditions for primary alveolar bone grafting to restore the dental bony arch.

• Metastases in odontogenic cysts: literature review and case presentation.

  Authors: Wolfgang Eichhorn, Manfred Wehrmann, Marco Blessmann, Philipp Pohlenz, Felix Blake, Rainer Schmelzle, Max Heiland

  Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 04/2010; 109(4):582-6.

  Malignant tumors in the oral cavity are relatively rare. About 5% of all malignant growths in the body are localized in the oral cavity. The vast majority of oral malignancies are primary tumors withMalignant tumors in the oral cavity are relatively rare. About 5% of all malignant growths in the body are localized in the oral cavity. The vast majority of oral malignancies are primary tumors with squamous cell carcinoma being the most frequent and sarcomas occurring very seldom. Secondary tumors caused by hematogenous spread arising from a tumor localized elsewhere in the body are extremely rare. About 1% of all oral cancers are metastases to the jawbones and the surrounding soft tissues. Metastases to the jaws are mainly caused by malignant tumors of the breast, lung, kidney, bone, and colon. They occur in the late state of the disease and are regularly detected by staging examinations including scintigraphy. Even more rare are metastases into odontogenic cysts. Odontogenic cysts include dentigerous cysts, periapical or radicular cysts, and the keratocysts-nowadays declared as keratocystic odontogenic tumor. The incidence of odontogenic cysts is about 10% to 15% of all oral biopsies and therefore general dentists are frequently faced with these types of lesions. The aim of this study was to review the literature regarding metastasis into odontogenic cysts and to further highlight this rare entity with the help of a clinical case.

• Clinical follow-up examination of surgically treated fractures of the condylar process using the transparotid approach.

  Authors: Jan Klatt, Philipp Pohlenz, Marco Blessmann, Felix Blake, Wolfgang Eichhorn, Rainer Schmelzle, Max Heiland

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 03/2010; 68(3):611-7.

  The surgical approaches for the open treatment of condylar process fractures have been controversial. In our study, we evaluated the morbidity of the transparotid approach during 2 years ofThe surgical approaches for the open treatment of condylar process fractures have been controversial. In our study, we evaluated the morbidity of the transparotid approach during 2 years of follow-up. A total of 48 patients with condylar process Class II and IV fractures according to classification of Spiessl and Schroll, were included in the present study. Of the 48 patients, 16 were female and 32 male. The patient age range was 16 to 79 years (average 36.52). All patients were treated using the transparotid approach, with rigid internal fixation using miniplates. Follow-up examinations were performed for a minimum of 6.5 months and a maximum of 25 months (average 12.16) after surgical treatment. At the follow-up examination, the patients completed the Mandibular Function Impairment Questionnaire, and the examiner completed the Helkimo index. X-rays taken before, directly after, and 6 months after surgery were compared. None of our patients had problems with wound healing; 2 patients developed a fistula of the parotid gland; and 4 patients developed palsy of the facial nerve that was completely reversible after 6 weeks. The results of the Mandibular Function Impairment Questionnaire and the Helkimo index revealed only a few subjective and objective problems after 6 months. The transparotid approach to condylar process fractures is most appropriate for strongly displaced Class II fractures. Especially for very old patients with dementia, for whom maxillomandibular fixation is contraindicated, this approach is very appropriate. Another benefit to this type of patient is the short operating time, with an average of 45 minutes.

• Primary osteoplasty using calvarian bone in patients with cleft lip, alveolus and palate.

  Authors: Wolfgang Eichhorn, Marco Blessmann, Philipp Pohlenz, Felix A S Blake, Gerd Gehrke, Rainer Schmelzle, Max Heiland

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 09/2009;

  PURPOSE: The results of primary bone grafting in terms of initial cleft width, existence or absence of a lateral incisor and scar formation in the donor area are compared. METHODS: After primaryPURPOSE: The results of primary bone grafting in terms of initial cleft width, existence or absence of a lateral incisor and scar formation in the donor area are compared. METHODS: After primary osteoplasty with calvarian bone at an average age of 24 months (4-56 months) radiographic assessment was carried out in 31 patients with 40 alveolar clefts. The bone formation in the grafted area was assessed using dental radiographs taken at 66 months on average (13-114 months) after primary bone grafting. According to the Abyholm classification patients were assigned to 4 groups (indices I-IV) with indices I and II being rated as a success. RESULTS: We observed success (indices I and II) in 76% and poor results (index IV) in 14%. The causes for the poor results were an alveolar cleft width of 11-12mm in three cases, an extraction of a decayed deciduous tooth 17 months after bone grafting in one case and a traumatic transplant loss in another case. The non-existence of a lateral incisor and a broad cleft are related to poor results. CONCLUSION: Based on the results presented, primary bone grafting using calvarial bone seems to be a promising alternative in bridging narrow alveolar defects. This method allows early intervention at an age in which children do not recognize themselves as cleft patients. The preservation of the deciduous teeth is equally important regarding their functional stimulus for bone development.

• The use of navigation (BrainLAB Vector vision(2)) and intraoperative 3D imaging system (Siemens Arcadis Orbic 3D) in the treatment of gunshot wounds of the maxillofacial region.

  Authors: Alexander Gröbe, Christoph Weber, Rainer Schmelzle, Max Heiland, Jan Klatt, Philipp Pohlenz

  Oral and maxillofacial surgery. 09/2009;

  PURPOSE: Gunshot wounds are a rare occurance during times of peace. The removal of projectiles is recommended; in some cases, however, this is a controversy. The reproduction of a projectile imagePURPOSE: Gunshot wounds are a rare occurance during times of peace. The removal of projectiles is recommended; in some cases, however, this is a controversy. The reproduction of a projectile image can be difficult if it is not adjacent to an anatomical landmark. Therefore, navigation systems give the surgeon continuous real-time orientation intraoperatively. The aim of this study was to report our experiences for image-guided removal of projectiles and the resulting intra- and postoperative complications. PATIENTS AND METHODS: We investigated 50 patients retrospectively; 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region. Eighteen had surgical removal of projectiles without navigation assistance. RESULTS: There was a significant correlation (p = 0.0136) between the navigated surgery vs. not-navigated surgery and complicaton rate, including major bleeding (n = 4 vs. n = 1, 8% vs. 2%), soft tissue infections (n = 7 vs. n = 2, 14% vs. 4%), and nerval damage (n = 2 vs. n = 0, 4% vs. 0%; p = 0.038) and between the operating time and postoperative complications. A high tendency between operating time and navigated surgery (p = 0.1103) was shown. When using navigation system, we could reduce operating time. CONCLUSION: In conclusion, there is a significant correlation between reduced intra- and postoperative complications, including wound infections, nerval damage, and major bleeding, and the appropriate use of a navigation system. In all these cases, we could present reduced operating time. Cone-beam computed tomography plays an important role in detecting projectiles or metallic foreign bodies intraoperatively.

• Clear-cell odontogenic carcinoma: a new case and long-term follow-up of an old case, and review of the literature.

  Authors: Heiner Werle, Felix A S Blake, Uta Reichelt, Rainer Schmelzle, Max Heiland

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 07/2009; 67(6):1342-8.

• Intraoperative cone-beam computed tomography in oral and maxillofacial surgery using a C-arm prototype: first clinical experiences after treatment of zygomaticomaxillary complex fractures.

  Authors: Philipp Pohlenz, Felix Blake, Marco Blessmann, Ralf Smeets, Christian Habermann, Philipp Begemann, Rainer Schmelzle, Max Heiland

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 04/2009; 67(3):515-21.

  PURPOSE: To describe the first clinical applications of intraoperative cone-beam computed tomography with an integrated flat-panel detector in oral and maxillofacial surgery after surgical treatmentPURPOSE: To describe the first clinical applications of intraoperative cone-beam computed tomography with an integrated flat-panel detector in oral and maxillofacial surgery after surgical treatment of zygomaticomaxillary complex fractures PATIENTS AND METHODS: Nine cone-beam computed tomography datasets of patients with zygomaticomaxillary complex fractures were intraoperatively acquired using a mobile isocentric C-arm (PowerMobil; Siemens Medical Solutions, Erlangen, Germany), including a flat-panel detector. Datasets based on 400, 200, and 100 fluoroscopic images were performed with different tube currents (4.6 mA, 3.3 mA, 2.3 mA, 1.2 mA, and 0.5 mA) and a current tube voltage of 100 kV. Postprocessing resulted in 15 different datasets available for comparison with corresponding preoperative computed tomography datasets. Four oral and maxillofacial surgeons and 2 experienced radiologists evaluated each dataset regarding noise, transition, and the delimitation of landmarks. RESULTS: All examinations were successfully performed. Reconstructed datasets showed high-resolution images of all midfacial osseous structures in near-computed tomography quality. Regarding high-contrast structures, detailed analyses of datasets acquired in this study suggest that the parameters 400 projections, 1.2 mA, and 100 kV are sufficient. In terms of soft-tissue visualization, a higher level of mA seems preferable. CONCLUSIONS: The tested prototype predicts a new era in cone-beam computed tomography imaging. The integration of a flat-panel detector will overcome the limitations of current available systems. The size of the field of view is increased allowing regularly the visualization of the whole facial skeleton. Particularly in cases of open reduction of unilateral fractures, the assessment of symmetry is of clinical value.

• Conditioning of myocutaneous flaps.

  Authors: Wolfgang Eichhorn, Felix A S Blake, Philipp Pohlenz, Gerd Gehrke, Rainer Schmelzle, Max Heiland

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 02/2009;

  PURPOSE: The improvement of the ischaemic tolerance of myocutaneous flaps is of clinical importance and hence the subject of numerous investigations. METHODS: In an attempt to increase the ischaemicPURPOSE: The improvement of the ischaemic tolerance of myocutaneous flaps is of clinical importance and hence the subject of numerous investigations. METHODS: In an attempt to increase the ischaemic tolerance, 20 myocutaneous flaps (rectus abdominis muscle) in pigs were elevated and perfused with various, established solutions prior to the onset of ischaemia. The flaps were elevated, utilizing the superior epigastric vessels as the pedicle. Ten flaps were flushed with the University of Wisconsin solution, five with the Euro-Collins solution and the last five with a Ringer-Lactate solution, prior to the 6h long, normothermic ischaemia. On the day of operation, the first, third, fifth, seventh and tenth postoperative day clincical examinations and thermography were performed as well as biopsies. Additionally, on the tenth postoperative day, the rate of necrosis was determined morphometrically as the average of three measurements. RESULTS: Ten days after surgery, the flaps pretreated with the University of Wisconsin solution displayed a vital surface area of 89%, the Euro-Collins solution 23% and the Ringer-Lactate solution 14%. Histologically, muscle tissue proved to be more susceptible to ischaemia than skin. CONCLUSION: Regarding the rectus abdominis flap in a pig model, the University of Wisconsin solution proved superior in the prevention of ischaemic injury compared with the Euro-Collins solution and Ringer Lactate. In accordance with the literature, muscle tissue proved to be more susceptible to ischaemia than skin in our study.

• Distraction osteogenesis in secondary microsurgical mandible reconstruction: Report of seven cases.

  Authors: Lei Li, Felix Blake, Ali Gbara, Eva Gudewer, Rainer Schmelzle

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 08/2008; 36(5):273-8.

  INTRODUCTION: Fibula, ilium and scapula are the preferred donor areas for vascularised bone grafts. For secondary mandibular reconstruction, however, compromises often have to be made as a result ofINTRODUCTION: Fibula, ilium and scapula are the preferred donor areas for vascularised bone grafts. For secondary mandibular reconstruction, however, compromises often have to be made as a result of the poor quality of the covering soft tissue and recipient vessels especially in irradiated patients. Callus distraction osteogenesis is a complementary method for optimising the intermaxillary relationship and the facial profile from an aesthetic point of view. MATERIALS AND METHODS: Thirteen distractions were performed in seven patients following microsurgical mandibular reconstruction over a period of 4 years, all by the same surgeon. Intra-oral distraction devices were predominately applied. After a 7-day healing period, the callus distraction was begun, involving two advisements per day of 0.5mm each. The distraction devices were removed after a consolidation phase of 4-5 months. RESULTS: Ten of the 13 distractions were uneventful with an average bone lengthening of 20mm, retained after a follow-up time of 6-47 months (average 27 months). The intermaxillary relationship and the facial profile were improved in all cases. Distraction plate fractures, screw loosening or absence of new bone formation were the complications encountered in the other three patients. CONCLUSION: Regarding the high complication rate, a successful outcome cannot be expected with greater certainty. Thus the indication should be stringent when including this procedure within the possible treatment alternatives available to the clinician.

• Mechanical aspects of a multidirectional, angular stable osteosynthesis system and comparison with four conventional systems.

  Authors: Ali Gbara, Max Heiland, Rainer Schmelzle, Felix Blake

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 05/2008; 36(3):152-6.

  BACKGROUND: Following open reduction, internal fixation of fractures of the mandible is predominantly achieved using plates and screws. Today, a multitude of osteosynthesis systems are available onBACKGROUND: Following open reduction, internal fixation of fractures of the mandible is predominantly achieved using plates and screws. Today, a multitude of osteosynthesis systems are available on the market. One therapy modality, primarily developed for orthopaedic surgery, is using angular stable osteosynthesis plate systems. The dominating principle of these is the bond between screw and plate following insertion. This principle of an "internal fixateur" results in a more stable fixation of the fragments associated with less compression of the bone surfaces. MATERIAL: A new multidirectional osteosynthesis system (TiFix=Smartlock, Hamburg - Germany) was modified to fit the maxillofacial region and compared with four other well established osteosynthesis systems developed by Mondial, Medicon, Synthes, Leibinger-Stryker, one of these (Unilock by Synthes) being also angular stable. The resistance to deformation in varying directions was investigated following fixation in four different materials. RESULTS: The TiFix system proved more resistant to deformation even when mounted with fewer screws than the non-angular stable systems. CONCLUSION: This system results in greater stability even when fewer screws are used. For the clinician this means smaller access incisions, less soft tissue trauma, better aesthetic results, decreased duration of operation and a reduction of costs.

• Clinical implementation of a multidirectional, angular stable osteosynthesis system in maxillofacial traumatology.

  Authors: Ali Gbara, Max Heiland, Rainer Schmelzle, Felix Blake

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 05/2008; 36(3):157-60.

  AIM: To investigate whether a multidirectional, angular stable osteosynthesis system is suitable for the treatment of mandibular fractures and to compare it with well established available systems.AIM: To investigate whether a multidirectional, angular stable osteosynthesis system is suitable for the treatment of mandibular fractures and to compare it with well established available systems. MATERIAL AND METHODS: Following preliminary testing in an animal model, the multidirectional angular stable system TiFix 2.3 obtained from Litos (Hamburg, Germany) was utilised for internal fixation of 39 mandibular fractures. These involved four symphyseal fractures, 17 parasymphyseal, 16 of the angle of the mandible and two comminuted fractures. The surgical and postoperative course was closely scrutinised. Radiographs were taken after 6 months and all plates removed under local anaesthesia. Photographs were taken intraoperatively and the plates and surrounding soft tissues were salvaged for histological analysis. Additionally, these operations were compared with treatment of equivalent fractures which were treated with conventional, non-angular stable systems. The relative costs have also been evaluated. RESULTS: In 33 of the 39 fractures one TiFix plate sufficed for osteosynthesis. The plate most often used was a 2-hole plate which was applied in 25 (55.5%) fractures, followed by the 4-hole plates used in 16 (35.5%) fractures. In two comminuted fractures, four 6-hole plates were used (9%). In 17 patients the operation lasted less than 30 min, in 20 patients less than 60 min, in two less than 120 min. In all cases, the operations were shorter, and due to the plates' dimensions fewer screws had to be used, thus reducing the costs. DISCUSSION: This angular stable system enabled reduction of the amount of the implant material. Also reduced were the operation time and the cost of the procedure. Furthermore, in the future it will allow smaller access incisions and better preservation of the soft tissue integrity.

• 3D C-arm as an alternative modality to CT in postmortem imaging: technical feasibility.

  Authors: Philipp Pohlenz, Marco Blessmann, Lars Oesterhelweg, Christan R Habermann, Philipp G C Begemann, Christian Schmidgunst, Felix Blake, Dirk Schulze, Klaus Püschel, Rainer Schmelzle, Max Heiland

  Forensic science international. 04/2008; 175(2-3):134-9.

  OBJECT: The aim of our study was to demonstrate the image quality of the new device using human cadavers, extending the horizon of available imaging modalities in forensic medicine. MATERIALS ANDOBJECT: The aim of our study was to demonstrate the image quality of the new device using human cadavers, extending the horizon of available imaging modalities in forensic medicine. MATERIALS AND METHODS: Six human cadavers were examined, revealing C-arm data sets of the head, neck thorax, abdomen and pelvis. High-resolution mode was performed with 500 fluoroscopy shots during a 190 degrees orbital movement with a constant tube voltage of 100 kV and a current of 4.6 mA. Based on these data sets subsequent three-dimensional reconstructions were generated. RESULTS: Reconstructed data sets revealed high-resolution images of all skeletal structures in a near-CT quality. The same image quality was available in all reconstruction planes. Artefacts caused by restorative dental materials are less accentuated in CBCT data sets. The system configuration was not powerful enough to generate sufficient images of intracranial structures. CONCLUSION: After the here-demonstrated encouraging preliminary results, the forensic indications that would be suitable for imaging with a 3D C-arm have to be defined. Promising seems the visualization local limited region of interest as the cervical spine or the facial skeleton.

• Short tandem repeat polymorphism in exon 4 of esophageal cancer related gene 2 predicts relapse of oral squamous cell carcinoma.

  Authors: Marco Blessmann, Jussuf T Kaifi, Paulus G Schurr, Asli Cihan, Viacheslav Kalinin, Florian Trump, Artun Atac, Max Heiland, Philipp Pohlenz, Felix Blake, Rainer Schmelzle, Jakob R Izbicki

  Oral oncology. 03/2008; 44(2):143-7.

  Short tandem repeat (STR) polymorphisms in exon 4 of esophageal cancer related gene 2 (ECRG2) are a prognostic marker for squamous cell carcinoma (SCC) of the esophagus. The aim of the present studyShort tandem repeat (STR) polymorphisms in exon 4 of esophageal cancer related gene 2 (ECRG2) are a prognostic marker for squamous cell carcinoma (SCC) of the esophagus. The aim of the present study was to correlate these STRs with clinical outcome of the similar tumor type oral squamous cell carcinoma (OSCC). DNA of 81 patients that underwent complete surgical resection of OSCC was analyzed for STRs TCA3/TCA3, TCA3/TCA4 and TCA4/TCA4 in exon 4 of ECRG2 by PCR, capillary electrophoresis and DNA sequencing. ECRG2 STR TCA3/TCA3 were found in 45 (56%), TCA3/TCA4 in 33 (41%) and TCA4/TCA4 in 3 (3%) patients. TCA3/TCA3 was significantly associated with reduced relapse-free survival of OSCC, compared with TCA3/TCA4 and TCA4/TCA4 genotypes (P<0.05; log-rank test). TCA3/TCA3 STR was independent prognostic factor determined by multivariate Cox regression analysis (p<0.05). STR polymorphism TCA3/TCA3 in exon 4 of ECRG2 is associated with poor relapse-free survival in surgically completely resected OSCC patients and might be a potential prognostic marker.

• The medial approach to the fibula: a feasible alternative.

  Authors: Felix Blake, Max Heiland, Rainer Schmelzle, Juergen Harms, Heiner Werle, Philipp Pohlenz, Lei Li

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 03/2008; 66(2):319-23.

  PURPOSE: Since the first harvesting of a microsurgical fibula in 1974 by Ueba and in 1975 by Taylor, using the fibula for osseous reconstruction has proven to be a valuable approach. The harvestingPURPOSE: Since the first harvesting of a microsurgical fibula in 1974 by Ueba and in 1975 by Taylor, using the fibula for osseous reconstruction has proven to be a valuable approach. The harvesting technique, which has been refined by subsequent investigators, has become increasingly standardized, today providing a clear, reproducible method. The procedure involves elevating the fibular graft from lateral, choosing the shortest route to reach the fibula. One disadvantage of this approach is that the bone often obstructs visualization of the vascular pedicle, which lies medially, promoting unintentional injury. In addition, this method is associated with some donor site morbidity, prompting further investigations into accessing the fibula. Here we present an alternative approach for harvesting the fibula and highlight the pros and cons of each approach. PATIENTS AND METHODS: Between 1999 and 2006, a total of 38 microsurgical (23 for the mandible, 9 for the extremities, and 6 for the maxilla) fibula grafts were harvested through the medial approach. RESULTS: In all cases, the patency of the posterior tibial, peroneal vessels, and the tibial nerve could be visualized. Two flaps failed (both mandible, for a success rate of 94.7%). No ischemic or wound healing complications of the lower limb were observed. CONCLUSIONS: The medial approach for harvesting the fibula is a feasible alternative to the lateral approach and provides the surgeon with a comparable likelihood of success. If for some reason access from the lateral approach is contraindicated, then the medial route should be considered.

• Major mandibular surgical procedures as an indication for intraoperative imaging.

  Authors: Philipp Pohlenz, Marco Blessmann, Felix Blake, Ali Gbara, Rainer Schmelzle, Max Heiland

  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 03/2008; 66(2):324-9.

  PURPOSE: This study investigated 3-dimensional (3D) imaging with intraoperative cone beam computed tomography (CBCT) in major mandibular reconstruction procedures. PATIENTS AND METHODS: The studyPURPOSE: This study investigated 3-dimensional (3D) imaging with intraoperative cone beam computed tomography (CBCT) in major mandibular reconstruction procedures. PATIENTS AND METHODS: The study group was comprised of 125 patients (83 males, 42 females) admitted for surgical treatment of the mandible. The patients ranged in age from 3 months to 91 years (average age, 40.72 +/- 22.843 years). Surgical procedures of the mandible were subdivided into repair of body fractures (17 patients), angle fractures (21 patients), condylar fractures (14 patients), and multiple fractures (30 patient). In addition, the study group included 21 patients undergoing orthognatic surgery and 22 undergoing reconstructive surgery on the mandible. Intraoperatively, 3D images were generated with a mobile CBCT scanner (Arcadis Orbic 3D; Siemens Medical Solutions, Erlangen, Germany). RESULTS: During open reduction of mandibular fractures, not all fracture sites can be readily exposed for direct visual control. For example, the lingual cortical bone of the mandible is difficult to assess intraoperatively. This structure and others can be effectively visualized using the 3D mode of CBCT. Furthermore, screw placement can be evaluated, specifically in insertions near the alveolar nerve. The intraoperative acquisition of the data sets is uncomplicated, and the image quality is sufficient to allow evaluation of the postoperative result in all cases. CONCLUSION: Intraoperative CBCT has proven to be a reliable imaging technique for providing visual control during major mandibular procedures.

• Cervical soft tissue imaging using a mobile CBCT scanner with a flat panel detector in comparison with corresponding CT and MRI data sets.

  Authors: Max Heiland, Philipp Pohlenz, Marco Blessmann, Christian R Habermann, Lars Oesterhelweg, Philipp C Begemann, Christian Schmidgunst, Felix A S Blake, Klaus Püschel, Rainer Schmelzle, Dirk Schulze

  Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 01/2008; 104(6):814-20.

  OBJECTIVE: The aim of this study was to evaluate soft tissue image quality of a mobile cone-beam computed tomography (CBCT) scanner with an integrated flat-panel detector. STUDY DESIGN: Eight freshOBJECTIVE: The aim of this study was to evaluate soft tissue image quality of a mobile cone-beam computed tomography (CBCT) scanner with an integrated flat-panel detector. STUDY DESIGN: Eight fresh human cadavers were used in this study. For evaluation of soft tissue visualization, CBCT data sets and corresponding computed tomography (CT) and magnetic resonance imaging (MRI) data sets were acquired. Evaluation was performed with the help of 10 defined cervical anatomical structures. RESULTS: The statistical analysis of the scoring results of 3 examiners revealed the CBCT images to be of inferior quality regarding the visualization of most of the predefined structures. Visualization without a significant difference was found regarding the demarcation of the vertebral bodies and the pyramidal cartilages, the arteriosclerosis of the carotids (compared with CT), and the laryngeal skeleton (compared with MRI). Regarding arteriosclerosis of the carotids compared with MRI, CBCT proved to be superior. CONCLUSIONS: The integration of a flat-panel detector improves soft tissue visualization using a mobile CBCT scanner.