Majeed Rana

Publications of Majeed Rana

• 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.

• Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study.

  Authors: Ali Modabber, Christina Legros, Majeed Rana, Marcus Gerressen, Dieter Riediger, Alireza Ghassemi

  The international journal of medical robotics + computer assisted surgery : MRCAS. 12/2011;

  BACKGROUND: The introduction of computer-assisted surgery was a milestone in functional reconstructions of facial skeletal defects. PATIENTS AND METHODS: We compared five computer-assisted and fiveBACKGROUND: The introduction of computer-assisted surgery was a milestone in functional reconstructions of facial skeletal defects. PATIENTS AND METHODS: We compared five computer-assisted and five conventional reconstructions with fibular grafts in the course of a pilot study. A rapid prototyping guide translated the computer-assisted surgery plan into intraoperative utilizable models. We intraoperatively measured the time needed for shaping the graft to the recipient site and the ischaemic time. Furthermore, the size of donor site defect compared to the required transplant length was evaluated. RESULTS: Shaping procedure and ischaemic time turned out significantly shorter when compared to conventional surgery without cutting guide (p = 0.014). Using surgical guides, there was no change between the defect size of the fibula and the necessary transplant size. In conventional surgery, a mean change of 1.92 cm occurred (p = 0.001). CONCLUSION: The surgical guide significantly reduced shaping time and consequently ischaemic time. These factors can influence flap survival. The fibular donor site defect was downsized. Copyright © 2011 John Wiley & Sons, Ltd.

• 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.

• 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.

• Comparative evaluation of the usability of 2 different methods to perform mild hypothermia in patients with out-of-hospital cardiac arrest.

  Authors: Majeed Rana, Jörg W Schröder, Erol Saygili, Umer Hameed, Dirk Benke, Rainer Hoffmann, Patrick Schauerte, Nikolaus Marx, Obaida R Rana

  International journal of cardiology. 11/2011; 152(3):321-6.

  Several studies have shown that mild hypothermia (32-34°C) markedly mitigates brain damage after cardiac arrest (CA). This study aimed to compare the efficacy of the non-invasive cooling deviceSeveral studies have shown that mild hypothermia (32-34°C) markedly mitigates brain damage after cardiac arrest (CA). This study aimed to compare the efficacy of the non-invasive cooling device Hilotherm Clinic (Hilotherm GmbH, Germany) with conventional cooling to induce and maintain mild hypothermia in patients after out-of-hospital CA. 50 adult patients with an indication for controlled mild hypothermia were prospectively assigned to conventional cooling (n=20) or cooling with the Hilotherm system (n=30). Patients receiving a cooling therapy by Hilotherm were treated either with 0.35 m(2) (n=20) or with 0.7 m(2) (n=10) surface area of cooling sleeves. The speed of cooling was significantly higher in both Hilotherm groups compared to conventional cooling (Hilotherm 0.7 m(2): 0.91 ± 0.08°C/h, Hilotherm 0.35 m(2): 0.47 ± 0.04°C/h, and conventional: 0.3 ± 0.04°C/h, p ≤ 0.003). Temperature deviation from the target temperature of 33°C was significantly higher in the conventional group compared to both Hilotherm groups. During induction of mild hypothermia a significant reduction of the mean arterial blood pressure and the heart rate was observed without significant differences between the groups. However, the speed of cooling (range 0.3-0.91°C/h) did not correlate to the decrease of blood pressure and heart rate. Norepinephrine dosing during induction of mild hypothermia and re-warming (1st-2nd day) was significantly increased compared to the 3rd day after admission in all groups. Dobutamine dosing and 30 days in-hospital mortality did not differ significantly between the groups. Rapid and reliable mild hypothermia can be better achieved by the non-invasive cooling system Hilotherm compared to conventional cooling with ice packs and cold infusion.

• 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.

• 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.

• Piezoelectric-assisted removal of a benign fibrous histiocytoma of the mandible: an innovative technique for prevention of dentoalveolar nerve injury.

  Authors: Maximilian E H Wagner, Majeed Rana, Wolfgang Traenkenschuh, Horst Kokemueller, André M Eckardt, Nils-Claudius Gellrich

  Head & face medicine. 01/2011; 7:20.

  In this article, we present our experience with a piezoelectric-assisted surgical device by resection of a benign fibrous histiocytoma of the mandible.A 41 year-old male was admitted to our hospitalIn this article, we present our experience with a piezoelectric-assisted surgical device by resection of a benign fibrous histiocytoma of the mandible.A 41 year-old male was admitted to our hospital because of slowly progressive right buccal swelling. After further radiographic diagnosis surgical removal of the yellowish-white mass was performed. Histologic analysis showed proliferating histiocytic cells with foamy, granular cytoplasm and no signs of malignancy. The tumor was positive for CD68 and vimentin in immunohistochemical staining. Therefore the tumor was diagnosed as primary benign fibrous histiocytoma. This work provides a new treatment device for benign mandibular tumour disease. By using a novel piezoelectric-assisted cutting device, protection of the dentoalveolar nerve could be achieved.

• A new model for the characterization of infection risk in gunshot injuries: technology, principal consideration and clinical implementation.

  Authors: Constantin von See, Majeed Rana, Marcus Stoetzer, Conrad Wilker, Martin Rücker, Nils-Claudius Gellrich

  Head & face medicine. 01/2011; 7:18.

  The extent of wound contamination in gunshot injuries is still a topic of controversial debate. The purpose of the present study is to develop a model that illustrates the contamination of woundsThe extent of wound contamination in gunshot injuries is still a topic of controversial debate. The purpose of the present study is to develop a model that illustrates the contamination of wounds with exogenous particles along the bullet path. To simulate bacteria, radio-opaque barium titanate (3-6 μm in diameter) was atomized in a dust chamber. Full metal jacket or soft point bullets caliber .222 (n = 12, v0 = 1096 m/s) were fired through the chamber into a gelatin block directly behind it. After that, the gelatin block underwent multi-slice CT in order to analyze the permanent and temporary wound cavity. The permanent cavity caused by both types of projectiles showed deposits of barium titanate distributed over the entire bullet path. Full metal jacket bullets left only few traces of barium titanate in the temporary cavity. In contrast, the soft point bullets disintegrated completely, and barium titanate covered the entire wound cavity. Deep penetration of potential exogenous bacteria can be simulated easily and reproducibly with barium titanate particles shot into a gelatin block. Additionally, this procedure permits conclusions to be drawn about the distribution of possible contaminants and thus can yield essential findings in terms of necessary therapeutic procedures.

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

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

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

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

• The Hannover experience: surgical treatment of tongue cancer--a clinical retrospective evaluation over a 30 years period.

  Authors: Horst Kokemueller, Majeed Rana, Jennifer Rublack, Andre Eckardt, Frank Tavassol, Paul Schumann, Daniel Lindhorst, Martin Ruecker, Nils-Claudius Gellrich

  Head & neck oncology. 01/2011; 3:27.

  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 1980 and 2009, a total of 341In 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 1980 and 2009, a total of 341 patients with squamous cell carcinoma of the tongue were treated at our Department. The average follow-up was 5.2 years. 309 patients received surgical treatment, which was combined in nearly 10% with neoadjuvant and in nearly 20% with postoperative radio(chemo)therapy. 32 patients were excluded from surgery and received primary radiation. Local and regional failure occurred in 23.9% and 20.4%, leading to a total failure rate of 37.2% after an average duration of 1,6 years. N-Status, extracapsular spread and clear margins were identified as the dominant factors for survival, which was calculated with 54.5% after 5 years. 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 new treatment strategies for primary tumour disease and for tumour recurrence.

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

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

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

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