Pharmacokinetic profile in late pregnancy and cord blood concentration of tipranavir and enfuvirtide

The data on the use of tipranavir and enfuvirtide in pregnancy are very limited. We performed a pharmacokinetic profile in a pregnant woman with multidrug-resistant HIV-1 infection at 37 weeks gestation. Tipranavir levels were in the therapeutic range and the cord blood concentration at delivery was relatively high when compared with other protease inhibitors. No enfuvirtide was detected in the fetal compartment. Tipranavir and enfuvirtide were successfully used in pregnancy, but possible toxicities must be kept in mind.

Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study

Induced hypotensive anaesthesia and isovolaemic haemodilution are well-established blood-sparing techniques in major surgery. This prospective study compared them for blood loss, transfusion requirements, and surgical field quality during standardized orthognathic operations. In a surgeon-blinded trial, 60 healthy patients requiring either Le Fort I osteotomy or bimaxillary surgery were randomly allocated to receive normotensive anaesthesia, induced hypotensive anaesthesia, or induced hypotensive anaesthesia combined with isovolaemic haemodilution. Blood loss and haemoglobin level were measured intraoperatively and calculated on postoperative day 3. The surgeons rated surgical field quality. Mean blood loss was 1021.63, 392.38 (p<0.05) and 1191.65ml in the normotensive, hypotensive and haemodilution groups, respectively. Mean haemoglobin level immediately after surgery was 9.3, 10.3, and 7.4g/dl (p<0.05), respectively. No hypotensive group patients received transfusions; four normotensive group patients required allogenic transfusions; seven haemodilution group patients needed autogenous retransfusions (p<0.05). Surgical field quality was significantly better in the hypotensive than in the normotensive (p<0.05) or haemodilution (p<0.05) groups. In orthognathic surgery, hypotensive anaesthesia significantly reduces blood loss and transfusion requirements and minimizes allogenic transfusions risks. Induced hypotensive anaesthesia combined with isovolaemic haemodilution has no additional blood-sparing effects but impairs surgical field quality.

In vitro antibacterial activity of Lucilia sericata maggot secretions

Maggots of the green blowfly, Lucilia sericata, are used as an alternative to surgical intervention and long-term antiseptic therapy for the treatment of chronic wounds. The secretions of maggots are known to have antibacterial properties. To quantify the bactericidal effect of secretions from larvae of L. sericata, an in vitro test model based on the modified European quantitative suspension test (EN 1040) was developed, in which a co-culture of maggots and bacteria (Micrococcus luteus,Escherichia coli, methicillin-sensitive Staphylo-coccus aureus) in tryptic soy broth was tested. The numbers of bacterial colonies with and without maggot exposure were compared after 24, 48 and 72 h of exposure. The mean log(10) reduction factor (RF) for bacterial elimination per maggot was >4 at all examined times for all tested bacteria. Thus, maggot secretion fulfilled the required definitions of an antiseptic. In addition, the maggots' ability to ingest bacteria was also evaluated. Maggots contained viable bacteria after 48 h of contact with the respective organisms. These maggots also continued excreting bacteria. Therefore, maggots should be disposed of after use as they must be regarded as medical waste.

Oesophageal squamous cell neoplasia in head and neck cancer patients: upregulation of COX-2 during carcinogenesis

Patients with (previous) head and neck cancer (HNC) are at high risk for developing second squamous cell cancer of the oesophagus. The role of cyclooxygenase-2 (COX-2) in oesophageal squamous carcinogenesis has not yet been investigated in this high-risk group. Therefore, this study examined COX-2 mRNA and protein expression in oesophageal biopsies and resected tissues of 44 HNC patients. The evaluation covered 55 oesophageal tissue samples (18 invasive oesophageal squamous cell cancers, four high- and eight low-grade dysplasias, 25 normal squamous epithelia) from the 44 patients. mRNA levels of COX-2 were measured by real-time PCR using a LightCycler. COX-2 protein expression was studied immunohistochemically and graded by a staining score. COX-2 mRNA was detected in all samples, and its levels correlated positively with the immunohistochemical staining score (P<0.05). COX-2 expression was upregulated during oesophageal squamous carcinogenesis in HNC patients, that is COX-2 expression increased significantly from normal oesophageal squamous epithelium to low- and high-grade dysplasia and finally to invasive squamous cell cancer (P<0.001). Our findings suggest that COX-2 upregulation contributes to oesophageal squamous carcinogenesis in HNC patients. Prospective studies are needed to evaluate the chemopreventive potential of COX-2 inhibitors in this high-risk group.

[Clinical and molecular genetic observations on families with cherubism over three generations]

BACKGROUND

Cherubism is a rare fibro-osseous disorder that almost exclusively affects the maxilla and mandible.

CASE REPORT

We report on three affected males in three generations in family A, and ten affected patients in family B. The youngest affected relative in family A also had craniosynostosis. His father and grandfather had cherubism and clubbed fingers.

RESULTS AND DISCUSSION

Cherubism was mapped to region 4p16.3. Because of the associated craniosynostosis, we excluded the FGFR3 gene as a candidate gene for cherubism. The inheritance pattern is autosomal dominant with variable expression. The penetrance is 100% in males and 50-70% in females. We found incomplete penetrance in males, which does not conform with all publications.

Implant-supported titanium prostheses following augmentation procedures: A clinical report

BACKGROUND

This report describes a novel technique for fabricating retrievable implant-supported titanium (Ti) prostheses in patients requiring a comprehensive treatment plan involving the combined efforts of maxillofacial surgery and implant prosthodontics.

METHODS

Following bone graft reconstructive surgery and implant placement prosthetic treatment was initiated by inserting ITI-Octa abutments. An impression was made, and a framework was fabricated by fusing Ti-cast frameworks to prefabricated titanium copings by laser-welding. This was followed by veneering or fabrication of a removable denture with Ti metal re-enforcement.

RESULTS

Favourable clinical results have been achieved using these screw-retained Ti implant-supported restorations for patients treated with reconstructive bone graft-surgery, with clinical observation periods ranging from three to four years.

CONCLUSIONS

The present observations suggest that these screw-retained implant-supported Ti prostheses may be a meaningful contribution to implant prosthodontics, facilitating retrievable restorations of optimum biocompatibility, good marginal precision and with a good esthetic result. However, controlled clinical studies are needed to establish the long-term serviceability of these Ti restorations.

Screening for oesophageal neoplasia in patients with head and neck cancer

Due to advanced disease at the time of diagnosis the prognosis of oesophageal cancer is generally poor. As mass screening for oesophageal cancer is neither feasible nor reasonable, high-risk groups should be identified and surveilled. The aim of this study was to define the risk of oesophageal cancer in patients with (previous) head and neck cancer. A total of 148 patients with (previous) head and neck cancer were prospectively screened for oesophageal cancer by video-oesophagoscopy and random oesophageal biopsies. Even in a macroscopically normal looking oesophagus, four biopsy specimens were taken every 3 cm throughout the entire length of the squamous oesophagus. Low- or high-grade squamous cell dysplasia was detected histologically in 10 of the 148 patients (6.8%). All but one dysplasias were diagnosed synchronously with the head and neck cancers. In addition, oesophageal squamous cell carcinoma was diagnosed in 11 of the 148 patients (7.4%). Most invasive cancers (63.6%) occurred metachronously. The risk of squamous cell neoplasia of the oesophagus is high in patients with (previous) head and neck cancer. Surveillance is recommended in this high-risk group.

Primary thinning of the myocutaneous vastus lateralis flap

To expand the indicational spectrum of the myocutaneous vastus lateralis flap, which is often too voluminous for intraoral application, primary thinning of the fat and muscle component of this microsurgical transplant was performed in 14 patients. The surgical technique includes subfascial localization of at least one myocutaneous perforating vessel of the lateral circumflex femoral artery and its dissection through the fascia, muscles and fatty tissue up to the skin. The epifascial fatty tissue is completely removed except for a 1-2 cm wide cuff around the perforating vessel. The thinning technique was used for covering 10 intraoral and 4 extraoral defects and enabled the raising of skin flaps with a thickness of 4 mm even in obese patients. The vessel pedicle length of the thinned flaps was between 12 and 16 cm; flap size varied between 4x5 and 9x15 cm and the donor sites were directly closed. In one case, there was a partial necrosis (20%), but the other flaps healed without complications. The described method allows the raising of thick myocutaneous as well as thin skin flaps from the same donor region.

[Primary thinning and de-epithelialization of microsurgical transplants from the lateral thigh]

To expand the indicational spectrum of the myocutaneous vastus lateralis flap, which is often too voluminous for intraoral application, we performed extreme, primary thinning of the fat and muscle component of this microsurgical transplant in 14 patients. After subfascial localization of the 0.5- to 1.0-mm-thick perforating vessel, it is exposed through the fascia and muscles up to its exit from the descending branch of the lateral circumflex femoral artery. After isolating the perforating vessel, it is no longer necessary to include parts of the vastus lateralis muscle in the flap. The fatty tissue of the remaining epifascial fat component is completely removed except for a ca. 1- to 2-cm-wide cuff of fatty tissue and fascia around the perforating vessel. When performing this primary radical removal of the subcutaneous fatty tissue, care should be taken not to injure the deep subdermal vascular plexus. In addition to the thinning procedure, de-epithelialization of the skin was performed using scalpel blade dissection (five patients) or carbon dioxide laser (6 W, five patients). This thinning technique was used for covering ten intraoral and four extraoral defects and enabled the raising of skin flaps with a thickness of 3-5 mm even in obese patients. The vessel pedicle length of thinned flaps was between 12 and 16 cm; flap size varied between 4 x 5 and 9 x 15 cm, and the donor sites were directly closed. In one case, there was a partial necrosis (20%), but the remaining flaps healed without complications. On the intraoral flaps, a thin, smooth and pliable surface developed after re-epithelialization within 3-6 weeks. The described method expands the application possibilities of the myocutaneous vastus lateralis flap for a large number of intraoral and flat defects with minimal donor-site morbidity.

Elastic fibers in the human temporo-mandibular joint disc

The elastic fiber content of 12 articular discs, removed from 12 patients with complete anterior or medio-anterior disc displacement, was examined. Eight to 12 sagittal sections (3 microm each) were acquired for each disc and stained with modified resorcin-fuchsin for visualization of elastic fibers. The program "CUE-2 Image Analyzer Morphometry" digitized all sections with 800x magnification, calculated the elastic fiber content and reconstructed it 3-dimensionally. The calculated volume density of the entire disc was a mean x(tot)= 0.339 +/- 0.060% of the total tissue. The highest fiber content of 2-4% was found in the posterior area at the transition to the bilaminar zone. 61% of the elastic fibers were located in the bilaminar zone, 10% in the posterior, 2% in the intermediary and 26% in the anterior band. There were substantially more fibers in the cranial part of the posterior region and at the medial edge as compared to the mean fiber distribution of the posterior band and the bilaminar zone. A third of these fibers were found in the inferior layer, particularly in the lateral part. Exactly the opposite fiber distribution was seen in the anterior band. The fibers frequently appeared in the caudal layer, especially in the lateral periphery, but there were fewer fibers in the medial cranial layer.

Immunohistochemical examination of an orbital alveolar soft part sarcoma

BACKGROUND

A 32 year-old male patient had a 6-week history of left-sided proptosis. Computer tomography revealed a 16x15x15 mm smooth and well-defined mass between the optic nerve and the medial and superior rectus muscles in the left orbit.

METHODS

The tumour was excised via a cranio-medial orbitotomy approach.

RESULTS

Histopathological examination, immunohistochemistry and electron microscopy findings were consistent with an alveolar soft part sarcoma. Immunohistochemical staining showed positive immunoreactivity for neuronespecific enolase, vimentin, p53 (30%), p21 (10%) and cyclin D1 (20%), and negative immunoreactivity for CD45, cytokeratins, S-100 protein, glial fibrillary acidic protein, synaptophysin, chromogranin, calcitonin, serotonin, thyreoglobulin, desmin, myosin, actin, HMB-45, pRB, p16 and BCL-2. The growth fraction of the tumour cells was 3%. At examination 4 years after surgical excision, there was no evidence of local recurrence or for metastases.

CONCLUSION

Alveolar soft part sarcoma of the orbit is a rare malignant tumour best controlled by surgery. The unpredictable behaviour of these neoplasms, however, indicates the need for long-term follow-up.

The use of implant-supported ceramometal titanium prostheses following sinus lift and augmentation procedures: a clinical report

This clinical report presents rationale and clinical procedures involved in the use of ceramometal implant-supported titanium-cast prostheses for the rehabilitation of patients with atrophic maxillae requiring iliac crest grafting procedures. Favorable clinical results have been obtained, although clinical observation periods have been limited. The present observations suggest that osseointegrated ceramometal titanium prostheses could form a valuable part of restorative therapy following augmentation procedures. Furthermore, these titanium prostheses may be a meaningful contribution to implant prosthodontics, facilitating restorations of optimum biocompatibility.

[Synovial chondromatosis (chondrometaplasia). Contribution to the differential diagnosis of temporomandibular joint diseases]

A rare case of synovial chondromatosis of the temporomandibular joint with unspecific symptoms is presented. This causes difficulties in classifying the different clinically and technically acquired features at differential diagnosis. The concept of chondrometaplasia as being triphasic and self-limiting is strongly supported and extreme care should be taken during therapy in order to avoid any unnecessary destruction and mutilation. This case seems to indicate that chronic parafunctional overload was the initiating stimulus for this reactive metaplastic process. Nonphysiologic overstrain of any cause should be diagnosed and corrected.

[Raising a radial flap with primary wound closure by prefabrication of split skin fascia flaps]

A disadvantage of the radial forearm flap is the removal of skin from a functionally important and aesthetically exposed region. To minimize the donor site morbidity with this flap, we have thus far used a two-phase procedure for intraoral defect coverage in 15 patients: In a first step, a 0.5-mm split thickness skin graft is transplanted to the forearm fascia and settles there over a period of 2 weeks. In step two, the prefabricated fascial-split thickness skin graft can be raised with complete preservation of the forearm skin and microsurgically transferred like a conventional radial forearm flap. We have obtained the following results with this procedure: (1) All skin grafts took completely on the forearm fascia. (2) Prefabricated fascial-split thickness skin flaps could be raised like conventional radial forearm flaps. (3) The very thin and moldable flaps were excellently suited for intraoral lining and showed complication-free healing. We conclude that tension-free, primary closure of the donor site can be achieved with minimal aesthetic and functional impairment.

Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects

Based on findings from anatomical dissections of the skin of the peroneal artery, we used the osteocutaneous fibula flap for combined replacement of the mandible and floor of the mouth in 24 patients, form November 1993 to December 1995. There were 22 primary and 2 secondary reconstructions; the mean age of the patients (2 women and 22 men) was 64 years. The length of the fibula segments ranged between 5.5 and 18 cm, the size of the skin component between 3 x 5 and 6 x 15 cm. Corresponding to the results of our anatomical studies, the skin island was exclusively raised form the distal third of the lower leg, and the donor sites were generally covered with split thickness skin grafts. The average length of the dissected vascular pedicle was 11 cm, so that a vein graft was only required in one case. Flap raising and tumour resection were always carried out simultaneously. Fibula osteosynthesis was done with titanium miniplates; the insertion of endosseous implants followed secondarily. The success rate was 95.8% with one transplant loss and pseudarthrosis in one case. Despite the limited width of the fibula, the shape of the mandible was satisfactorily reconstructed in all patients, and the thin, pliable component enabled intraoral coverage with only negligible surplus volume. Chronic wound-healing disturbances at the donor site of the skin island occurred in two cases; impairment of walking ability was not detected. According to our experience, the use of the osteocutaneous fibula flap is a valuable method for the reconstruction of composite mandibular defects.

Improvement of the radial forearm donor site by prefabrication of fascial-split-thickness skin grafts

A basic disadvantage of radial forearm flaps is the removal of skin from a functionally important and cosmetically exposed region. To minimize the donor-site morbidity of the radial forearm flap, we have thus far used a two-phase procedure for intraoral defect coverage in five patients: In a first step, a split-thickness skin graft is transplanted to the forearm fascia, which "takes" there over a period of 2 weeks. In step two, the prefabricated fascial-split-thickness skin flap can be raised with complete preservation of the forearm skin and microsurgically transplanted like a conventional radial flap. Performing this procedure, we have obtained the following results: (1) All skin grafts "took" completely on the forearm fascia. (2) Prefabricated fascial-split-thickness skin flaps could be raised without any problems, like conventional radial forearm flaps. (3) All flaps were excellently suited for defect coverage in the oral cavity as very thin and moldable grafts and "took" without any complications. (4) Tension-free primary closure of all forearm donor sites was achieved with only slight cosmetic and functional impairment.

Intraoral defect coverage with muscle flaps

PURPOSE

This study investigated whether wound healing after the use of purely muscular flaps for intraoral defect coverage is negatively influenced by insipient muscular atrophy and the absence of a covering layer.

MATERIALS AND METHODS

In an experimental study, microsurgical transplantation of muscle flaps from the anterior abdominal wall was carried out in 18 Lewis rats. A nerve anastomosis for motor reinnervation was not performed. Atrophy of the muscle flaps was determined by measuring the reduction of their size and weight after 3, 8, and 20 weeks. In the clinical part of the study, free muscle transplants from different donor regions (vastus lateralis, pectoralis major, internal oblique, and temporalis muscles) were used for defect coverage in various areas of the oral cavity. To study epithelization, punch biopsy specimens from the muscle surface were taken at periods of 2 to 4 weeks up to 6 months for histologic evaluation. Final evaluation of reconstruction results with special regard to speech, tongue mobility, mouth opening, chewing, and swallowing took place after 6 months.

RESULTS

In the experimental study, average weight loss of the muscle flaps was 67% after 20 weeks, and the remaining surface area was 71%. The number of myocytes was only about 30% compared with control muscles, and parts of the flap appeared as a thin fibrous membrane. Clinically, this atrophy led to restricted mobility in such areas as the floor of the mouth, the buccal plane, and the tongue. Muscle flaps covering solid structures such as bones or reconstruction plates adapted well to the transplant bed, and the atrophy of the muscle led to no constriction of the surrounding tissue. Atrophy also did not have a negative effect when muscle flaps were placed in the region of the pharyngeal wall. Epithelization started from the edges after 2 weeks and was concluded after 8 weeks in all transplants if no additional radiation was performed. The muscle tissue was sufficiently resistant so that infection, fistulization, and necrosis did not occur.

CONCLUSIONS

Muscle flaps undergo considerable atrophy with a cicatricial transformation and reduction of flexibility. Despite these disadvantages they can be used in the hard palate, the alveolar crest, and in the pharyngeal wall without causing functional restriction. Because of constriction of the surrounding tissues, mobile areas such as the buccal plane, the floor of the mouth, and the tongue are not suitable as sites for muscle transplants.

[Significance of vascularization of jejunal transplants in secondary reconstruction of the mandible]

There is a difference in the vascular architecture of myocutaneous flaps and jejunal free flaps both available to replace resected mucosal tissue of the oral cavity after surgical treatment of oral cancer. The question in whether the mobilization of jejunal free flaps is possible without respect to the anastomized vessels in particular in secondary reconstruction procedures to achieve a bony continuity of the mandible. From 1985-1992 22 patients were operated on using microsurgically anastomized jejunal free flaps. In 7 cases a secondary mandibular reconstruction by means of microsurgically anastomized iliac crest grafts was performed. In respect of our results we recommend in cases of secondary mandibular reconstruction with mobilisation of the jejunal flap. 1. preoperative digital subtraction angiography, 2. temporary clamp of anastomized vessels with observation of the perfusion of the jejunal flap, 3. intraoperative doppler-sonography. These techniques allow a save evaluation of the vessels of the donor site prior to microvascular anastomoses for secondary bony reconstruction of the mandible.

[Influence of different local anesthetics on the in vitro collagen synthesis of periodontal fibroblasts]

The influence of different local anesthetic fluids in an in-vitro-experiment of periodontal ligament cells was researched. Mepivacain, articain, lidocain and prilocain were used in the study. The common commercial local anesthetic fluids were in a proportion 1:1, 1:10 and 1:30 diluted, before they were placed in the incubator with cultures of periodontal ligament cells. At the 1st and 14th day after the experiment the synthesis of collagen type I, III, V and VI were determined with an ELISA. The mepivacain dilution of 1:30 had, compared with the controls the slightest influence on the collagen synthesis of periodontal ligament cells. Further clinical investigations must show if through dilution of the local anesthetic solution an adequate anesthesia can be reached.

[Morphological changes of peripheral nerves following intraneural injection of local anesthetic]

Neurosensory disturbances of the third branch of the trigeminal nerve occur in rare cases without any operative treatment near the nerve involved. The most frequently affected nerve branches are the inferior alveolar nerve and the lingual nerve. We examined the problem of intraneural injection of local-anaesthetic solutions in an experimental study on animals. After intraneural injection of Articain (4%)-solution in the ischiadic nerve of Wistar rats and the lingual nerve of cats no toxic lesions were observed. It can be assumed that neurosensory disturbances caused by intraneural local-anaesthetic injection are the result of intraneural haematomas with consecutive fibrosis.

[Increased expression of adhesion molecules in oral lichen planus]

Adhesion of cells to other cells and to the matrix is the prerequisite for a multitude of cell interactions such as the emigration of circulating leukocytes to sites of inflammation, antigen-presentation, cell-mediated cytotoxicity, cell anchorage and differentiation. In the past few years, a large family of adhesion molecules has been defined which are receptors for these adhesion events. Using immunohistochemical techniques we analyzed the distribution pattern of adhesion molecules in the buccal mucosa of 12 patients with oral lichen planus reticularis and compared it with 12 specimens of normal oral mucosa. In lichen planus, a neo-expression of the antigens VLA-1, 3, 5 and 6, which are receptors for collagen, fibronectin and laminin, could be detected on T cells and macrophages infiltrating the basement membrane zone. ICAM-1, the specific ligand of LFA-1, normally only expressed by endothelial cells, showed a focal expression on basal keratinocytes at sites of intramucosal T cells. The abundance of adhesion molecules on leukocytes and keratinocytes in oral lichen planus is indicative of a special state of activation. It enables the leukocytes to penetrate the tissue, especially the basement membrane zone, to persist in this environment and to exercise their effector functions.

A proposed relationship between circumference and conduction velocity of unmyelinated axons from normal and regenerated cat hindlimb cutaneous nerves

Data on the conduction velocities and circumferences of unmyelinated axons in cat hindlimb nerves obtained in two laboratories, each working independently of the other, have been brought together and compared. Results were obtained from normal, regenerated and deafferented nerves. Matching the conduction velocity and circumference distributions against one another suggested that conduction velocity (theta), in m/s, is linearly related to circumference (s), in microns, according to the equation theta = 0.24s. If this relationship is correct, it applies equally well to both sympathetic postganglionic and unmyelinated afferent axons.

[Indications for plate osteosynthesis in childhood]

Miniplate osteosynthesis has become the method of choice in the surgical treatment of fractures in adults. The question arises whether or not miniplates should be used more frequently for childhood fractures as well. A clinical and experimental study of 121 fractures during the growth period was conducted to determine the criteria guiding the decision for the use of miniplates. Test in which miniscrews were unscrewed from fresh cadaver jaw bone showed that sufficient retentive forces for fracture stabilization can be achieved even with very short screws (5 mm). Miniplate osteosynthesis can also be applied in the treatment of mandibular fractures during the growth period from the eighth year of life onward.

[Sonographic diagnosis of mandibular fractures in children]

We investigated the possibilities of sonographic diagnostics of bone fractures in a clinical study. 18 patients with fractures of the lower jaw were examined. The technical procedure and typical symptoms are described. The sonographic analysis shows fractures with dislocations greater than 1 mm. Today it is not possible yet to exclude a fracture by sonographic diagnosis alone.

Induction and upregulation of adhesion receptors in oral and dermal lichen planus

The expression pattern of well-defined cell surface adhesion receptors called VLA-family, LFA-1 and ICAM-1 was determined semiquantitatively in biopsies of oral (n = 12) and dermal lichen planus (n = 5) and compared to normal uninvolved human oral mucosa (n = 12) and skin (n = 12) using an indirect immunoperoxidase technique. In both oral and dermal lichen planus, an induction of the beta 1-integrins VLA-1 and VLA-3 and an upregulation of VLA-6 was found in T cells infiltrating the basement membrane zone. These cell surface molecules function as receptors for collagen, fibronectin and laminin. A focal induction of ICAM-1 on basal keratinocytes could be detected at sites of intramucosal T cells. These results suggest that investigated adhesion receptors are crucially involved in the aggregation of T cells in both conditions. Further investigations have to be done to determine the functional role of these adhesion receptors in lichen planus.

Reinnervation of autotransplanted teeth. A histological investigation in monkeys

The reinnervation of 8 autotransplanted teeth in 4 green vervet monkeys (Ceropithecus aethiops) was examined. The lateral maxillary incisors of each animal were extracted and transplanted to the contralateral side. The root formation was incomplete with an open apical foramen. The monkeys were killed 1, 2 or 4 months after transplantation and examined histologically by a S-100 monoclonal antibody staining. A few single nerve fibres could be seen 1 month after transplantation. After 2 months, several nerve bundles could be detected throughout the whole pulp. After 4 months, a larger number of nerve bundles, comparable to the densely innervated dental pulp of non-transplanted teeth, could be seen throughout the whole pulp.

[Treatment concept of tumor-induced maxillofacial pain]

From 1987 to 1989 forty-six patients with primary or recurrent maxillofacial tumors which could not be treated curatively came to our clinic because they suffered for facial pain. Their treatment was carried out in cooperation with the pain clinic of the department of anesthesiology. In 8 patients causal therapy with palliative chemotherapy primarily carried out on an outpatient basis was successful. In the other patients oral application of opiates was the therapy of choice. In only few cases invasive techniques were required to relieve facial pain.

[Dysesthesia and anesthesia of the mandibular nerve following dental treatment]

An inquiry to all practising dentists of Schleswig-Holstein and Cologne was performed to estimate the incidence of long time lingual nerve damage. 50 cases were reported and analyzed according to findings and causes. Further on the Cologne inquiry took into consideration 43 injuries of the n. alveolaris inferior. The results of the study allow a statement on the necessity to inform the patient before the operation.

[Management and treatment of patients with atypical facial pain]

The term "atypical facial pain" refers to a pain disease and should not be used for pain of peripheral origin. As a rule atypical facial pain is induced by a peripheral tissue trauma not necessarily associated with nerve lesions. The intensity of pain does not correlate with the measurable magnitude of the trauma. If treatment is possible, it will be the more successful the earlier it is started. Therapy comprises transcutaneous electric nerve stimulation, sympathetic nerve block, drug therapy and psychotherapy.

DNA grading of oral squamous carcinomas. A preliminary report

The prognostic validity of the DNA-malignancy-grade (DNA-MG), ranging on a continuous scale from 0.00 to 3.00 was tested in a preliminary study on 7 patients with oral squamous cell carcinomas. Monolayer smears were prepared after a cell separation procedure from paraffin-embedded surgical tumor specimens. Feulgen staining was performed automatically in a modified Shandon staining machine. A TV image analysis system with an automatic microscope (TAS plus, Leitz, FRG) was used for DNA measurements. The DNA-MG revealed a strong correlation with the patients prognosis. 3 patients who died after having a tumor relapse (mean survival = 10 months) had DNA grades greater than 1.40, whereas patients who survived without having a tumor relapse (mean survival = 53 months) revealed DNA grades below 1.00. Additionally, the DNA-malignancy-grade was closely correlated with the histopathologic malignancy grades.

Reconstruction of the mandibular denture bearing area and freeing of the tongue after tumor surgery

Vestibuloplasty together with a loosening of the tongue and covering the mucosal defects either with a split thickness skin graft or an autologous mucosal graft was performed on 35 patients previously treated for squamous cell carcinoma. The interval between tumor resection and the reconstructive procedures averaged 20 months. In 34 patients the denture bearing area improved, and in 31 patients, better mobility of the tongue occurred with, therefore, better phonation.