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1.  Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study 
Head & Face Medicine  2013;9:18.
Background
The aim of orbital wall reconstruction is to reestablish anatomically exact orbital volumes to avoid long-term complications. Navigation could facilitate complex reconstructions.
Methods
Quality of the orbital reconstruction (n = 94) was measured based on (A) volume changes and (B) on 3D shape deviations compared to the unaffected side. Volume analysis included segmentation of the orbital cavity in the pre- and post-operative 3D data set (VoXim®, IVS Solutions, Germany), and shape analysis was performed by vector-based 3D tools (Comparison®, 3Dshape, Germany).
Results
Orbital volume of the unaffected side ranged from 26.6 ml ± 2.8 ml in male and 25.2 ml ± 2.6 ml in female (CT). Significant orbital enlargement was found in orbital fractures with involvement of the posterior third of the orbital floor and in comminuted fracture pattern. Reconstructed orbital volume ranged from 26.9 ± 2.7 ml in male and 24.26 ± 2.5 ml in female (CBCT). 3D Analysis of the color mapping showed minor deviations compared to the mirrored unaffected side.
Conclusion
Measurements demonstrate that even in comminuted orbital fractures true-to-original reconstruction is feasible.
doi:10.1186/1746-160X-9-18
PMCID: PMC3750456  PMID: 23815979
Orbital fractures; Computer-assisted surgery; Orbital volume; Imaging analysis platform
2.  Correction: Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap - a randomised prospective trial 
Background
Oral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.
Methods
This study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.
Results
Average increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value > 0.05.
Conclusions
Based on the results of this study, there was no significant difference in mouth opening after reconstruction with radial forearm free flap compared to nasolabial flap.
doi:10.1186/1750-1172-8-86
PMCID: PMC3776419
3.  Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap - a randomised prospective trial 
Background
Oral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.
Methods
This study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.
Results
Average increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value > 0.05.
Conclusion
Based on this study radial forearm free flap is a superior method compared to transposition of nasolabial flap to cover the surgical wound of oral submucous fibrosis.
doi:10.1186/1750-1172-8-56
PMCID: PMC3717039  PMID: 23915701
Oral sub mucous fibrosis; Nasolabial flap; Radial free forearm flap; Microvascular anastomosis
4.  Designing the ideal model for assessment of wound contamination after gunshot injuries: a comparative experimental study 
BMC Surgery  2012;12:6.
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 6.5 × 57 mm 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.
doi:10.1186/1471-2482-12-6
PMCID: PMC3342864  PMID: 22490236
Forensic science; Wound infection; Gunshot; Projectile; Gelatin
5.  Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy 
The 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.
doi:10.1186/1748-717X-6-159
PMCID: PMC3247073  PMID: 22087558
6.  Piezoelectric-assisted removal of a benign fibrous histiocytoma of the mandible: An innovative technique for prevention of dentoalveolar nerve injury 
Head & Face Medicine  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 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.
doi:10.1186/1746-160X-7-20
PMCID: PMC3213176  PMID: 22040611
Piezosurgery; benign fibrous histiocytoma; mandibular tumor; dentoalveolar nerve; atraumatic bone surgery
7.  Pre-operative planning for mandibular reconstruction - A full digital planning workflow resulting in a patient specific reconstruction 
Head & Neck Oncology  2011;3:45.
Objectives
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 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.
Materials and methods
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.
Results
In primary alloplastic mandible reconstruction, shape and size of the reconstruction plate could be predefined and prebent prior to surgery.
Clinical relevance
This study provides modern treatment strategies for mandibular reconstruction.
doi:10.1186/1758-3284-3-45
PMCID: PMC3195208  PMID: 21968330
Mandibular reconstruction; backward planning; patient specific implant; computer-assisted surgery
8.  The Hannover experience: Surgical treatment of tongue cancer - A clinical retrospective evaluation over a 30 years period 
Head & Neck Oncology  2011;3:27.
Objectives
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.
Materials and methods
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.
Results
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.
Conclusions
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.
Clinical relevance
This study provides new treatment strategies for primary tumour disease and for tumour recurrence.
doi:10.1186/1758-3284-3-27
PMCID: PMC3123311  PMID: 21600000
tongue cancer; squamous cell carcinoma; resection; survival; prognostic factors

Results 1-8 (8)