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The aim of this study was to evaluate the clinical features as well as the visual results and determine the prognostic factors after the removal of retained intraocular foreign bodies (IOFBs).At our centre we conducted a non-randomised, non-comparative retrospective analysis of records of 31 patients with intraocular foreign bodies treated using pars plana vitrectomy and other conventional surgical techniques during a 3-year period between January 2006 and December 2008. Using the OTS classification for ocular injuries (United States Eye Injury Registry [USEIR]), we evaluated the visual outcome and various pre-, intra- and postoperative clinical factors.Almost all patients (96.8 %) were male with a mean age of 32.29 years ± 13.38 SD (SD = standard deviation). The most common cause of ocular injury was hammering (58 %), in 27 cases the IOFB was magnetic. Follow-up ranged from 1 to 34 months with a mean of 4.5 months. In 30 eyes, the IOFBs could be removed during the first surgery. The average time between injury and surgery was 15.78 ± 23.45 SD hours for 27 patients (87.1 %). In 3 cases the intraocular foreign body (IOFB) was removed 7, 9, 14 days after the injury. In one case the IOFB was removed in a second surgery 40 days after the injury. In 23 cases we performed pars plana vitrectomy, for 8 patients we performed anterior segment surgery, in 21 cases the lens was also removed. At the time of surgery initial vitreous haemorrhage was present in 17 patients (54.8 %). OTS score for ocular injury was calculated as 2.45 ± 0.78 SD. Initial visual acuity was below 20 / 200 in 61.3 % of the cases. Subsequent to surgical treatment over a mean follow-up of 2.5 months, 25 patients (80.64 %) achieved a visual acuity of 20 / 200 or better (0.69 ± 0.35 SD). Best corrected visual acuity was significantly better for ocular injuries with a higher OTS score (p = 0.000095). Other significant factors for good visual outcome were good initial visual acuity (p = 0.002), the absence of vitreal haemorrhagies (p = 0.024) and small size of the IOFB (p = 0.043). Postoperative complications included retinal detachment (9.67 %), endophthalmitis (3.22 %) and PVR (3.22 %).Acceptable visual results could be achieved after the removal of posterior segment IOFBs by vitrectomy. A reliable classification of ocular injuries may provide significant information about the prognosis of injuries with intraocular foreign bodies.

The patent nasopalatine duct is a rare anomaly in the anterior maxilla. During the early fetal period, a bilateral and epithelium-lined duct is formed within the primary palatal process as an oro-nasal communication. However, the duct obliterates and degenerates before birth. A persisting patent or through-and-through nasoplatine duct is therefore considered a developmental anomaly. A patent nasopalatine duct normally presents as one (or two) tiny openings lateral or posterior to the incisive papilla. In such a case, the ducts can be partially or completely probed with gutta-percha points with subsequent radiographic imaging. The patients report strange sensations such as squeaking noise, palatal drainage, nasal regurgitation, or airway communication between nasal and oral cavities; however, patients rarely complain about pain. About 40 cases have been documented in the literature. We describe two patients who have been referred to our department for evaluation of "sinus tracts" in the anterior palate. Since a patent nasopalatine duct can become a diagnostic pitfall, a thorough inspection of the mucosa around the incisive papilla is essential to avoid unnecessary endodontic or surgical interventions in the area of the central maxillary incisors.

Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy.A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: "Ein Kindergeburtstag", the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest.All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of "ma ma ma" and "na na na" (p=0,003, respectively p=0,033). Intonation of the vowel /a/1 also revealed significant changes regarding the pre- and postoperative values (p=0,006). However, the obtained values had no significant impact on the nasality characteristics of speech.This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.

Lacrimo-auriculo-dento-digital (LADD) syndrome, also known as Levy-Hollister syndrome, is characterized by pronounced dysplasias in various organ systems. The resulting disturbances affect primarily the lacrimal glands, the inner and outer ear, the salivary glands, and the osseous framework. Although the degree to which the different organs are involved varies considerably, dental anomalies are regularly reported. An autosomal-dominant trait has been recognized for this syndrome, but the majority of cases described in the literature concerned sporadic new mutations. We report on this unusual and relatively unknown syndrome with reference to a 13-year-old girl suffering from LADD syndrome presenting symptoms of severe xerostomia and various craniofacial malformations, hearing loss, enamel dysplasia, microdontia, and hypodontia.

In recent years, lengthening the human mandible by distraction osteogenesis has become an accepted treatment to correct severe mandibular hypoplasia. Using intraoral unidirectional and extraoral bidirectional distraction devices we report about our experiences and results in the application of the bone distraction technique in four selected cases of syndromal disease, including various forms of mandibular hypoplastic malformations. The patients involved were a boy with Pierre Robin syndrome, a girl with unilateral facial hypoplasia in Goldenhar's syndrome, a case with Nager's syndrome, and a rare case of midline deficiency caused by partial deletion of chromosome 18 (18p-syndrome). The distraction period lasted from 6 to 30 days and new bone formation, ranging from 6 to 28 mm, was achieved.

CT with multiplanar reconstruction of the jaws (DentaScan) is the method of choice for the radiographic assessment of the mandible and maxilla. It is instrumental in delineating the relationship between bony lesions and the adjacent anatomy. Therefore, this technique allows precise evaluation of the intricate details of the oral cavity. Using it, distinct characterization of pathology including infectious, metabolic, congenital and neoplastic lesions can be obtained.

Three case studies from the patient population of the University Hospital of Aachen (RWTH) are used to describe indications for primary surgical intervention in skeletal dysgnathia. Such preconditions may apply in the case of mandibulo-alveolar protrusion, anomalies where there is little or no option to fixing orthodontic appliances (enamel hypoplasia or shortened crowns), severe transversal discrepancies and skeletal dysgnathia with pronounced malpositioning in the alveolar process and the teeth. The advantages are improved compliance (through the patient experiencing success at the outset of treatment) and limitation of postoperative orthodontic treatment to occlusive fine adjustments of the occlusion, resulting in an appreciable reduction in both the degree and duration of tooth movement and tissue damage.

Two-dimensional conventional X-rays and computer tomographic imaging systems contribute to the diagnosis and surgical planning of patients with orofacial malformations. The ability to reformat CT scans into three-dimensional osseous and soft tissue surface images has a significant impact on the diagnosis and management of orofacial malformations. Cephalometric evaluation with teleradiography provides precise insight into both the skeletal structures and the soft parts, enabling the radiologist to assess the relationship among the different parts in a given subject, at any given time and in relation to the normal.

In 15 adult patients with severe dentomaxillofacial deformities we integrated 3-dimensional cephalometry and 3D-model surgery with individually milled or stereolithographically built skull models in our combined orthodontic/surgical diagnosis and treatment planning. After the generation of contiguous axial CT-scans the CT data sets were transferred to a commonly used computing system (IBM-PC) to reconstruct 3D-images from any point of view. After the definition of measurement points, distances and angles at the skin and bone surface a 3-dimensional cephalometric analysis could be performed directly in the 3D-objects on the monitor. This allows a quantitative assessment of skeletal asymmetries. The transfer of CT data to life-size 3D-skull models and replacement of imprecise dental arches by dental casts different orthodontic and surgical treatment concepts could be evaluated. The 3D-model surgery represents a new quality of treatment prediction in the individual dentomaxillofacial morphology. The orthodontic set-up and 3D-model surgery permit a verification of the feasibility of the most suitable mobilization and placement of bone segments. The clinical treatment sequences indicated that the integration of 3-dimensional cephalometry and 3D-model surgery in patients with severe asymmetric dentomaxillofacial deformities allowed a higher precision of diagnosis and treatment planning.

Correction of dentofacial deformities requires a high standard of teamwork between the orthodontist, the oral surgeon and the general dentist. Both, orthodontist and maxillofacial surgeon must establish a combined treatment plan and a time schedule. The treatment goal of presurgical orthodontic preparation includes three-dimensional intra-arch alignment to provide ideal conditions for orthognathic surgery. A typical case report is presented.

In this clinical study the position of the mandibular condyles of 40 patients treated for malocclusion by surgical splitting of the mandibular ramus alone or combined with Le Fort I osteotomies was studied on lateral linear TMJ tomograms. Linear tomograms of the right and left TMJ with the mandible closed were taken from each patient prior to surgery and 6 months postoperatively. The postoperative changes in condylar position wee assessed in terms of direction and amount. Condylar displacements were found in 89% of the examined joints, most of them were less than 2mm. All types and combinations of displacement occurred, however, general trends in direction depending on the type of treatment could not be established with statistical significance. The type of surgical correction, its direction and amount did not seem to have an effect on the direction and amount of condylar displacement resulting. A comparison of the measured values with data in the literature showed that the amount of condylar displacement was markedly less--this seemed to be attributable to our precise evaluation method and a more sophisticated surgical technique.

The present first part of two of a historical overview on ankylosis of the TMJ and syngnathia covers the period from antiquity to the 2nd half of 19th century. Etiology, case studies and the first therapeutic approaches are documented on the basis of long forgotten and meanwhile hardly accessible original sources.

In three cases of c.c.d. it could be shown, that combined orthodontic and surgical treatment provided further possibilities for the treatment of severe problems in permanent dentitions as well as correcting extreme skeletal discrepancies of the facial skeleton in c.c.d. Well-scheduled removal of supernumerary teeth creates space for the spontaneous eruption of delayed teeth. By the use of carefully applied orthodontic forces, alignment of even extremely displaced teeth is shown to be possible. Furthermore, it is demonstrated that careful planning and realization of osteotomies in the midface can remarkably improve the facial appearance and the relationship of the jaws thus facilitating particularly future prosthodontic treatment.

In our opinion ameloblastic fibro-odontoma seems to be a true neoplasia. Complex composite odontomas and compound composite odontomas represent hamartomatous malformations. The ameloblastic fibro-odontoma seems not to differentiate into a complex composite odontoma. Since ameloblastic fibro-odontomas bear great resemblance to common odontomas, it is suggested that all odontomas be sent to a qualified oral pathologist for microscopic examination.

86 patients with dentofacial anomalies were examined to evaluate signs and symptoms of the stomatognathic system after orthognathic surgery. Clinical signs and symptoms were graded according to the anamnestic and clinical dysfunction index of Helkimo. Restriction of mouth opening in 37 patients influenced the anamnestic dysfunction index mainly to higher postoperative levels although the occurrence of symptoms as pain and tmj sounds decreased. No relationship between tmj pain-dysfunction and type of dysgnathia, surgical approach, molar support before and after surgery, age and sex was noted. It is concluded that surgical correction of dentofacial anomalies has a possible benefitialeffect on certain symptoms as tmj pain, but relief or impairment of clinical signs cannot be predicted preoperatively.

Within the last 2 years 26 endosseous implants have been used in combination with orthognathic surgery in the maxilla and mandible. The results show, that endosseous implants can be used simultaneously with orthognathic surgery. This helps to treat dysfunctions often seen in partially edentulous patients that undergo orthognathic surgery and at the same time reduce the risk of relapse by achieving stable occlusion.

A case of Cheilognathoschisis in a bull calf is demonstrated. The author supposes, that the malformation, which Neophytou reported, was a cheilognathoschisis too.

The formation of exostoses of the upper and lower jaw is a frequent finding and should be treated for esthetic and functional reasons. An unusual case of severe palatal fibromas and concomitant vestibular exostosis in a 36-year-old woman is presented. Identical symptoms are found in the patient's father and her 8-year-old daughter.

Developmental deformities of the permanent dentition are of primary concern in the treatment of patients suffering from cleidocranial dysostosis. The therapeutic approach should be based on interdisciplinary cooperation between orthodontists as well as oral and maxillofacial surgeons. Therapy may include surgical exposure of impacted teeth in combination with removal of supernumerary teeth. Already during the surgical procedure orthodontic bands and brackets may be attached. The next step in treatment should consist of orthodontic alignment of the teeth and correction of the jaw relations. In most cases, midfacial hypoplasia and corresponding abnormal jaw relations are also present. This deformity is best treated with midfacial osteotomy. Following this second surgical intervention, orthodontic treatment is completed in order to establish an optimal result regarding function and esthetics.

For the first time the frequency of freckles and of dysplasias of the eyebrows was examinated in 756 pupils. The percentage of the freckles was 21, and of the dysplasias of the eyebrows 28.5 in both sexes. The following examination of 287 orthodontic patients (66 males with hypodontia, 60 males with normal number of the teeth; 92 females with hypodontia, 69 females with normal number of the teeth) has demonstrated the high significance of incidence of freckles and of dysplasias of the eyebrows in patient with hypodontia. This phenomenon is important, because extraoral stigmatas can indicate to disturbances of the development of teeth and also to anomalies of the number of the teeth.

The division of responsibility between orthodontics and surgery is determined by the severity of deviation in facial development. In young, growing patients the border cannot be always determined at first. As a result there is an area of overlap whose extent is primarily influenced by the developmental age and cooperativeness of the patient, as well as by the cephalofacial type and therefore growth pattern. When the indications are for a surgical treatment of the facial structures, thre is a fundamental change in the orthodontic goals. One of the first steps of a joint planning must be the determination of which facial structures, in which directions and to what extent, must be the determination of which facial structures, in which directions and to what extent, should be surgically moved. The proposed, but not yet realised, skeletal outline is the matrix for the orthodontic preparation. The presurgical efforts include, at a minimum, the removal of occlusal barriers that would interfere with the surgical displacement of the skeletal units and at a maximum, the anticipating coordination of both arches so that immediately after surgery perfect occlusal harmony is reached.