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Injury to the facial skeleton may result not only in aesthetic but also functional deficits. Computer-assisted surgery promises predictable reconstructive results. In clinical routine the authors use the combination of preoperative planning, intraoperative navigation and intraoperative imaging to treat complex facial trauma. With preoperative planning the intended reconstructive results can be precisely preplanned and guided intraoperatively using navigational surgery. Intraoperative imaging achieves the final intraoperative validation. Using computer-assisted surgery dislocation and malformation of fragments and transplants can be avoided in facial reconstruction. This means reliable quality control of surgical outcome and the number of further surgeries can be reduced in this complex reconstructive surgery.

The dental and oral rehabilitation of patients with severe trauma that involves the oral cavity is demanding and challenging. Recently, advanced surgical techniques and innovations in oral implantology led to more sophisticated treatment modalities that may better fulfill the patients needs in special situations. Young people rather often suffer from accidents--at school and during leisure activities--in a period of their life that has a great impact on their physical, mental and personal development. Thus, the wish for a quick functional and esthetical rehabilitation contrasts with the complex clinical situation and the compromised oral conditions. All persons involved in the rehabilitation process--including the patient--must seek for the best solution that takes into account treatment time, invasivity of procedures and patients morbidity. Further, it is also observed that insurances very much stress the reduction of cost and the simplicity of treatment. This will also influence the treatment planning and the sequence of the procedures as shown by the following case.

Injuries to the lower jaw in cats occur frequently in the area of the temporomandibular joint. In most of these cases, successful treatment necessitates a temporary surgical occlusion of the jaw. After a brief survey of various occlusion methods, a simple technique is opted for in which labial reverse sutures of non-absorbable material are threaded through buttons. This is the preferred method of treatment employed by the University of Munich Department of Animal Surgery. During the past ten years, 107 cats were treated using this method. It was possible to check the healing process via clinical and radiological examinations in 72 of these patients. In a further 21 cases, information was obtained through questioning the owners. The collected data revealed that the method described above, which originally had been intended to temporarily occlude the jaw in polytraumatized cats, has proven to be an effective final therapy in most cases. Of the total of 93 patients with a known case history, 81 cats (87%) showed no need for rigid fixation. Over all, 94% of treated patients were free of discomfort, while 68% of the fractures and luxations radiographically reevaluated had healed anatomically.

Most recently there seems to be a general turning away from the use of rectangular osteosynthesis miniplates in the treatment of maxillofacial fractures and in plastic surgery. Meanwhile a novel design based on circular arcs and connecting bars has been successfully employed. Its particular two-dimensional shape allows three-dimensional deformation without damaging the plates or the openings required for screw insertion. Apart from a reduced plate-bearing area and an increased torsional stability during adaptation to the bone surface, this new plate geometry and the complete system excells by its high tissue compatibility. This later characteristic is attributable to the choice of the bioinert material titanium, which has been processed into a special alloy.

Prescription habits, dose and form of application of analgesics were investigated in a retrospective study of postoperative pain alleviation involving 250 patients. On the basis of clinical and pharmacological criteria, a prescription regime is presented for Paracetamol as used singly and in combination with Codeine. The prescription regime has been tested in a prospective study involving 50 patients and found to be effective.

Fractures and injuries of the face and jaws in children differ from those in adults with regard to common occurrence and seriousness of injury. Injuries occur predominantly at school or during sports, whereas car accidents are not significant. 7% of our children had fractures of the middle face , compared with a much higher incidence in adults. In such cases, it is always necessary to look for a fracture of the skull base. For the transport of the seriously injured child, respiration and circulation must be safeguarded . Intubation and treatment of haemorrhage must, in the case of serious injury, be placed first. It is only then that transport to a specialised clinic can be carried out. Special features of diagnosis and therapy in children are indicated.

Modern treatment of fractured jaws includes the anatomical and functional restoration of the broken mandible and the middle part of the face. The central feature on the one hand, is the reposition and fixation of the fractured skeletal parts in the correct axial line, and on the other hand, occlusal rehabilitation, which is to be considered the criterion of a correct position for the dentigerous fragments. For this purpose, conservative and/or operative measures cone into question, according to the type of fracture and dislocation. The conservative methods enable reposition and fixation of fragments by means of dental fixation dressings. At the present time, wire suture and wire suspension which are always combined with conservative methods as well as plate osteosynthesis are to be mentioned as the most common operative procedures for fractures of the mandible and the middle part of the face.

During a 5 year period 59 patients with gunshot wounds were treated in the Department of Maxillo-facial Surgery at Munich University. Two patients, who developed local problems secondary to latent infection due to missiles retained for 31 and 32 years, are presented. These missiles were surgically removed. Today, compared to the past, the interval between the gunshot injury and the surgical removal of the missile from the mandible because of the use of antibiotics and improved surgery may be considerable.

With the external Cranial-fixator we can achieve a stable fixation of the severe maxillofacial injuries. In a period of 10 years (1973-1982) 61 patients were treated with a external cranial fixation, which is tolerated very well by the patients. The intermaxillary fixation is not necessary, the application is easy, the morbidity rate is low and the results are good (table 3 und 4).