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The aim of the study was to compare incidences and types of injury incurred between e-scooter crashes and bicycle crashes. This retrospective study included all victims of e-scooter crashes who were treated in the department of oral and maxillofacial surgery during a 12-months interval.A comparison was made with a cohort of patients who underwent bicycle crashes. Study parameters included type of fracture, soft tissue and dental affection, necessity of inpatient or outpatient treatment, the use of helmets, and the time of admission. In total, 400 patients were included. Of these 40 had suffered a crash on an e-scooter and 360 on a bicycle. Descriptive statistics showed a low helmet-wearing rate among cyclists (16.1% of recorded cases), with no helmet wearing recorded among e-scooter users. E-scooter-related crashes showed a higher rate of facial soft-tissue injuries (77.5%, p = 0.049) than among cyclists (61.7%), as well as a higher rate of dental injuries (27.5%, p = 0.017) compared with the bicycle cohort (13.3%). Facial fractures were also more common in the e-scooter cohort (45% vs 25.8%, p = 0.010). Admission was typically at the weekend - in the afternoon for the bicycle cohort and in the evening and at night for the e-scooter cohort. As a consequence of the fact that e-scooter riders seem to have an increased risk of facial injuries, it seems that an awareness campaign might be necessary to encourage helmet usage and to persuade intoxicated persons to use public transportation instead.

The study aimed to clarify (1) the effect of the Beneslider distalization appliance on maxillary molars (M1+2), (2) the type of tooth movement, and (3) changes in skeletal parameters.Dental distalization paths and transversal changes were measured according to the distance of the pterygoid vertical as well as on the virtualized 3D plaster model.Distalization of the second premolar (P2; T1 - T2) was 2.51 mm (±1.81 mm; P.001) combined with a distal tipping of 6.50° (±5.09°; P.001), whereas for M1 a distalization of 3.49 mm (±1.10 mm) occurred with negligible tipping (0.73° ± 5.04°). No significant differences (T1 - T2) on sagittal and vertical skeletal variables were found within or between G1+2. In contrast, a significant increase in N-Sp' in G2 and in Sp'-Gn in G1+2 with consecutive Hasund index reduction was shown. Comparing T1 and T2, the device had an effect on the transversal development.The Beneslider distalization appliance causes an effective distalization of M1+2, with slight second premolar tipping. No modification of skeletal parameters was recorded, but a relevant effect on Hasund index and the transverse was found.

Purpose Oral squamous cell carcinomas (OSCC) adjacent to the mandible or with clinically suspected bone infiltration are surgically treated either with marginal or segmental resections. This retrospective study compared both resections regarding local recurrence and lymph node recurrence or secondary lymph node metastases. Methods All consecutive primary OSCC cases between January 2007 and December 2015 that underwent mandibular marginal or segmental resection were included. Rates of local and lymph node recurrences or secondary metastases and possible risk factors such as tumor localization according to Urken’s classification were recorded. Results In total, 180 patients with 85 marginal (group I) and 95 segmental (group II) mandibular resections were analyzed. The local recurrence rates were comparable between the groups (28.2% vs. 27.4%; p = 0.897). Lymph node recurrences or secondary metastases were higher in group I (9.4% (n = 8) vs. 6.2% (n = 6); p = 0.001). Tumor localization appears to affect the outcomes. Significantly fewer local and lymph node recurrences/metastases were found for Urken’s classification SB and S calculated by two-proportion z-test (p = 0.014 and 0.056, respectively). Local recurrences mostly emerged from soft tissues, which should be resected more radically than the bones. Conclusion While bone infiltration appears technically well controllable from an oncologic view, local recurrences, and lymph node recurrences/metastases remain an issue. Regular clinical aftercare with imaging is crucial to detect recurrences.

The aim of the study was to analyze the role of temporal muscle and particularly tendon pathology in patients suffering from craniomandibular dysfunction (CMD) using magnetic resonance imaging.Retrospective analysis of MRI examinations was carried out with regard to temporal muscle fibrosis and fatty degeneration and particularly temporal tendon rupture, thickening, and degenerative signal alterations. Descriptive statistics and the Mann-Whitney U-test were used for statistical evaluation.Structural lesions of temporal muscle parenchyma were the absolute exception. PD hyperintensity, pronounced contrast enhancement, or peritendinous fluid collections along the temporal tendon were found only to a small extent, and a (partial) rupture occurred in only one case. The tendon diameter showed only slight variability. The Mann-Whitney U-test provided no results indicating a causal connection between degenerative joint or disc disease and temporal tendon pathology.A large sample of 128 magnetic resonance imaging examinations provided no evidence of a major role of temporal tendinitis in clinical CMD syndrome.· Retrospective analysis of temporal tendon in CMD patients.. · Abnormal structural findings along the tendon seen only rarely.. · Obviously no crucial role of temporal tendon lesions in CMD syndrome..· Stimmer H, Grill F, Waschulzik B et al. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. Fortschr Röntgenstr 2022; 194: 1242 - 1249.ZIEL: Ziel der vorliegenden kernspintomografischen Untersuchung ist es, die Bedeutung von Läsionen des Musculus temporalis und insbesondere der Temporalissehne für das klinische Syndrom der kraniomandibulären Dysfunktion (CMD) zu untersuchen. In einer retrospektiven Analyse von MRT-Untersuchungen der Kiefergelenke wurden Fibrose und fettige Degeneration des Musculus temporalis und insbesondere Verdickung, degenerative Signalveränderungen und Ruptur der Temporalissehne beurteilt. Zur statistischen Auswertung kamen deskriptive Statistik und der Mann-Whitney-U-Test zur Anwendung. Strukturelle Läsionen des Musculus temporalis waren die absolute Ausnahme. Nur vereinzelt wurden ein Signalanstieg in PD-gewichteten Sequenzen, eine vermehrte KM-Aufnahme oder peritendinöse Flüssigkeitsansammlungen entlang der Temporalissehne gefunden, eine (Teil-)Ruptur der Sehne nur in einem Fall. Der Sehnendurchmesser zeigte nur eine geringe Variabilität. Der Mann-Whitney-U-Test erbrachte keine Hinweise auf eine kausale Verbindung zwischen degenerativer Gelenkerkrankung und Läsionen der Temporalissehne. In einer größeren Stichprobe von 128 MRT-Untersuchungen der Kiefergelenke fanden sich keine Hinweise auf eine wesentliche Rolle der temporalen Tendinitis beim klinischen Syndrom der kraniomandibulären Dysfunktion (CMD). · Retrospektive Analyse der Sehne des Musculus temporalis bei CMD-Patienten.. · Nur selten strukturelle Läsionen der Temporalissehne.. · Offensichtlich keine wesentliche Rolle von Läsionen der Temporalissehne beim klinischen CMD-Syndrom..

The aim of this study was to examine the lateral pterygoid muscle (LPM) parenchyma, myotendinous junction, and tendon in temporomandibular disorder (TMD) patients using 3T magnetic resonance imaging (MRI). Results were compared with findings reported in the literature, in which the LPM has been attributed a major role in triggering TMD. 3T MRI was used for temporomandibular joint (TMJ) imaging. The MRI images of 63 patients were analysed for muscle contracture and atrophy, tendon rupture, signal alterations of the tendon, tendon contrast enhancement, and peritendinous fluid collection. Descriptive statistics and the coefficient estimate method were used for statistical analysis. Focus was placed on the association between LPM tendon pathology and TMJ lesions like osteoarthritis and disc displacement. Severe lesions of the LPM tendon and muscle parenchyma, like rupture or fibrosis, were detected in very few cases. Only moderate signs of tendinosis were found in TMD patients. In contrast, there was a clear correlation between tendon lesions and osteoarthritis or anterior disc displacement. These results indicate the need to discuss and question the role of the LPM and its tendon in TMD. Data suggest that LPM and tendon lesions are part of complex degenerative changes of the TMJ, and it seems less likely that a LPM disorder is causative in TMD.

This pilot study aimed to evaluate the association of plasma ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and S100 calcium-binding protein B (S100B) with intracranial abnormalities visible on a computed tomography (CT) scan (CT positive) and injury severity in acute traumatic brain injury (TBI). For these purposes, a cohort of 109 adult TBI patients was recruited within 6 h from the injury event. A hyperacute subcohort of 20 patients who had their blood collected within 2 h from injury was analyzed separately for early acute biomarker levels. Levels of GFAP and UCH-L1 were analyzed using the prototype Abbott i-STAT™ TBI Plasma Test (Abbott Laboratories, Abbot Park, IL), alongside S100B measurement (Elecsys; Roche Diagnostics, Penzberg, Germany). In the hyperacute subcohort, GFAP and UCH-L1, but not S100B, levels were significantly higher in the CT-positive group compared to CT-negative patients. AUC values for differentiation between CT-positive and CT-negative patients were 0.97 for GFAP, 0.87 for UCH-L1, and 0.60 for S100B. Severity discrimination, defined by Glasgow Coma Scale (GCS) score, was then analyzed in the total patient cohort. Levels of all three biomarkers were significantly different between mild (GCS, 13–15) and moderate/severe (GCS, 3–12) injury groups. UCH-L1 showed the highest area under the curve value for severity discrimination (0.94), followed by GFAP (0.91) and S100B (0.83). These results support the clinical utility of GFAP and UCH-L1 as TBI biomarkers able to rule out CT-positive injury in acute TBI. Moreover, excellent differentiation of GFAP and UCH-L1 between mild and moderate/severe TBI groups affirms their close association with the underlying pathology.

Cochlear implantation meanwhile is a well established standard therapy in different forms of hearing loss in most ages. Clear depiction of the cochleovestibular anatomy and the cochlear nerve are very important for indication and effectiveness of cochlear implantation. Aim/objectives: Therefore the question raises whether Highfield MRI improves precision of preoperative diagnostic imaging especially along the the intrameatal portion of the vestibulocochlear nerve.We analyzed the MRI scans of 216 temporal bones from 2007 until 2017. In all patients, CI was planned. We compared examinations using 1.5 and 3.0 T MR systems under the aspect of intracanalicular detection of the facial nerve, cochlear nerve, and the vestibular branches.3 T-MRI was able to detect the cochlear nerve in all cases, a very important criterion for CI-indication. 3 T-MRI was also superior in the detection of facial nerve and especially the vestibular branches.The most effective preoperative examination of CI-candidates is the combination of 3 T MRI and multislice HR-CT of the temporal bone.

This longitudinal study compared functional, anatomical, and quality of life (QoL) outcomes after closed reduction (CR) versus open reduction and internal fixation (ORIF) of condylar head fractures (CHFs). The aim was to determine predictability of results and to establish prognostic factors for poor outcomes, thus allowing therapeutic decision making between CR and ORIF. All fractures of the non-surgical group were treated by CR with maxillomandibular fixation (CR-MMF) according to an managed analogically. Morphological and functional results were acquired using axiography and clinical functional diagnostics, as well as MRI in problematic cases. Outcomes were compared with those of a collective of patients treated by ORIF with small fragment screws (SFS), according to a uniform standard. A total of 26 patients with 29 unilateral and bilateral CHFs of the non-surgical group were examined over a period of 28.5 months after completion of therapy and compared with a collective of 54 patients with 73 CHFs treated by ORIF. Statistically significant differences were found between both groups in protrusion and mediotrusion on the fracture side, in favour of ORIF. Significantly more patients in the ORIF group were symptom free in terms of the Helkimo dysfunction index and the RDC TMD compared with conservatively treated patients. Associations between Angle class and Helkimo dysfunction index, and between occlusion or number of teeth and pain after CT, could be confirmed. Given their respective indications, both treatment options demonstrated acceptable results in the majority of cases. However, for therapeutic decision making, it is crucial that the long-term results after CR are significantly less predictable. Our study showed only few positive prognostic factors for a stable functional outcome after CR such as isolated CHFs with stable occlusal conditions in younger patients (

The intraoperative cytological assessment of bony resection margins (ICAB) is a feasible diagnostic approach to support frozen section for assessment of invasion of margins of soft and hard tissue. However, complex resection margins could challenge both diagnostic approaches. Our objective here was to identify the limitations of intraoperative diagnostic methods for assessing margins. We present an advanced cytological approach to assess complex margins that may solve the problem. Data from 119 patients in whom frozen section was supported by ICAB, were reviewed and the reasons for false results analysed. In 35 patients with squamous cell carcinoma infiltrating bone, specimens (n=100) from the resection margin went through an intraoperative cell isolation process for the cytological assessment of bony margins (ICAB). The results were compared with the histological results of the corresponding margins of bone as a reference. Limitations to the assessment of operative bony margins intraoperatively included an infiltrative histological pattern of growth of the carcinoma, with carcinoma cells disseminated within the cancellous bone, complex and uneven resection margins with soft and bony tissue, inflammation, and signs of previous radiotherapy. Intraoperative cell isolation plus (ICICAB) allowed the microscopic assessment of up to 1cm3 of bony tissue to detect disseminated carcinoma cells within the cancellous bone with a sensitivity of 92.3% (95% CI 74.9% to 99.1%), and a specificity of 100% (95% CI 95.1% to 100%), and positive and negative predictive values of 100% (95% CI 85.8% to 100%) and 97.4% (95%CI 90.8% to 99.7%), respectively. Intraoperative cell isolation is a feasible new technique to support ICAB and frozen section in the assessment of bony and soft tissue margins.

Background Imaging provides crucial staging information for treatment planning of head and neck squamous cell carcinomas (HNSCCs). Despite technical progress in imaging techniques, defining the extent of bone involvement preoperatively remains challenging and requires intraoperative information to control for adequate resection. The intraoperative cytological assessment of the bone resection margins (ICAB) provides information whether bone is infiltrated by carcinoma. The aim of this study was to assess the diagnostic value of preoperative imaging compared with ICAB in order to achieve carcinoma-free bone margins. Materials and Methods 108 HNSCC patients underwent preoperative computed tomography (CT), magnetic resonance imaging (MRI) and orthopantomogram (OPG) for staging and surgical planning. Curative resection was planned based on imaging. Intraoperatively, the resection margins were controlled by ICAB. The diagnostic value of preoperative imaging and ICAB was assessed with reference to the histological findings. Results CT showed a sensitivity of 89.7%, specificity of 63.0%, positive predictive value (PPV) of 85.9%, and negative predictive value (NPV) of 70.8%. MRI revealed a sensitivity of 45.5%, specificity of 66.7%, PPV of 71.4% and NPV of 40.0%. OPG-imaging had a sensitivity of 64.7%, specificity of 76.2%, PPV of 81.5%, NPV 57.1%. In comparison, ICAB provided a sensitivity of 78.6%, specificity of 95.7%, PPV 73.3%, and NPV 96.7%. The accuracy was 82.1%, 52.9%, 69.0%, and 93.5% for CT, MRI, OPG, and ICAB, respectively. Conclusion Preoperative imaging lacks accuracy in defining adequate bone resection margins, compared with ICAB. ICAB supports preoperative imaging and intraoperative frozen sections to improve bone margin control.

The purpose of the present study was to investigate the degree and clinical relevance of synovitis in craniomandibular dysfunction. In total, 140 temporomandibular joints were examined using a 3 T MRI scanner. Quantitative analysis of synovial enhancement was performed and interrelated with arthrosis deformans, degenerative disc disease, joint effusion, bone marrow edema and restriction of motion. We found a statistically high and significant correlation between the degenerative changes as mentioned above and the intensity of synovial enhancement. The study shows that typical MRI findings in CMD patients are often combined with signs of synovitis. Presumably joint inflammation has an effect on the clinical signs and symptoms and also the prognosis of CMD. These results should be taken into consideration when selecting treatment. · 3T-MRI using a dedicated coil is the method of first choice in the examination of CMD syndrome.. · MR imaging allows quantification of increased synovial enhancement.. · There is a highly significant correlation between degenerative changes of the disc or cartilage and synovitis.. · Results of the study are relevant for the clinical assessment and therapy of CMD syndrome..· Stimmer H, Ritschl L, Goetz C et al. What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. Fortschr Röntgenstr 2019; 191: 924 - 931.ZIEL: Ziel der vorliegenden Untersuchung war es, das Ausmaß und auch die klinische Bedeutung der Synovialitis beim Syndrom der kraniomandibulären Dysfunktion zu untersuchen. Insgesamt 140 Kiefergelenks-MRTs wurden nach Untersuchung mit einem 3T-MR-System ausgewertet. Dabei wurde die synoviale Kontrastmittelaufnahme als entscheidendes Kriterium einer entzündlichen Gelenkbeteiligung quantitativ erfasst und in Relation gesetzt zu Arthrose, Diskusdegeneration, Diskusverlagerung, Gelenkerguss, Knochenmarködem und Einschränkung der Bewegungsexkursion. Es zeigte sich ein statistisch hochsignifikanter Zusammenhang zwischen den oben genannten bei CMD häufig vorzufindenden degenerativen Veränderungen einerseits und Zeichen der Synovialitis andererseits. Die Studie zeigt, dass die typischen MRT-Befunde bei CMD-Patienten häufig münden in bzw. überlagert werden von einer Gelenkentzündung, welche sich manifestiert in Form einer Synovialitis. Es ist davon auszugehen, dass sich diese entzündliche Komponente auswirkt auf das klinische Beschwerdebild und die Prognose. Von Bedeutung ist diese Erkenntnis auch für die Wahl der Therapie. · 3T-MRT mit dedizierter Spule ist die Methode der Wahl zur Abklärung der kraniomandibulären Dysfunktion.. · Entzündliche Veränderungen der Synovialitis sind MR-tomografisch quantitativ erfassbar und reproduzierbar.. · Statistisch hochsignifikanter Zusammenhang zwischen degenerativen Veränderungen des Diskus bzw. des Gelenkknorpels und Synovialitis.. · Ergebnis der Studie relevant für klinisches Verständnis und Therapie der CMD..· Stimmer H, Ritschl L, Goetz C et al. What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. Fortschr Röntgenstr 2019; 191: 924 – 931.

Thin and pliable flaps with long, high calibre pedicles are ideally suited to lining the inside of the mouth. The radial forearm free flap has been our flap of choice until now, but we are unhappy with its potential for complications at the donor site. As an alternative, 30 patients have been treated in our unit with peroneal perforator flaps. Magnetic resonance (MR) angiography is necessary preoperatively to identify major perforating vessels. Flaps were raised using a lateral approach after the position of the most suitable perforator had been marked on the skin. The skin flaps were outlined in the proximal half of the lower leg with a maximum width of 5 cm to allow for direct closure of the wound. Five patients (of the original 35) were excluded after the results of MR angiography were known. All perforators identified on MR angiography could be exposed in the proximal half of the lower leg and most had a septocutaneous course. Reconstructions were in the floor of the mouth (n=16), tongue (n=11), and buccal mucosa (n=3). All but one flap survived with satisfactory functional results. The donor site morbidity was low. With the aid of MR angiography the peroneal perforator flap is a safe option for intraoral reconstruction. For small and medium sized defects we think that this flap is a good alternative to others, particularly if direct closure at an inconspicuous donor site is desired.

The literature about bony defects in the semicircular canal system is highly inconsistent. Therefore, we analyzed a series of 700 high-resolution multislice CT examinations of the temporal bone for semicircular canal dehiscencies. An unselected group of ENT patients with different clinical symptoms and variable age was chosen. We found semicircular canal dehiscence in 9.6% of temporal bones, superior semicircular canal was affected mostly (8%), less common posterior semicircular canal (1.2%); only in 3 cases (0.4%), lateral semicircular canal showed dehiscence. In 60% of SSC dehiscence, we registered bilateral manifestation. The so-called "third mobile window" in semicircular canal dehiscence causes a great variety of clinical symptoms like vertigo, nystagmus, oscillopsies, hearing loss, tinnitus and autophonia. Comparison with anatomic studies shows that CT examination implies the risk of considerable overestimation; this fact emphasizes the important role of clinical and neurophysiological testing.

The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative evaluation of adequate collateral perfusion is essential. We investigated whether magnetic resonance angiography (MRA) accurately shows anatomical variants and pathological stenoses of the vessels of the lower leg and whether it can replace conventional invasive techniques. Conventional digital subtraction angiography (DSA) was used in a prospective study of 15 patients, and contrast-enhanced MRA postoperatively. Arteries were evaluated by three radiologists for: size of vessel at the trifurcation; hypoplastic or missing vessels; appreciable stenosis or vascular occlusion, or both; atherosclerotic malformations; and overall vascular topography. High resolution MRA enabled a reliable judgement to be made of the vessels of the lower leg. MRA definitively detected hypoplastic vessels, stenoses, occlusion, or atherosclerotic changes of the vessels, and enabled both accurate assessment of the quality of vessels and the preferred site for the harvest of the flap. As it is a low risk procedure, it can be done in the outpatient department with no risk of radiation. It can easily replace conventional DSA.

Our intention was to evaluate whether enlargement of the cochlear aqueduct could play a role in dysfunctions of the inner ear. There is little literature dealing with the question of cochlear aqueduct (CA) enlargement and results of reported radiological examinations are contradictory. Therefore, we decided to analyse 400 high-resolution CT-scans of the temporal bone to examine the diameter of the CA. We used scan-data from a 64-line multislice spiral-CT-scanner stored in our PACS-System. CA-enlargement was defined as a diameter of more than 1 mm in the whole otic capsule portion. A classification with four types of CA's proposed by Migirov and Kronenberg in 2005 was applied. Statistical analysis of diameters, different CA-types and side asymmetry was performed. We did not find any CA exceeding 1 mm in diameter in the otic capsule portion, there is no evidence of CA-enlargement, not even in patients with inner ear malformation. A new aspect compared with published literature to date is that nearly in all cases CA was identified, but in different degrees. According to our findings, it seems to be very unlikely that CA-enlargement is a reason for pathologic inner ear condition as it is in case of large vestibular aqueduct.

We report the case of a 46-year-old woman with subacute onset of pain in the right shoulder–arm region, initially without neurologic deficits. About 2 weeks later progressive polysegmental paresis of the right shoulder girdle and proximal arm muscles appeared. Because of the time course and the predominance of motor symptoms primarily Parsonage–Turner syndrome was suspected. Parsonage–Turner syndrome is a rare disease affecting the upper part of the cervicobrachial plexus, characterized by sudden onset of severe one-sided shoulder pain, followed by paresis of the shoulder and arm muscles, probably caused by an inflammatory or allergic process. MR-imaging however revealed the typical signs of vertebral artery dissection. Intramural hematoma in the dorsolateral vessel wall caused compression of the C5 and C6 radicular nerve. The reason for the patient's symptoms and complaints was a polyradicular motoric compression syndrome. This emphasizes that vertebral artery dissection can manifest in some rare cases with a peripheral neurologic deficit. This might be typically radicular or clinically similar to Parsonage–Turner syndrome. Therefore it is necessary to think about this differential diagnosis especially in younger patients suffering from pain and weakness in the shoulder–arm region without degenerative disk disease or pathologic findings along the cervicobrachial plexus fibers.

Advantages and disadavantages of the three most commonly-used bone grafts for mandibular reconstruction are widely known, but biomechanical experimental studies are rare. We have done loading tests on cadaveric mandibles reconstructed with fibular, iliac crest, and scapular grafts using 3 different osteosynthesis systems to detect and compare their primary stability. Loading tests were done on mandibles with grafts from the fibula and iliac crest and published previously. A 4.5cm paramedian L-type defect was reconstructed with scapula using 2 monocortical non-locking plates, 2 monocortical locking plates, or a single bicortical locking plate/fracture gap in 18 human cadaveric mandibles. These were loaded on to the "Mandibulator" test bench and the movement of fragments in 3 dimensions was assessed and quantified by a PONTOS® optical measurement system. Comparison of the osteosynthesis groups showed that the miniplate was significantly superior to the 6-hole TriLock® plate for both fibular and iliac crest grafts. The fibular graft gave greater stability than the iliac crest and scapular grafts for all 3 osteosynthesis systems. All bony specimens offered sufficient resistance to mechanical stress within the recognised range of biting forces after mandibular reconstruction, independently of the choice of bone graft and osteosynthesis system used. Anatomical and surgical advantages need to be taken into account when choosing a graft. Stability can be maximised with a fibular graft, and further optimised by enlarging the binding area by using the "double barrel" method. Computer simulated experiments could segregate factors that biased results, such as morphological differences among cadavers.

It is well known that the treatment protocols for hematopoetic neoplasms carry a high risk of long-term oncogenicity. However, few reports have been published of sarcomas as secondary malignancies. An unusual case report of a soft tissue sarcoma appearing as a secondary cancer is presented, with a review of the published data. The present report involves a soft tissue sarcoma of the neck that occurred 18 years after curative treatment of acute myeloid leukemia by induction chemotherapy and bone marrow transplantation. Consecutive graft-versus-host disease affected the cervical skin. Soft tissue sarcomas appearing as secondary tumors are rare in oncology. The presented case describes the appearance of a sarcoma 18 years after curative treatment of acute myeloid leukemia. This is only the second case of this type reported in published studies.

Whereas extraintestinal manifestations of inflammatory bowel disease in general are quite common, cerebral vasculitis is considered a very rare condition. We present a case of Crohn's disease-associated vasculitis mimicking migraine with aura.A 28-year-old woman with Crohn's disease and known migraine with aura had suffered from daily migraine attacks with recurrent focal neurological deficits for 6 weeks. Cerebral magnetic resonance imaging showed multiple acute, subacute, and chronic ischemic lesions in different vascular territories. Magnetic resonance and computed tomography angiography demonstrated vessel changes consistent with cerebral vasculitis. Laboratory investigations revealed systemic inflammation and lymphomonocytic pleocytosis of cerebrospinal fluid, supporting the diagnosis of Crohn's disease-associated vasculitis. Symptoms and inflammatory parameters quickly normalized after high-dose prednisolone treatment. During immunosuppressive therapy, migraine recurred only once in 11 months.Cerebral vasculitis is a very rare but severe complication in Crohn's disease and should be excluded in case of comorbidity with migraine with aura. In our patient, migraine with aura may have been the only symptom of cerebral vasculitis for several years.

Purpose The computed tomography (CT) scan is currently the gold standard in the imaging of orbital fractures. The weak points of this imaging modality, however, include restricted soft tissue depiction as well as the radiation. Both attributes are of particular importance in children because of the high rate of trapdoor fractures and the radiation to the lens. Although magnetic resonance imaging (MRI) is not associated with these drawbacks, it has not been established in the primary diagnosis of pediatric orbital fractures. The aim of our study was to establish the use of MRI with a special orbital coil for the primary diagnosis of pediatric orbital trauma. Patients and Methods In our retrospective study, 14 pediatric patients presented to our department with a blunt orbital trauma from 2003 to 2007. Twelve of 14 patients with orbital floor fractures required surgical reconstruction. Until 2004, imaging was carried out by plain x-rays and CT scan for a decision regarding the necessity of surgery. Since introducing the MRI microscopy orbital coil in 2004, CT scans have been replaced by MRI for the primary fracture diagnosis in 8 pediatric cases. Kappa statistics have been applied to assess inter- and intraobserver reliability for CT scans and MRI. This study shows our experiences using MRI in combination with conventional x-rays to determine the operative approach in 2 of the 8 pediatric cases suffering from blunt orbital trauma. Results The most common causes for pediatric orbital trauma in our collective were accidents. In 8 cases using MRI as the primary imaging modality, depiction of the fracture dislocation and differentiation of the adjacent fatty and muscle tissue was excellent and indication for surgery was distinct. MRI reached a high intra- and inter-rater agreement level (κ = 0.80). Conclusion MRI combined with a microscopy orbital coil is a valuable alternative to the CT scan in the primary diagnosis of pediatric orbital fractures. Floor fractures, and particularly muscle incarceration, should be diagnosed by high resolution MRI combined with a microscopy coil instead of CT to avoid radiation to the lens and to obtain a better soft tissue depiction.

Squamous cell carcinoma is the most common malignant neoplasm of the larynx. One of the most important influences on prognosis is the presence of metastases to the cervical lymph nodes. Accurate determination of lymph node involvement is therefore a prerequisite for individualized therapy in patients with squamous cell carcinoma of the larynx. Clinical palpation of the neck is not very accurate and the role of imaging techniques such as ultrasound, ultrasound-guided fine needle aspiration cytology, color Doppler ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography is being applied in order to improve upon the results of clinical investigation alone. According to our investigations and review of the literature, the accuracy of computed tomography scanning (84.9%) and magnetic resonance imaging (85%) was superior to palpation (69.7%) and ultrasound (72.7%). Ultrasound-guided fine needle aspiration cytology showed an accuracy of 89% and was in the same range with positron emission tomography (90.5%).

Namens seiner Magnifizenz, des Rektors der Technischen Universitat Wien, der leider verhindert ist, an der heutigen Veranataltung teilzunehmen, begruse ich Sie zur Sponsionafeier. Die Sponsion stellt den feierlichen AbachluB des Studiums an unserer Universitat dar, eines Studiums, das sicherlich nicht leicht ist, und daa einen hohen Einsatz erforderte, von Ihnen, meine Herren Absolventen, aber euch von Ihren Familien.