Frankfurt am Main, Germany
Frankfurt am Main, Germany

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Landes C.A.,Frankfurt University | Laudemann K.,Frankfurt University | Petruchin O.,Frankfurt University | Revilla C.,Frankfurt University | And 4 more authors.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | Year: 2012

Background. A novel maxillary 3-segment osteotomy (3SO) was evaluated versus the conventional 2-segment-osteotomy (2SO) for surgically assisted rapid maxillary expansion. 3SO was performed bilaterally between the lateral incisors and canines at the former junction of the lateral alveolar processes with the premaxilla. Study design. Of 98 included patients (n = 53 retrospectively and n = 45 prospectively; 68 complete datasets), 47 patients' preoperative and postexpansion cast models were evaluated for transverse maxillary dental and skeletal expansion, dental tipping, attachment loss, and front teeth angulation, and on photographs the pink esthetic score (PES) was assessed preoperatively versus postoperatively. Results. Three-SO expanded to a larger extent with more symmetry than 2SO, at the price of more dental tipping and front teeth angulation (independent t test). The PES showed better esthetic outcomes for 3SO (Mann-Whitney U test). Conclusions. Disadvantages of 2SO, such as median diastema, midline shift, median papilla infringement, asymmetric expansion, septum and columella dislocation, high forces on the periodontal apparatus, and subsequent attachment loss were overcome with 3SO. Bilateral double osteotomies appeared to promote higher volumes of callus formation, thus preventing relapses. © 2012 Elsevier Inc. All rights reserved.


Seeberger R.,University of Heidelberg | Kater W.,Frankfurt University Medical Center | Schulte-Geers M.,Frankfurt University Medical Center | Davids R.,Frankfurt University Medical Center | And 2 more authors.
British Journal of Oral and Maxillofacial Surgery | Year: 2011

Different devices are available to aid surgically-assisted maxillary expansion. In this study we have evaluated the changes to the anchoring teeth, the hard palate, and the lower nasal passage made by tooth-borne distraction devices. Thirty-one patients (mean (SD) age 28 (2) years) with deficiencies in the transverse width of the maxilla were examined by computed tomography and cone beam scans before and after operation. The data were analysed with the help of Wilcoxon's signed rank test and Spearman's r correlation. The mean (SD) distraction width was 6.5 (2.3) mm. All anchorage teeth were tilted (p < 0.01). The axes changed by a mean (SD) of 4.8 (0.9)° in the first premolar and 3.1 (0.8)° in the first molar. The nasal isthmus increased by a mean (SD) of 2.5 (0.3) mm. The hard palate adjacent to the anchoring teeth increased anteriorly by a mean (SD) of 2.8 (0.4) mm and posteriorly by 2.7 (0.4) mm. The hard palate was lowered by 1.2 (0.8) mm. There was a significant correlation in the distraction width, with changes in the intercoronal and interapical distances of the anchoring premolars (p < 0.05) and with the interapical distance of the anchoring molars (p < 0.01). There was also a correlation between the distraction width and the overall gain in width of the lower nasal passage (p < 0.05). The results suggested that surgically-assisted maxillary expansion with tooth-borne devices has significant effects on the anchoring teeth, the nasal floor, and the hard palate. Both tilting of the teeth and an evenly distributed movement of the segments were seen. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.


PubMed | Frankfurt University Medical Center, Mainz University Medical Center and University of Mannheim
Type: | Journal: Urology | Year: 2016

To evaluate the long-term outcomes in patients with classic bladder exstrophy (CBE) and continent anal urinary diversion (CAD) for continence, upper urinary tract status, secondary malignancies and sexual function.The medical records of 82 exstrophy patients having undergone CAD in our department between 1970 and 2015 were reviewed. Patients were invited for follow-up examinations and asked to complete validated questionnaires relating to sexual function.Thirty-two of 57 eligible patients with a median follow-up of 23.9 years were included in the study. Ninety-seven percent of patients were fully continent during the daytime. Upper urinary tract and renal function remained stable in 75% and 87%, respectively. 5 patients developed secondary malignancies originating from the rectal reservoir. Forty-one percent received prophylactic alkaline substitution. Sexual function as measured by the FSFI and the IIEF was negatively affected in all domains in both genders. Eighty-six percent of patients had a stable relationship and 35% were married. Five women conceived a total of 6 healthy children. Paternity rate was 40 percent.CAD constitutes an effective treatment option with acceptable long-term outcomes in exstrophy patients in whom all attempts at restoring the lower urinary tract have failed. Long-term follow-up of the upper urinary tract, assessment of acid-base balance and endoscopy of the recto-sigmoid reservoir are paramount for the safety of this type of management. Evaluation of sexual dysfunction should be an active part of follow-up.


PubMed | Frankfurt University Medical Center
Type: Comparative Study | Journal: Oral surgery, oral medicine, oral pathology and oral radiology | Year: 2012

A novel maxillary 3-segment osteotomy (3SO) was evaluated versus the conventional 2-segment-osteotomy (2SO) for surgically assisted rapid maxillary expansion. 3SO was performed bilaterally between the lateral incisors and canines at the former junction of the lateral alveolar processes with the premaxilla.Of 98 included patients (n = 53 retrospectively and n = 45 prospectively; 68 complete datasets), 47 patients preoperative and postexpansion cast models were evaluated for transverse maxillary dental and skeletal expansion, dental tipping, attachment loss, and front teeth angulation, and on photographs the pink esthetic score (PES) was assessed preoperatively versus postoperatively.Three-SO expanded to a larger extent with more symmetry than 2SO, at the price of more dental tipping and front teeth angulation (independent t test). The PES showed better esthetic outcomes for 3SO (Mann-Whitney U test).Disadvantages of 2SO, such as median diastema, midline shift, median papilla infringement, asymmetric expansion, septum and columella dislocation, high forces on the periodontal apparatus, and subsequent attachment loss were overcome with 3SO. Bilateral double osteotomies appeared to promote higher volumes of callus formation, thus preventing relapses.

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