International Poster Journal of Dentistry and Oral Medicine, Supplement DGMKG/2016

Odontogenic myxoma of the jaws is an uncommon benign neoplasm of ectomesenchymal or mesenchymal origin. It has been reported to be the fourth commonest odontogenic tumor. This article presents a rare case of odontogenic myxoma located right condyle of a 45-year-old female patient with a brief review of the pathogenesis, clinical, radiological and histopathological characteristics of odontogenic myxoma. Keywords: odontogenic myxoma of the condyle, temporomandibular joint replacement

Introduction: Orbital reconstruction can be performed by using different kinds of alloplastic materials. Especially in solitary fractures of the orbital floor, the application of individual prefabricated CAD/CAM-implants represents a novel and increasingly used procedure. In this case report, we show the application of an CAD/CAM-implant in a complex nasoorbitoethmoid fracture combined with plate osteosynthesis and Polydioxanone foil. Case report: We report about the case of a 28-year-old professional football player with craniocerebral injury and a midfacial fracture due to collision in a football match. Preoperative CT-diagnostics showed a displaced and multiple fragmental fracture of the naso-ethmoidal complex involving the inferior orbital margin, medial orbital wall and orbital floor. Repositioning and osteosynthesis of the complex fracture was done over intra- and extraoral access. The reconstruction of the orbital floor was realized by using an individual CAD/CAM-implant in navigation-guided surgery. The medial orbital wall was reconstructed with a Polydioxanone foil. Results: By virtual mirroring of the opposite orbital frame in preoperative planning, it was possible to prefabricate an individual CAD/CAM-implant in order to reconstruct the fractured orbital floor. Despite the complex and difficult fracture of the naso-ethmoidal complex with multiple fragments, anatomical correct reconstruction of the displaced inferior orbital margin could be successfully done through the preoperative planned repositioning site of the CAD/CAM-implant. The accurate reconstruction of the orbital floor allowed intraoperative gain of time and and resulted in good rehabilitation of the patient. Conclusion: Individual prefabricated orbital floor CAD/CAM-implants can be successfully used in complex fractures and may be combined with other methods and materials. By correct planning, the described procedure can be advantageously in surgery and postoperative outcome. Keywords: CAD/CAM-implant, Reconstruction of the orbit, Orbital floor fracture, Nasoorbitoethmoid fracture

Introduction: The cemento-ossifying fibroma (COF) comprises a benign, solid tumor, which is rich in cells and fibrous stroma, and variable parts of mineralized tissue (bone/cementum) [1]. COFs typically occur among the second and fourth decade of life and are most commonly located in the region of the lower jaw. Females are affected more often than males [2,3]. COFs show radiopaque and radiolucent variations in radiographic images and can be asymptomatic for a long time [3]. To get a distinctive diagnosis, it is necessary to perform a histological evaluation. However, for rare tumor entities, dignity cannot be ascertained surely- neither clinically nor radiologically or in histological ways. Case description: A 24-year-old female was admitted to our center with the radiological finding of a solitary mass, which expanded up to 3x 2.4 cm in the right lower jaw, infiltrating parts of the lingual cortical bone with direct contact to the roots of the teeth 46 and 47. Clinically, no further abnormalities could be detected. After the initial tumor resection, the histological examination resulted in the diagnosis of a cemento-ossifying fibroma. Still, a low-grade osteosarcoma could not be ruled out. In the course of a radical tumor resection, a partial continuity resection of the lower jaw was performed and a patient-specific, microsurgical, musculo-osseous iliac crest transplant was harvested using CAD/CAM templates and inserted into the bony defect. The postoperative course was uneventful and the definite histological examination confirmed the diagnosis of a COF. Follow-ups showed no evidence of a recurrence. After implant loading and prosthetic rehabilitation, the patient is now free of complaints and very satisfied with the outcome of the therapy. Conclusion: Even after an excisional biopsy, in some cases the dignity of tumors of the lower jaw cannot be determined exactly. Therefore, extensive findings often require a radical surgical procedure with primary bone reconstruction, even if the tumor is being classified as benign lesion later on. COFs require an early radical surgical handling, because on the one hand cases with inoperable tumor size have been described and on the other hand COFs bear the potency to recur and can possibly even undergo malignant transformation. Against this background, the follow- up after tumor resection should amount to no less than ten years [4,5]. Keywords: cemento-ossifying fibroma of the lower jaw, benign tumor of the lower jaw, tumor resection, rare bone tumor lower jaw

Adult cleft lip and palate patients with maxillary hypoplasia and recurrent palatal fistulas need special technique in surgery. 5 Patients were treated with free flap surgery (forearm or fibula), 2 patients recives rigid external distraction (RED II). Keywords: fibula free flap, forearm flap, external rigid distraction device, cleft palate

The case reported shows a 54-year-old Caucasian woman returning from a holiday travel to tropical Peru with an erythematous infraorbital swelling. Since initial therapeutic approaches with an antibiotic regimen proved inadequate ensuing sonographic examinations eventually diagnosed myasis. Myasis is an infectious disease which mainly occurs in tropical and subtropical regions of the world where the climate is hot and humid. It is characterized by infestation of human (or animal) tissue with fly larvae or dead larval tissue. The in our case causative insect Dermatobia hominis belongs to the class of two-winged flies (Diptera) and is native to Central and South America. The therapy consists of surgical removal of the larva in-toto. We propose contemporary screening for myasis in travelers to tropical regions with signs of soft tissue inflammation to impede unnecessary diagnostic delay. Keywords: Myasis, Dermatobia hominis, Travel medicine, Infraorbital skin

Introduction: Root amputation (RA) is a well established method for tooth preservation. Aim of this retrospective study was the identification und investigation of parameters which are influencing the long-term result after root amputation. Methods: 216 patients (♂ 111, ♀ 106) on which in total 261 root amputations were performed could be included. Inclusion criteria were: (1) postoperative success of RA minimum 12 months, (2) availability of postoperative x-ray, (3) availability of minimum 1 radiological control. In addition to the long-term result, tooth type, age, use of synthetic bone replacement material, parodontal status and gender was investigated concerning the long-term prognosis after RA. Results: The results show 5 year success-rate (5-y-SR) of 78.2% and a 10 year success rate (10-y-SR) of 63.1%. The comparison of the tooth types (molars, premolars, frontal teeth) showed for the upper frontal teeth a 5-y-SR of 81.5% and a 10-y-SR of 62.7%. The upper premolars had a 5-y-SR of 68.8% and a 10-y-SR of 55.0%. The upper molars had a 5-y-SR of 88.1% and a 10-y-SR of 77.2%. The 5-y-SR of the lower frontal teeth was 83.1%, the 10-y-SR 71.2%. The lower premolars showed a 5-y-SR and a 10-y-SR of 72.6%. The lower molars had a 5-y-SR of78.8% and a 10-y-SR of 59.6%. There was no statistical difference in-between all these tooth types. The evaluation of the 5-y-SR and 10-y-SR of the age-groups ( Keywords: root amputaion, oral surgery, dental implantation, endodontics

Background: Necrotizing fasciitis (NF) is a rare life-threatening infection characterized by a rapid and progressive necrosis of subcutaneous tissues and fascia with resultant skin gangrene and further systemic toxicity. NF is mostly reported in extremities, trunk and perineum, while head and neck structures account for only 3-4% of all reported cases. Cervical NF is an even more severe condition, with a high mortality rate, usually caused by dental infection, infection secondary to trauma, throat abscess, osteoradionecrosis or, more rarely, to salivary gland infection. A higher mortality is reported to occur in patients with evolution to mediastinitis, condition called descending necrotizing fasciitis or descending necrotizing mediastinitis. When this complication is accompanied by immunosuppressive conditions, such as diabetes, the infection is often reported as fatal. Case report: We present the case of a 18-years-old female Afro-descendant patient who developed a NF after ambulant extraction of a single third molar (48). Although she got antibiotics (Amoxicillin) beginning right after extraction she developed a descending necrotizing fasciitis. For nearly two weeks symptoms were rare (i.e. due to her dark skin) and undefined which may have protracted the diagnosis finding process. On the other hand the Diabetes type I of the patient may have abet the severity of the symptoms. When diagnosis was found two weeks after extraction CT showed signs of large air retentions in subcutaneous cervical and thoracic tissue as well as a distinctive mediastinitis Although extensive incisions and multiantibiotic therapy was performed condition progressed rapidly leading to a severe sepsis and lead into death of the patient. Conclusion: The presented case highlights the important role of dental infections as initial focus of cervical necrotizing fasciitis, as well as the value of early recognition of the disease and prompt clinical and surgical intervention for a successful outcome, especially in patients with systemic disabling immune conditions. Keywords: cervical necrotizing fasciitis, wisdom tooth removal, mediastinitis

The giant cell tumor of the mandible is a local agressive benign tumor of the bone which is usually treated by wide excision. Nevertheless it has a high rate of recurrence, especially if in young patients the surgery is less radical in order to preserve teeth. A new non surgical treatment could be the medication with Denosumab. Denosumab is a human monoclonal IgG2 antibody that binds RANKL thereby inhibiting the stimulation of osteoclasts and giant cells. Two patients with recurrence of giant cell tumors of the mandible are treated since may and july 2014 with Denosumab 20 and 60mg every 3-6 months. The radiologic control after 20 and 22 months showed recalcification of the tumor and prevention of further growth. Treatment is well tolerated. The metabolism of Calcium is monitored closly without pathologic findings. The risc of a chemically induced osteonecrosis is low in young patients but should be considered. Denosumab should be evaluated as an alternative treatment to agressive surgery in cases of refractory giant cell tumor of the mandible. Keywords: Denosumab, jaw, mandible, giant cell tumor, osteonecrosis

Introduction: Extra-skeletal chondromas are rare and benign cartilaginous neoplasms that normally occur in hands and feet. An analysis of the up to now published literature reveals only one comparable case in the preauricular region. Material and methods: This case-report describes the rare case of an extra-skeletal chondroma in the preauricular region, its resection and the following reconstruction of the temporomandibular joint. Results: Finding the diagnosis of an extra-skeletal chondroma was complex and difficult because swelling and medical imaging initially provided ambiguous results. The histopathologic sample was also difficult to interprete. Due to that sample had to be referred to a reference-pathology. Conclusion: Extra-skeletal chondromas are rare benign tumors. Their appearance in the haed and neck area is extremely rare and the diagnostic process is extremely difficult due to several possible differential diagnosis although extensive clinical and imaging possibilities are available. Keywords: extra-skeletal chondroma, temporomandibular joint

Background: It is well known that under immunosuppressive therapy latent infectious diseases come cumulated to a reactivation as for example a tuberculosis. Case report: We present a 49years old patient with a history of psoriasis geographica for 30 years and several immunosuppressive therapies. After changing the immunosppressive therapy to infliximab (Remicade) psoriatic symptoms went better while he developed within one month a fever resistant to antibiotics and a severe weight loss. In a nonresident performed CT and Mediastinoscoy showed an infiltrate in the left lung lobe and a mediastinal lymph node enlargement. Sample material gained by mediastinoscopy revealed. While medication with remicade was paused the named symptoms regressed spontaneously and further medication was performed with Fumaderm. One year after first appearance of the named symptoms they developed again. At that moment the patient recognized a supraclavicular swelling on the left side and again fever and weight loss. In a once more performed CT cervical melt-down lymph nodes were seen while the lung showed no pathologic result. A afterwards performed lymph node picking showed material that could be assigned to a typical tuberculosis by PCR for the first time while granulomas with central eosinophilic necrosis revealed once more no acid-proof rod cells. However a systemic tuberculostatic therapy could induce a full restitutio ad integrum for the patient. Conclusion: Diseases that require an immunosuppression entail always the risk to develop malignant diseases, the activation of autoimmune disorders and the reactivation of latent infectious diseases which one should consider when starting a therapy with immunosuppressive substances. Keywords: extrapulmonary tuberculosis, Infliximab, Psoriasis geographica

Objective: Eagle syndrome (ES) is a pain syndrome caused by an elongated styloid apophysis or an ossified styloid ligament. It is characterized by a complex range of symptoms in head and neck region. The most effective treatment is surgical shortening of the styloid apophysis. Case: The authors report of a case of a 53-year old woman, suffering from Eagle-syndrome, presenting with a two-week history of unilateral in pain of the maxilla and TMJ. Further the authors performed a follow-up examination six years after surgical treatment via cervical approach. Conclsions: Surgical treatment via cervical approach appears to be an effective and safe option with low morbidity and mortality in treatment of symptomatic Eagle-syndrome of adults. Keywords: Eagle syndrome, styloid process, styloid apophasis, styloid syndrome, parapharyngeal approach

The authors aimed to assess quantity, readability and comprehensibility of patient information material on craniofacial disfigurements on websites of german hospitals with a department of Craniomaxillofacial Surgery. In total, websites of n=83 departments where assessed for information on cleft lip palate, dysgnathia and craniosynostosis. Only 53,3 % of the searches where successful. The found information material was analyzed for its readability using a score consisting of four well-established readability formulas adjusted to german language ("Hohenheimer Veorstaendlichkeitsindex"). Readability of the found information material was poor. Selected texts where presented to a group of students (n=73), who were asked to rate comprehensibility using a well-established questionnaire for written information in german language ("Hamburger Verstaendlichkeitsmodell"). All analyses texts had deficits in simplicity and arrangement of information. Summing up, the authors recommend critical reevaluation and where necessary correction of presented patient information material online. Keywords: readability, comprehensibility, craniofacial disfigurements, informed consent

The alveolar ridge undergoes atrophy and dimensional changes subsequent to tooth removal. Preservation of the alveolar crest can enhance the surgical site before implant placement. In the socket preservation procedure, a distinction can be made between the filling and the sealing of the socket. While the filling with substitute materials can cause disruption or delay of new bone formation, the sealing with free soft tissue grafts can lead to necrosis due to small diffusion surfaces. An autogenous composite graft is presented, which has a better healing chance by increased diffusion area. Moreover it could accelerate bone formation by osteoinduction. Keywords: alveolar ridge preservation, socket preservation, autogenous composite graft

While the treatment of chronic odontogenic maxillary sinusitis is based on clear rules the management of acute purulent sinusitis of dental origin may produce a therapeutic dilemma. Often necessary additional drainage through the inferior nasal meatus or an oroantral fistula can cause further damage and promote chronic sinusitis. An alternative temporary drainage to the vestibular space is advised, which might avoid these problems. Keywords: odontogenic maxillary sinusitis, maxillary sinus, empyema, oroantral fistula, drainage, mucociliary clearance

Most commonly occurring in the trunk and extremities, intramuscular hemangiomas (IMH) may be rare tumors in the head and neck region. There they show predominant involvement of the masseter and trapezius muscles. Due to their nonspecific symptoms, often these tumors are misdiagnosed. The muscle infiltrative growth can lead to confusing them with malignant neoplasms. A case of IMH in a five-year-old girl is presented here. After an initial conservative treatment, the neoplasm was then treated by surgical excision, because of a progressive growth trend and re-occurring functional complaints. In addition to the clinical, diagnostic and histo-pathological findings, treatment of intramuscular hemangiomas with multipleform phleboliths is discussed. There is no recurrence after a one-year follow-up. Keywords: intramuscular hemangioma, masseter muscle, phlebolith, soft tissue neoplasm, head and neck surgery

Background: Arteriovenous malformations (AVM) are congenital vascular lesions and occur most commonly in the head and neck area [1]. In contrast to hemangiomas, AVM are rarities and show progressive growth and high recurrence-rates [2, 3]. Since more than 90% of the AVM are clinically significant, a treatment is usually necessary [4]. Case Report: We report about a 40-year-old male who was admitted to our clinic center suffering from a manifested and progressive AVM of the left cheek, which initial appeared about ten years ago. In addition to a strong, tough, non-movable swelling of the left cheek, typical signs like pain, overheating and telangiectasia of the affected skin were recognizable. As a result of the extensive growth of the AVM, the upper molars were dislocated and induced an ulceration of the buccal mucosa. Magnetic resonance imaging showed a large, two-parted tumor of the left face, which presented typical characteristics of an AVM in the angiography. The interventional multiple embolization with ethylene-vinyl alcohol copolymer (Onyx) could not achieve a significant reduction of the tumor mass. Therefore, the subtotal resection was performed by protecting the outer skin and the facial nerve. The defect was filled up with a free, microvascular-anastomosed latissimus dorsi muscle flap. Over an observation period of one year, the patient was still free of recurrence and satisfied with the aesthetic result. Conclusion: In cases of extensive AVM in the facial area, an interdisciplinary approach with embolization, subsequent resection, and immediate reconstruction is the goal for adequate functional and aesthetic outcomes. Subtotal resection reduces morbidity even without increasing the risk of recurrence. Keywords: AV- malformation, subtotal resection

Introduction: Computer assisted design (CAD) is fast becoming a standard in microvascular fibular transplantation for mandible reconstruction as bony transfer can be performed with a high level of accuracy. Implant born prosthetic rehabilitation of these patients is still challenging however. In order to place dental implants at the earliest possible moment they should be inserted at the same time as the fibular bone graft is performed. To optimise the potential of virtual planning it is sensible to perform implant placement according to the opposing teeth/jaw and to position the mandibular bone in prosthetically optimal position, i.e. perform true backward planning as an integrated planning step along with the fibula osteotomy cuts and plate hole pre drilling. Materials and Methods: Using the Computed-Tomography (CT) data of each individual patient, virtual surgery was performed in order to resect and reconstruct the mandible. Simultaneous implant placement was included in the standard planning. The positioning of these implants was determined in collaboration with a prosthodontist specialised in tumour reconstruction. The fibular bone was then positioned according to the ideal position of the implants, based on the opposing occlusion, and cutting guides as well as a patient specific reconstruction plate ordered. The implants were placed extra-orally and the bone segments placed in their definitive position using a transfer splint. Postoperatively the precision of the reconstruction was checked by performing a second CT which was compared to the original plan. Results: Both the bone segments as well as the dental implants demonstrated good precision as compared to the planning data. Discussion: The inclusion of the drill-guides for dental implants, integrated in the patient-specific cutting guides for the fibula enabled to perform true digital backward planning with immediate guided implant placement in cases of mandibular reconstruction. Conclusion: We present a fully digitalized workflow for accurate dental implant placement integrated in the virtual osteotomy planning of vascularized free fibular bone grafts and implement this clinically to ensure early functional implant placement. Keywords: Implants, Fibula Free Flap, 3D planning, virtual surgery, complete virtual workflow, computer assisted reconstruction, facial defects

Background: Primary malignant melanoma (MM) of the oral mucosa is a rarity and only occurs in an amount of 1.5 to 2% of the total number of all melanomas. The clinical picture may be very heterogeneous. Confusion with other benign oral mucosal lesions or compromises to radical therapy can induce far-reaching consequences. Case report: A 42-year-old female presented with externally secured, histological diagnosis of MM of the palatal mucosa. Eight years earlier, a MM was been excised at the first time. Two recurrence-operations followed by 4 and 5 years. At first presentation in our center, a 1 x 1.5 cm ulcerated defect after biopsy alio loco could be found in the area of the hard palate. The further work-up revealed no evidence for regional or distant metastases. However, the single photon emission computed tomography showed tracer accumulation in projection onto the hard palate region of the lesion. Surgery comprised the complete removal of the hard palate with primary reconstruction of the defect by means of a fasciocutaneous forearm flap. Histologically, cells of MM could only be detected sporadically and without evidence for osseous invasion, corresponding to a stage I disease. Tumor-board recommended no adjuvant therapy. One year after treatment, the patient is disease-free and had no functional deficits concerning speaking, swallowing or eating. Conclusion: The tendency to recur and the aggressiveness of a mucosal MM make a radical surgical approach essential. Even larger defects can be reconstructed without or minimal functional deficits. Therefore, and in order to evaluate adjuvant therapy options, the treatment in correspondingly aligned oncological centers should be performed. Keywords: malignant melanoma, palatal mucosa, recurrence

Infections in the mouth, jaw and face are mostly seen as infiltrates or abscesses with odontogenic cause. With little diagnostic effort we can quickly reach the desired treatment success through a causal therapy. A diagnostic and therapeutic challenge represent atypical disease process, which are located in various medical disciplines and are difficult to assign to an agent. In our case report, we represent a immunocompetent 42-year-old patient with no systemic diseases, which envisioned a massive upper lip swelling with bullous-phlegmonösem appearance. There was a detailed diagnostics and interdisciplinary investigation of the disease, which ultimately led to the diagnosis of kerion celsi. This is the maximum variation of tinea barbae, which is often accompanied by severe infiltration, pustule, abscess formation and hair loss. The disease proceeded despite intravenous and topical treatment with antivirals and antibiotics initially progressive. There were also pronounced thrombophlebitis at various intravenous access points, and an infestation on the right arm. Tropical and rheumatoid diseases were excluded as consultants. A pathology proof was not achieved despite multiple samples were taken. The disease was also assessed from different disciplines (Dermatology, Rheumatology, Internal Medicine) differently. Among systemic and topical antifungal therapy ultimately showed a regressive course and corroborated the diagnosis of kerion celsi. Kerion celsi often complicates diagnostics in oral and maxillofacial surgery. It represents the maximum variation of dermatophytosis and is often accompanied by secondary bacterial infections, and requires a long-term systemic therapy. Keywords: Vasculitis, infection, upper lip swelling, impetigo, erysipelas, pathergy phenomenon, thrombophlebitis, cellulitis, herpes zoster, kerion celsi

Introduction: The SAPHO syndrome involves the rare disease pattern of the chronic recurrent multifocal osteomyelitis (CRMO), which mostly appears in childhood and young agers. The diagnosis delays when there is participation of the facial bones since the leading symptoms of osteomyelitis often cover up further symptoms of CRMO. The aim of the following presentation is to point out the possibility of the existence of CRMO against the background of juvenile osteomyelitis. Case Report: A 15-year-old healthy boy was admitted to our department with a swelling of his left cheek. The clinical and radiological diagnostics showed a submucosal abscess emanating from the tooth 36 associated with a vast ostitis surrounding its roots. The treatment comprised oral antibiosis, intraoral incision and extraction of the tooth throughout the sub-acute interval. After 4 weeks, the boy presented further complains caused by an obviously interrupted wound healing. The computer tomography of the lower yaw and the bone scintigram displayed the probable cause for this; namely an osteomyelitis. A probe of tissue taken from the inflammated area confirmed the diagnosis. Consulting the pediatric and dermatologic department, the diagnosis of CRMO could be denominated by the implementation of the existence of acne and pustulosis. The following treatment included a corticoid-pulse-therapy. Since then, the patient did not show further discomfort or relapse. Conclusion: The development of an interrupted wound healing like osteomyelitis in juvenile patients needs enhanced treatment, involving different medical departments. In particular, CRMO has to be taken into account for diagnosis determination. Keywords: CRMO, SAPHO, corticoid-pulse-therapy

Introduction: Tumor growth and progression goes hand in hand with a functionally vascularity. Till now the molecular basics are not fully understood. In this investigation the gene expression of ANGPT1 and ANGPT2 was analysed and correlated to each other. Further the gene expression and the ratio were compared to clinical parameters. Material and Method: The gene expression patterns of ANGPT1 and ANGPT2 from 83 OSCC samples were analysed. Data were correlated to each other and to clinical parameters. The statistical analysis was done with SPSS (version 22) Results: ANGPT1 and ANGPT2 showed a contrary gene expression. Relating to tumour size ANGPT1 is down regulated and ANGPT2 is up regulated. Relating to differentiation grade ANGPT1 is up regulated (p > 0.0001***) in G1 and down regulated in G2 and G3. The expression ratio of ANGPT1/ANGPT2 increases with tumour size (p > 0.007**) and differentiation grade (p > 10-8****). Conclusion: On the basis of our results, expression ratio of ANGPT1/ANGPT2 is a potential prognostic factor for tumour angiogenesis, growth, and aggressiveness. Keywords: gene expression, OSCC, angiopoetine

Background: Ewing sarcomas are among the most frequent malignant bone tumors among children and young adults. Extraskeletal Ewing sarcomas are a rarity, even more so within the Head&Neck-Region.. Worldwide there are only a handful of cases published. Methods: A 20 years old male patient was presented to our clinic by a colleague in private practice. He had removed a pea-sized pediculated tumor from the anterior base of the mouth which he considered to be a granuloma. The histopathological analysis unveiled a Ewing sarcoma which was validated by two further reference labs. We proceded to perform an exended excision around the basis of the former tumor pedicule. Within the specimen no remains of the sarcoma could be found. The consecutive radiological diagnostics - MRI & 18F FDG-PET/CT - did not reveal any remaining tumor as well as no suspicious structures for metastasic disease. The interdisciplinary tumor conference agreed upon an adjuvant radio-chemotherapy. This recommendation, however, was rejected by the patient. For this reason consecutive clinical and radiological (MRI and PET/CT) follow-ups were arranged with the patient on a short-time interval basis. For 60 months the patient has been involved in follow-up surveillance. Up tll now there has been no sign of relapse or metastasis. Conclusion: For the treatment of Ewing sarcomas within children and young adults an established S1-Guideline (AWMF) exists that aim primarily at the treatment of skeletal manifestations. For the treatment of Ewing sarcomas of soft tissue, especially within the Head&Neck-region, the guideline presents us with a challenge regarding borders of resection. Despite being a very rare disease specific therapy guidelines should be available also fort he Head&Neck-region. Keywords: Extra-skeletal ewing sarcoma, intra oral sarcoma, sarcoma treatment

Necrotizing fasciitis (NF) is rare but potentially life threatening thus immediate diagnosis and intervention is required. NF is a rapidly spreading infection of the deeper layers of the skin, subcutaneous tissues with extension along fascial planes and subsequent necrosis. In most cases it is caused by group A streptococcus. The port of entry is often local. Keywords: necrotizing fasciitis - head - neck - mediastinum

Background: Computer-assisted 3D planning combined with CAD/CAM-wafers is more and more common in orthognathic surgery. Nevertheless, the adjustment of the vertical position of the maxilla still stays difficult with this method. Fixation of the mandible to the zygoma using osteosynthesis as a reference is a possible solution. Objectives: Aim of the study was to evaluate the precision of maxillary movement using CAD/CAM-wafers combined with temporary fixation of the mandible. Methods: 10 bimaxillary operations were virtually planned on base of a CT-scan followed by performing a virtual Le-Fort-I-osteotomy with digital maxillary advancement. For transferring the planned position of the maxilla into the operation site CAD/CAM-wafers were generated. Fixation of the mandible to the zygoma was performed using a conventional wafer representing the habitual occlusion. To evaluate the accuracy of this method pre- and postoperative CT-scans were compared by measuring the 3D-deviation of five occlusal landmarks defined on a scanned digital dental impression which was superimposed to the CT-datasets. Findings: The median deviation over all landmarks was 0.76mm. There was a median deviation of 0.97mm in transversal, 0.62mm in sagittal and 1.05mm in vertical plane. The maximal deviation between planning and postoperative results was 2.03mm in the transversal, 2.23mm in the sagittal and 2.58mm in the vertical plane. There was no significant difference between all 3 planes with a generally high precision itself. Conclusion: The method shows to be very precise with a good clinical applicability. However, using mandible fixation for vertical reference prolongs the surgical procedure for approximately 30-45 minutes. Keywords: orthognatic surgery, 3D planning, CAD/CAM generated splint, accuracy