Siegfried Jank

Bio: Siegfried Jank is an academic researcher from University of Innsbruck. The author has contributed to research in topics: Temporomandibular joint & Orbital Fracture. The author has an hindex of 12, co-authored 24 publications receiving 598 citations.

Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study.

Abstract: Objective. The purpose of the study was to investigate whether a flexible, biodegradable material (Ethisorb) shows better long-term results with regard to diplopia, bulbus motility, and exophthalmos/enophthalmos compared to the use of lyophilized dura-patches and polydioxanone (PDS) foils. Methods. During a period of 6 years 435 patients with an orbital fracture were investigated retrospectively. Inclusion criteria were patients with fractures of the orbital floor with a maximum size of 2 × 2 cm. Bulbus motility, exophthalmos, enophthalmos, and diplopia were investigated during a period of 2 years. Results. One hundred twenty orbital floors were reconstructed by lyophilized dura-patches, 81 by PDS, and 136 by Ethisorb. An exploration without an implantation was performed in 91 patients. The long-term investigation 12 to 15 months after surgery showed an exophthalmos and enophthalmos incidence of 1%, whereas a reduced bulbus motility and diplopia were found in 5% and 4%, respectively. Fifteen to 24 months after surgery 2% of the patients had an exophthalmos and 1% had an enophthalmos. A reduction of bulbus motility was found in 4% of the patients, and diplopia was found in 3%. The use of Ethisorb resulted in a significantly lower incidence of exophthalmos 3 months after surgery compared to PDS. Conclusion. The low rate of acquired bulbus motility demonstrates acceptable results in using Ethisorb in the floor of the orbit. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:16-22)

Clinical signs of orbital wall fractures as a function of anatomic location.

Abstract: Objective The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor. Study design The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component. Results Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence ( P = .001) of diplopia and exophthalmos ( P = .039) than fractures without involvement of the medial wall. Conclusion Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.

Disk Displacement of the Temporomandibular Joint: Sonography Versus MR Imaging

Abstract: OBJECTIVE. The purpose of this study was to determine the value of dynamic sonography in the evaluation of internal derangements of a temporomandibular joint (TMJ) during maximal mandibular range of motion.SUBJECTS AND METHODS. Maximal mandibular range of motion was performed during high-resolution sonography of the TMJ in 64 consecutive patients (128 joints; nine males and 55 females; age range, 17-65 years; mean age, 35 years 6 months), all of whom subsequently underwent MR imaging. MR imaging confirmed disk displacement with reduction in 27 joints and disk displacement without reduction in 60 joints of the 128 examined. The high-resolution sonography and MR imaging findings for these 27 and 60 TMJs, respectively, were analyzed.RESULTS. Dynamic high-resolution sonography performed during the maximal range of motion helped to detect 81 instances (93%) of internal derangement, 22 instances (82%) of disk displacement with reduction, and 50 instances (83%) of disk displacement without reduction. There was o...

High-resolution ultrasonography of the TMJ: helpful diagnostic approach for patients with TMJ disorders ?

Abstract: SUMMARY. Purpose: The purpose of this study was to investigate patients with a clinical diagnosis of internal derangement to determine the diagnostic value of static high resolution ultrasonography (HR-US) when compared with magnetic resonance imaging (MRI). Patients: Sixty-six patients (132 temporomandibular joints [TMJs]) with a clinical diagnosis of internal derangement were investigated by HR-US and MRI. Methods: MRI and HR-US investigations were performed by experienced radiologists. The sonograms were done with a real-time 12-Mhz linear-array scanner. The HR-US interpretation errors were re-evaluated retrospectively by the same radiologist knowing the MRI results by comparing these with the ‘prospective’ and ‘retrospective’ diagnoses. The prospective and retrospective diagnoses were also compared with each other. Results: Eighty-seven of the 132 TMJs had a disc displacement proved by MRI in the closed-mouth position. At maximum mouth opening, 54 TMJs had a disc displacement. The prospective interpretations showed a sensitivity and specificity of 78% each, accounting for an accuracy of 78%. At maximum mouth opening, HR-US resulted in a sensitivity of 61%, a specificity of 88% and an accuracy of 77%. The retrospective interpretations yielded a sensitivity of 90%, a specificity of 84% and an accuracy of 88% in the closed-mouth position. At maximum mouth opening, HR-US showed a sensitivity of 73%, a specificity of 95% and an accuracy of 86%. Conclusion: HR-US is suitable for the detection of disc displacements in the TMJ. However, further studies may be warranted to reduce the proportion of false-positive interpretations, thereby avoiding the application of unnecessary treatment. r 2001 European Association for Cranio-Maxillofacial Surgery

Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography.

Abstract: OBJECTIVE. The purpose of our study was to evaluate the diagnostic performance of sonographic elastography and B-mode sonography individually and combined in the differentiation of reactively and metastatically enlarged cervical lymph nodes.SUBJECTS AND METHODS. Eighty-five lymph nodes (metastatic, n = 53; reactive, n = 32) from 37 patients were examined by both elastography and B-mode sonography in this prospective study. Elastographic patterns were determined on the distribution and percentage of the lymph node area with high elasticity (hard), with pattern 1 being an absent or very small hard area to pattern 5, a hard area occupying the entire lymph node. The cutoff line for reactive versus metastatic was set between patterns 2 and 3; patterns 3–5 were considered metastatic. B-mode sonographic diagnosis was based on the sum of scores for five criteria: short-axis diameter, shape, border (regular or irregular), echogenicity (homogeneous or inhomogeneous), and hilum (present or absent). The cutoff line f...

High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound.

Abstract: Objective To determine the prevalence of temporomandibular joint (TMJ) disease in a cohort of children with new-onset juvenile idiopathic arthritis (JIA), and to compare magnetic resonance imaging (MRI) with ultrasound (US) for the detection of acute and chronic changes of TMJ arthritis. Methods Between January 2005 and April 2007, children with newly diagnosed JIA were prospectively evaluated for TMJ arthritis. Prior to imaging, jaw pain and disability were assessed with questionnaires and physical examination. The TMJs of all patients were imaged with MRI and US within 8 weeks of diagnosis. Results Of the 32 patients enrolled, 78% were female, and the median age was 8.6 years (range 1.5–17.2 years). Acute TMJ arthritis was diagnosed in 75% of the children by MRI and in none by US; chronic arthritis was diagnosed in 69% by MRI and in 28% by US. Findings of both acute and chronic TMJ disease were detected by MRI in 53% of the patients. Of those with acute TMJ arthritis, 71% were asymptomatic, and 63% had normal findings on jaw examination. Fifty-six percent of patients with acute disease had an improved maximal incisal opening after corticosteroid injection. Among these responders, 56% had been asymptomatic and had normal jaw examination findings. Conclusion TMJ arthritis was present in the majority of patients with new-onset JIA. Findings on MRI along with responses to treatment among asymptomatic patients with normal jaw examination findings suggest that a history review and physical examination are not sufficient to screen for TMJ disease. Our results also suggest that MRI and US findings are not well correlated, and that MRI is preferable for the detection of TMJ disease in new-onset JIA.

Retrospective analysis of orbital floor fractures—complications, outcome, and review of literature

Abstract: This retrospective study aimed at investigating indications, surgical approaches, and the materials used for orbital floor reconstructions, as well as the clinical follow-up, particularly with regard to postoperative complications This study comprised 189 patients who underwent surgery for fractures of the orbital floor between 2003 and 2007 Diagnosis and treatment were based on both physical examination and computed tomography scan of the orbit Patients were retrospectively analyzed for data, such as mechanism of injury, classification of fracture, and complications The most common cause of injury was physical assault followed by traffic accidents Surgery was conducted with a mean delay of 29 days after the incident Mid lower eyelid incision was the most common surgical approach to the orbital floor For orbital floor reconstruction, polydioxanone sheets (705%) were mainly used, followed by Ethisorb Dura (233%) and titanium mesh (62%) There were 190% of patients who showed postoperative complications: 58% suffered from persisting motility impairment, 37% from enophthalmos, 32% from consistent diplopia, 26% from ectropion, and 05% from orbital infection Intraorbital hematoma (32%) represented the most severe complications, one patient suffered lasting impairment of sight and another one, complete blindness of the affected eye If postoperative impairment of vision becomes evident, immediate surgical intervention is mandatory Retrobulbar hematoma is more likely to occur in heavily traumatized patients with comminuted fractures and also in patients taking anticoagulative medication The subciliary approach to the orbit and repeated operations by the same approach are associated with a higher risk of developing ectropion