Introduction: One of the basic chronic diseases of the MFH domain that is treated on an outpatient basis is temporomandibular dysfunction (TMD). It represents a number of pathological conditions that lead to the dysfunction of the normal function of the stomatognatic system. Observing the etiologic factors of this condition, temporomandibular TM trauma, poor habits such as infantile type of swallowing, tongue depression, and tectogenic disturbance of the myofunctional squamous system are reported in order to reconstruct the defects of neighboring regions. Material and Methods: The study included 60 patients divided into 3 groups: Group I without predetermined temporomandibular dysfunction, Group II with TMD, and Group III where one of the muscles of the masticatory group was used during the reconstruction procedure. Results: Statistically obtained results show that in group III there is a large difference in postoperative measurement after 6 weeks. Discussion: In the mentioned patients divided into three groups, the measurement of the pressure strength expressed in N follows certain states with it measured values, which coincides with comparative studies. Conclusion: From the obtained results we conclude that the parameter used, the strength of the lower jaw bite is a significant indicator of the chewing system functioning.

Introduction: Flap of the temporal muscle (m. temporalis) with its natural position, its mass and its length, compared with other bound and free microvascular flaps, is the method of choice for covering the middle part of the face after the removal of large tumor masses. Material: The study included a sample of 36 patients who were surgically treated due to malignant process at the middle face level with the performed partial, total or bilateral maxillectomy at the Clinic for Maxillofacial Surgery, University Clinical Center in Sarajevo. The sample is divided into three groups. Methods: The usual procedure of lifting the temporal flap in the first group, at the second extension of the coronoid processus. A group of three-elongated myofascial flap, which includes lifting the muscle along with deep temporal branches of maxillary artery with deep temporal fascia, its two layers and associated stem of thesuperficial temporal artery. Results: Statistical analysis of the length indicated that in group III the mean length was 9.83 cm, group II- 8.25, and group I- 6 cm. The longest segmental lobe in group three provides safer work and the length of the lifted lobe with double vascular stem. This provides coverage of defects that cross over the median line of the middle face. The results coincide with the comparative world studies. Conclusion: For large defects at the meddle part of the face that overlap the median line, an extraordinary solution is elongated myofascial flap with double vascular supply, with a larger flap mass and a length of about 9.83 cm.

Oral melanoma (OM) occurs from activated or genetically altered epidermal melanocytes. There is no scientific evidence that OM can be linked to physical, chemical and thermal irritation, or to other risk factors of the oral cavity. According to fi gures from various countries, OM accounts for 0.2% to 7.5% ( Japan) of all cases of melanoma of the skin and mucous membrane. The male to female ratio of OM is 2:1. About 80% of OMs are located in the mucosa of the palate and maxillary gingiva. This paper presents two cases of oral mucosal melanoma of the upper and lower lips in women aged 62 and 59 years. Diagnosis, differential diagnosis and therapy are reported.

AIM To investigate an incidence of recurrence of pleomorphic adenoma of the parotid gland in relation to the choice of surgical procedure. METHODS All patients with a diagnosis of pleomorphic adenoma of parotid gland who underwent surgery at the Department of Maxillofacial Surgery (MFS) of the Clinical Center of the University of Sarajevo (CCU), Bosnia and Herzegovina, in the period 01 January 1992 - 31 December 2010 were included in the study. The incidence of recurrence and complications in relation to the choice of surgical procedure (enucleation, excision of the tumor, superficial parotidectomy and total parotidectomy) as well as the choice of diagnostic procedures were compared. For all variables measured the arithmetic mean (x), standard deviation (SD), the correlation coefficient (r), and χ 2 test were used. RESULTS A total of 81 operations were performed on 60 patients. The highest recurrence rate was after enucleation (88.9%), then after excision (46.9%), and the least after superficial (4%) and total parotidectomy (0%). The highest number of complications was noted after the surgery of recurrence (8.3%), because it was difficult to preserve facial nerve in the previously treated area. CONCLUSION Both total or superficial parotidectomy were optimal surgical procedures which, if applied at the first surgery of pleomorphic adenoma, provided almost 100% certainty of healing. All subsequent surgeries carry a higher risk of complications, e.g. severe lesion of facial nerve.

UNLABELLED Aim of the study was to present the best methods for reconstruction of extensive defects after removal of the head and neck cancer. INTRODUCTION Key to success of reconstrucive surgery is choosing an appropriate option that aim at single stage replacement of lost tissue and provide the integrity, function and aesthetic outcome in a perfect balance. PATIENTS This descriptive study was carried out between march 2009. And march 2013. at the Clinic of Maxillofacial surgery, Clinical center of University of Sarajevo, Bosnia and Herzegovina. A total number of 483 patients with extensive defects were included. RESULTS Most of the patients 421 (87%) were males. The diagnosis of squamous cell carcinoma was present in 355 (73.5%) cases wich was statistically significant. Pectoralis major myocutaneous flap was the most common reconstruction method, in 267 (55.3%) cases. Second common method used were local flap 147 (30.4%), then temporal flap 36 (7.5%). Infrahyoid flap, latissimus dorsi, radial forearm free flap and free fibula graft were also used. The prevalence ofpectoralis major myocutaneous flap was statistically significant. The most comon complication among donor and recipient side was hematoma. Total flap necrosis occured in 9 (1.9%) patients. Comparing donor and recipient side in common complications there were no statistical significant difference. CONCLUSION Wich technique for closure to choose depends on the complexity of defect. The pectoralis major myocutaneous flap continues to be the most universal flap in head and neck reconstruction.

INTRODUCTION The relationship between the optic disc size, neuroretinal rim and cup diameter is the key in identifying glaucomatous changes in optic nerve head. Like some other biological characteristics, changes of the optic disc differ among healthy populations, thus hindering detection of pathological changes. MATERIAL AND METHODS From the total number of 90 patients, we selected those that have optic disc diameter less than 1.30 mm, greater than 2.10 mm, as well as patients with a size of disc diameter ranging from 1.31mm to 2.09 mm. In all patients after anamnesis and standard ophthalmologic examination (best corrected visual acuity-BCVA, Goldman aplanatic tonometry, pachymetry, gonioscopy), we also performed the OCT analysis of the optic nerve head. RESULTS AND DISCUSSION Glaucomatous changes in small optic discs may remain unnoticed unless there is a high degree of suspicion. The assesment of the optic disc size is an important, but often overlooked component of the diagnostic evaluation in glaucoma. There was a statistically significant strong positive correlation between the size of the optic disc diameter and cup diameter, larger optic disc diameter means greater cup diameter. Due to the large variation in the cup size in healthy subjects, the assessment of the morphology of the neuroretinal rim or cup diameter can be more helpful in evaluation of glaucomatous optic disc damage than the value of C/D ratio itself. CONCLUSION Evaluation of the optic disc size and C/D ratio is an essential part in diagnostic procedure and management of glaucoma. OCT analysis in patients with small optic disc diameter showed the least sensitivity in all three categories (normal, abnormal and uncertain OCT results). The OCT results in the small optic disc diameter are the least reliable in the diagnosis of glaucoma. More complexed long-term study is needed to evaluate this complicated relations between optic disc diameter, C/D ratio, neuroretinal rim and other important clinical factors in emerging glaucoma disease.

Orbital defects after malignant tumor removal represent a major problem for satisfactory reconstruction. Treatment and surgical reconstruction according to the regular surgical protocol improves with each new case contributing to continuous improvement of surgical techniques in order to achieve better reconstruction of the defect. In our modification in 20 patients there was presented a new method of reconstruction of the defect where the orbits included also a part of the muscle (sternocleidomastoid muscle) for better stabilization at the desired position on the immediate ocular prosthesis installation site in order to quickly overcome the postoperative defect after orbital exenteration. Application of modified temporoparietal slice gives good functional and cosmetic results, and is recommended to be used for reconstruction of defects after orbital exenteration.

INTRODUCTION Understanding technique of flap surgery allow uncompromising tumor resection and operation of tumors previously considered inoperable. Infrahyoid neuro-myocutaneous flap (IHNMCF) is pedicled flap harvested from the anterior part of the neck. IHNMCF is a good solution for the moderated sized defects of the head and neck below the zygomatic arch. The objective of this article was to describe modified infrahyoid neuromyocutaneous flap used for reconstruction of tongue and mouth floor defects, immediate after removing neoplasm. CASE REPORT A 63 year old patient were hospitalized with pathohistologically confirmed-squamocellular carcinoma. The tumor were in the region of the ventral part of the mouth. Magnetic resonance imaging (MRI) and ultrasound investigation of the head and neck showed detectable nodes in the right side of the neck and suspicious nodes in the left side of the neck. Through the transmandibular approach it was performed a wide local excision of the tumor. IHNMCF was harvested from the right side. It was performed meticulous microvascular procedure venous end-to-end anastomosis of the right superior thyroid vein to the left superior thyroid vein. Patient is during procedure subjected to the supraomohyoid neck dissection on the left side and radical neck dissection on the right side. DISCUSSION AND CONCLUSION Disadvantage of this modified infrahyoid flap is the extremely limited arc of rotation. This seriously limits its applications to specific situations, where defects are located very close to the flap. Othervise, advantage of this modified flap is that radical neck dissection is not contraindication anymore. In this case flap was successful, without flap necrosis or complications in the donor side. Speech and swallow were without significant decrease. After radiation therapy flap remained sufficiently soft, trophic and mobile.

INTRODUCTION Pedicled temporalis muscle flap presenting a good flap for closing large craniofacial defects. Careful surgeons usually do not mobilize temporalis muscle flap enough to make appropriate use, fully closure, especially if defect exceeds the median line. PATIENTS AND METHODS Temporalis flap was used in 16 patients, ages ranged between 12 and 76. In all cases defect reconstruction was done by useing new method of extending standard temporal muscle flap. During surgical procedure it is very important to keep periosteal elevator in close contact with the bone. Then, there is no risk for pedicle injury. After vascular pedicle is identified elevating temporal muscle has to be continued by releasing the muscle insertion from the coronoid process. By this way, flap length and arc of rotation is increased. RESULTS The flap remained viable in all instances. Most of the patients experienced no perioperative complications. There was no major complications or mortality as a result of performed procedures. CONCLUSION With this division, flap length was increased at least 2 cm wich is enough for covering defects crossing the midline. Instead of using bilateral temporalis muscle flaps for defect closure, unilateral is sufficient. With this extension of the pedicle length now rotation point is not at the level of the zygomatic arch but lower part mandibular neck.

UNLABELLED The aim of this study is to determine relationship between oral hygiene and colonisation of Candia species in oral cavity. INTRODUCTION Maintenance oral hygiene is reducing pathological agents in the mouth and preventing violation of oral health. MATERIAL AND METHODS Study included 140 patients. For oral hygiene assessement were used the dental plaque index, oral hygiene index and dental calculus index. Ph test strips were used to determine pH of saliva. For isolation of Candida species oral swabs were taken to all patients. RESULTS It was found out that pH of oral cavity does not varies notably, no matter of oral hygiene level. Candida species were identified in 28.6% respondents. The most present were Candida albicans, in 85% cases. The presence of plaque, tartar and high index oral hygiene (IOH) in patients with Candida is statistically significant. It was found that 83.4% of patients with Candida poorly maintained oral hygiene. Poor oral hygiene is associated with a significantly higher score in the presence of tartar, plaque and high IOH. In total patient's population 67% has amalgam fillings. Presence of amalgam fillings in patients with identified Candida was statistically significant. CONCLUSION This study indicates low level of oral hygiene. Correlation between presence of Candida species and poor oral hygiene was proved. Also Candida was more present among patients with amalgam fillings. Improvement of oral hygiene is necessery for oral health and health in general, as well.

Introduction: Early diagnosis is the key to a good prognosis in treatment of maxillofacial malignant tumors and diagnostic delay can lead to metastasis and to adverse health outcomes. Delay can be classified to the: delay associated with patient and as delay associated with the healthcare professional. Aim: The aim of this study was to show importance of early detection of maxillofacial malignant tumors and establishing doctrine in diagnostic procedure. Patients and methods: In this 10 years retrospective study were evaluated 146 patients with diagnosed maxillofacial malignant tumors. Results: We find out that most of the patients after became aware of symptoms visited phyisician within 2 months (42%), within 6 months 25 % of patients visited physician, 20% in a period between months and one year, and still there is about 13 % of patient who shows up after more than a year. In this study 70 patients examined by specialist two weeks after their first visit to the doctor, 58 patient were under some treatment (diagnostic or therapeutic) in primary care first month and 18 patients stayed under some kind of treatment without specialist examination more than a month. Testing delay was 9 days median between completion of tests and presentation to the board. In this study average treatmant delay lasts 3 days. Conclusion: Against delay of treatment is very important education of population, mobilizing healthcare professionals, the most important point in wich we can reduce delay and not waste precious time is not to use inappropriate diagnostic and terapeutic tehnique, but to refer the patients in referral center where will be implemented appropriate diagnostic procedure. .

Frontal sinus fractures make up about 2-15% of all facial fractures.This is relatively low frequency of occurrence, but it has a large potential of complication and may involve not only the frontal sinuse but more importantly the brain and the eyes. The management depends of the complexity. If anterior wall is fractured with grossly involved nasofrontal duct (NFD) in the injury it is paramount to occlude NFD. Very often, sinus obliteration is done at the same time. In our expirience autogenous cancellous bone graft is considered to be the best grafting material. It has the less short - or long-term complications and the donor site morbidity is insignificant.

Introduction: Cranial base surgery is presenting a great challenge for every maxillofacial surgeon and neurosurgeon. Diagnostic procedure, MRI and CT are absolutely essential for visualizing this area. Aim: The aim of this study was to compare two diagnostic procedures and to determine which method is more sensitive in detecting the skull base encroachment. Patients and methods: In twenty cases, where there clinically confirmed malignant tumors of the maxillofacial region, were performed CT and MRI scan. Results: We found out that MRI discovered more precisely intracranial spread than CT, and there was significant difference between distribution of the results in the MRI and CT diagnostic procedure (p

A cutaneous horn is a uncommon and rare lesion. It is a conical projection of hyperkeratotic epidermis. Vary from a few milimeters to a several centimeters in length. The cutaneous horn is a clinical diagnosis and different histologic lesions have been documented at the base of the keratin mound. We presented a 77 years old female with a large "horn" of 3 years duration, arising from her forehead. Excision was performed and defect was covered by split thickness skin graft. Hystopathology reported keratoacanthoma at the base of the horn. By reviewing cutaneous horns presented in literature we can declare that this is one of the biggest cutaneous horn recorded cases. Also it is important to mention that horn itself is not the most important issue, but rather the underlying condition, which may be malignant.