Emeka NKENKE

Today there are numerous conditions that might require the administration of antiresorptive medication. Osteoporosis, chronic recurrent multifocal osteomyelitis and bony metastases of malignant tumors are examples. Typical examples of this kind of medication are Denusomab (e.g. Prolia, Xgeva) or bisphosphonates (e.g. Fosamax, Bonviva, Zometa). An important adverse effect is the development of an osteonecrosis of the jaws that is characterized by exposed bone, halitosis, pain and pus formation. The treatment of this condition is dependent on the extent of the osteonecrosis and the general health condition of the patient. Whenever possible a conservative approach is adopted that avoids surgery. However, sometimes the removal of the necrotic bone might become necessary.

The placement of dental implants is a very effective approach to restore chewing function. Teeth might get lost due to trauma, periodontal disease or trauma. Especially, when a trauma has occurred the aim is to place implants immediately to prevent bone resorption. However, often the bone volume will be inadequate in the regions where implants are needed. In these cases there is a need for bone augmentation procedures in order to facilitate implant placement. Today there are numerous different approaches to bone augmentation that have to be selected carefully. Autogenous bone or artificial bone substitutes might be chosen for the procedures. Implants can be placed immediately or after a healing period of the bone grafts of some months. Depending of the individual patient case also computerized planning and the adoption of guided implant surgery can make sense in order to make this kind of surgery as comfortable as possible for the patient. After a healing period of approximately 3 months the implants will be restored with artificial crowns.

Since more than two decades Prof. Nkenke is practicing cleft lip and palate surgery. He is performing the closure of the lip as well as the palate on a regular basis. Naso-alveolar molding is included in the treatment concept. Typically, the lip repair is performed by the end of the third month while the repair of the palate can start from the 6 th month on. At an age of around 11 years also additional bone grafting of the alveolar cleft might become necessary. In order to offer a comprehensive treatment approach, Prof. Nkenke is has built an interdisciplinary team (otorhinolaryngologist, speech pathologist, orthodontist, pediatric dentist, psychologist) that can handle all the issues that children with the given malformation and their parents might come across. Prof. Nkenke also has specialized in secondary corrections. These include rhinoplasty, corrective surgery to the lip and advancement of the maxilla.

Prof. Nkenke treats craniomalformations like craniosynostosis (e.g. oxycephaly, plagiocephaly, skaphocephaly, trigonocephaly) in an interdisciplinary team together with a neurosurgeon. Depending on the complexity he might choose to perform virtual surgical planning and the use of surgical cutting guides for the reshaping of the cranial vault. Patients who suffer from M. Apert or M. Crouzon often suffer from a hypoplastic midface resulting in the inability to close the eyes completely and problems with breathing that sometimes even can cause sleep apnea. Midfacial advancement on the LeFort III level solves these issues. Prof. Nkenke performs computerized planning of these interventions on a regular basis. It is well known that the most stable result of the advancement of the midface is achieved by distraction osteogenesis. Therefore, Prof. Nkenke performs this kind of surgery with buried internal distraction devices that are almost invisible and do not impair the social activities of the child.

Several different conditions can cause cysts. These cysts can be the consequence of delayed eruption of teeth, of infections or benign or sometimes even malignant tumors. By harvesting biopsies benign and malignant tumors have to be ruled out. In the next step depending on the size of the cyst a decompression (cystostomy) will be performed. This approach allow for spontaneous bony regeneration of the cystic lesion and reduces the risk of damaging of adjacent structures like teeth or nerves to a minimum. An alternative is the complete removal of the cyst (cystectomy) that might also include filling of the defect with autogenous bone or bone substitutes. Depending on the clinical and radiological presentation of the individual case the treatment concept will be chosen.

Prof. Nkenke uses distraction osteogenesis as an alternative to conventional bone grafting when a bony defect has to be filled. He also adopts this technique in craniofacial surgery and orthognathic surgery when a pronounced advancement of the maxilla is needed. Depending on the complexity of the procedure Prof. Nkenke will choose computerized planning and patient specific distraction devices. Distraction osteogenesis yields stable results and avoids harvesting of bone from additional surgical sites.

Fractures of the facial bone typically occur as a result of trauma especially during sports or conventional falls. The fractures can affect mandible as well as maxilla. Typically, the treatment should be performed as soon as possible. It includes the reduction of the fracture and its stabilization by titanium plates and screws. Today in most of the cases there is no need to restrict mouth opening after the surgery by maxillo-mandibular fixation. For cases of fractures of the orbital floor Prof. Nkenke recommends the use of individually planned, prefabricated, patient specific metal sheets for reconstruction. If a fracture should have healed in an inadequate position because there was no possibility to treat the fracture adequately, when it happened, Prof. Nkenke will be happy to correct the shape of the jaw and to bring it back to a position where the patient will be able chew again in a normal way.

The placement of dental implants is a very effective approach to restore chewing function. Teeth might get lost due to trauma, periodontal disease or trauma. Especially, when a trauma has occurred the aim is to place implants immediately to prevent bone resorption. However, often the bone volume will be inadequate in the regions where implants are needed. In these cases there is a need for bone augmentation procedures in order to facilitate implant placement. Today there are numerous different approaches to bone augmentation that have to be selected carefully. Autogenous bone or artificial bone substitutes might be chosen for the procedures. Implants can be placed immediately or after a healing period of the bone grafts of some months. Depending of the individual patient case also computerized planning and the adoption of guided implant surgery can make sense in order to make this kind of surgery as comfortable as possible for the patient. After a healing period of approximately 3 months the implants will be restored with artificial crowns.

Today there are numerous conditions that might require the administration of antiresorptive medication. Osteoporosis, chronic recurrent multifocal osteomyelitis and bony metastases of malignant tumors are examples. Typical examples of this kind of medication are Denusomab (e.g. Prolia, Xgeva) or bisphosphonates (e.g. Fosamax, Bonviva, Zometa). An important adverse effect is the development of an osteonecrosis of the jaws that is characterized by exposed bone, halitosis, pain and pus formation. The treatment of this condition is dependent on the extent of the osteonecrosis and the general health condition of the patient. Whenever possible a conservative approach is adopted that avoids surgery. However, sometimes the removal of the necrotic bone might become necessary.

Reconstructive surgery of the head and neck is performed to close bony and/or soft tissue defects that can be present as the consequence of trauma or tumors. The aim is to restore function (e.g. speech, chewing, swallowing) and an unobtrusive facial appearance. Different bone grafts and soft tissue grafts can be harvested from different regions of the body and will be transferred to the defect. Sometimes free flaps have to be adopted that require microvascular surgery in order to secure an independent vascularization of the flaps. Prof. Nkenke has specialized in this kind of surgery and is happy to provide a comprehensive planning of the surgery (including computerized techniques) and patient specific implants in order to come as close as possible to the situation before the defect occurred.

A certain percentage of the population is prone to bone resorption around the natural teeth as a consequence of chronic infection. Patients typically suffer from mobile teeth, pain, swelling of the gums and pus formation. The aim of periodontal surgery is the removal of the infection and the reconstruction of the bone in order to restore stability of the teeth. Depending on the severity of the disease the surgery can be performed under local anesthesia. If there should be a generalized pronounced infection, general anesthesia is recommended.

The placement of dental implants is a very effective approach to restore chewing function. However, sometimes the bone volume is inadequate to place the implants where they are needed. In these cases there is a need for bone augmentation procedures in order to facilitate implant placement. Today there are numerous different approaches to bone augmentation that have to be selected carefully. Autogenous bone or artificial bone substitutes might be chosen for the procedures. Implants can be placed immediately or after a healing period of the bone grafts of some months. Depending of the individual patient case also computerized planning and the adoption of guided implant surgery can make sense in order to make this kind of surgery as comfortable as possible for the patient.

Reconstructive surgery of the head and neck is performed to close bony and/or soft tissue defects that can be present as the consequence of trauma or tumors. The aim is to restore function (e.g. speech, chewing, swallowing) and an unobtrusive facial appearance. Different bone grafts and soft tissue grafts can be harvested from different regions of the body and will be transferred to the defect. Sometimes free flaps have to be adopted that require microsurgery in order to secure an independent vascularization of the flaps. Prof. Nkenke has specialized in this kind of surgery and is happy to provide a comprehensive planning of the surgery (including computerized techniques) and patient specific implants in order to come as close as possible to the situation before the defect occurred.

The salivary glands (parotid gland, submandibular gland, sublingual gland) can be affected by a number of different problems. Especially, pain and swelling can bother the patient. Also there can be benign and malignant tumors that need close attention. Depending on the individual condition of the patient Prof. Nkenke is happy to offer the adequate treatment that might be endoscopically or might require partial or total removal of the gland.

The maxillary sinus often is affected by infections. Depending on the cause of infections different approaches have to be chosen to fix the problem. Especially, it is necessary to rule out dental causes for the infection. Prof. Nkenke is able to perform the surgery endoscopically or to choose a different approach depending on the cause of the condition.

Sleep apnea is a complex condition that impairs quality of life, seriously. There are different treatment options that also include the hypoglossal nerve stimulator. Prof. Nkenke is glad to offer a wide spectrum of treatment approaches, but stresses the value of bimaxillary advancement of the jaws by rotation advancement. This kind of surgery can be performed at any age and still is one of the safest options for the treatment of sleep apena. The patients feel an immediate postoperative effect because the apnea episodes are reduced close to zero.

Prof. Nkenke has specialized in esthetic facial surgery and, therefore, is able to provide comprehensive skin cancer surgery. The aim is to remove the tumor completely while leaving the facial appearance unobtrusive. Depending on the size of the tumor and the patient’s individual tendency towards scar formation secondary corrective surgery might become necessary.

Prof. Nkenke offers the full scope of treatment of trauma to the head and neck. Whenever necessary, surgery will be planned virtually and patient specific implants will be fabricated to secure the highest quality of fracture treatment. Depending on the severity of the trauma sometimes also secondary reconstructions might become necessary that can include scar correct, rhinoplasty or soft tissue augmentation.

Prof. Nkenke provides comprehensive treatment for oral cancer. Initially, based on clinical examinations and CT or MRI scans a treatment plan is developed and discussed with the patient. In complex cases the treatment will be interdisciplinary involving an oncologist and/or and radiotherapist. The aim of the surgery is to remove the tumor completely, while leaving function (e.g. speech, swallowing, chewing) untouched. In order to avoid spread of the tumor the surgical treatment almost always includes the removal of the lymphnodes of the neck (neck dissection). Bony or soft tissue defects will be reconstructed, immediately. This procedure might include free flap surgery. The surgery typically requires general anesthesia and the length of the inpatient stay can be variable.

Prof. Nkenke offers the full scope of orbital surgery including orbital decompression and also performs upper and lower eye lid blepharoplasty. For cases of fractures of the orbital floor Prof. Nkenke recommends the use of individually planned, prefabricated, patient specific metal sheets for reconstruction.
The images of the patient case are taken from Nkenke et al. Untreated 'blow-in' fracture of the orbital floor causing a mucocele: report of an unusual late complication. .J Craniomaxillofac Surg. 2005;33:255-259.

Prof. Nkenke is happy to offer the full scope orthognathic surgery which includes virtual surgical planning and simulation of the outcome of surgery. The fixation of the jaws in the new position can performed with prefabricated patient specific metal plates. The surgery is done typically under general anesthesia. The inpatient period at the hospital does last between one and 4 days depending on the complexity of the surgery.

Prof. Nkenke is happy to offer the full scope of TMJ surgery. He performs the repair of TMJ fractures. He is also able to operate on TMJ ankylosis and to do total joint replacement. Prof. Nkenke also performs arthrocentesis and lavage arthroscopic surgery of the TMJ. Sometimes it will be necessary to treat locking or luxation of the joint by open surgery.

Prof. Nkenke is happy to offer the full scope of TMJ surgery. He performs the repair of TMJ fractures. He is also able to operate on TMJ ankylosis and to do total joint replacement. Prof. Nkenke also performs arthrocentesis and lavage arthroscopic surgery of the TMJ. Sometimes it will be necessary to treat locking or luxation of the joint by open surgery.