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ABSTRACT: Congenital auricular anomalies can be categorized either as malformational or deformational. The first are characterized by a partial absence of the skin or cartilage resulting in a constricted or underdeveloped pinna and require surgical correction. Deformations are characterized by a misshaped but fully developed pinna and are best treated by auricular molding.
Authors want to present their case load in treatment of infants affected by deformational auricolar anomalies and describe their techniques using early splinting for congenital auricular deformities, like prominent ear, lop ear, constricted ear, Stahl's ear
Between 2009 to 2011, in Maxillo and Oral Surgery Unit, a nonsurgical technique was used to treat 22 ears affected by deformational anomalies in 12 patients soon after birth. Four patients were female. This kind of nonsurgical correction of the deformed auricle was performed on lop ears (n=6), constricted ears (n=8), prominent ears (n= 4), Stahl's ear (n=4). Children more than two months old were also excluded. The mean of treatment time was 5.5 weeks.
according to the Authors and the parents 100% of treated auricles improved. Improving at the end of the molding treatment was observed in 18% of the auricles, but recurrence to one year of stopping treatment. There were not complications caused by this procedure.
The nonsurgical molding has the advantage to correct at a very early age a cosmetic abnormality, giving a natural and in the most of the time a satisfactory results, with a prevalence rate of complications of much less than surgical corrections.
European review for medical and pharmacological sciences 11/2012; 16(11):1554-8. · 1.04 Impact Factor
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ABSTRACT: BACKGROUND: Indications for treatment of patients with maxillo-mandibular malformations have to be researched both in the severity of anatomical alteration affecting the face and psychological outcomes. Indeed, it has been underlined that patients decide to undergo orthodontic and orthognathic procedure mainly for aesthetical issues. Moreover the early combined functional and surgical treatment improves relationship skills in young adults. Dealing with these "aesthetic" features pre surgical planning presents some additional challenges. Even if orthognatic surgery aims to the correct repositioning of skeletal bases but we must achieve complete patient satisfaction. AIM: The Authors present a new parameter to be considered in the planning of patients who undergo orthognatic procedure being the restitution of the face the patient would have had without any pathologic mechanism with respect of the aesthetic features of the family. MATERIALS AND METHODS: Authors identified a series of parameters discussed by Arnett et al and performed a clinical and photographic evaluation of these parameters, in latero-lateral view, directly on the relatives of the patients. A cephalometric analysis, was performed and a series of parameters has been taken into account. CONCLUSIONS: It is very difficult to standardize universal parameters acceptable and applicable for every single case, considering that patient's awareness of the anatomical defect and post-surgical satisfaction don't relate to the correct cephalometric evaluation and the real aesthetic outcomes.
European review for medical and pharmacological sciences 10/2012; 16(10):1430-1432. · 1.04 Impact Factor
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ABSTRACT: Cocaine blocks the reuptake of norepinephrine and dopamine of the sympathetic nervous system. It has a psychomotor stimulating effect that provokes euphoria, motor activity and an amplification of a well being sensation similar to the effect of amphetamines. Well known are the systemic effects of cocaine abuse (acute myocardial infarction, cardiac arrhythmias, aortic ruptures, cerebrovascular accidents). Several local effects are also documented involving above all palatal mucosa and central midface structures. The most common palatal lesions are fistulae resulting from ischemia caused by the constricting effect of cocaine on small vessels, mucosal breakdown, loss of palatal bone, and loss of nasal mucosa. IF cocaine use becomes chronic and compulsive, wider lesions may cause extensive destruction of the osteocartilagineous structures of the nose, sinus and palate, a syndrome called CIMDL (cocaine-induced midline destructive lesion). Many techniques have been described to treat these defects depending on the size and the involved structures of the face. These techniques range from local flaps to complex free flaps. The authors describe a case of a median hard and soft palatal fistula resulting from cocaine abuse treated with local bilateral palatal flaps, and analyze the most common therapeutic options described in literature.
European review for medical and pharmacological sciences 02/2012; 16(2):280-2. · 1.04 Impact Factor
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ABSTRACT: Iatrogenic injury of the inferior alveolar or lingual nerves frequently leads to legal actions for damage and compensation for personal suffering. The masseter inhibitory reflex (MIR) is the most used neurophysiological tool for the functional assessment of the trigeminal mandibular division. Aiming at measuring the MIR sensitivity and specificity, we recorded this reflex after mental and tongue stimulations in a controlled, blinded study in 160 consecutive patients with sensory disturbances following dental procedures. The MIR latency was longer on the affected than the contralateral side (P < 0.0001). The overall specificity and sensitivity were 99 and 51%. Our findings indicate that MIR testing, showing an almost absolute specificity, reliably demonstrates nerve damage beyond doubt, whereas the relatively low sensitivity makes the finding of a normal MIR by no means sufficient to exclude nerve damage. Probably, the dysfunction of a small number of nerve fibres, insufficient to produce a MIR abnormality, may still engender important sensory disturbances. We propose that MIR testing, when used for legal purposes, be considered reliable in one direction only, i.e. abnormality does prove nerve damage, normality does not disprove it.
The Journal of Headache and Pain 06/2011; 12(4):485-8. · 2.43 Impact Factor
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L Manganaro,
A Tomei,
F Fierro,
M Di Maurizio,
P Sollazzo,
M E Sergi,
V Vinci,
S Bernardo,
D Irimia, P Cascone,
M Marini
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ABSTRACT: The aim of our study was to investigate the role of fetal magnetic resonance imaging (MRI) as a complement to ultrasound (US) in the evaluation of cleft lip and palate (CLP), whether isolated or in association with syndromic conditions.
We enrolled 24 pregnant women (27 fetuses) (mean gestational age 23.7 weeks) with a level-two US diagnosis of cleft lip (CL) or CLP with or without associated central nervous system (CNS) or facial-bone anomalies. All individuals underwent a fetal MRI examination to study the facial skeleton, CNS and fetal body. For each fetus, the main anatomical facial landmarks and biometric parameters [anteroposterior diameter (APD), biparietal diameter (BPD), inferior facial angle (IFA), frontomaxillary angle (FMA), bi-orbital diameter (BOD), intraorbital diameter (IOD)] were measured.
Twenty-five of 27 fetuses had a US diagnosis of CL or CLP. MRI confirmed the diagnosis in 16/25 fetuses and added information about the extent of the cleft and the degree of involvement of the anterior and posterior palate in 8/25 fetuses. MRI ruled out the diagnosis in 1/25 fetuses and identified an alteration of the parameters IFA, FMA and IOD in 6/24 fetuses.
In the study of CLP fetal, MRI is able to define the degree of involvement of the posterior palate and the lateral extent of the cleft with higher diagnostic accuracy than US. Furthermore, MRI provides a complete study of the fetal head and biometric development of the facial bones, thus enabling early detection of potential syndromic conditions.
La radiologia medica 04/2011; 116(7):1134-48. · 1.44 Impact Factor
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ABSTRACT: Foreign bodies in the anterior cranial fossa are unusual. This is a case of a 50-year-old man who presented with a dental implant displaced into the anterior cranial fossae, which was removed endoscopically with dural reconstruction.
International Journal of Oral and Maxillofacial Surgery 10/2009; 39(1):92-3. · 1.51 Impact Factor
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ABSTRACT: Temporomandibular joint disorders (TMJ-D) may be associated with the onset of neuropathic pain. The purpose of this study was to prospectively assess if, at the open-mouth position, the distance between the temporomandibular joint (TMJ) disk and the mandibular nerve is shorter in patients with TMJ-D and neuropathic pain vs patients with TMJ-D without neuropathic pain or in healthy people.
After ethical committee approval, we evaluated by MR imaging 16 TMJs with TMJ-D and neuropathic pain, 16 TMJs with TMJ-D without neuropathic pain, and 16 TMJs of healthy volunteers. All of the subjects were informed about the study procedure. We evaluated the distance between the TMJ disk and the mandibular nerve at the oval foramen level. Furthermore, the presence within the TMJs of internal derangement, osteoarthrosis, joint effusion, and bone marrow edema was evaluated.
At the maximal open-mouth position, the distance between the TMJ disk and the mandibular nerve is shorter in patients with TMJ-D and neuropathic pain than in patients with TMJ-D without neuropathic pain or in healthy volunteers (P < .05). The imaging findings of TMJ internal derangement, effusion, osteoarthrosis, and bone marrow edema were present both in patients with TMJ-D without neuropathic pain and in patients with TMJ-D and neuropathic pain.
We suggest that a closer proximity between the TMJ disk and the mandibular nerve could be one of the causes of the onset of neuropathic pain in patients with TMJ-D and neuropathic pain.
American Journal of Neuroradiology 05/2009; 30(7):1414-8. · 2.93 Impact Factor
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ABSTRACT: The aim of this work was to describe the anatomy of the temporomandibular joint (TMJ), the masticator spaces and their possible variance by means of magnetic resonance imaging MRI.
We evaluated one TMJ in each of 28 volunteers (14 males and 14 females) without temporomandibular disorders. The TMJ with mouth closed was evaluated on axial, coronal and sagittal planes obtained with a 1.5 Tesla magnetic resonance scanner. MRI scans of the anatomic patterns of the temporomandibular region were analyzed and compared with the classical anatomy notions reported in the literature. Morphometric evaluation of the temporomandibular region and the medial and lateral pterygoid muscles was carried out.
MRI anatomy of the TMJ, the masticator spaces and their possible variance were accurately described. In addition, morphometric evaluation of the TMJ and the masticator spaces was performed. Statistical analysis of the measurements showed that the length of the structures related to the glenoid fossa were usually longer in the female than in the males, whereas the condyle and masticator muscles were usually greater in the males than in the females. T-tests showed no significant differences (P > 0.05) between the measurements of the right and left TMJ.
In preoperative maxillofacial surgery assessment, MRI is a useful tool to reduce operating time, avert surgical complications and improve patient outcome.
Minerva stomatologica 04/2009; 58(4):127-43.
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ABSTRACT: Osteodistraction is currently used in those disorders presenting with osseus tissue deficit, excellent results having been obtained in the craniofacial complex. The factors contributing to the success of this procedure are a thin layer of subcutaneous tissue, minimum movement of the cutis, good vascularization of the soft tissues, and the good healing that ensues. The good plastic effects on the soft tissues and the possibility of constantly modulating the strength and monitoring the results have led to distraction osteogenesis gaining increasing consensus in the treatment of congenital and acquired deformities and in some selected cases, for the treatment of osseous deficits caused by trauma, postsurgical outcomes, or even severe alveolar deficits. Furthermore, in the last few years, this surgical technique has been successfully used in the treatment of pediatric deformities such as hemifacial microsomia, some severe class II skeletal deformities, and some syndromic cases, such as the treatment of temporomandibular ankylosis outcomes. In our opinion, guidelines in the indications for distraction are mandatory to select the procedure best suited to the pathologic situation of each individual patient.
Journal of Craniofacial Surgery 08/2005; 16(4):563-71. · 0.82 Impact Factor
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ABSTRACT: Hyaluronic acid is one of the components of synovial fluid. According to what is already well known in national and international biomedical literature, hyaluronic acid in the context of the TMJ serves two important biomechanical tasks. The first is feeding the articular cartilage; the second is lubricating the components of the joint. These two functions served by the same element change each other according to the continuous alternation of values of pressure in the articular cavity. The authors propose to overcome this statement by demonstrating that hyaluronic acid plays a third function in the TMJ, which is the biomechanical function of stabilizing the articular components.
Journal of Craniofacial Surgery 12/2002; 13(6):751-4. · 0.82 Impact Factor
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ABSTRACT: The authors analyze the functions of the synovial membrane and the chemical-physical properties of synovial fluid. In particular they evaluate the role played by synovial fluid in the complex mechanism of the temporomandibular joint. Every single part that belongs to the temporomandibular joint, together with the stomatognathic apparatus, plays a specific and particular role according to the dynamics and to the preservation of the correct temporomandibular joint physiology. The physiological postural and functional relationship between the various parts of the temporomandibular joint is guaranteed by a number of biomechanical restrictions that lead and influence the regular execution of the articular movements. The most involved biomechanical restrictions in the temporomandibular joint are the temporomandibular ligament, the lateral disc ligament, the bilaminar zone or retrodiscal tissue, the synovial membrane, and the synovial fluid.
Journal of Craniofacial Surgery 08/1999; 10(4):301-7. · 0.82 Impact Factor
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ABSTRACT: Fractures of the mandibular condyle represent 20% to 35% of all mandibular fractures. There are several clinical variants of this type of fracture that give rise to different problems in relation to their classification and treatment. A sample of 16 patients (of a total of 280 patients examined and treated from 1985 through 1995) with mono- and bilateral, displaced and decomposed, condylar fractures that occurred during growth were examined by the authors, who assessed, by a 2-year follow-up, the relevant clinical, functional, and instrumental parameters. On the basis of the data gathered by this study, a plan was drawn up for treating these patients that takes into account the different situations, such as either a nonsurgical or surgical treatment (by the use of condylectomy or external rigid fixation), and points out the advantages and disadvantages of each method.
Journal of Craniofacial Surgery 02/1999; 10(1):87-92. · 0.82 Impact Factor
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Journal of Craniofacial Surgery 10/1998; 9(5):433-7. · 0.82 Impact Factor
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ABSTRACT: The authors focus on a case of scleroderma, or progressive systemic sclerosis. Scleroderma is a disease of unknown cause, characterized by an abnormal synthesis of connective tissues that causes a sclerosis of the skin involving organs and systems at various levels. It may appear in different forms and may involve, although not frequently, the maxillofacial district. The authors examined a 21-year-old woman who had been diagnosed with systemic progressive sclerosis in 1994. The patient showed a strong limitation of oral aperture, evidenced by an electrognathographic test, and osseous changes. Panoramic and full-mouth intraoral radiographs showed a complete agenesis of coronoid processes on both sides, whereas the angles and the rising branches of the mandibular and periodontal ligaments appeared normal. The patient was diagnosed as having maxillofacial localization of scleroderma with involvement of coronoid processes bilaterally.
Journal of Craniofacial Surgery 10/1998; 9(5):472-6. · 0.82 Impact Factor
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ABSTRACT: The studies carried out by Nitzan et al. (1991) to the assumption that the simple washing of the upper compartment of the temporo-mandibular joint, without introducing the arthroscope, associated to the application of a bite at night was sufficient to obtain a pain relieving effect and an improvement in the joint functionality in cases of internal derangement of TMJ. The purpose of this work is to assess the long-term results obtained in our department by using only the arthrocentesis without the association of other therapeutic procedures for evaluating the benefit brought by the simple washing of the upper compartment of the joint.
A sample of 10 patients subjected to arthrocentesis with an average follow-up of 23.8 months was examined. The evaluation of the patients was based on a clinical analysis and a series of instrumental tests including orthopanoramic X-rays, stratigraphies, RNM in some cases and an electrognatographic test. The parameters taken into consideration were maximum opening, articular noises, local pain in the articular region, the occurrence or not of headache.
In our opinion arthrocentesis is a method of simple application, well accepted by patients, leading to a clear improvement of symptoms, as far as pain relieving effect and functionality are concerned, thanks to the possibility to drain by washing the constituents of the inflammation and the mediators of pain; this method may be applied routinely, as therapeutic support, in those patients with clinical histories of condilo-meniscal uncoordination and presenting limitations in the opening of the mouth and articular pains.
Minerva stomatologica 05/1998; 47(4):149-57.
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ABSTRACT: Prenatal diagnosis of craniomaxillofacial malformations permits early surgery, before 6 months of life and possibly, in the near future, in utero, thereby obtaining the best aesthetic and functional results. Increased knowledge of embryology has largely improved the diagnosis of craniomaxillofacial anomalies, their classification, and therapeutic protocols. We analyzed nine pregnancies (one twin) in which cleft lip and palate (CLP)--isolated or associated with, for example, holoprosencephaly, hypertelorism, and micrognathia--was diagnosed by ultrasonography. Only one fetus of these pregnancies was later operated on in our unit. This patient, with 7 years follow-up, represents our clinical case. For these cases, early diagnosis of CLP allowed informed parental choice regarding the continuation or termination of the affected pregnancy and planning of surgical procedures to correct the malformation. This is demonstrated by the presented clinical case involving an infant operated on within 6 months with success.
Journal of Craniofacial Surgery 04/1998; 9(2):190-5. · 0.82 Impact Factor
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ABSTRACT: Among tumors concerning the orbit, hemangiopericytoma is one of the most unusual forms. This tumor has a vascular origin and usually appears as a fleshy, well-circumscribed mass, characterized by slow growth and lack of soreness. Its biological traits include a mostly benign nature, a potential malignancy, and, most of all, a highly frequent recidivation. This study of double recidivation shows this can occur even after a long lapse of time and the new tissue can acquire malignant traits. Finally, we describe the modes of the surgical approach, which aims at intervening the most radical cases to reduce recidivation to a minimum.
Journal of Craniofacial Surgery 02/1998; 9(1):55-9. · 0.82 Impact Factor
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ABSTRACT: Several controversies still exist regarding the etiopathogenesis, diagnosis, and type of surgical treatment used in response to paranasal sinus mucocele. We wish to contribute to the standardization of therapeutic treatment for paranasal sinus mucocele by reporting our clinical experience in "open surgery." This analysis considers 53 patients--23 males and 30 females (age range: 11-80 years)--affected by frontoethmoidal or sphenoidal sinus mucocele whom we have surgically treated. Patients were classified according to age, sex, previous surgical treatment in the nasal area, symptoms, and acute visual difficulties; 15 patients showed disease in the frontal area, 28 in frontoethmoidal area, and 10 in the posterior ethmoidal or sphenoidal area (or both); in 18 patients the disease had reached the intracranial region. Transfacial approaches were used in all patients who did not show evidence of disease in the intracranial region. Of all the incisions performed 18 were coronal, 16 were paralateral, and 4 were through upper eyebrow approaches; a transnasal endoscopic approach was used in only 1 patient in whom the intracranial region was affected by disease. All patients showed satisfying functional and aesthetic results during and after recuperation.
Journal of Craniofacial Surgery 10/1997; 8(5):391-8. · 0.82 Impact Factor
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ABSTRACT: Synovial chondromatosis is a benign monoarticular arthropathy characterized by metaplastic cartilaginous foci developed in the synovial membrane. We present a review of the literature and report on five additional cases of synovial chondromatosis of the temporomandibular joint. Radiographic examination by computed tomographic scan allowed us to identify this disease as articular chondromatosis; however, a definitive diagnosis can be made only by histopathologic examination. In all cases surgical treatment led to the complete remission of symptomatology and to the functional recovery of the joint. Diagnosis and surgical therapy are discussed.
Journal of Craniofacial Surgery 10/1996; 7(5):352-7. · 0.82 Impact Factor
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ABSTRACT: In this article the use of a rigid external fixation system is proposed for the early treatment of condylar fractures. This method offers the advantage of not damaging the articular structures during reduction and allows early mobilization for a rapid recovery. In our Centre 28 patients have been treated with the rigid external fixation system, with good functional results. Of these 15 men and 13 women, 22 had a monocondylar fracture and 6 had a bicondylar fracture. In all the cases there was complete recovery of the occlusal stituation and of the mouth opening; no patient surgically treated with this method has ever presented problems of a local or general nature. The purpose of this report was to evaluate the use of external fixation for the treatment of extracapsular condylar fractures with luxation of the fragment out of the glenoid cavity.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 11/1995; 80(4):394-7. · 1.46 Impact Factor
