[show abstract][hide abstract] ABSTRACT: The placement of implants requires adequate basic conditions. Insufficient bone height and width in the area of the maxilla, because of expansion of the maxillary sinus and atrophic resorption of the alveolar ridge, represent a common anatomical complication, which can be solved by augmentation of the floor of the maxillary sinus. It is commonly shared that autologous bone graft is the gold standard method in the augmentation of the Higmoro antrum. The reconstruction of atrophies with adequate bone volume and density has become a viable treatment option with high predictability and success rates. The purpose of this study was to present the results obtained with a surgical procedure aimed at reconstructing (rehabilitating) advanced maxillary atrophies. This method includes the use of intramembranous, corticocancellous bone grafts harvested from the iliac crest. These are then fixed to the residual bone by endosseous implants.
[show abstract][hide abstract] ABSTRACT: If an abscess is not able to establish drainage through the skin surface or into the oral cavity, it may spread diffusely through fascial planes of the neck's soft tissue. Once the infection descends into the submandibular space, it may extend to the lateral pharyngeal space, and then to the retro-pharyngeal space. From here, it may reach the thyroid gland. The authors here describe a case of submandibular phlegmon derived from a periapical abscess of inferior premolar, which has reached the thyroid gland. The damage caused to the gland resulted in the release of a conspicuous quantity of thyroid hormones, thus causing a thyrotoxic pattern: temperature, cutaneous pallor, excessive perspiration, tremor, tiredness, weight loss, increased appetite, and tachycardia. Additionally, the gland's edema caused dysphagia and dysphonia commonly seen with thyroid gland enlargement. After dental drainage and appropriate anti-inflammatory and antibiotic therapy, administration of oral beta-blockers and corticosteroid therapy were performed to counteract thyrotoxicosis in order to prevent recurrences. Finally, a root canal was performed once the thyrotoxicosis had been resolved.
[show abstract][hide abstract] ABSTRACT: The number of patients who need treatment for dentofacial abnormalities has increased over the past 30 years. Facial alterations can influence both the patient's self-confidence and his interpersonal relationships, possibly generating emotional or physical handicaps. This qualitative study discusses a patient's psychological dissatisfaction with a postoperative outcome, despite the esthetic and functional success of the treatment.
The Oral Health Status Questionnaire, Post Surgical Satisfaction Questionnaire, Illness Behavior Questionnaire, and a clinical interview were used for the research methodology.
Oral surgeons are encouraged to identify, presurgery, the patient's true motivation. An efficacious behavioral model is proposed that might help the patient transition through the consequences stages of the psychosocial changes associated with facial reconstructive surgery.
Orthognathic surgery involves more than the correction of a physical problem. The psychological needs of the patient must be recognized and acknowledged, and communication between surgeons and patients is essential. It is important to understand that any surgical treatment that modifies body image could generate psychological disorders for some patients. Early surgical intervention and a referral for psychological counseling may reduce long-term morbidity. This case report should alert attending surgeons and orthodontists to possible unfavorable psychological sequelae.
World journal of orthodontics 02/2005; 6(2):141-8.
[show abstract][hide abstract] ABSTRACT: The anterior iliac crest is the harvest site preferred by many authors because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. The purpose of the present paper is to present a review of anterior iliac crest harvesting techniques and to illustrate the most serious sequelae reported in the literature. A clinical series is also presented in order to evaluate what is, in our experience, the degree of morbility connected with this donor site. We have controlled 107 patients who underwent bone harvesting from the anterior iliac crest between 1980 and 2000, investigating minor complications such as walking deficiency (immediate and long-term) the formation of seromas, haematomas, adynamic ileus and more serious complications such as retroperitoneal haemorrhages, abdominal hernias, ileus fractures, nervous lesions (immediate and long-term). From our survey it emerged that, among the major complications, incidentally rarely reported in the international literature, we found only a small percentage of cases involving damage to nervous structures. Minor complications were also limited and the only problem remains difficulty in walking after the operation which resolves fully in almost all cases. We can therefore state that the anterior iliac crest remains, to date, an excellent site for harvesting and there is no significant morbility and the surgeon has numerous techniques available for reducing the incidence of complications to the minimum.
[show abstract][hide abstract] ABSTRACT: Fractures of the zygomatic-orbito-maxillary complex (ZOM) are among the most frequent in maxillo-facial surgery. The study evaluates treatment for this type of fracture in the long-term and the sequelae linked to it. Patients who had been operated between february 1998 and november 1999 to reduce and retain ZOM fractures were subjected to check-up examination at the Maxillo-Facial Surgery Operative Unit, Florence. Cases selected had been operated via trans-oral access with incision of the superior vestibular fornix and where necessary with application of means of retention (Foley balloon and/or wire or plate-and-screw osteosynthesis). In these patients, the presence of residual deformities was evaluated together with enophthalmos, diplopia, compromised mouth opening if present, inflammation of the mucosa of the maxillary sinus, and above all incidence of sensory deficit in the distribution area of the infra-orbital nerves and the dental plexus. Particular attention was paid to evaluating tooth sensitivity on the side involved by the trauma, for any damage of the dental plexus. The most frequent sequela found in our group was lesion of the infra-orbital nerves, and a lower percentage of other sequelae such as residual deformities, enophthalmos or diplopia. Interestingly, in all cases in our series there was a significant reduction in tooth sensitivity on the side of the lesion, above all in the anterior sectors.
[show abstract][hide abstract] ABSTRACT: The aim of this study is to evaluate the psychological assessment of 20 patients after orthognathic surgery. Body image, anxiety levels, depression, somatic symptoms, aggressiveness and quality of life have been evaluated using 3 different questionnaires (BDDE, SQ, Q-LES-Q) during the postsurgical period. Analysis of the questionnaire has shown that the patients undergo orthognathic surgery mainly for esthetical reasons and, even if they could be considered normal, psychological evaluation followed by a proper support is a must. The present study has mainly developed and outlined this aspect.
BDDE has been utilised to evaluate body image, self-estimation and social relationship. It was evident that the psychological impact after surgery represents a "revolution" for the patient. The "new face" may generate psychological problems for the patients. The SQ test has been used to evaluate the emotional profile. We also considered it essential for our study to evaluate several aspects of the quality of life of our sample group. The body image, particularly when others find it pleasing or displeasing may affect everyday life behaviour.
The study reports positive results in the psycho-emotional profiles and in several aspects of the quality of life, while the results of the self-perception of the body image could be considered average.
Reported data show that the corrections following orthognathic surgery have a positive impact on the assessment of the patients and on the personal and social attitude and behaviour, however suggesting, a long term psychological support to assure a satisfactory postoperative recovery.
[show abstract][hide abstract] ABSTRACT: The correction of oral and maxillo-facial mal-formations causes lesions to sensitive nerves due to the invasive and traumatic surgery techniques required. Generally neuro-sensory and cutaneous-mucosal defects are reversible, with full recovery within 6-12 months. In a follow-up study (2 and 8 years) we found altered tactile and pain sensitivity in 43% of patients at subjective evaluation, with objective alteration in 17% of the group. Dental sensitivity evaluated by a pulp test showed an increase in for all teeth tested; values were higher for superior than for inferior teeth. Despite the increased pulp sensitivity threshold, due to the surgical damage, no signs of pulp disease were detected. Quality of life was not affected even by such a high subjective change in sensitivity. We therefore believe that patients undergoing orthognathic surgery must be fully informed; they must be made to understand the risks involved, and that damage may occur to sensitive nerves following surgery. All surgeons, including those with experience in the field, should continually seek to improve their skill and learn new techniques, in order to reduce complications to a minimum.
[show abstract][hide abstract] ABSTRACT: A case of hyperostosis of the left hemimandible medial face in a young patient is reported. This in an interesting case both for the remarkable size and the location of the lesion and because it was unique and asymmetrical; as a matter of fact this pathology, frequent on the jaws, is usually symmetrical and bilateral. The most probable etiopathogenetic hypothesis for the case presented to our observation seems to be an unknown localized stimulation of osteoblastic cells. Considering its size, the lesion was removed.
[show abstract][hide abstract] ABSTRACT: The correction of oral and maxillofacial malformations need invasive and traumatic surgery techniques that may cause damages to nerves. Some lesions related symptoms have been described especially with regard to sensory nerves and, more rarely, also to motor nerves. A case personally observed is described.
[show abstract][hide abstract] ABSTRACT: A questionnaire was given out to a group of 124 dentists in order to find out their level of knowledge of HIV infection. The answers show that dentists are reluctant to work with HIV-seropositive patients and that knowledge of control and diffusion of the disease is poor.
[show abstract][hide abstract] ABSTRACT: A case of two histologically different contemporary multiple primary cancers of the breast and the oral cavity is reported. The clinical and histopathological description of the lesions is completed by a discussion on the most recent reported data.
[show abstract][hide abstract] ABSTRACT: Oral hairy leukoplakia is a new clinicopathological entity. Little is known about its etiology, pathogenesis and natural history. It is considered a specific marker of HIV infection, although it has been also reported in HIV-negative patients. The etiology appears related to Epstein-Barr virus. Hairy leukoplakia has a characteristic clinical and histopathological aspect, but it is not specific. Because hairy leukoplakia may be easily confused with other lesions of the tongue, the dentist should be very careful in making the final diagnosis. Hairy leukoplakia is usually asymptomatic and treatment is not necessary. In cases of extensive lesions or psychological intolerance of the patient, useful drugs are acyclovir and vitamin A derivatives.
[show abstract][hide abstract] ABSTRACT: Recently, an increasing incidence of oral Kaposi's sarcoma in association with acquired immunodeficiency syndrome (AIDS) has been observed. This article describes the clinical features and the histopathologic spectrum of oral epidemic Kaposi's sarcoma in six HIV-positive patients. Etiopathogenic, epidemiologic, therapeutic aspects of Kaposi's sarcoma of the oral cavity and its interrelationship with AIDS are discussed.
[show abstract][hide abstract] ABSTRACT: A patient with Kaposi's sarcoma of the oral cavity is reported. The intralesional use of vinblastine may be an effective treatment for small Kaposi's sarcoma lesions of the mouth or the skin that are painful or create cosmetic problems.
[show abstract][hide abstract] ABSTRACT: The Authors report a case of mucoepidermoid tumor that began its growth inside the mandible. The central neoplasms of the jaws and of salivary origin are an unusual finding but the mucoepidermoid is the far more common with 45 cases already reported.
[show abstract][hide abstract] ABSTRACT: Authors have compared the cases of maxillo-facial fractures that have been admitted in the Maxillo-Facial department during a six months period before and after the mandatory use of helmets; that is from January through June in the years 1986 and 1987. A decrease in the number of injured (- 13.3%) and also a rate change was noted: the motorcycle drivers lost a 20.1%, while the adults who drove the motorbikes increased; a raise was found in the bicycle too (+ 8.7%). The lesions of the mandibular increased from 36.7% to 46.1% due to the protection offered to the maxilla by the helmets.
[show abstract][hide abstract] ABSTRACT: The authors have studied 680 cases of mandibular fractures by traffic accident that have been observed during a 10 years period in the department of Maxillo-Facial Surgery of the Florence University. Some interesting results have been found: male are more often injured than female (about 70% of all cases) during their second and third decades of life. Among the means of transport authors have found that the motorcycles (motorbikes included) and cars are more often involved, both with an equal number of cases; but the motorcycles are to be considered more dangerous because they are around in a smaller number.