1,721,072 research outputs found
Asimmetrie maxillo-mandibolari con alterazioni della dimensione verticale ed alterazioni morfostrutturali axio-cervicali
No full textINTRODUZIONE – Da circa quattro anni stiamo eseguendo studi morfologico-strutturali sulle ripercussioni dei dimorfismi asimmetrici maxillo-facciali sul sistema atlo-assiale (1,2,3). Scopo del presente lavoro è stato quello di valutare l’influenza delle modificazioni asimmetriche della dimensione verticale su tale sistema.
MATERIALI E METODI – 18 pazienti con dimorfismi asimmetrici dei mascellari associati a modificazione della dimensione verticale, 12 di sesso femminile e 6 di sesso maschile, di età compresa tra 19 e 35 anni. Il check-up scheletrico è stato eseguito con OPT, Rx telecranio 3P, TC, TC-3D; la RM per i tessuti muscolo-legamentosi ed articolari. 5 soggetti presentavano condylar helongation, 3 condylar hypoplasia; 3 asimmetria maxillo-mandibolare da hemifacial microsomia di grado I, 7 dismorfismo asimmetrico maxillo-mandibolare associato a marcato progenismo con aumento signficativo dell’angolo goniale.
RISULTATI – Oltre ad alterazioni morfostrutturali e spaziali a carico delle strutture del basicranio, sono emersi derangements del sistema articolare atlo-epistrofico. Il dente dell’epistrofeo appare costantemente sublussato rispetto all’arco dell’atlante. Tali dimorfismi cranio-assiali si ripercuotono caudalmente sulle altre vertebre e sulle piccole articolazioni dei processi traversi delle stesse, determinando atteggiamenti scoliotici della colonna ben evidenti nei nostri rilievi. Vi è proporzionalità fra grado di asimmetria e depiazzamento atlo-epistrofico. Questo si manifesta nella sua entità maggiore (circa 10 gradi) nei dimorfismi asimmetrici con iperdivergenza.
CONSIDERAZIONI E CONCLUSIONI – I dimorfismi asimmetrici con modificazioni della dimensione verticale si ripercuotono sull’assetto spaziale delle strutture cranio-assiali con cui costituiscono un sistema integrato neuro-muscolo-scheletrico. Ne derivano evidenti atteggiamenti scoliotici di tutto il sistema atlo-assiale. Emerge in definitiva da tale ricerca, secondo gli AA, il substrato anatomofisiopatologico delle sindromi altiche cranio-cervico-brachiali talora gravemente invalidanti e presenti in tutti i casi. Viene data altresì ragione dei compensi posturali indispensabili per ristabilire la planarità del basicranio, la visione complanare binoculare e la stessa complanarità delle strutture recettoriali labirintiche.
BIBLIOGRAFIA
1.CORBACELLI A., LUPI E., DI EMIDIO P., CUTILLI T. Atlo- axioid-occipital junction deragement in the mandibular asimmetry. J of Craniomaxillofac Surg. Vol. 26, suppl. 1:32, 1998.
2.CORBACELLI A., CONTINENZA M.A., CUTILLI T., Modificazioni strutturali del basicranio nelle asimmetrie maxillo-mandibolari.Rivista Italiana di Chirurgia Maxillofacciale n.3, 2000: 25-30.
3.CORBACELLI A., CUTILLI T., Maxillomandibular Asymmetries and cranio-vertebral morphostructural and postural alterations. International Symposium on Orthognathic Surgery, Udine, October 2001
EFFETTI DELLA CORREZIONE CHIRURGICA ORTOGNATICA DELLE ASIMMETRIE MAXILLO-MANDIBOLARI SULLE SINDROMI ALGICHE CRANIO-CERVICO-BRACHIALI ASSOCIATE
No full textINTRODUZIONE – Nell’ambito di una ricerca sulle alterazioni del complesso atlo-occipitale e le sindromi algiche cranio-cervico-brachiali riscontrate nelle asimmetrie maxillo-mandibolari (1,2,3), è stata eseguita una valutazione degli effetti della correzione chirurgica ortognatica su tali quadri algici.
MATERIALI E METODI - 18 casi di asimmetrie maxillo-mandibolari con modificazione della dimensione verticale, 12 di sesso femminile e 6 di sesso maschile, di età compresa tra 19 e 35 anni. I pazienti associavano sindromi algiche in regione occipitale (area 1), regione cervicale (area 2), regione dorsale (area 3), arto superiore (area 4). E’ stata effettuata la valutazione del dolore con la Scala Analogica Visiva (VAS). L'ampiezza è rappresentata da una linea lunga 10 cm con tacche ad ogni cm. 0 indica I'assenza di dolore, 10 il peggiore dolore immaginabile. Gli intervalli di 2,5 definiscono, rispettivamente, dolore lieve, moderato, forte, grave. La scala viene compilata dal paziente. La prova è stata eseguita in fase preoperatoria, a 5 giorni, a 6 mesi e a 12 mesi dall’intervento.
RISULTATI – Sono stati registrati i seguenti valori medi: in fase preoperatoria, 6,75 per l’Area 1; 8,36 per l’Area 2; 5,53 per l’Area 3; 4,67 per l’Area 4. A 5 giorni dall’intervento chirurgico, 1,06 per l’Area 1; 1,53 per l’Area 2; 1,19 per l’Area 3; 1,00 per l’Area 4. A 6 mesi, 0,89 per l’Area 1; 1,00 per l’Area 2; 1,47 per l’Area 3; 0,69 l’Area 4. A 12 mesi, 0,47 per l’Area 1; 0,39 per l’Area 2; 0,75 per l’Area 3; 0,06 per l’Area 4.
CONSIDERAZIONI E CONCLUSIONI - I risultati ottenuti nel campione considerato indicano che il riequilibrio maxillo-mandibolare ha determinato una complessiva, significativa riduzione dei disturbi algici e funzionali cranio-cervico-brachiali, con una sensibile caduta dei valori nell’immediata fase postoperatoria. I dati sono attualmente oggetto di analisi della varianza per misure ripetute entro soggetti, prendendo in considerazione ulteriori parametri di correlazione.
BIBLIOGRAFIA
1.CORBACELLI A., LUPI E., DI EMIDIO P., CUTILLI T. Atlo- axioid- occipital junction deragement in the mandibular asimmetry. J of Craniomaxillofac Surg. Vol. 26, suppl. 1:32, 1998.
2.CORBACELLI A., CONTINENZA M.A., CUTILLI T., Modificazioni strutturali del basicranio nelle asimmetrie maxillo-mandibolari.Rivista Italiana di Chirurgia Maxillofacciale n.3, 2000: 25-30.
3.CORBACELLI A., CUTILLI T., Maxillomandibular Asymmetries and cranio-vertebral morphostructural and postural alterations. International Symposium on Orthognathic Surgery, Udine, October 2001.
4.BENECH A., FASCIOLO A., DE GIOANNI P.P., MADARO E., Valutazione della postura in soggetti distatici prima e dopo intervento chirurgico. Minerva stomatologia vol. 46.1997, 435-441
Maxillomandibular asymmetries and cranio-vertebral morphostructural and postural alterations. Report 1. Skull base repercussion
No full textAims The Authors performed a research to define the physiopathological and clinical correlations between myoskeletal alterations of the stomatognathic apparatus and the cranio-cervical system in the subjects with maxillomandibular asymmetries.
Materials and Methods 87 cases of maxillomandibular asymmetries (44 mandibular asymmetries, 28 maxillary asymmetries, 15 maxillomandibular asymmetries) with temporomandibular pain syndrome, vertebral and brachial pain and postural troubles are
selected. Standardized CT and MR studies are performed to myoskeletal, articular and anatomical surgical evaluation of the dysmorphosis. The attention have been centred on the skull base and the cranio-vertebral structures.
Results and Conclusions Anatomical and craniometric analysis allowed to individualize in the skull base two areas delimitated from the gleno-occipital-mastoid structures named by Authors “gleno-occipital-mastoid triangles”.
The analysis of diagnostical imaging verified in all the cases the presence of three-dimensional spatial modifications of the skull base that involve particularly the structures of the gleno-occipital-mastoid triangle.
The skull base loses its normal spatial position and morphological and spatial modifications of the glenoid temporal structures (asymmetry of the articular surfaces), the occipital condyles (morphological and spatial asymmetry) and the mastoid process (morphological asymmetry) ensue. Alterations of the pterygoid process are also present.
The study of the etiopathological mechanism of the postural troubles with vertebral pain
syndrome represent a field of research much controversial.
The Authors report evident data of muscular and skeletal correlations between mandibular, maxillary and maxillomandibular asymmetries and skull base. This structure feels the effect of the asymmetrical condition of the facial structures. Considering his strategic function in the axial postural system, the results of this research appears very expressive
Facial Nerve paralysis in the early clinical evidence of Warthin’s tumor of the parotid gland
No full textThe facial nerve paralysis in parotid tumors is usually a sign of malignancy. Only 14 cases of facial neurological damage in histologically benign tumors of the major salivary gland are described in the English-language literature. The Authors report an unusual case of facial paralysis present at the first clinical observation of a benign parotid tumor (Warthin's Tumor). Fine-needle aspiration biopsy (FNAB) suggested an oncocytic process. Intraoperative histological examination of the lesion revealed a Warthin's tumor. Partial parotidectomy was performed with a microscope-assisted dissection that allowed the preservation of the branches of the facial nerve. A complete functional recovery of the left facial nerve was observed in the following 30 postoperative days. No recurrence of neurologic deficit and tumor relapse have been observed at three years follow-up. The Authors believe that in parotid benign tumors the neurological damage may be caused by compression and stretching of the nerve due to the rapid enlargement of the tumor or its trappement in the surrounding areas undergoing inflammatory and fibrous reactions.
KEY WORDS: Facial paralysis-Warthin parotid tumor-Adenolymhom
Mandibular condylar fractures and acute atlanto-axial subluxation. Part 1 - A new clinical and nosographic evidence
No full textAim and Study Design. The AA have studied the acute repercussions of condylar mandibular fractures on occipital-atlanto-axial joint. 25 non consecutive cases (16 Males and 9 Females, Age -mean-range: 22.96 years /14-36) observed and treated in the Maxillofacial Surgery Department of the University of L’Aquila have been considered. Types of fractures - Unilateral: 19 cases (solitary: 12; associated with other mandibular fractures: 7, homolateral : 2). Bilateral: 6 cases (equivalent: 2, not equivalent: 4). A control group was constituted by 10 patients, 5 males and 5 females, aged from 19 to 24 years (mean-range: 21.6) suffering from acute isolated cervical distorsion (whiplash). The study has been executed by the analysis of x-ray and CT-CT/3D of the mandibular condylar regions, the occipital-atlanto-axial structures and the cervical region.
Results. In all the cases of fractures of the mandibular condyle an acute alteration of the junctional atlanto-axial structures was present. Unilateral Solitary Condylar Fractures. In these cases the AA have observed an atlas rotation, homolateral to the side of the condylar fracture, independently of the level of the fracture (intra or extracapsular). The rotation seems to be proportional to the entity of the condylar fragments dislocation on the horizontal plane and it causes a modification of the articular relations between atlas and axis (atlanto-axial subluxation) and between the atlas and the occipital bone. The AA have observed a constant derangement of the cranio-axial joint on the three planes of the space. In particular, on the vertical plane the CT reconstructions show on the right and left side a different height between the atlanto-axial articular spaces. The largest one is homolateral to the side of the condylar fracture.
Unilateral Condylar Fractures Associated with other Mandibular Fracture (homolateral or not)
In these case the AA have observed the same alterations of the occipital-atlo-epistropheal joint, but while on the horizontal plane the rotation of the atlas is always homolateral to the condylar fracture, on the vertical plane the largest atlanto-axial articular space is homolateral to the mandibular fracture with more dislocation of the fragments of fracture (usually the associated not homolateral mandibular fracture). Bilateral Condylar Fractures. In the equivalent fractures the AA have observed no alteration of the cranio-cervical joint. In the not equivalent fractures, they have observed the atlas rotation on the horizontal plane and the junctional derangement on the vertical plane, homolateral to the condylar fracture with greatest dislocation. Control Group. In all the cases the loss of the physiological cervical lordosis has been observed. Alterations on the horizontal and vertical planes, as the rotation of the atlas, atlanto-axial subluxation or the joint derangement, instead has never revealed.
Conclusions. The AA affirm that these results represent a new nosographic entity associated with the condylar mandibular fractures with important clinical, insurance and legal repercussions
MANDIBULAR CONDYLAR FRACTURES AND ACUTE ATLANTO-AXIAL SUBLUXATION PART 2 A PHYSIOPATHOLOGICAL FACTOR FOR THE CERVICAL SPINE SPRAIN
No full textAim and Study Design. The AA debate the physiopathology of the acute cervical injure in the event of mandibular condylar fractures. To achieve this specific purpose they have used the same sample of patients than in the Part 1. 25 non consecutive cases of condylar mandibular fractures (16 Males and 9 Females, Age -mean-range: 22.96 years /14-36) observed and treated in the Maxillofacial Surgery Department of the University of L’Aquila have been studied. Type of fracture - Unilateral: 19 cases (solitary: 12; associated with other mandibular fractures: 7, homolateral : 2). Bilateral: 6 cases (equivalent: 2, not equivalent: 4). A control group has been constituted by 10 patients, 5 males and 5 females, aged from 19 to 24 years (mean-range: 21.6) suffering from acute isolated cervical distorsion (whiplash). The study has been executed by the analysis of x-ray and CT-CT/3D of the mandibular condylar regions, the occipital-atlanto-axial structures and the cervical region.
Results. The AA point out that in all the patients the following constant alterations that link up with these fractures have been observed: the rotation of atlas, the atlanto-axial subluxation and the derangement of the occipital-atlanto-epistropheal joint, homolateral to the side of the mandibular condylar fracture. The cervical spine shows the constant loss of physiological lordosis with hinge between C3 and C4.
In the whiplash, as the AA have been able to assess in the control group, there aren’t alterations of occipital-atlanto-axial joint and the kinetic vector is placed on the longitudinal plane.
In the mandibular condylar fractures the kinetic mechanism is completely different regarding the whiplash. The point of entry is the chin and the kinetic vector is oriented down-up, sometimes oblique in the opposite side. Subsequently the kinetic force is transmitted throughout the mandibular structure and causes the condylar or bicondylar fracture. The kinetic vector is placed before on the vertical plane, then on the horizontal plane and later on the vertical plane. Therefore the dynamics of the crash cannot cause the swaying of the head as in the whiplash. Indeed in the mandibular condylar fractures the AA have observed the cervical distorsion with the loss of lordosis on the sagittal plane without whiplash and also they observed a constant derangement of the cranio-cervical joint and the atlanto-axial subluxation. Conclusions. These results allow to delineate a different physiopathological mechanism: in the event of mandibular condylar fractures, the sprain of the cervical spine seems to be caused by the acute atlanto-axial subluxation
L’intervento di etmoido-fronto-sfenoidectomia per via transmascellare (De Lima-Pietrantoni) nel trattamento delle polisinusiti odontogene
No full textGli AA descrivono l’utilizzazione della etmoido-fronto-sfenoidectomia per via transmascellare (intervento di De Lima - Pietrantoni) nelle polisinusiti odontogene. Sovente la flogosi odontogena mascellare si estende, per le note correlazioni anatomo-funzionali, prima all’etmoide e successivamente agli altri seni paranasali (sfenoidale ed
eventualmente frontale). Il classico intervento di Caldwell-Luc, universalmente utilizzato nelle sinusiti mascellari odontogene, non può essere in grado di risolvere tale patologia infiammatoria. Gli Autori descrivono l’intervento di De Lima – Pietrantoni e le metodologie diagnostiche e strumentali che ne permettono, allo stato attuale, la massima sicurezza nel prevenire complicanze endocraniche, vascolari e nervose e la massima affidabilità ai fini dei risultati della bonifica dei focolai flogistici e della loro persistenza nel tempo.
L’esperienza degli Autori è relativa a 31 casi di polisinusite odontogena comprendenti: 19 flogosi estese periapicali di premolari e molari superiori; 7 casi dovuti a fistole oro-antrali; 2 dovuti a penetrazione di materiale di otturazione dentaria nel seno mascellare; 3 casi nei quali la flogosi
polisinusale era dovuta a cisti odontogene suppurate parasinusali.
Gli Autori sottolineano: a) l’assenza di complicanze neicasi trattati; b) l’efficacia dell’intervento, specie nelle gravi comunicazioni oro-antrali complicate dalla flogosi polisinusale; c) infine, l’assenza di recidive con follow-up fino a 10 anni
Surgical procedure to restoring nasal airway in the severe nasal respiratory insufficiency (“narrow nose”)
No full textAim. Often serious nasal respiratory insufficiency represents the many trouble in adult patients who show the “narrow nose”. The AA consider “narrow nose” a nasal structure
characterized from reduction of the transversal diameters of the nasal pyramid and simultaneous reduction of the width of the nasal fossae.
In their clinical experience the AA founded that this condition reveals associated with unidimensional or threedimensional maxillary hypoplasia and underline that the only nasal surgery cannot solve the problem.
The AA propose their surgical procedure that’s capable in our opinion to restore in these cases both the nasal respiratory functionality and the occlusal parameters.
Matherial and Method. 32 subjects, 18 females and 14 males, aged from 21 and 37 years, with serious nasal respiratory insufficiency and maxillary defects have been considered. In
the preoperative check-up also rhinomanometric investigations was performed to value the nasal respiratory functionality. 15 subjects underwent maxillary advancement and surgical palate expansion, 9 patients maxillary advancement and unilateral Schuchardt osteotomy, in 5 cases Le Fort I osteotomy and bilateral Schuchardt osteotomy; in 3 cases Schuchardt osteotomy was associated with Wassmund osteotomy. In 7 cases iliac autogenous bone grafts have been used. In all of 32 cases septoplasty according to the Cottle technique performed backway through the same surgical pathway was executed.
Results. The AA consider that mean expansions of 4 mm of the nasal floor determine an
additional triangular prism-shaped space with a volumetric increase of the entire nasal fossa that can estimates at least of 700-800 mmc (increase of 1 cmc of the nasal respiratory space).
The rhinomanometric controls proved the normality and stability of the layouts ( 24 months follow-up). Also the controls of the correction of the maxillary defects showed good and stable
features.
Conclusion. The AA underline that many adult subjects with nasal respiratory
insufficiency associate maxillary defects. The maxillary dismorphism is the main cause of the serious reduction of the respiratory nasal space. Only nasal surgery cannot solve the problem. The one time simultaneous surgical procedure (maxillary osteotomies associated with Cottle’s septoplasty) as AA performed revealed to be very efficacious. The AA conclude that orthognathic surgery associated with the nasal septum surgery is the fundamental condition in these subjects to efficacious and stable restore of the nasal respiratory space and functionality, and morphological and functional results of the masticatory apparatus
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