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Head-facial hemangiomas studied with scanning electron microscopy.
No full textINTRODUCTION: Hemangiomas of the head or face are a frequent vascular pathology, consisting in an embryonic dysplasia that involves the cranial-facial vascular network. Hemangiomas show clinical, morphological, developmental, and structural changes during their course. METHODS: Morphological, structural, ultrastructural, and clinical characteristics of head-facial hemangiomas were studied in 28 patients admitted in our hospital. Nineteen of these patients underwent surgery for the removal of the hemangiomas, whereas 9 patients were not operated on. All the removed tissues were transferred in our laboratories for the morphological staining. Light microscopy, transmission electron microscopy, and scanning electron microscopy techniques were used for the observation of all microanatomical details. All patients were studied for a clinical diagnosis, and many were subjected to surgical therapy. RESULTS: The morphological results revealed numerous microanatomical characteristics of the hemangiomatous vessels. The observation by light microscopy shows the afferent and the efferent vessels for every microhemangioma. All the layers of the arterial wall are uneven. The lumen of the arteriole is entirely used by a blood clot. The observation by transmission electron microscopy shows that it was impossible to see the limits of the different layers (endothelium, medial layer, and adventitia) in the whole wall of the vessels. Moreover, both the muscular and elastic components are disarranged and replaced with connective tissue. The observation by scanning electron microscopy shows that the corrosion cast of the hemangioma offers 3 periods of filling: initially with partial filling of the arteriolar and of the whole cast, intermediate with the entire filling of the whole cast (including arteriole and venule), and a last period with a partial emptying of the arteriolar and whole cast while the venule remains totally injected with resin. CONCLUSION: Our morphological results can be useful to clinicians for a precise diagnosis on the aftereffects of hemangiomas
Endoscopic endonasal versus transfacial approach for blowout fractures of the medial orbital wall
No full textAbstract
In the last decades, the introduction of computed tomography has allowed an increase in the number of diagnosed fractures of the medial orbital wall. To repair medial wall fractures, many surgical techniques have been proposed (1), each one with its advantages and disadvantages. In this study, we compared endoscopic endonasal and transcutaneous reduction approaches in terms of surgery time and clinical outcome. Between 2001 and 2005, 81 patients with orbital wall fractures were treated at our department. Among these 81 patients, 24 (29.63%) were affected by a medial orbital fracture. Patients with fracture to both floor and medial walls underwent floor reduction by a transcutaneous subpalpebral approach (n = 9, 11.1%), whereas patients with isolated medial wall fracture underwent medial wall reduction by a transcutaneous subpalpebral approach using alloplastic implants (n = 8, 9.88%) or were treated by endoscopic approach (n = 5, 6.17%). After surgery, oculomotor function improved in all 22 patients. None of the patients had complications. Computed tomography revealed a well-consolidated site of fracture in both endoscopic endonasal and transcutaneous approaches. The average operating time for endoscopic endonasal and transfacial approach was 50 and 45 minutes, respectively. In this paper, the author proposed a results comparison between the endoscopic approach and the transcutaneous one
The endoscopic approach a odontogenic keatocyst involving the mandibular condyle. A case report
No full textThe odontogenic keratocyst (OKC) has been always an interesting subject to debate since Philipsen first described it as a distinct entity in 1956. Nevertheless, the large variability and the lack of homogeneity between patients in the different studies did not allow to develop universally recognized guidelines for the KOT treatment. The aim of this paper is to present a new surgical technique to approach to high dimensions KOT located at the level of mandibular ramus and condyle, consisting in enucleation and courettage under endoscopic vision
Posttraumatic trigeminal nerve impairment: a prospective analysis of recovery patterns in a series of 103 consecutive facial fracture
No full textPURPOSE: To report the incidence of peripheral trigeminal nerve posttraumatic impairments and to compare different recovery patterns as observed in consideration of different fracture-related variables within 12-month follow-up.
PATIENTS AND METHODS: Ninety-seven consecutive patients with 103 facial fractures were included involving emergence areas of supraorbital nerve, infraorbital nerve, or the region between the mandibular and mental foramina. Presurgical and postsurgical clinical neurosensory testing sessions were performed in each patient. Results of these assessments were compared within fracture characteristics and different sites of trauma. Statistical analysis (chi-square test) was performed on clinical observations.
RESULTS: The incidence of trigeminal nerve impairments was 70.9% (54.4% in nondisplaced fractures, 88.2% in dislocated fractures, 100% in fractures with a direct nerve injury). Severe impairment was found in direct nerve injures and in many dislocated fractures. Mean recovery time was smaller in nondisplaced fractures than in dislocated fractures. Considering fracture site, the highest incidence of initial trigeminal nerve impairment was found in midfacial nondisplaced fractures. Midfacial fractures had better prognosis than mandibular fractures, and best prognosis was encountered in nondisplaced midfacial fractures. Residual hypoesthesia persisted in 11 sides with direct nerve injury after 12 months and involved tactile and discriminative sensibilities.
CONCLUSION: Recovery patterns of posttraumatic trigeminal dysfunction are related to site and type of fracture; intraoperative assessment of involvement of nerve bundles within fracture rimes was associated with an incomplete recovery at the 12th month. Impairment of temperature and nociception are highly related to a direct nerve injury
Approccio endoscopico alle lesioni benigne intraossee coinvolgenti il condilo mandibolare: nuova tecnica chirurgica
No full textBenign neoplasms involving frontal sinus: endoscopy vs open surgery
No full textThe aim of this paper was to analyze the most proper surgical approaches for frontal sinus, that due to its proper anatomic features, has a particular relation with nasal cavities. Indeed its anatomic opening (ostium) is strictly related to a complex ethmoidal structure prechamber mainly composed by the frontal recess. This constitutional feature makes the endoscopic approach more complex in comparison with the other major sinuses treatment. The following work presents a systematization of surgical approach in relation to the different pathologies, analyzing differences and results throughout the comparison of two groups: one treated with the endoscopic approach and the other with open surgery. Assessment of the two different surgical approaches allows to point out that surgical approach choice must consider several parameters such as neoplasm localization, extension, dimension and frontal recess anatomic features
The endoscopic approach a odontogenic keatocyst involving the mandibular condyle. A case report
No full textThe odontogenic keratocyst (OKC) has been always an interesting subject to debate since Philipsen first described it as a distinct entity in 1956. Nevertheless, the large variability and the lack of homogeneity between patients in the different studies did not allow to develop universally recognized guidelines for the KOT treatment. The aim of this paper is to present a new surgical technique to approach to high dimensions KOT located at the level of mandibular ramus and condyle, consisting in enucleation and courettage under endoscopic vision
Complications of bicortical screw fixation observed in 482 mandibular sagittal osteotomies
No full textBicortical screw fixation after bilateral sagittal split osteotomy (BSSO) of the mandible is commonly used in orthognathic surgery and allows many advantages compared with osteosynthesis wires and maxillomandibular fixation. Complications include early loosening, hardware exposition, skeletal instability or early relapses, persistent nerve impairments, infection, and scar formation. This article is based on a retrospective analysis of complications of bicortical screw fixation observed in 241 consecutive patients with dento-skeletal Class III, corresponding to 482 sides, during the immediate postoperative period and at 1, 3, 6, and 12 months' follow-tip. In the immediate postoperative period, poor stability of fixation caused by screw loosening was observed in 3 of 482 (0.62%) sides; at the 1-month follow-up, infections were encountered in 12 (2.48%) sides at mandibular angles. Additional complications were not seen in the series. Stability of fixation was found in the 482 sides at 12 months. However, complications directly related to bicortical screws were observed in 15 sides or 3.11%. Age and gender of patients were not correlated with the incidence of complications. Assiduous follow-up during the early postoperative period and 1 and 2 months after surgery is recommended in patients with bicortical screw fixation after BSSO to verify adequate oral hygiene and provide early observation of the onset of any infections, skeletal instabilities, or relapses
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