1,721,052 research outputs found
Submental Orotracheal Intubation: An Alternative to Tracheotomy in Transfacial Cranial Base Surgery
No full textThis retrospective study evaluated the safety and efficacy of submental intubation not only for trauma treatment but also for oncological cranial base surgery. The medical records of 24 patients who underwent submental intubation from 1996 to 2002 were reviewed. There were 6 procedures for craniofacial trauma, 12 transmaxillary approaches to the clivus for clivus chordomas, and 6 transmaxillary approaches to the cranial base for chondrosarcomas. Time required for intubation, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. The submental orotracheal intubation was completed successfully in all patients. No accidental extubations or tube injuries occurred. The mean time required for intubation was 5 minutes. The only complication was one case of superficial infection of the submental wound. The intraoral and submental accesses healed with minimal scarring in all patients. Submental orotracheal intubation is a useful and safe technique for airway management of craniomaxillofacial traumas and during transfacial approaches to the cranial base. It avoids the complications associated with tracheostomy. It also permits considerable downward retraction of the maxilla after a Le Fort I osteotomy and is associated with good clival exposure. Furthermore, it does not interfere with maxillomandibular fixation at the end of the surger
Reconstruction of the orbital walls in surgery of the skull base for benign neoplasms
No full textSurgery for benign neoplasm extending into the orbital roof requires immediate reconstruction to avoid complications, which include transmission of the cerebral pulse to the globe, bulbar dystopia, diplopia, and fibrosis of the oculomotor muscles. Many alloplastic materials have been employed for such reconstruction, but currently most authors agree that autologous bone graft is the best option. Using calvarial bone in adults and split ribs in children, we have operated on eight patients for fibrous dysplasia (five cases), neurofibroma (two cases), or meningioma (one case). After a median follow-up period of two years and six months, good morphology of the orbit was maintained with no ocular symptoms
Fibrous dysplasia of the orbital region : current clinical perspectives in ophthalmology and cranio-maxillofacial surgery
No full textPURPOSE: To describe the multidisciplinary diagnosis and treatment of patients with orbital fibrous dysplasia, a slowly progressive disease that may lead to asymmetry, disfigurement, and functional ocular problems. METHODS: Ten patients with orbital fibrous dysplasia underwent bifrontal craniotomy through a coronal flap, with the removal of the supraorbital arch and dysplastic process involving the anterior and middle base of the skull. Four patients underwent superior orbital fissure and optic nerve canal decompression. Reconstruction was performed by using an autologous bone graft for both the adults and children, in whom a rib graft was preferred. The mean follow-up was 53.2 +/- 18.3 months (range, 14 to 94 months). The patients' preoperative status and postoperative status were compared. RESULTS: The immediate and long-term morphologic and aesthetic results were good in all cases. All of the patients complained of some degree of diplopia during the immediate postoperative period, but the problem spontaneously resolved within 1 to 6 months in all but one case. No postoperative reduction in visual function was observed in the patients who underwent optic nerve decompression. The only reported complication was the irregular reabsorption of regrafted dysplastic bone in one patient. CONCLUSIONS: A multidisciplinary approach to orbital fibrous dysplasia is fundamental for treatment planning and execution
Current therapeutic options and novel molecular markers in skull base chordomas
No full textChordomas are extremely rare tumours. They arise in the spheno-occipital region in 35% of cases. Chordomas usually present benign histopathological features but often exhibit a malignant clinical behaviour. Radical surgical removal and high-dose radiation therapy seem to be effective in tumour control and to improve survival rate. Despite the advancements in microsurgical techniques and the development of radiation therapies, clival chordomas still represent a challenge. Nevertheless it appears that chordomas that have been resected to the same extent and that received post-operative radiotherapy might exhibit different rates of regrowth. This result supports the hypothesis that the recurrence rate of chordomas might be dependent on biological variables other than the extent of resection and the post-operative radiotherapy. Genetic and molecular studies on oncogenesis of chordomas are still limited, but they represent the basis for the development of molecular targeted therapies. We present a review of the current knowledge about skull base chordomas biology, therapeutic options and related clinical outcom
A peculiar case of midface reconstruction with four free flaps in a cocaine-addicted patient
No full textCocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses and palate, a syndrome called CIMDL (cocaine-induced midline destructive lesion). In such cases, reconstructive procedures of the lost soft and hard tissues may be indicated, such as local flaps, regional flaps, and free revascularised flaps. Also, prosthetic obturators have been suggested to overcome the functional problems related to the tissue loss. However, the majority of publications are related to relatively small defects, whereas articles related to the surgical treatment of large midfacial defects are less frequently reported. The objective of this article is to report the authors' experience concerning a unique case consisting of a complex reconstruction of a severe cranial base, midface, palate, and nose defect following cocaine abuse with four revascularised flaps followed by prosthetic restoration with implant-supported prostheses
Optic nerve compression in craniofacial fibrous dysplasia: early diagnosis and treatment
No full textAnterior cranial base reconstruction
No full textThis atlas, organized in two sections -neurosurgical section and maxillo-facial section- provides a comprehensive overview of the most modern surgical techniques in cranio-facial and skull base surgery.
Each chapter describes in detail the anatomic structures and offers a step-by-step description of the technical aspects of the surgical approaches to the cranial base.
Written by leading experts in cranial base surgery and featuring more than 300 intraoperative photographs and surgical drawings, the volume will be a very practical and useful tool for residents, surgeons and otolaryngologist
The history of the hypophysis : the pioneering studies of Edoardo Gemelli
No full textResearch into the embryological development of organs has been of relevant interest for contemporary medicine since the 19th century. In particular, some organs, such as the pituitary gland, or hypophysis, were deemed not to have a specific function. They were thus considered as rudimental organs, a mere residue of evolution. Edoardo Gemelli was an Italian doctor and friar, who was among the first to study this topic, under the supervision of Professor Camillo Golgi in Italy from 1903 to 1908. He gave a detailed description of the embryological development of the pituitary gland in mammals, also unveiling the functional role of the gland in water balance and growth. He addressed and tried to correctly embody the relevance of Darwin's theory of evolution, which was spreading following its publication in 1859. His findings, herein reported, are thus of both scientific and anthropological relevance for their contribution to the understanding of the morphofunctional nature of the hypophysis and of the theory of evolution, respectively
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