Carlotta Pipolo

Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol.

Background Odontogenic sinusitis is a relevant infectious condition of the paranasal sinuses. The widespread use of dental implants and reconstructive procedures for dental implant placement has led to new types of complication. To the authors’ knowledge, no publication has extensively examined sinonasal complications resulting from dental treatment, and no classification system allowing standardization and comparison of results is currently available. This study was designed to (a) analyze the results obtained from surgical treatment of complications resulting from dental procedures combining functional endoscopic sinus surgery (FESS) and an intraoral approach and (b) propose a new classification system and standardized treatment protocols for sinonasal complications resulting from dental procedures. Methods A total of 257 patients consecutively treated with FESS (136 in conjunction with oral surgery) were included in the study. Different clinical situations were integrated into a new classification system based on the pathogenesis and clinical aspects of each case, with the aim of identifying homogenous treatment groups. Results were evaluated for each class. Results Of the 257 patients, 254 were successfully treated with surgery performed according to the proposed protocols. Three of 257 patients required a second surgery, after which they completely recovered. Complications of implant and preimplant surgery (maxillary sinus floor elevation) showed longer recovery times. Conclusion The results obtained are very encouraging. The majority of patients (254/257; 98.8%) were successfully treated with the proposed protocols. These results seem to indicate that the rationalization of surgical treatment protocols according to the initial clinical situation may significantly improve the clinical outcome.

Sphenopalatine endoscopic ganglion block in cluster headache: a reevaluation of the procedure after 5 years

Cluster headache (CH) is considered the most painful form of primary headaches. It is characterized by severe unilateral pain, typically associated with autonomic manifestations and may be divided into an episodic and a chronic form. The latter is often resistant to a multitude of medication and is, therefore, very hard to treat. In 2002, our group developed a technique for the endoscopic sphenopalatine ganglion block that was able to ameliorate the symptoms in 55% of drug-resistant chronic CH patients. This paper is intended as an update on the technique as well as a comparison in effectiveness to our prior approach.

Prevention and treatment of postoperative infections after sinus elevation surgery: clinical consensus and recommendations.

Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given.

Transnasal 3D endoscopic skull base surgery: questionnaire-based analysis of the learning curve in 52 procedures

In the past decade, surgical treatment of skull base pathologies has greatly advanced through the advent of the endoscope and later of the high definition endoscope. Recently a new type of three dimensional (3D) scope has been introduced to permit the surgeon a real stereoscopic vision of the operating field and to overcome the limitations of the 2D endoscopic set up. As with all new technologies a formalized adaptation period is essential for the surgeon to secure steady outcomes and low complications. To determine the subjective difficulties that one may encounter during this sensitive period we therefore devised and analyzed a questionnaire that evaluated the first ten procedures with the 3D device of junior and senior ENT and neurosurgeons. 52 consecutive patients were treated with purely 3D transnasal endoscopy for skull base pathologies. Sensation of strain or dizziness, difficulties in anatomical orientation and difficulties in performing the surgical gesture were assessed for each surgeon. The learning curve and difficulties of junior and senior surgeons are discussed and strategies to overcome the initial problems are devised. Our results confirm that after only few procedures, the advantages of the 3D endoscopic system including better visualization and depth perception are able to outweigh the inconveniences that go hand in hand with the learning of a new skill set.

Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy.

This study aimed to evaluate the prevalence and the relationship of sleep breathing disorders (SBDs) and laryngeal motility alterations in patients with drug‐resistant epilepsy after vagus nerve stimulator (VNS) implantation. Twenty‐three consecutive patients with medically refractory epilepsy underwent out‐of‐center sleep testing before and after VNS implantation. Eighteen eligible subjects underwent endoscopic laryngeal examination post‐VNS implantation. Statistical analysis was carried out to assess an association between laryngeal motility alterations and the onset/worsening of SBDs. After VNS implantation, 11 patients showed a new‐onset mild/moderate SBD. Half of the patients already affected by obstructive sleep apnea (OSA) showed worsening of SBD. All of the patients with a new‐onset OSA had a laryngeal pattern with left vocal cord adduction (LVCA) during VNS stimulation. The association between VNS‐induced LVCA and SBD was statistically significant. This study suggests an association between VNS and SBD, hinting to a pivotal role of laryngeal motility alterations. The relationship between SBD and VNS‐induced LVCA supports the need to routinely investigate sleep respiratory and laryngeal motility patterns before and after VNS implantation.

Review of computational fluid dynamics in the assessment of nasal air flow and analysis of its limitations

Abstract Nasal breathing difficulties (NBD) are a widespread medical condition, yet decisions pertaining to the surgical treatment of chronic NBD still imply a significant degree of subjective judgement of the surgeon. The current standard objective examinations for nasal flow, e.g., rhinomanometry and acoustic rhinomanometry, do not suffice to reliably direct the surgeon on the extent of any necessary surgery. In the last two decades, several groups have therefore considered the numerical simulation of nasal airflow. Currently, these analyses take many hours of labor from the operator, and require a huge amount of computer time and the use of expensive commercial software. Most often, their results are insufficiently validated so that virtual surgery, which is the eventual application, is still absent in clinical practice. Very recently, however, attempts at considering the finest details of the flow are beginning to appear, for example unsteady turbulent simulations validated through laboratory measurements through particle image velocimetry. In this paper, we first discuss recent developments in how computational fluid dynamics (CFD) is helping surgeons improve their understanding of nasal physiology and the effect of surgical modifications on the airflow in the nasal cavity. In a second part, the procedural and modeling challenges that still prevent CFD from being routinely used in clinical practice are surveyed and critically discussed.

Antral retriever and displaced dental implants in the maxillary sinus

PurposeRemoval of antral foreign bodies after implantation is mandatory to avoid infectious processes and may be a troublesome question. Different surgical approaches could be considered, with several limitations and morbidities. MethodsWe present a new tool (Antral Retriever) conceived to remove antral dental implants or any other migrated material through a minimally invasive canine fossa approach, under continuous endoscopic view and local anesthesia. Results and ConclusionsAntral Retriever enables the surgeon to successfully remove antral foreign bodies through a canine fossa approach under continuous endoscopic visualization and local anesthesia, with minimal discomfort for the patient.

Odontogenic and rhinogenic chronic sinusitis: a modern microbiological comparison.

Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) play a relevant, often underappreciated role in paranasal sinus infections. Treating SCDDT patients requires tailored medical and surgical approaches in order to achieve acceptable success rates. These approaches differ from common rhinogenic sinusitis treatment protocols mostly because of the different etiopathogenesis. Our study comprehensively evaluated microbiology and antibiotic resistance in SCDDT patients and compared findings with a control group of patients affected by rhinogenic sinusitis.

Effects of CT resolution and radiodensity threshold on the CFD evaluation of nasal airflow

The article focuses on the robustness of a CFD-based procedure for the quantitative evaluation of the nasal airflow. CFD ability to yield robust results with respect to the unavoidable procedural and modeling inaccuracies must be demonstrated to allow this tool to become part of the clinical practice in this field. The present article specifically addresses the sensitivity of the CFD procedure to the spatial resolution of the available CT scans, as well as to the choice of the segmentation level of the CT images. We found no critical problems concerning these issues; nevertheless, the choice of the segmentation level is potentially delicate if carried out by an untrained operator.

Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology

Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children. Methods: The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014. Results: Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified. Conclusion: The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.