Grimaldi M

Lipostructure technique in Romberg syndrome

Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and the cause of this alteration are unknown. Pathogenesis of this syndrome is not clear: some authors refer the atrophy of subcutaneous system to the alteration of sympathetic system, whereas others refer it to an alteration of the nervous system referred to the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association to this health disorder are as follows: trigeminal neuritis, facial, and epilepsy, the last one being the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years, and soon after, it becomes stable. Today, plastic surgery with graft of autogenous fat can be performed after stabilization of the disease. The objective of this work is, through the presentation of a clinical case, suggesting a therapeutic plan formed by 2 sequential treatments: poliglactic acid to obtain skin thickening followed by Coleman technique for reconstructing three-dimensional projection of face contour restoring the superficial density of facial tissues. The results we obtained prove the efficacy of combining these 2 treatments, and the satisfaction of the patient confirms the quality of our results.

Mechanisms of bone resorption: analysis of proinflammatory cytokines in peritoneal macrophages from titanium implant--an experimental design.

Cytokines, and interleukin-6 in particular, are inflammatory peptide mediators that are extensively studied as regulators of bone tissue homeostasis. They seem to be involved in osteoclast activation and bone resorption and probably play a role in osseointegrated implant rejection. In this study we investigate the ability of titanium implants to cause an imbalance in the homeostatic equilibrium of cytokines using the peritoneal cavity of DB-A2 mice as a model. The inflammatory response was evaluated as a messenger ribonucleic acid expression determined by the semiquantitative reverse transcriptase—polymerase chain reaction technique in peritoneal macrophages from titanium-implanted mice. Interleukin-6 release was detected by a specific quantitative enzyme-linked immunosorbent assay. Our results have shown that titanium implants do not significantly stimulate the proinflammatory cytokine system compared to the control group. The enzyme-linked immunosorbent assay test confirms, after a peak in secretion at day 1 compared with basal levels, a clear decrease in interleukin-6 at basal levels on following control at 6 and 9 days after implantation. The study of the interaction between implanted biomaterials and inflammatory mediators seems to be very promising.Perhaps a better understanding of the mechanisms of bone resorption could lead to finding a new clinical solution for patients with osseointegrated implant rejection.

Orbital reconstruction: bone-anchored implants.

The authors present their experience on reconstruction by extraoral bone-anchored implants technique, showing two patients from a total of 13, treated for orbital reconstruction. They were selected from 66 patients treated for reconstruction of orbit, ear and nose using this technique by the staff of the Department of Plastic and Reconstructive Surgery of the University of Tor Vergata, Rome, Italy. They underwent orbital emptying due to cancer pathology. Surgical technique is described in detail; its final purpose being positioning of titanium fixtures on the orbital borders, necessary to anchor the silicone epithesis. The advantages and potential limits of this technique are exposed, exposing the important role of patients compliance. The importance of preliminary study on the patients is also emphasized and includes clinical evaluation and instrumental examination for surgical planning, completed by a photographic study in the three standard projections. Satisfactory aesthetic results were obtained by the use of this technique and the authors believe it may represent a valid option; complementary to more traditional ones, but is a first choice in patients who cannot endure major surgery or in case of failure of traditional techniques.

SPECT in the long-term evaluation of osteointegration in intraoral and extraoral implantology

&NA; Scintigraphic methods used in intraoral and extraoral implantology allow the evaluation of bone metabolism in the peri‐implant zones, providing anatomic images and functional dynamics information on the osteointegration process. Twenty‐five patients who underwent implantation operations for the application of intra‐ and extraoral prostheses were studied using technetium 99 m single photon emission computed tomographic (SPECT) procedures to evaluate osteointegration dynamics at 3 weeks, and 3, 6, 12, and 24 months. The study demonstrates that radiation emission peaks 3 weeks after surgery with the maximal bone remodeling activity and 6 months after surgery after the functional loading of the implants only in intraoral fixtures. High uptake past the eighth month after surgery has never been detected and must be considered abnormal. SPECT offers the possibility of obtaining a three‐dimensional reconstruction of the photon emission of selected structures. The use of these nuclear medicine methods in addition to traditional‐type radiological procedures introduces new possibilities, although still in the clinical experimentation phase, for early diagnosis and inserted implant prognosis.

Miniabdominoplasty for the treatment of aesthetic defects after Pfannenstiel incisions

We describe the miniabdominoplasty technique adopted in patients with unfavourable aesthetic defects after Pfannenstiel incisions and give our results from 32 patients. Eligibility criteria were cutaneous ptosis after Pfannenstiel incisions, and skin elastic enough to do the miniabdominoplasty. Exclusion criteria were obese or previously fat subjects in whom the operation was not possible. The technique is based on the combination of a miniabdominoplasty done obliquely up to the fascia, and liposuction. We operated on 32 patients from September 2005 to May 2006. We saw no postoperative bleeding, haematoma, or seroma. Thirty-one patients had a good final result. In one case postoperative asymmetry required secondary remodelling, which was done under local anaesthesia as an outpatient. After six months follow-up we recorded no asymmetry or change in body shape. We use the miniabdominoplasty technique for the correction of cosmetic abnormalities after Pfannenstiel incisions. It is feasible and safe, with a short operating time, and gives good aesthetic results and few postoperative complications. Further studies, with more patients, are now required to validate these results.