Ioannis Iatrou

Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience

UNLABELLED Trauma and facial fractures in a population of children have been analysed in several studies mainly regarding their incidence and much less their treatment modalities. AIM The aim of this study was to retrospectively analyse the treatment methods and outcome of facial fractures in children and young adolescents during the last decade and to discuss findings and propose treatment protocols. PATIENTS AND METHODS Patients of the Paediatric Maxillofacial department, treated for fractures of the facial skeleton were included in the study. Open reduction and osteosynthesis plate fixation (titanium and resorbable material) was the main treatment method with conservative treatment saved for selected cases. Titanium plates were removed after bone healing. Intermaxillary fixation (IMF) was not used regularly in mandibular fractures, with the exception of condylar fractures. RESULTS 156 children and young adolescents with 208 fracture sites in total were treated. 139 fracture sites (66.8%) were treated with open reduction and 69 conservatively. The mandible was affected in 49.0% of the cases, the maxilla in 21.2% (both with the alveolar process fractures included), the zygomatic complex in 10.1%, the orbital walls in 9.6%. There were 38 alveolar process fractures. CONCLUSION The results of the fracture treatment verified the usefulness of open reduction and plate fixation in children. There was no need for wire suspension and only occasional need for IMF. Closed reduction was selectively applied in condylar fractures and dento-alveolar trauma.

Miniplate osteosynthesis for fractures of the edentulous mandible: A clinical study 1989–96

Our 8 years experience of treating fractures of the edentulous mandible by miniplate osteosynthesis, is discussed. Forty patients (31 men and 9 women) aged 37 to 86 years (mean: 64.6 years, SD: +/- 14.07) with 67 fracture sites were treated. The surgical approach was mainly intraoral (37 out of 40 patients) without the use of intermaxillary fixation. The postoperative clinical and radiological findings are reported and discussed. The advantages of the method are of great importance since immediate postoperative opening of the mouth is permitted, as the fractured bones are anatomically stabilized by means of titanium miniplates and screws. Our results were felt to be satisfactory, with a reoperation rate of only 3.9% (two out of 51 operated fracture sites, 16 condylar fractures were treated conservatively). This allows us to propose intraoral miniplate osteosynthesis as a routine method of treatment in cases of edentulous mandibular fractures which are mainly seen in elderly people.

Intraosseous cystic lesions of the jaws in children : A retrospective analysis of 47 consecutive cases

OBJECTIVES The aim was to review the characteristics and treatment approach in 47 cases of intraosseous cystic lesions of the jaws in children. STUDY DESIGN Forty-three patients, 2-14 years old, with 47 cystic lesions of the jaws, were treated during the period 2000-2007. All cysts were surgically removed. No bone grafts were used and the teeth involved were preserved whenever possible. Removed tissues were examined histologically. Follow-up period ranged from 6 months to 7 years. RESULTS In 74.5% of the cases, cysts were enucleated, and in 17.0% they were marsupialized. Most commonly, the cysts were dentigerous (20, 42.6%), followed by eruption cysts, odontogenic keratocysts, and radicular cysts (10.6% each) and buccal bifurcation cysts (8.6%). CONCLUSION Cystic lesions in children were found to be mainly of developmental origin. Treatment was surgical removal without interfering, when possible, with the development of the dentition. Surgical approach was usually enucleation and, to a lesser extent, marsupialization.

Mandibular distraction osteogenesis for severe airway obstruction in Robin Sequence. Case report

Mandibular distraction osteogenesis (MDO) has been increasingly gaining interest over the last decade as a treatment alternative for the challenging airway management in infants with the Robin Sequence (RS). This paper is a case report of a male child diagnosed with RS, suffering from life-threatening airway obstruction and feeding difficulties, treated with tracheostomy and gastrostomy since infancy. After evaluation of the patient by a multidisciplinary team of specialists, MDO performed as soon as possible, was considered the optimal treatment, not only to address the severe micrognathia but also to allow early tracheal decannulation. As the lack of space intraorally contraindicated the use of internal distractors, they were placed externally bilaterally. The patient was successfully decannulated 3 weeks postoperatively and the gastrostomy was removed 1 month postoperatively. The mandibular expansion exceeded 20mm bilaterally and the maxilla-mandible discrepancy was fully corrected. There were no complications related to device placement, activation or removal. Follow-up clinical and radiographic examinations of the patient 1 year after the removal of the distractors revealed improved mandibular projection and continued mandibular growth. No significant scarring occurred at the surgical site and the patient has normal respiratory and feeding function.

Iliac crest morbidity following maxillofacial bone grafting in children: A clinical and radiographic prospective study

UNLABELLED Bone harvesting from the anterior iliac crest is commonly performed for grafting of maxillofacial defects. PURPOSE To evaluate the morbidity of the procedure in children and adolescents with clefts or maxillofacial defects after tumour removal. PATIENTS AND METHODS Between 2001 and 2008 36 consecutive patients who underwent iliac crest bone grafting using the trap-door technique were evaluated 6 months to 7 years postoperatively. Objective and subjective findings regarding the donor site mostly but also the recipient site were assessed by a standardized physical and radiological examination and a questionnaire. The donor site scar, neurosensory and motility function were evaluated clinically and osseous healing was investigated through radiographic examination of the ilium. RESULTS All respondent patients (29 out of the 36) tolerated the procedure well without major complications. Minor complications (mild pain and limp) were of short duration. No growth disturbances or contour deficits at the donor site were noted. No neurosensory or functional irregularities were detected. The donor site scar was considered aesthetically acceptable and most of the patients were satisfied with the functional outcome at the recipient site. CONCLUSIONS Bone harvesting from the anterior iliac crest was found to be a safe and reliable procedure for maxillofacial bone grafting in paediatric patients. No complications were encountered, the morbidity was minimal and the aesthetic outcome was good.

Treatment of central giant-cell granulomas of the jaws in children: conservative or radical surgical approach?

INTRODUCTION Although central giant-cell granulomas of the jaws (CGCG) tend to appear more often in children and young adults, most studies include patients of all ages. AIM Aim of this study was to present and discuss the characteristics, the selected treatment pattern and the outcome of central giant-cell granulomas of the jaws exclusively in children up to 13 years old, during a 10 years period. MATERIAL AND METHOD Twelve young patients, 5-13 years old were included in the study. CGCGs were surgically removed in toto by enucleation followed by curettage of the bone. Repair of the remaining bone defect was performed at the same operation in five cases. RESULTS All patients healed uneventfully and had prosthetic and/or orthodontic rehabilitation applied post-operatively. Regular long-lasting follow-ups were scheduled. Recurrence occurred in two cases (16.7%), it was small in size and was surgically treated again. CONCLUSIONS Conservative surgery, without extensive bone removal, for CGCGs of the jaws in children was successful in our cases. Additional repair of the osseous defect when needed and teeth rehabilitation as soon as possible are essential in children population. Follow-up needs to be long-lasting, to secure bone healing and unaffected jaw growth. Findings in children population of the present study were similar to those of adults or adolescent populations, although a rather low recurrence rate has been noticed.

Evaluation of lateral thermal damage and reepithelialization of incisional wounds created by CO2-laser, monopolar electrosurgery, and radiosurgery: a pilot study on porcine oral mucosa

OBJECTIVE This study aims to compare lateral thermal damage (LTD) produced by CO(2)-laser, monopolar electrosurgery (MES), and radiosurgery (MRS) and its effects on the reepithelialization of oral mucosa incisional wounds. STUDY DESIGN Five adult swine were submitted to standardized incisions at the tongue and gingiva by MES, MRS, CO(2)-laser and scalpel. Full-thickness specimens were harvested sequentially on days 1 and 3. All specimens were formalin fixed, paraffin embedded, cut, and stained with hematoxylin-eosin to quantify LTD extent. Sections of day 3 were stained for Ki-67 to assess epithelial proliferation at the incision margins. A multiple linear regression model and an analysis of variance were used to determine the correlation of each instrument with LTD extent and Ki-67 expression respectively. RESULTS LTD was most extensive in the CO(2)-laser but did not differ between the MES and MRS groups. No statistically significant differences regarding reepithelialization were noted among the investigated instruments. CONCLUSIONS CO(2)-laser produced more extensive LTD, without evident impact on reepithelialization.

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patients previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patients medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

Function of blood monocytes among patients with orofacial infections

Few data are available on the significance of the integrity of the innate immune system among patients with orofacial infections. This was assessed in the present study. Peripheral blood mononuclear cells (PBMCs) were isolated from 23 patients with orofacial infections before surgical debridement and from 12 healthy volunteers. PBMCs were stimulated with bacterial endotoxin (LPS) and with Pam3Cys. Concentrations of interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha (TNFα) were estimated in supernatants by an enzyme immunoassay. Concentrations of estimated cytokines released from PBMCs of healthy volunteers and of patients did not differ. Intensity of cytokine release after stimulation was related with the time until complete resolution of the infection (p: 0.046). It is concluded that adequate functions of blood monocytes are associated with favorable outcome after surgery for orofacial abscesses. It seems, however, that impairment of monocyte function predisposes to infection persistence.

Management of Intraosseous Vascular Malformations of the Jaws in Children and Adolescents: Report of 6 Cases and Literature Review.

ABSTRACT Background Intraosseous vascular malformations represent a rare clinical entity of the facial skeleton. The purpose of the current study was to present our experience in a Greek paediatric population and propose guidelines for the treatment of these jaws anomalies in children and adolescents. Methods A retrospective study (from 2009 to 2014) was performed to investigate the features and management of the intraosseous vascular anomalies in a Greek paediatric population. Results Six patients aged between 6 and 14 years were treated for intraosseous vascular malformations (4 venous and 2 arteriovenous) of the jaws. Five lesions were located in the mandible and one in the maxilla. In four lesions with pronounced vascularity superselective angiography, followed by embolization was performed. Individualized surgical treatment, depending on the size and vascularity of the lesions was applied in 4 patients. Conclusions The intraosseous vascular malformations of the jaws may escape diagnosis in paediatric patients. A multidisciplinary approach is important for their safe and efficient treatment. Embolization is recommended for extended high-flow lesions, either preoperatively or as a first-line treatment, when surgery is not feasible without significant morbidity.