M.L. Anghinoni

Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: a report of three cases.

Silent sinus syndrome is a rare disorder affecting the maxillary sinus unilaterally, characterized by ipsilateral enophthalmos and hypoglobus. The treatment is surgical: the endoscopic approach represents the gold standard for the restoration of normal sinus aeration, but there is no consensus in the management of the enophthalmos. Most authors suggest a two stage procedure consisting of endoscopic sinus surgery initially and a delayed secondary operation for the restoration of the orbital floor. We present our experience with three cases treated with a single-stage procedure, focusing on the advantages of this one-step approach.

Mandibular distraction in neonates: indications, technique, results

BackgroundThe Pierre Robin Sequence features were first described by Robin in 1923 and include micrognathia, glossoptosis and respiratory distress with an incidence estimated as 1:8,500 to 1:20,000 newborns. Upper airway obstruction and feeding difficulties are the main concerns related to the pathology. Mandibular distraction should be considered a treatment option (when other treatments result inadequate).Patients and methodsTen patients between the ages of 1 month and 2 years with severe micrognathia and airway obstruction were treated with Mandibular Distraction Osteogenesis (MDO).All patients underwent fibroscopic examination of the upper airway and a radiographic imaging and/or computed tomography scans to detect malformations and to confirm that the obstruction was caused by posterior tongue displacement. All patients were evaluated by a multidisciplinary team. Indications for surgery included frequent apneic episodes with severe desaturation (70%). Gavage therapy was employed in all patients since oral feeding was not possible. The two tracheotomy patients were 5 months and 2 years old respectively, and the distraction procedure was performed to remove the tracheotomy tube. All patients were treated with bilateral mandibular distraction: two cases with an external multivector distraction device, six cases with an internal non-resorbable device and two cases with an internal resorbable device. In one case, the patient with Goldenhars Syndrome, the procedure was repeated.ResultsThe resolution of symptoms was obtained in all patients, and, when present, tracheotomy was removed without complications. Of the two patients with pre-existing tracheotomies, in the younger patient (5 months old) the tracheotomy was removed 7 days postoperatively. In the Goldenhars syndrome case (2 years old) a Montgomery device was necessary for 6 months due to the presence of tracheotomy-inducted tracheomalacia. Patients were discharged when the endpoint was obtained: symptoms and signs of airway obstruction were resolved, PAS and maxillomandibular relationship improved, and tracheotomy, when present, removed. During the follow-up, no injury to the inferior alveolar nerve was noted and scarring was significant in only the two cases treated with external devices.ConclusionMandibular Distraction Osteogenesis is a good solution in solving respiratory distress when other procedures are failed in paediatric patients with severe micrognatia.

Midline Mandibular Osteotomy in an Asymmetric Patient

This case report shows the possibility of the application of a mandibular osteotomy to resolve mandibular asymmetry with independent and discordant movements of both bony segments. The authors report the case of a 25-year-old woman referred for mandibular asymmetry, with a transverse excess of the right hemi mandible and vertical defect of the left one. The patient underwent a bilateral sagittal split osteotomy, midline osteotomy, and genioplasty, which corrected the mandibular asymmetry with contraction of the entire right hemi mandible. A slight left vertical increase was also obtained through the surgically created lateral open bite. In the follow-up assessment, the patients face appeared symmetrical with normalization of the bizygomatic-bigonial relationships, and the facial shape corresponded to ideal anthropometric features. This technique resulted in resolution of mandibular asymmetry. In addition, mandibular osteotomy permits the esthetic management of the shape of the entire mandibular body in relation to the other third of the face.

How does the mandible grow after early high condylectomy

AbstractThe early high condylectomy (HC), removing the overgrowing area of the condyle, may be indicated for condylar hyperplasia. However, in young patients, when the HC removes the pathological overgrowing tissue the contralateral condyle is still growing. May this surgical procedure, in these growing patients, stop the operated side growth creating the conditions for an opposite asymmetry? Authors investigate the way the operated mandible develops after the early HC, both as a symmetry percentage and in an absolute value related to the unaffected side. A sample of 8 consecutive growing patients, 1 male and 7 females, referred to the Maxillofacial Surgery Department of Parma University for HC were investigated. Patients were longitudinally studied with 3 orthopantomographies at: T0 (diagnosis: mean age, 13 years; range, 11 years 2 months to 13 years 8 months), T1 (after surgery: mean age, 15; range, 13–18 years) and T2 (follow-up: mean age, 18 years; range, 17–20 years). The x-ray is used to study the condyle, ramus, and total vertical structures length by Mattila tracing method. The data were analyzed by the Student t test and Wilcoxon matched pairs test; P value was set at 0.5. The operated side was overcorrected by HC and; during the investigated period, its growth decreased from T0 to T1 and restarted from T1 to T2. The whole T0–T2 growth of the operated side was not statistically different from the one of the healthy side (P < 0.05). These results suggest that the operated side growth may continue in a more normal way after condylectomy.

Virtual Planning of a Complex Three-Part Bimaxillary Osteotomy

In maxillofacial surgery, every patient presents special problems requiring careful evaluation. Conventional methods to study the deformities are still reliable, but the advent of tridimensional (3D) imaging, especially computed tomography (CT) scan and laser scanning of casts, created the opportunity to better understanding the skeletal support and the soft tissue structures. Nowadays, virtual technologies are increasingly employed in maxillofacial surgery and demonstrated precision and reliability. However, in complex surgical procedures, these new technologies are still controversial. Especially in the less frequent cases of three-part maxillary surgery, the experience is limited, and scientific literature cannot give a clear support. This paper presents the case of a young patient affected by a complex long face dentofacial deformity treated by a bimaxillary surgery with three-part segmentation of the maxilla. The operator performed the surgical study completely with a virtual workflow. Pre- and postoperative CT scan and optical scanning of plaster models were collected and compared. Every postoperatory maxillary piece was superimposed with the presurgical one, and the differences were examined in a color-coded map. Only mild differences were found near the osteotomy lines, when the bony surface and the teeth demonstrated an excellent coincidence.