Paolo Arangio

Fast and early mandibular osteodistraction (FEMOD) in severe Pierre Robin Sequence

Pierre Robin Sequence (PRS) is a congenital abnormality characterized by mandibular hypoplasia, glossoptosis and often secondary palate cleft. It may be an isolated or part of a most complicated syndrome. The genetic syndrome that most frequently co-occurs is Stickler syndrome characterized by skeletal abnormalities, joint pain, congenital myopia and retinal detachment. The authors describe their fast and early mandibular osteodistraction (FEMOD) protocol in severe cases of PRS airway obstruction.

Importance of fetal MRI in evaluation of craniofacial deformities.

AimThis retrospective study aims at demonstrating the importance of a correct and detailed early diagnosis of craniomaxillofacial malformations affecting the fetus, which would (1) allow improvement in ultrasonography (US) diagnosis, (2) help in planning the therapeutic-surgical procedure, and (3) improve handling of the pathology by the families. Materials and MethodsBetween 2008 and 2011, a sample of 28 fetuses was selected, all with an ultrasound diagnosis of cleft lip (cheiloschisis—CL) and cleft lip and palate (palatoschisis—CLP) and craniofacial malformation, whose mothers had all underwent ultrasound diagnostic examinations and nuclear magnetic resonance (MRI). All cases were submitted to US examination between the 12th and 19th week of pregnancy, US-3D examination performed by a specialist radiologist between the 19th and 22nd week, and MRI examination between the 23rd and 33rd week of pregnancy. ResultsThe MRI confirmed the ultrasound diagnosis of 16/28 cases and added information in 11/28 cases, and in 1 (1/28) case, the MRI denied previous CL-CLP ultrasound diagnosis. Moreover, in this study MRI improved the analysis of the entire morphology of the fetuses in cases when syndromic involvement with the involvement of other organs needs to be determined. ConclusionsThe MRI method in fetal patients allows to obtain more details regarding the CL-CLP studied, allowing the medical-surgical team to plan, before the birth, the type of postnatal assessment and surgery to be performed, thus minimizing the impact on neonatal health and improving quality of life of both the patient and his family.

Myositis ossificans of the medial pterygoid muscle.

Myositis ossificans (MO) is a disease whose main feature is the formation of heterotopic bone involving muscle or any other soft tissue. Pathogenesis is not all clear, but trauma is universally recognized as a trigger event. Myositis ossificans can be divided into 2 classifications: MO progressiva and MO traumatica. The authors present a case of a 64-year-old man who was diagnosed with MOT of the left medial pterygoid muscle. The patient had a long clinical history of signs and symptoms of temporomandibular articulation related to previous conditions, and no major traumatic events were reported, apparently related to MOT.

Tinnitus in patients with temporo-mandibular joint disorder: Proposal for a new treatment protocol

The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old. The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution.

An unusual case of orbito-frontal rod fence stab injury with a good outcome

BackgroundHigh-energy non-missile penetrating injuries (stab injuries) account for a small percentage of penetrating head injuries and they present a series of special features.Case presentationA 35-year-old man suffered orbito-frontal? and trans-cranial injuries after falling five meters from a terrace onto a rod iron fence. The removal of the metal rod was performed outside the operating room. The orbital roof was exposed and repaired through a bifrontal craniotomy and the frontal sinuses were cranialised. The orbital floor and zygoma were plated with micro-screws.ConclusionThe patient recovered without significant complications, apart from a slight paresis of the right superior rectus; the ocular globe remained intact.The positive outcome obtained in this very challenging case is attributable to the competency of the Neurotrauma Unit and to the use of a synergistic approach which involved the contribution of neurosurgeons, maxillo-facial surgeons, radiologists and anaesthesiologists.

Early Secondary Alveoloplasty in Cleft Lip and Palate

The aims of this study were to present a personal surgical technique throughout the review of international literature concerning surgical techniques, objectives, and outcomes in early secondary alveoloplasty and to describe our personal surgical techniques in alveolar bone defect repair in cleft lip and palate. Throughout a literature analysis, it is now settled that early secondary alveoloplasty could reestablish the continuity of alveolar bone and prevent upper dental arch collapse after presurgical orthopedic upper maxilla expansion; it also might give a good bone support for teeth facing the cleft and allow the eruption of permanent elements with the bone graft and rebalance the symmetry of dental arch, improve facial aesthetic, guarantee an adequate amount of bone tissue for a further prosthetic reconstruction with implant, and finally close the eventual oronasal fistula. The surgical technique we are presenting permitted a total number of 35 early secondary alveoloplasty on which a long-term follow-up is still taking place. We can assess that early secondary alveoloplasty must be performed before permanent canine eruption. Iliac crest is the suggested donor site for bone grafting; orthopedic and orthodontic treatments must be performed in association with surgery, and if there is the dental element agenesia, an implantation treatment must be considered.

Management of Facial Trauma in Patients Older Than 75 Years

Abstract According to the literature and World Health Organization, elderly people are specified as persons older than 65 years of age. The authors believe that the indication for surgery patients over 65 is based on the restoration of functionality and the aesthetics. The behavior of the surgeon has to change with patients aged older than 75 years where the restoration of function and, therefore, a good quality of life is far more important than the aesthetic restoration. In a retrospective study of 1022 patients consecutively hospitalized at Maxillofacial department in Roma, Università “Sapienza,” the patients older than 75 years were analyzed. During this period, the data of all patients undergoing treatment because of trauma-related injuries were collected. Data were registered regarding etiology, localization of the injury, surgical treatment ratio, medium average stay, age, and sex distribution. Surgical treatment in these patients should be driven by the general condition of health whenever possible; reduction of facial fractures should be guided by the need to return a good quality of life for the patients. The goal of this study was to analyze a new group of population, people older than 75 years, that is, a real new and growing group of population.

Chondrocalcinosis: rare localization in the temporomandibular joint.

In this paper introduces a rare case of chondrocalcinosis of the temporomandibular joint secondary to hyperparathyroidism, diagnosed in a 64-year-old man. The patient complained of symptoms characterized by the presence of a swelling in the left pretragic preauricular region, accompanied by a limitation of the mandibular movements. Radiographic examinations suggested a diagnosis of synovial chondromatosis. Subsequently definitive histological analysis removed mass stated for a chondrocalcinosis of the left temporomandibular joint. The differential diagnosis is very hard, in this case it has been difficult for the rarity of the pathology described in literature; the exact diagnosis can be only formulated on histologic and citologic examination of the mass excised.

Evaluation of temporomandibular disorders before and after orthognathic surgery: Therapeutic considerations on a sample of 76 patients

Objectives: Temporomandibular disorders may be associated with dental and facial malformations. The aim of this study is to record the prevalence of TMDs in patients scheduled for orthognathic surgery, reporting the development of TMDs and symptoms during the entire period of the treatment, and demonstrating the benefits of a team effort on this population. Materials and Methods: Assessment of temporomandibular status was performed using the RDC/TMD criteria at T0 (prior to orthodontic therapy), T1 (3 months after the surgery), and T2 post-therapeutic cycle (6 to 12 months postoperatively). A total of 76 participants were included in the study; all the patients underwent surgical treatment: 12 had bilateral sagittal split osteotomy, 6 with condylar position devices; 64 had Le Fort I + bilateral sagittal split osteotomy, and 15 with condylar position devices. Results were evaluated with a paired-sample t-test and segmentation analysis. Results: Forty-seven patients were affected by TMDs. At T0, 25 patients experienced TMJ pain, 27 had muscular pain, 31 suffered headaches, 42 had disc dislocation with reduction, and 5 were affected by disc dislocation without reduction. Thirty-five patients had occlusal signs of parafunctions, 8 reported tinnitus, and 7 dizziness. At T1, TMJ pain changed from 33.3% to 4.44%, muscular pain changed from 35.5% to 11.1%, headaches improved from 40% to 6.67%, and disc dislocation from 55.2% to 17.7%. Segmentation analysis highlighted improvement after therapy; 57 patients were considered recovered, 14 improved, none were considered stable, whereas 5 patients demonstrated some worsening, 3 of whom had not presented disc dislocation before surgery. At T2, 71 patients were considered completely recovered or improved. Conclusions: Our data indicates beyond any doubt that both functional status and pain levels related to TMDs can be significantly improved with a multi-disciplinary approach. We concluded that surgeon′s intervention need to be modified in the presence of presurgical TMDs.

A Modified External Fixator System in Treatment of Mandibular Condylar Fractures

Abstract The purpose of this study is to evaluate patients outcomes after condylar fractures treated with the modified external fixation system from 2008 to 2012. A group of 58 patients with unilateral and bilateral fractures of mandibular condyle was admitted in the authors’ study. The final sample included a total of 44 patients, 24 males (54.6%) and 20 females (45.4%). The remaining 14 (24%) patients were excluded because they did not fulfill all the criteria requested. After 12 months from surgery, the functional-clinical evaluation of mouths maximum opening and mostly extent of lateral excursion and of protrusion showed the following results: 8% of the sample showed a maximum mouth opening <30 mm, 72% of the sample showed a maximum mouth opening between 30 and 40 mm, 20% of the sample showed a maximum mouth opening >40 mm lateral excursion (contralateral to fracture) and protrusion was respectively of 9.5 and 3.9 mm. Only 2 (4.5%) of the 44 evaluated patients reported headaches. 86.5% of the patients showed no postoperative temporomandibular joint dysfunction; 9% of them reported occasional clicking, while 4.5% reported recurrent disorders. The average satisfaction score of surgery outcome reported by patients was 94.5/100, and it ranged between 50/100 and 100/100.