Sandro Pelo

Fanconi anemia manifesting as a squamous cell carcinoma of the hard palate: a case report

Fanconi Anemia is a rare autosomal recessive disorder characterized by various congenital malformations, progressive bone marrow failure at a very young age and of solid tumors development. The authors present a rare case of a squamous cell carcinoma of the hard palate in a Fanconi Anaemia patient. The atypical clinical manifestation rendered the diagnosis more difficult. This case, for age of appearance, sex and localization, is unique in international literature. We recommend a quarterly follow up of the oral-rhino-pharynx complex in FA patients and to consider as carcinomas, all oral lesions that last more than two weeks.

Activities of masticatory muscles in patients after orthognathic surgery

AIM To evaluate left and right masseter and anterior temporalis muscle activity in patients before and after orthognathic surgery. PATIENTS Nineteen patients were enrolled, 9 males and 10 females, aged 17-34 years. Four patients were suffering from a prognathic syndrome (skeletal class II with mandibular retrusion) and were candidates for surgical correction involving a mandibular Bilateral Sagittal Split Osteotomy (BSSO), whereas the other 15 patients showed a progenic syndrome (skeletal class III with mandibular protrusion) and were selected for bimaxillary surgery with maxillary advancement and mandibular retrusion. METHODS Electromyographic examinations were carried out on all subjects presurgically and 6-8 months postoperatively. To verify the neuromuscular equilibrium, the electromyographic activities of both the right and left masseter and anterior temporalis muscles were registered and analysed calculating: percentage overlapping coefficient (POC, index of the symmetric distribution of the muscular activity determined by the occlusion) and torque coefficient (TC, index of presence of mandibular torque). RESULTS After surgery, a trend in the improvement of POC and TC indices was found, with a reduced intragroup variability. CONCLUSION The electromyographic evaluation allowed the impact of occlusion on neuromuscular equilibrium to be quantified, and showed that improvements gained by surgical intervention are primarily due to better occlusal stability and not to biomechanical advantages.

Distraction osteogenesis in the surgical treatment of craniostenosis: a comparison of internal and external craniofacial distractor devices

PurposeTo compare the practical difficulties of external and internal craniofacial distraction devices used in craniofacial advancement in terms of technical surgical limitations and patients’ discomfort.Materials and methodsThis study involved analysis of the pertinent literature and personal experience on the treatment of patients affected with syndromic craniosynostoses treated with craniofacial distraction advancement.ResultsOne hundred patients who underwent internal craniofacial distraction were analyzed. This kind of distraction device was found to be adequately tolerated by the patients with regards to physical and psychological aspects. They had relatively little impact on day-life activities. However, a significant drawback of this type of device is represented by the difficulty in controlling the vectors of distraction. Thirty-eight patients were analyzed after having received the implantation of an external craniofacial distraction device. This type of instrumentation was found to have a significant psychological impact and important limitation on recreational activities. External devices, however, offered important advantages in the control of the vectors of distraction, which could be modified according to the patient’s needs during the perioperative and early postoperative clinical course. There were no significant differences among the two types of devices with regard to osteogenesis and degree of facial advancement.ConclusionBoth internal and external devices are effective in distraction craniofacial advancement. However, significant differences do exist concerning the surgical aspects and the practical difficulties experienced by the patients.

Techniques on modeling the vascularized free fibula flap in mandibular reconstruction

In mandibular reconstruction with bone grafts, the functional and aesthetic outcomes are clearly influenced by reconstructive techniques. Vascularized free fibular flaps are considered the most suitable choice for mandible reconstruction because of their good aesthetic and functional outcomes. Several techniques have been described in literature. According to various authors, shaping of the fibular graft can be performed by means of computer-aided design/computer-aided modeling procedures for the evaluation of the presurgery anatomy and three-dimensional models of fibula graft. However, these models are expensive, require a strict realization of the programmed intervention, and are not easily adaptable to a surgical treatment different from the planned one. We report our experience on a technique for mandibular reconstruction using a free fibular flap, obtained by modeling a template on the resected mandible. Our operative technique consists of 5 steps: preplating, resection, template modeling, contouring of the fibula, and fixing the flap on the mandible.Template modeling is performed to record the length of the resected bone, the mandibular curvature on the 3 space planes, and the width of the basal bone. On the basis of the template, the fibula flap was modeled while still attached to the pedicle. The plates, positioned at the level of the fibular osteotomies, were preformed to make the fibula precisely fit in the template. Once the fibula was shaped, mandibular reconstruction was completed by positioning the fibula graft on the mandibular stumps. Bone graft modeling by means of template is a rapid, safe, and flexible method to reconstruct the mandible.

Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy—review of literature and meta-analysis

OBJECTIVE This study compared extracapsular dissection (ED) vs superficial parotidectomy (SP) in the treatment of pleomorphic adenoma and benign parotid tumors. STUDY DESIGN The research covered the years 1950-2011 in PubMed, Ovid MEDLINE, the Cochrane Database of Systematic Reviews, and Scopus. Of 1152 articles screened, 123 studies met the inclusion criteria. A review of the nomenclature of the different parotid surgery techniques was done. Recurrence rate, permanent facial nerve paralysis, and Frey syndrome of patients who underwent ED vs those who underwent SP were compared by meta-analysis. RESULTS Our meta-analysis data comparing ED and SP found that: (1) the recurrence rate is higher in patients treated with SP; (2) SP has a higher incidence of cranial nerve VII paralysis; and (3) Frey syndrome is more common after SP. CONCLUSIONS ED may be a viable option in the treatment of unilateral benign parotid tumors of the superficial lobe, sized less than 4 cm, without involvement of the facial nerve.

Three-dimensional analysis in facial asymmetry: comparison with model analysis and conventional two-dimensional analysis

The purpose of this study was to compare a computed tomographic (CT) three-dimensional analysis with a model analysis to use it as diagnostic aid for the evaluation of occlusal plane tilting in facial asymmetry. Ten patients with facial asymmetry underwent CT three-dimensional examination, plaster cast analysis, and two-dimensional cephalometric analysis. The distance between a reference plane to the upper first molar and upper canine was measured on three-dimensional CT, on models, and on cephalograms to assess occlusal plane tilting. Measurements taken on three-dimensional CT were compared with those taken on articulator and cephalograms, and the level of discordance between the different analyses was evaluated. Quantitative data on the occlusal tilting are similar, but three-dimensional CT gives a better representation of anatomy, thus reducing interpretative problems about altered individual anatomy. Three-dimensional CT seems to be so helpful in detecting individual anatomical variations that it can be adopted in the diagnosis for severe craniofacial asymmetry.

Aneurysmal Bone Cyst located in the Mandibular Condyle

A rare case of aneurysmal bone cyst (ABC) located in the mandibular condyle in a 10-year-old boy is presented. The patient came to our attention for a sudden swelling in the right temporomandibular region, the mouth opening was not reduced.A rapid growing mass, depicting soft tissue invasion, in the right condyle of the mandible was found. Clinically and radiographically it resembled to a malignant lesion. The surgical excision of the mandibular condyle allowed a complete removal of the lesion. The histological examination revealed a pseudocystic expanding osteolytic lesion containing blood-filled space separated by connective tissue and many osteoclastic giant cells, which was a conventional vascular ABC.The ABC is an infrequent bone lesion which can only be found very rarely at the craniofacial skeleton. There have been described about 160 cases of ABC originated in the molar region or in upper maxilla and even more rare is the location of this cyst in the mandibular condyle. Only 6 cases were reported in the literature to date.A complete surgical resection of this osteolytic lesion is the treatment of choice considering its high recurrence rate. The condyle was not replaced with any graft. Therefore a functional device was used after surgery to overcome the lack of the condyle and to stimulate the growth of the ramus.

Surgical Therapy for Osteonecotic Lesions of the Jaws in Patients in Therapy With Bisphosphonates

Objective: Surgical therapy to improve the symptoms and the lesions in osteonecrosis (ON) of the jaws in patients in therapy with bisphosphonates. Design: to evaluate the patients therapeutic protocols, performance status, and factors promoting ON to prevent surgical failure. Materials and Methods: 18 patients affected by osteonecrotic lesions of the jaws associated to BF, were treated by surgery. Results: The results were recorded after 6 months. All the patients showed improvement of symptoms, in particular the pain. In addition, all the patients referred to a sensation of fresh and clean mouth, the disappearance of fetor ex ore, and a healthy mouth. Conclusions: The management and the resolution of BF osteonecrotic lesions is arguable and complex because in most cases, the patients are affected by oncologic disease when the better approach is prevention, but when the ON lesion is clear, surgery can improve the symptoms and in some cases, it can be resolute. To prevent surgical failure, it can be useful to evaluate the patients therapeutic protocols, performance status, and factors promoting ON.

Complex craniosynostoses: a review of the prominent clinical features and the related management strategies

The protocols for clinical evaluation and management of children with complex craniosynostoses are significantly different from those used in single suture forms. The time at which the various anatomical and functional anomalies observed in the affected subjects become clinically relevant varies from patient to patient, consequently requiring a tailored approach. The clinical course is variable and influenced by multiple factors, acting at different steps of the children growth. Intracranial hypertension is a major concern already in the first months of life; active cerebrospinal fluid (CSF) dynamics disorders, venous hypertension, and progressive craniocerebral disproportion are considered the main pathogenetic factors. Cranial vault and skull base sutures synostoses account for the frequently observed increased venous pressure. Skull base abnormalities lead to upper airways obstruction, which, on one side, might create significant upper airways obstructive problems and, on the other, contribute to the increase in the intracranial pressure. Secondary Chiari malformation is common and considered as a progressive disorder, mainly due to progressive craniocerebral disproportion, venous hypertension, and CSF dynamics disorders. Optic nerve and orbit-related eye-globe diseases are also a major concern. Papilledema is mostly related to increased intracranial pressure. The skull base synostotic process is the base of significant abnormalities of the orbital space, ending in the common feature of significant proptosis with the consequent risk of corneal ulcers. Aims of this paper are to analyze the physiopathogenetic mechanisms at the base of the clinical manifestations presented by children with complex craniosynostoses, and the therapeutic options currently available.

Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants

Extensive resorption of the mandible increases the interarch space and rehabilitation with traditional dentures is often unsatisfactory due to the superficialization of intraoral muscles. A study of 19 patients who underwent augmentation of an atrophic mandible using a bilateral two-step osteotomy and interpositional bone graft technique is presented. Three horizontal bone cuts (one in the intraforamina and two in the molar region) were made and jointed together by two short vertical bone cuts mesialy to the mental nerve. The cranial fragment was lifted and the iliac bone graft was interposed recreating the correct intermaxillary relationship. A broad vascular pedicle was maintained during surgery, ensuring nutrition from the lingual side, essential to reduce resorption of the bone graft and cranial fragment. 141 Biomet 3i Osseotite((R)) implants were placed. Patients were rehabilitated with a full-arch implant-supported fixed prosthesis or an implant-supported overdenture. This clinical study describes the resorption process over a 4 year follow-up. 3 of 19 suffered from persistent neurosensitive disturbances. In conclusion, bilateral two-step osteotomy in association with interpositional bone graft is a reliable surgical means to recreate the anatomical morphology of the mandible.