Search

Background: An alternative approach to surgery for treating class II adult borderline patients is the non-extraction and multiloop edgewise archwire (MEAW) technique. The aim of the present study is to compare dentoskeletal effects of the orthognathic surgery with the MEAW technique., Methods: Thirteen adults (ten women, three men; mean age, 27.8 years) were consecutively treated using the MEAW approach. The control group was made of 13 adults (nine women, four men; mean age, 26.2 years) treated by orthognathic surgery and the multibracket appliance before and after surgery. Lateral headfilms before and after all the treatments were traced for linear and angular measurements, and data were blindly analyzed. ANOVA was conducted to compare any difference over time between the two treatments. Differences over time for each variable, separately for surgery and MEAW, were assessed by Wilcoxon test., Results: No significant differences between the two groups were detected at baseline. Both treatments were effective in correcting dental discrepancies. A significant difference over time between the two treatments was found in several cephalometric measurements., Conclusions: Considering the limits of the present sample the following conclusion emerged: in the MEAW group, the malocclusion correction was predominantly dentoalveolar, and a significant profile change was observed. Significant skeletal and occlusal plane changes were obtained with the orthognathic surgery approach.

Actinomycosis of the tongue is a rare form of infection whose initial clinical manifestation is a submucosal swelling that may mimic both benign and malignant neoplasias. Two cases are, presented and their clinical features and diagnostic criteria are discussed in the light of twelve cases drawn from the literature. Infection in the tongue is rare, though perhaps underestimated. It is generally located on the anterior two thirds laterally to the median sulcus, and presents as a moderately painful nodule set deep in the extrinsic and intrinsic muscles and poorly mobile on the adjacent planes. In a few weeks the lesion increases in size and painfulness with consequent loss of function in the absence of diagnosis and appropriate antibiotic management. Both our patients, in fact, presented with deep lesions and no apparent involvement of the mucosa, and were investigated by means of fine-needle aspiration biopsy (FNAB). The aspirated material was used to prepare both routine smears and cell blocks embedded in paraffin. The pathological material provided by this combination of methods proved quantitatively and qualitatively sufficient for the definitive diagnosis of actinomycosis in both cases.

The reconstruction of the loss of substance from the oral floor following demolitive cancer surgery aims to guarantee adequate tongue movement and the consequent preservation of phonatory and swallowing functions, as well as the possibility of using prosthetic rehabilitation. Large defects are resolved using musculocutaneous or free vascularised flaps, whereas smaller defects may be closed by first intention using alveolo-lingual suture. There are a number of drawbacks to this method: occurrence of fistulas immediately after surgery and secondary ankyloglossia. It is then necessary to resort to a second operation using dermoepidermic graft and plastic surgery of the oral floor to liberate the tongue. These problems may be resolved using a nasolabial flap. The flap can be prepared using either an upper or lower peduncle, it is relatively simple to perform and does not significantly prolong operating times. The contemporary dissection of the neck with ligature of the facial artery does not in our experience significantly influence flap vascularisation. The main drawback is the limited size of the flap (on average it is 6-7 cm long with a maximum width of 3-4 cm at the base. The upper edge is equally placed 7-10 mm from the medial side). The flap must be sufficiently thick to ensure an adequate blood supply to subcutaneous tissue, but the dissection plane must be sufficiently near the surface to preserve the facial nerve. It is important to prepare the graft bed so as to avoid creating tension after suture.(ABSTRACT TRUNCATED AT 250 WORDS)

The paper examine 40 cases of bone graft from the iliac crest used in maxillo-facial surgery. The immediate and late complications included pain with resulting difficulty of walking and, less frequently, hematoma, sensitivity disorders and dehiscence of the wound. Late complications were most frequently related to esthetic problems as well as a negligible number of persistent cases of difficult walking and neurological deficiencies. The results obtained were comparable to those most recently reported in the literature. The low incidence of immediate and late sequelae at the donor site and the characteristics of the bone graft confirm the suitability of iliac crest bone graft, in particular for use in reconstructive maxillo-facial surgery.

Results of early combined maxillo-facial and neurosurgical treatment of 53 craniofacial fractures are referred. The fracture location was in 31 cases central midfrontal, 10 lateral supraorbital and 12 combined central and lateral fractures. 35 fractures interested the floor and the posterior wall of frontal sinus, lacerating the underlying dura and cortical tissue. In 19 fractures orbital displacement was present. The key points in the management of these patients are: 1) Early (within 1 to 5 days) and one stage neurosurgical-maxillofacial procedure. Immediate intervention is indicated only in case of evolutive neurological lesions; 2) wide exposition of all the injuries through bicoronal incision and bone flap; 3) assessment of fractures pattern and amount of bone loss; 4) reconstruction of craniofacial frame with osteosynthesis and autologous bone grafts (35 cases iliac crest, 7 split calvarial graft); 5) interosseous wiring is used in sutured mosaic, small bone fragments and intraoperative temporary fixation; miniplates are used for rigid fixation of craniofacial pillars; 6) for optimal cosmetic result reconstruction of supraorbital ridge, nasoglabellar region and zygomatic arch is essential; 7) fractures involving the sinus floor, posterior wall and the nasofrontal duct result in direct communication between the nose and intracranial cavity with high risk of infection and mucocele formation. Cranialization of the sinus removing the posterior wall and all the mucosa is mandatory. The nasofrontal duct, the floor and sinus dead space are obliterated with autologous bone chips. Osteoneogenesis occurred in all the cases.