36 research outputs found
Quale analisi cefalometrica per la chirurgia maxillo-mandibolare in pazienti con sindrome delle apnee ostruttive notturne?
Lâavanzamento maxillo-mandibolare (AMM) è un trattamento efficace per pazienti affetti da sindrome delle apnee ostruttive notturne (OSAS) di grado severo. Sebbene il miglioramento dellâOSAS sia lâobiettivo principale di tale chirurgia, è necessario evitare un avanzamento maxillo-mandibolare eccessivo per garantire un gradevole risultato in termini di estetica facciale. A tale scopo, è necessario programmare preoperatoriamente lâentitĂ dellâAMM mediante unâanalisi estetica e cefalometrica. Le analisi cefalometriche di Steiner e Delaire vengono comunemente impiegate nella programmazione della chirurgia ortognatica per deformitĂ dentofaciali, tuttavia resta controverso il ruolo di tali analisi nei pazienti con OSAS candidati a AMM. Quarantotto pazienti con OSAS severa sono stati sottoposti a AMM. Abbiamo effettuato le analisi cefalometriche di Steiner e Delaire in tutti i soggetti. Per il tracciato di Steiner, abbiamo misurato la variazione degli angoli SNA e SNB, mentre per lâanalisi di Delaire, abbiamo misurato la variazione degli angoli C3/FM-CPA e C3/ FM-Me. LâAMM medio è stato di 6,9 + 3,8 mm per il mascellare superiore e 13,6 + 5 mm per la mandibola. Dopo lâintervento abbiamo riscontrato un miglioramento dellâIndice di Apnea-Ipopnea (40,47 + 7,64 preoperatoriamente vs. 12,56 + 5,78 postoperatoriamente). In tutti i pazienti, entrambe le tecniche cefalometriche hanno dimostrato una retrusione bimascellare preoperatoria. Dopo lâintervento, lâangolo SNA medio è aumentato da 78,18° a 85,58° (p < 0,001), mentre lâangolo C3/FM-CPA medio è aumentato da 81,19° a 89,71° (p < 0,001). Il valore medio dellâangolo SNB è aumentato da 74,33° a 80,73° (p < 0,001), mentre lâangolo medio C3/FM-CPA è passato da 80,10° a 87,29° (p < 0,001). Postoperatoriamente, sia il mascellare superiore che la mandibola risultavano in una posizione piĂš protrusa (p < 0,001) se analizzati secondo lâanalisi di Steiner rispetto al tracciato di Delaire. Lâutilizzo dellâanalisi cefalometrica di Delaire nella programmazione dellâAMM in pazienti con OSAS comporta un avanzamento maxillo-mandibolare superiore rispetto al tracciato di Steiner. Ă opportuno considerare le conseguenze di tale risulto sullâestetica facciale durante la programmazione chirurgica e nel consenso informato preoperatorio in pazienti con OSAS candidati a AMM
Dynamic Landscapes, Emerging Territories
As a result of the pressing environmental and technological conditions dominant
today, new frontiers for architectural production are emerging. Fueled
by accelerated change and increased connectivity, these trajectories operate
across multiple scales and domains. The evolving relationship between place,
technology, and occupancy formulates a complex active structure that tends
to have fluctuating levels of activity and impact. These conditions are giving
way to hybridized settings where the interdependence of digital and analog is
altering the very politics of place and identity. In response to the prevalence
of amalgamated settings, the paradigm of âDynamic Landscapes, Emerging
Territoriesâ is presented.
Dynamic Landscapes have definitions and presence in multiple locations
simultaneously, requiring new methods of documentation and assessment
in order to conceive appropriate design responses. The paper uses the Syrian
Refugee Crisis as a case study for deciphering the implications inherent in displacement
in the context of dynamic landscapes. Furthermore, it presents an opportunity to think of new architectural trajectories rooted and driven by the
animation of such sites. Inherently dynamic, forced displacement presents rich emerging territories where design carries significant impact and facilitates a
tangible reassessment of a refugeeâs narrative. Supported by robust information networks and active feedback loops, displaced landscapes as such can learn
from their residents and inform their imminent futures specifically, as well as
our collective human occupancy at large.
Within constantly changing milieus, architectureâs premises and processes are being challenged to respond to fluctuating contexts and provide for transient occupancies. While some may see this as a loss of spatial agency when it comes to design, these conditions present an opportunity to think of new architectural trajectories that are rooted and driven by the dynamism of multilayered landscapes and new approaches towards practice
Ionic currents influencing spontaneous firing and pacemaker frequency in dopamine neurons of the ventrolateral periaqueductal gray and dorsal raphe nucleus (vlPAG/DRN): A voltage-clamp and computational modelling study
Recovery of infraorbital nerve function after zygomaticomaxillary cheek pedicled flap
The zygomaticomaxillary cheek pedicled flap (ZMCF) involves the intentional section of the infraorbital nerve to reflect the flap laterally in order to give access to the rhinopharynx, clivus and upper cervical spine. The aim of this trial was to examine the recovery of sensation of the infraorbital nerve, both quantitatively (touch sensation, localisation test, two-point discrimination) and qualitatively (sharp/blunt test, temperature sensation, pain sensitivity, dental sensitivity) in 7 patients, at least 12 months after surgery. In each patient, four cutaneous areas (lower eyelid, nose ala, upper lip, cheek) and the upper vestibulum were tested. Results of each test in all the examined areas were evaluated and compared with the data obtained on the nonoperated side (control side). Results of neurosensory tests indicated good recovery of sensation with little difference in comparison with the control side, showing that the functional consequence of ZMCF should actually be considered only as a transitory event
Modified genioplasty and bimaxillary advancement for treating ostructive sleep apnea syndrome
Mandibular distraction osteogenesi with a small semiburied device in neonates: report of 2 cases.
Congenital nasal pyriform aperture stenosis: diagnosis and management.
Congenital nasal pyriform aperture stenosis is a rare and potentially lethal form of airway obstruction in newborns. Immediate recognition and appropriate therapy are mandatory for this potentially life-threating condition. This anomaly may present as an isolated malformation or may be associated with other cranial-facial anomalies. Clinically, CNPS shows unspecific symptoms of nasal airway obstruction such as apnoic crisis, episodic cyanosis and inability to nurse. The purpose of this report is to present author's experience in the surgical management of this rare pathology in 3 patients. Patients and Methods Three cases of congenital nasal pyriform aperture stenosis were reviewed for presentation of the disorder, management and effectiveness of the surgical treatment.
RESULTS:
All the patients underwent a surgical correction of the pyriform aperture stenosis using a sublabial approach followed by nasal stenting. During the follow-up no cases of restenosis, respiratory failure or cyanosis were detected.
CONCLUSIONS:
Congenital pyriform aperture stenosis should be suspected in newborns with clinical signs of severe nasal obstruction associated with a difficulty to pass a small catheter though the anterior nasal valve. Timely recognition is mandatory to prevent a potential deadly outcome. Surgical correction of the stenosis though a sublabial approach followed by a nasal stenting revealed to be most effective treatment for these patients
Infant mandibular distraction in absence of ascending ramus: case series
Background: Severe microretrognathia with the absence of ascending mandibular ramus is a challenging deformity and treatment must aim to avoid tracheostomy or remove it as soon as possible. Although it is not often reported, mandibular distraction osteogenesis represents a valid treatment option in infants affected by hypoplastic mandible Pruzansky-Kaban type IIb and III. Case presentation: The authors describe 3 cases of infants affected by severe respiratory insufficiency due to congenital mandibular hypoplasia, with follow up ranging from 4 to 8 years. Clinical and technical considerations on treatment choices and outcomes are discussed starting from review of the literature and direct clinical experience. Conclusion: Early mandibular distraction, specifically bidirectional distraction, is an effective and repeatable technique that leads to mandible lengthening with counterclockwise rotation, pogonion projection increase, anteropositioning of the tongue base, and expansion of oropharyngeal volume with positive effect on the respiratory problems of the infant. Even in Treacher Collins patients, known to have a low decannulation rate, all of these elements are essential for effective speech and swallowing therapy and for a subsequent attempt of decannulation