Surgical evolution in the treatment of mandibular condyle fractures

Background: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation. Methods: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture. Results: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope. Conclusions: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application

Mandibular bone and gingival epithelium during bisphosphonates treatment: an experimental study

Bisphosphonates (BP) are stable analogues of pyrophosphate with a P-C-P structure and 2 side chains attached to the carbon atom. Intravenous bisphosphonates are primarily used and effective in the management of cancer-related conditions in the context of solid tumors, such as breast cancer, prostate cancer, and lung cancer. Moreover bisphosphonates are subministred to patients with metabolic bone disease such as osteoporosis and Paget disease. Bisphosphonate-associated osteonecrosis of the jaws (BONJ) is a really complication of intravenous bisphosphonates therapy in patients with cancer. It is common knowledge that the jaws have a greater blood supply than other bones and a fasterbone turnover rate, related both to their daily activity and presence of teeth which mandates daily bone remodeling around the periodontal ligament; moreover bisphosphonates toxicity to epithelial cells has been well documented. On this basis, the aim of this experimental study is to evaluate the pathological changes of the mandibular bone and oral mucosa in rat treated with bisphosphonates. In details we have analyzed, by immunoistochemical and scanning electron microscopic methods, biopsy of mandibular bone and of gingival mucosa in rat treated with bisphosphonates after 7, 15, 30, 45, 60 days of assumption of drugs and after 7 and 30 days from the end of the treatment. Our results show great area demineralization bone mixed to normal bone, moreover in the demineralization bone it’s possible to observe numerous micro lacunae. In the correspondence samples of gingival epithelium we observe changes of histological structure and the disappearance of protein adhesion system cells to cells and cells to matrix. On this basis it is intriguing to speculate that the adverse effects of BP on oral epithelium may play a critical role in the initiation of BONJ an “outside-in” hypothesis

Masseteric artery pseudoaneurysm: A rare complication in orthognatic surgery

Pseudoaneurysm rarely develops after orthognathic surgery, and can cause symptoms such as facial swelling, delayed bleeding, and development of a pulsatile soft mass. The aim of this report is to highlight a case of a masseteric artery pseudoaneurysm following orthognatic surgery, describing the possible while rare occurrence and its treatment. At the ninth postoperative day, persistent facial swelling and bleeding from the intraoral surgical wounds and nose occurred, followed by a syncope. Support therapy was administered, and an Angio-CT was requested. The results of the scans raised suspicion of the presence of a pseudoaneurysm. After the stabilization of the clinical picture a therapeutic angiography was performed. A pseudoaneurysmatic dilatation was documented in the distal portion of the left masseteric artery and was promptly excluded from the main circle. This artery derived, as an anatomical variant, from a common branch originating from the internal maxillary artery. While this complication is more commonly reported in traumatology, in cases of suspicious intraoperative bleeding, persistent facial swelling, and late-onset nasal-oral hemorrhage, pseudoaneurysms of the maxillofacial district should be considered as a possible complication of orthognatic surgery

Erratum to: Surgical evolution in the treatment of mandibular condyle fractures

BACKGROUND: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation. METHODS: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture. RESULTS: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope. CONCLUSIONS: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application

Complex craniofacial trauma resulting from fireworks blast

The authors report the case of a patient who sustained a complex craniofacial trauma secondary to a recreational fireworks blast. Initial assessment and management were performed with a multi-disciplinary approach to achieve control of cerebral hemorrhage, debridement of wounds and brain, isolation of the brain from the external environment, reconstruction of the cranial base floor, and orbital and facial reconstruction. Modification of multiple conventional approaches, along with a multispecialty surgical team, were used to deal effectively with this unusual patient who was treated by single-stage immediate management. Reconstruction of both the intracranial and extracranial compartments was considered successful with a satisfactory cosmetic result

Can a 3D Virtual Imaging Model Predict Eagle Syndrome?

Eagle Syndrome is an underestimated syndrome with broad and often unspecific signs and symptoms. Both the neuropathic and vascular patterns need a thorough investigation in terms of all their clinical and radiological aspects. A positional/dynamic study is mandatory in the case of suspicion of Eagle Syndrome due to the strong influence of head and neck positions. This work aims to propose a new virtual technique able to predict conflicts between the styloid process and neck vascular structures

Anterior skull base reconstruction with a galeal-pericranial flap

Excision of neoplasm and trauma involving the anterior cranial base may often result in communication between the intracranial and extracranial compartments. Many techniques have been proposed to obtain a watertight separation. We report our 5 years of experience in the management of anterior skull base defects using a galeal-pericranial flap. Between January 2001 and April 2006, 22 patients were treated for a cranial base reconstruction at the University of Messina. Five of them presented with persistent cerebrospinal fluid (CSF) leak after previous craniofacial trauma. Ten underwent a combined maxillofacial-neurosurgical approach for the removal of a benign tumor involving the anterior skull base. Seven had severe craniofacial trauma, which required an intervention of reconstruction of the anterior skull base. In the whole series, a galeal-pericranial flap was used to separate intra- and extracranial compartments. No patients developed postoperative brain contusions or subdural-epidural blood collections. Throughout the follow-up period, there was no evidence of flap failure. In all but one patient, no postoperative CSF leak was evident. In One patient, a mild transient postoperative CSF leakage was present. There has been no recurrent CSF leak or meningitis. The follow up average of 23 months shows no incidence of infection. Even if our series does not comprise malignancies and previously irradiated patients, our data confirm the validity of the galeal-pericranial flap for the surgical management of minimal and moderately sized defects of anterior cranial base

Biodegradation of Crude Oil by Individual Strains and a Mixed Bacterial Consortium in Simulation of Marine Environment

Petroleum hydrocarbons are the most widespread contaminants in the marine environment. The fate of petroleum in sea water is largely controlled by mechanical, physical and chemical factors which influencing the natural transformation of petroleum (oil weathering) and oil bio-degradation. On the basis of these considerations, bioremediation techniques have been developed and improved for cleaning up oil-polluted marine environment as alternative to chemical and physical techniques. To elucidate the cooperative action of mixed microbial populations in the biodegradation of crude oil, we constructed artificial consortia composed of two to three bacteria (Alcanivorax borkumensis strain SK2, Rhodococcus erythropolis HS4 and Pseudomonas stutzeriSDM) capable to degrade oil hydrocarbons. Using these consortia, we investigated the mechanism by which efficient biodegradation of crude oil could be accomplished by the mixed populations for application in natural environment (bioaugmentation). All experiments were carried out in microcosms systems containing seawater (with and without inorganic nutrients) and oil was used as sole carbon source. All data obtained (Total DAPI Count, Live/Dead staining, Card-FISH and GC-FID hydrocarbons analysis) confirmed the fundamental role of bacteria belonging to Alcanivorax genus in degradation of linear hydrocarbons in oil polluted environments. Indeed, in all experimentations carried out in seawater with or without inorganic nutrients showed as rates of oil degradation are almost total in presence of this bacterium

The Utility of Capsicum annuum L. in Internal Medicine and In Dentistry: A Comprehensive Review

Capsaicin is a chili peppers extract, genus Capsicum, commonly used as a food spice. Since ancient times, Capsaicin has been used as a “homeopathic remedy” for treating a wild range of pathological conditions but without any scientific knowledge about its action. Several studies have demonstrated its potentiality in cardiovascular, nephrological, nutritional, and other medical fields. Capsaicin exerts its actions thanks to the bond with transient receptor potential vanilloid subtype 1 (TRPV1). TRPV1 is a nociceptive receptor, and its activation starts with a neurosensitive impulse, responsible for a burning pain sensation. However, constant local application of Capsaicin desensitized neuronal cells and leads to relief from neuropathic pain. In this review, we analyze the potential adjuvant role of Capsaicin in the treatment of different pathological conditions either in internal medicine or dentistry. Moreover, we present our experience in five patients affected by oro-facial pain consequent to post-traumatic trigeminal neuropathy, not responsive to any remedy, and successfully treated with topical application of Capsaicin. The topical application of Capsaicin is safe, effective, and quite tolerated by patients. For these reasons, in addition to the already-proven beneficial actions in the internal field, it represents a promising method for the treatment of neuropathic oral diseases