Surgical sequence of reduction in double mandibular fractures treatment

Le fratture mandibolari costituiscono una quota che va dal 40% al 62% di tutte le fratture facciali. In circa la meta dei casi le fratture mandibolari sono multiple e tra queste una quota consistente presenta due rime di frattura. L' alta frequenza di fratture doppie è da attribuire alla particolare forma della mandibola. Da un punto di vista biomeccanico la mandibola può essere assimilata per grandi linee ad un arco le cui estremita sono costituite da condili. tali strutture sono libere di ruotare all' interno delle cavità glenoidi assicurando in tal modo un certo grado di ammortizzazione in risposta ai traumi. Nonostante non vi siano dubbi circa le indicazioni chirurgiche delle fratture mandibolari doppie non è ancora chiaro quale frattura dovrebbe essere trattata prima. Lo scopo di questo studio è quello di chiarire, in base alla nostra esperienza, la corretta sequenza chirugica di riduzione da seguire nel trattamento delle fratture mandibolari doppie. Abbiamo condotto uno studio retrospettivo su un campione di pazienti operati presso il nostro reparto nel periodo compreso tra Gennaio 2007 e Gennaio 2010. Abbiamo incluso nello studio solo i pazienti trattati per doppia frattura mandibolare e li abbiamo suddivisi in due gruppi basandoci sulla diversa sequenza di riduzione delle fratture. I pazienti sono stati seguiti con uno stretto follow-up clinico e radiologico per valutare le variabili outcome di confronto tra i gruppi. L' analisi dei risultati ha evidenziato che i pazienti (gruppo A) in cui è stata ripristinata prima la dimensione orizzontale (frattura toothbearing) e poi quella verticale (non- toothbearing) hanno ottenuto minori complicanze postoperatorie e ridotti tempi operatori rispetto al gruppo di confronto (gruppo B). Il ripristino della dimensione orizzontale fornisce una guida per ottenere la riduzione efficace delle fratture non-toothbearing e il ripristino della dimensione verticale. In conclusione, sulla base della nostra esperienza e dei risultati ottenuti, in caso di fratture mandibolari doppie, gli autori suggeriscono la riduzione in prima istanza delle fratture toothbearing e successivamente qualle in area non-toothbearing.AIM: This study aims to clan, according to our experience, the correct surgical sequence which should be followed in order to treat double mandibular fractures.MATERIAL OF STUDY: From January 2007 to January 2010, we have conducted a retrospective study on a sample of patients operated on in our department. We include only those cases in which the jaw was fractured in 2 places, in particular patients who suffer a fracture in tooth-bearing areas (symphysis, parasymphysis, and anterior body) and also contralaterally in non tooth-bearing areas (posterior body, angle, ramus, and condyle). The sample was divided into 2 groups based on the fracture sequence of reduction.RESULTS: At 1-year follow-up, the group of patients who received first the tooth-bearing fractured areas treatment, followed by treatment of non tooth-bearing fractured area on bifocal mandibular fracture (Group A), showed less postoperative complications and reduced surgical time and costs.DISCUSSION: In patients of group B, the non-execution of rigid IMF for the non tooth-bearing fractures made bone segments more free to move. Thus, reduction and fixation of non tooth-bearing fractures is facilitated, but poses a greater risk of complications. The surgeon in this case does not have the occlusal help guide; thus, the tooth-bearing fracture reduction and the subsequent fixation may be imperfect.CONCLUSION: It is recommended from this study that reduction of the tooth-bearing fragment be prior to that of the tooth-free fragment for the double mandibular fracture

Reconstruction of small orbital floor fractures with resorbable collagen membranes

Orbital floor fractures are the most common facial fractures. The goals of orbital floor fracture repair are to free incarcerated or prolapsed orbital tissue from the fracture defect and to span the defect with an implant to restore the correct anatomy of the orbital floor and the pretrauma orbital volume. No consensus exists on the choice of implants to be used for orbital floor reconstruction, and several implant materials are available.Our study intended to evaluate, for the first time, the effectiveness and complications related to the use of a resorbable collagen membrane in the reconstruction of small pure blow-out fractures. From October 2008 to November 2010, 23 patients who underwent reconstruction of the orbital floor using a resorbable collagen membrane following fracture were included in this study. At the 6-month follow-up, only 2 patients (9%) reported postoperative complications secondary to the operative procedure (surgical approach, orbital floor dissection), but these were not directly related to the use of the membrane. In 12 cases, a computed tomography scan revealed new bone formation beneath the membrane.On the basis of this data, we believe that the use of a resorbable collagen membrane is a safe and effective alternative for reconstruction of small (<3 cm(2)) pure orbital floor fractures

Reconstruction of small orbital floor fractures with resorbable collagen membranes

Orbital floor fractures are the most common facial fractures. The goals of orbital floor fracture repair are to free incarcerated or prolapsed orbital tissue from the fracture defect and to span the defect with an implant to restore the correct anatomy of the orbital floor and the pretrauma orbital volume. No consensus exists on the choice of implants to be used for orbital floor reconstruction, and several implant materials are available.Our study intended to evaluate, for the first time, the effectiveness and complications related to the use of a resorbable collagen membrane in the reconstruction of small pure blow-out fractures. From October 2008 to November 2010, 23 patients who underwent reconstruction of the orbital floor using a resorbable collagen membrane following fracture were included in this study. At the 6-month follow-up, only 2 patients (9%) reported postoperative complications secondary to the operative procedure (surgical approach, orbital floor dissection), but these were not directly related to the use of the membrane. In 12 cases, a computed tomography scan revealed new bone formation beneath the membrane.On the basis of this data, we believe that the use of a resorbable collagen membrane is a safe and effective alternative for reconstruction of small (<3 cm(2)) pure orbital floor fractures

Akreos Adapt AO Intraocular Lens Opacification: A Case Report.

A 79-year-old hyperglycemic patient was referred to the 'Santa Maria delle Croci' Hospital, Ravenna, Italy. He presented with visual impairment in the right eye. Four years ago, he had had an uneventful cataract surgery in the right eye. We observed an opacification of the intraocular lens (IOL) causing significant visual disturbance. The IOL was exchanged. Unfortunately, pathologic analysis was not performed. Patient-related factors such as hyperglycemia and hypertension might have been responsible for the opacification. To our knowledge, there is only one previous report of opacification of the Akreos Adapt AO IOL

Clear cell myoepithelial carcinoma ex pleomorphic adenoma of parotid gland: Case report and review of literature

Myoepithelial carcinoma (MC), also known as malignant myoepithelioma, shows an infiltrative and destructive growth [1]. Myoepithelial neoplasms account for about 1.5% of all salivary tumors, and MC is even more rare, representing about 10% of myoepitheliomas [1e3] with a reported incidence of 0.2% of all salivary gland tumors. In this case, the cytological diagnosis (pleomorphic adenoma) and negative lymph nodes, addressed the surgeon for a parotidectomy, following guidelines and literature [27]. The best treatment for huge, relapsing tumors, notwithstanding cytological diagnosis, is not only parotidec- tomy, as lymphadenectomy should be performed too, given myoepithelial carcinoma's high-grade potential and unpredictable biologic behavior. Careful patient follow-up and staging, is therefore essential for better characterization and understanding of this tumor's behavior in the future. We also considered a more conservative treatment following guidelines, as this case was lacking metastases and lymphatic involvement, considering that application of guidelines, surgical and clinical expertise and appropriate technology can contain potential medicolegal implications [28]

Multiple myeloma vs. breast cancer patients with bisphosphonates-related osteonecrosis of the jaws: a comparative analysis of response to treatment and predictors of outcome

Multiple myeloma (MM) and breast cancer (BC) are the two most common diseases associated with bisphosphonates-related osteonecrosis of the jaws (BRONJ), for which different therapeutical approaches have been proposed. The aim of this study was to compare the clinical behaviour of BRONJ in patients with MM vs. BC and the time of healing in terms of clinical and symptomatological remission, following a standardized therapeutic protocol. METHODS:Twenty-six BRONJ patients (13 men with MM and 13 women with BC) were prospectively enroled and treated with a specific systemic and topical antibiotic therapy. Several predictors of outcome were also evaluated. RESULTS:Nine patients (69.2%) with BC and 10 patients (76.9%) with MM progressed towards a complete clinical remission (CR) in a mean healing time of 183.3 days [SD: 113.7; 95% confidence interval (CI): 95.95-207.7] and 372.0 days (SD: 308.0; 95% CI: 151.7-592.3) (P = 0.776), respectively. The clinical improvement was statistically significant (P = 0.0013 and P = 0.0014), as well as the assessment of pain (P = 0.0015 and P = 0.0015), in MM and BC group, respectively. Cox regression analysis revealed that just triggering events (P = 0.036) were found to be significant predictors of outcome of BRONJ healing. CONCLUSIONS:Both groups of cancer patients experienced clinical and symptomatological remission regardless their malignancy, but BC patients earlier than MM patients