Correlation between cranial base morphology and the position of the glenoid fossa in patients with facial asymmetry

The purpose of this study was to relate the facial asymmetries with possible impairments of the skull base, particularly with regard to the three-dimensional position of the glenoid fossa. Fifty-eight subjects met the inclusion criteria (25 men and 33 women) and were included in the analysis. All patients underwent three-dimensional computed tomographies. Patients were classified into 3 asymmetry groups: vertical plane asymmetries, transversal plane asymmetries (TAs), and hybrid forms. A control group, composed of 29 subjects having obstructive sleep apnea syndrome with no asymmetries, was used to compare data from the study populations. The glenoid fossa moved forward and superiorly on the affected side if compared with the healthy side both in the vertical plane asymmetry group and in the TA groups (P < 0.001). Differences were wider in the TA group. Statistically significant differences regarding the middle and posterior cranial base angles were observed between the affected side of the TA patients and the control group. We reported an amplitude reduction of the middle cranial base angle and an increase of the posterior cranial base angle in the affected side. The glenoid fossa could represent the missing link between the development of the temporal region and the ipsilateral hemimandible

Bilateral condylar resorption in Down syndrome.

Asymptomatic idiopathic condylar resorption is a rare disease of difficult diagnosis and treatment. We review the literature about this rare condition and report a case of a patient, affected by Down syndrome, who underwent a complete untreated bilateral condylar resorption in adolescence and then developed pain on chewing only 20 years later. Despite a precise orthodontic and surgical therapeutic plan, treatment had to be discontinued because of patient lack of compliance. This case is the first of its kind to be reported and emphasizes the need for special attention in patients with disability

Use of microvascular free flaps in the reconstruction of the anterior and middle skull base

Different reconstruction techniques of the anterior and middle skull base as consequence of a defect after surgical treatment of neoplastic pathologies are described in the literature. The aim of the present study is to present our experience regarding the use of microvascular free flaps for reconstruction of the anterior or middle skull base after large defects caused by removal of malignant neoplasms. From 2000 to 2004, in the Department of Maxillo-Facial Surgery of the University of Rome "La Sapienza" and "Tor Vergata; " 13 surgical procedures for reconstruction of anterior and middle skull base defects by free flaps were performed in 11 patients. Data on patient demographics, histopathology, location and size of defect, type of reconstruction, and postoperative complications were obtained from medical record charts. A safe soft tissue closure of the intracranial space was achieved in all patients. Defect repair was accomplished by revascularized transfer of rectus abdominis flaps in seven cases, latissimus dorsi muscle flaps in two patients, radial forearm flap in one case, and fibula flap in one case. There were two total flap losses; the secondary defect repair was accomplished in both cases by revascularized transfer of latissimus dorsi muscle flap. No donor site complications were observed in all the flaps. The mean operation time was 85 hours; patients were hospitalized for a mean period of 14 days. The method of choice for the reconstruction of anterior or middle skull base defect should be based upon careful evaluation of the single case and, particularly, the localization and entity of the residual defect. For defects that require large amounts of soft tissue, the latissimus dorsi free flap and the rectus abdominis free flap are the best appropriate choices for reconstructive procedures for anterior and middle skull base tumors

Transnasal endoscopic approach to the impacted maxillary canine

The inclusion of maxillary canines is a very common condition. The intraoral approach to the canine extraction can be buccal or palatal depending on the position of the tooth. However, in some cases, the proximity to the nasal floor or the side wall of the nose makes the transoral approach rather invasive. The aim of this article was to describe a novel transnasal endoscopically assisted approach for the extraction of high palatal/paranasal impacted canines. Thirty-seven maxillary canines have been extracted in 29 patients. The surgical approaches were buccal in 5 cases, palatal in 24 cases, and transnasal endoscopically assisted in 8 cases. Patients treated with the transnasal approach required the least amount of pain killers in the postoperative period, and the average of the operative time was shorter than that of the transoral extraction. In our opinion, the transnasal endoscopically assisted approach is a safe and effective procedure for the extraction of highly impacted maxillary canines located within 2 cm from the piriform aperture

Trismus-pseudocamptodactyly syndrome: a 20 year follow-up

Trismus-Pseudocamptodactyly Syndrome (TPS) is a rare autosomal syndrome characterised by the inability to open the mouth fully, pseudocamptodactyly, short stature and foot deformities. The maxillofacial feature entails hyperplasia of the coronoid processes which mechanically interfere with the zygomatic processes during mouth opening

OSAS treatment with oral appliance: assessment of our experience through the use of a new device

Obstructive sleep apnea syndrome (OSAS) is defined as repeated episodes of obstruction of the upper airway and oxygen desaturation of the arterial hemoglobin. OSAS is associated with loud snoring, excessive daytime sleepiness, cardiovascular and neurocognitive disease, increase risk of road accidents

Vertical distraction osteogenesis combined with bilateral 2-step osteotomy for preprosthetic rehabilitation of edentulous mandible

The aim of the current study was to appraise the effectiveness of distraction osteogenesis combined with bilateral 2-step osteotomy for the vertical augmentation of atrophic edentulous mandibles. To verify the predictability of this technique, we evaluated bone density and vertical bone gain of a cohort of 27 patients. The intraoral alveolar distractor was placed in the symphyseal area; then, it was left in situ for 2 months after surgery to consolidate the newly formed bone. A total of 189 implants were inserted. The main complications' issue was tied up to the neurosensory disturbances of the inferior alveolar nerve, which disappeared few months after the surgery.At the end of the distraction osteogenesis, a mean vertical bone gain of 10.5 mm evaluated by comparing preoperative and postoperative computed tomography was reached. Three months after the surgery, the radiologic data indicated that the difference in the mean bone density, recorded in Hounsfield units (HU), between the distracted bone and the preexisting mandibular bone was not statistically significant (P > 0.05). The last measurements done showed that the osseous density in the distraction chamber was higher than the original medullary bone density: the regenerated bones were more dense (876.8 [205.9] HU) than the preexisting medullary bone (312.1 [142.3] HU) and less dense than the preexisting cortical bone (1721.1 [170.4] HU) at the ninth month.In conclusion, this approach appeared to be a viable solution for the improvement of vertical volume in atrophic mandibles

Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial

The aim of this study was evaluate the morbidity after anterior iliac crest bone harvesting by comparison of 2 approaches: medial and intracortical