Cognitive recovery after severe traumatic brain injury in children/adolescents and adults: similar positive outcome but different underlying pathways?

PRIMARY OBJECTIVE: Does younger age at the time of severe traumatic brain injury (STBI) protect from cognitive symptoms? To answer this question, the authors compared the neuropsychological profile of late school-age children/adolescents and young adult patients at mid- and long-term recovery periods (6 and 12 months post-STBI). METHODS AND PROCEDURES: Twenty-eight children/adolescents and 26 clinically matched adults were tested on measures of general intelligence, attention, executive functions, visuoperceptual, visuospatial and visuoconstructive abilities. Coma duration and the post-acute Glasgow Outcome Scale (GOS) score were used as predictor variables in a series of regression analyses. MAIN OUTCOMES AND RESULTS: Children/adolescents and adults similarly improved on most measures, except for visuospatial and visuoconstructive skills, which worsened in time for children/adolescents. Coma duration significantly predicted performance IQ and visuoperceptual scores in children/adolescents. The GOS score significantly predicted performance and verbal IQ, sustained attention, visuoconstructive and long-term memory skills. Coma duration predicted executive function skills in both age groups. CONCLUSIONS: (1) No evidence was found for a neuroprotective effect of younger age at STBI; and (2) Coma duration and GOS score predicted neuropsychological recovery in children/adolescents and adults, respectively. This suggests the existence of underlying age-specific recovery processes after STBI.

Cognitive and adaptive functioning after severe TBI in school-aged children.

OBJECTIVE: Persistent cognitive and behavioural deficits have been documented in children suffering severe TBI. The aim of the present study was to examine the cognitive and adaptive profile of children of school age with severe TBI. METHODS: This study selected 118 patients and divided them into three groups according to the severity of their clinical-functional picture. All the patients received a functional assessment using the Wee-FIM. Subjects with reduced responsiveness were evaluated by LOCFAS. Last, the cognitive profile children with a better recovery were described with WISC-III and Leiter-R and their adaptive behaviour with VABS. RESULTS: Group 1 (n = 77) showed a borderline cognitive level with a disharmonious profile between VIQ and PIQ, significant deficits in the Processing Speed and Perceptual Organization Indices, lastly specific adaptive behavioural deficits. Length of coma correlated with their cognitive and adaptive profile. Group 2 (n = 14) included subjects with severe language and/or motor disabilities presenting with a partial cognitive functioning level moderately impaired. Group 3 (n = 27) included patients with reduced responsiveness (LOCFAS ≤ 3). CONCLUSIONS: In the first 12 months following severe TBI, 22.9% children stayed in minimal responsiveness, 11.9% showed debilitating language and motor deficits and 65.2% showed a more favourable cognitive recovery and could be assessed by WISC-III.

Recurrent pleomorphic adenoma of the parotid gland: role of neutron radiation therapy.

Recurrent pleomorphic adenoma (RPA) of the parotid gland represents a challenging task for maxillofacial surgeons. The role of radiotherapy in the treatment of RPA of the parotid gland has been studied in previous experiences, and its use has been considered questionable. The aims of our article were to analyze and illustrate a case of RPA, initially treated with enucleations at another institution, showing a multinodular pattern with positivity for S-100 protein and cytokeratin, managed with conservative parotidectomy and neutron radiotherapy.

Major facial trauma after helicopter landing.

Injuries in civil aviation can occur as a consequence of work-related accidents happening in airport. The ground crew can sustain slips, trips, falls, and machinery accidents. Most such accidents are observed when aircraft is departing. This clinical report describes a case of an airport ground assistant severely injured by a helicopter after the strike with a main rotor blade that was slowing after that the craft was landed and the engine was stopped, and reports surgical emergency treatment of life-threatening facial lesions.

Treatment of recurrent mandibular ameloblastoma with segmental resection and revascularized fibula free flap.

The adamantinoma is characterized by a high rate of local recurrence. Because of this peculiarity, radical treatment is generally preferred than conservative surgery. Resection with free margins is associated with lower risk of recurrence but is not recurrence free; thus, the importance of long and scrupulous follow-up is evident. The aim of this study was to present a patient with recurrent mandibular adamantinoma after box resection with safety margins of 1 cm that has necessitated of a segmental resection with 1-step reconstruction with revascularized fibula free flap.

Esthetic positioning of rigid internal fixation in tripod zygomatic fractures: an innovative surgical technique.

Tripod displaced zygomatic fractures are generally treated with rigid internal fixation at the intraorbital rim (IOR), frontozygomatic (FZ) suture, and zygomaticomaxillary buttress. Intraorbital rim fixation is associated with complaints of poor esthetic results and miniplate intolerance. Although different solutions were previously reported as 2-point fixation or resorbable fixation at the IOR, a 3-point fixation is considered the best choice for maintaining an optimal zygomatic stability after reduction. Consequently, the best goal is to perform a surgical technique that provides a 3-point fixation and avoids the consequence of subjective and objective alterations at the IOR and FZ areas. We propose an innovative technique that proved to be a simple, effective method to eliminate postsurgical sequelae due to rigid internal fixation positioning in the IOR and FZ areas.

Treatment of oligodontia with endo-osseous fixtures: experience in eight consecutive patients at the end of dental growth.

Clinical manifestations of oligodontia consist in agenesia of multiple teeth eventually with deciduous retained teeth, atrophy of alveolar ridge, aberrations of teeth dimension, and shape, with consequent aesthetic and functional defects. The first choice treatment is based on a team collaboration of maxillo-facial surgeon, orthodontist, and prosthodontist, and is conditioned by various clinical parameters as number and site of lacking teeth, age and dental development of patients, eventual alveolar ridge atrophy. Treatment planning should be individualized for each patient. In our experience, based on 8 consecutive patients at the end of dental growth affected by oligodontia, endo-osseous fixtures positioning was carried out in consideration of long-lasting stability and optimal aesthetical characteristics. In 5 patients rehabilitative preprosthetic surgical procedures were performed, consisting in 2 sinus lift with immediate positioning of 3 fixtures in both cases, 4 heterologous bone graft in postextractive sites with retained ankylotic deciduous teeth and 1 positioning of reabsorbable biomembrane. A temporary removable denture was positioned immediately after surgery in order to obtain a prompt aesthetical and psychosocial restore. Osseointegration ratio as observed at 8.5 years follow-up was analyzed according to surgical variables and differences in prosthetic rehabilitation (fixtures supporting single crown versus multiple crowns). Successful osteointegration was observed at 8.5 years mean follow-up in 58 fixtures, corresponding to a 96.6% ratio. Failure of integration was encountered in fixtures immediately positioned in postextractive sites having a mild grade of bone atrophy, supporting single crown. A rate of success of 100% was observed in cases of immediate or delayed positioning in postextractive or traditional sites.Fixtures positioning in patients affected by isolated oligodontia, without malformative syndromes, and at the end of dental development, is subject to the same recommendations for patients with lacking permanent teeth not caused by agenesia.

Warthin's tumor of the hard palate.

Warthin's Tumor (WT) or papillary cystadenoma lymphomatosum is typically located in parotid gland. Extraparotid localization of WTs (EPWT) was rarely described in ectopic salivary tissue in the latero-cervical and para-parotid lymph nodes. Localization in the hard palate is exceptional. This paper describes pre-surgical diagnostic work up and surgical management of a solitary WT localized in the hard palate as found in a 27-year-old Caucasian woman. With consideration of uncertain pre-surgical diagnosis obtained with FNAC, intraoperative histologic examination of frozen sections was planned. Conservative surgical approach was performed. After WT was diagnosed with histology, a local bone curettage was made. Clinical and radiographic follow-up at 12th month was negative for relapse.