Facial growth and morphology of cleft lip and/or palate patients after corrective surgery according to P.I.S.A. technique.

Cleft lip and/or palate patients (CLP) undergo corrective surgery that can affect facial growth. The aim of this study was to analyze facial growth and maxillary development of CLP subjects after surgery according to P.I.S.A. technique (Peri osteoplasty Improves Symmetry and Aesthetic). Cephalometric tracings of 55 patients were performed, thirty-three of which belonged to the test group, while the lasting twenty subjects were part of the control group. The test group was formed by cleft lip and/or palate patients after surgical repair according to P.I.S.A. technique. The control group included patients unaffected by this malformation, with an Angle's first class, selected from the Michigan Growth Study sample. Facial growth and upper maxilla development analysis was carried out by comparing the data obtained from the cephalometric traces of cleft patients who performed an early surgery, with the values of the same parameters measured in non-cleft subjects, providing the normal values. The results of this study showed, in the test group, a maxillary and mandibular bi-retrusion, a more negative facial convexity, the absence of a marked discrepancy in the skeletal relationships, a slight tendency towards hyper-divergence. .

Treatment of failed back surgery syndrome.

Objectives. To evaluate the long-term results of different therapies for failed back surgery syndrome (FBSS). Materials and Methods. From 1992 to 1997, 49 patients were treated for FBSS. Twenty patients were treated medically. Twenty-four patients, who did not respond to medical therapy, underwent spinal cord stimulator (SCS) implant and five underwent further spine surgery. All patients were evaluated by VAS, PDI, and the Oswestry Scales before treatment and at follow-up. Leg pain, back pain, work status or daily activities, drug side effects, and use of analgesic medications after implantation were examined. Follow-up ranged from 24 to 84 months (mean 42 months). Results. At last follow-up, the patients treated medically demonstrated good results on leg and low back pain in eight cases; in other cases, good results were transitory and several therapeutic courses were necessary to control the pain. Two patients treated medically had substantial side effects. All but two patients treated with SCS demonstrated good results for their leg pain; whereas those treated for back pain with SCS had poor results. Two patients still needed continuous drug administration. Conclusions. Medical therapy is effective for leg and back pain; nevertheless, several courses of therapy may be necessary. SCS is an effective treatment for leg pain, however, its effectiveness on back pain appears to be inadequate.