Trismus-pseudocamptodactyly syndrome: a 20 year follow-up.

BACKGROUND: 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. CASE REPORT: A 22-year- old girl affected by a severe form of TPS was followed from the age of three years. Bone reossification was observed after two coronoidotomies of both hyperplasic coronoid processes. After the decision to perform a coronoidectomy, the four-year follow-up showed a favourable outcome. Meanwhile the patient developed an anterior open bite which was treated with a fourth orthognathic surgery. The follow-up underscores how the correction of malformation leads to the generation of EMG activity of the masticatory muscles after many years of passiveness.

Reconstruction of severe atrophic jaws with Fresh Frized Bone Allografts: clinical histologic and histomorphometric evaluation.

OBJECTIVES: Rehabilitation of maxillary edentulism with implant-supported prostheses has come into common clinical practice. Although autologous bone has osteoinductive, osteoconductive and osteogenetic properties, its use is subject to certain disadvantages such as: Increased morbidity Limited amount of bone harvested from each donor site. AIM: The aim of this study is to analyze clinical, histological and histomorphometric results of homologous bone for implantoprosthetic rehabilitation in severe atrophic jaws. PATIENTS AND METHODS: Twenty consecutive patients, 14 female and 6 males, were treated with homologous bone bank. Treatment protocol consist of: first surgycal step, trasversal and vertical volume restore, second surgycal step: screw remove, specimen biopsy and insert implant fixtures. RESULTS: Data show that Fresh Frozen Bone Allografts (FFBA) could be a valuable substitute for autologous bone, in as much as histological and histomorphometric results are widely overlapping. CONCLUSIONS: Homologous bone is a valuable option for its large availability with a low cost, good versatility, no morbidity at the donor site, shorter surgical time and hospital stay.

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

BACKGROUND: 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. AIM: The aim of this study is to evaluate non-surgical therapy for OSAS using a mandibular advancement device (MAD) that provides for lower jaw protrusion and for an adequate vertical opening, that allows for greater airflow. MATERIALS AND METHODS: The device was assembled using the working principles of "Herbst-like" appliances and splints of neuromuscular deprogramming of the "Federici" type used for gnathologic treatments. We selected 17 males and 4 females, with an average age of 42 years, and an average BMI of 29. Eighteen patients were treated with our oral appliance, 1 patient was treated with the orthesis proposed by Schmidt-Nowara et al and 2 patients were treated with the oral appliance proposed by Johal and Battagel. All patients used the appliance for at least 6 months. RESULTS: After treatment with the oral appliance, the posterior airway space increased (p = 0.0002); no statistically significant difference for the improvement degree of OSAS severity (p = 0.1085) was shown; an improvement was found in: AHI (p = 0.0028); Nadir O2 (p = 0.0035); TO2 < 90% (p = 0.0140); 2 patients presented with temporomandibular joint (TMJ) discomfort. CONCLUSIONS: Our MAD has proved effective in improving the polysomnographic and radiographic parameters and assures good TMJ compliance.

Occlusal alterations in unilateral coronal craniosynostosis.

There are few studies on maxillomandibular skeletal alterations. Twenty-one patients with unilateral coronal craniosynostosis were analysed and compared with controls. Landmarks analysed were: sella-nasion-point A and B angles, point A-nasion-point B angle, interincisal angle, angle of superior incisor axis on the sella-nasion plane, lower incisor to mandibular plane angle, Frankfort mandibular plane angle, zygomatic-frontal suture (Z), point on the most concave part of pyramidal apophysis of the upper maxilla (Mx), antegonial incisure (AG), upper (UMT) and lower (LMT) molar teeth. Differences were significant for class II dentoskeletal occlusion (p<0.0001), mandibular hyperdivergence (p<0.0001), lingualization of superior incisor (p<0.005), deviation of inferior interincisal contralateral line to the synostosis (p<0.0001) in the plagiocephalic population. Compared with contralateral counterpoints, Z (p<0.05), Mx (p<0.005) and UMT (p<0.0005) on the affected side were closer to the midline; AG (p<0.0005) and LMT (p<0.05) were further from it. On the frontal plane, Z, Mx, UMT, LMT and AG on the affected side were higher. Vertical and transversal contraction of the jaw of the synostotic side and laterodeviation of the mandibular interincisal line of the contralateral synostotic were clear. The altered position of the glenoid cavity, anteriorized in unilateral coronal craniosynostosis, could be the cause of mandibular dentoskeletal asymmetry.

Case report of oligodontia: long term stability of orthognatic surgery and prosthetic rehabilitation.

Oligodontia may compromise the harmonious development of the masticatory system. The quantity and quality of agenesis determines the type of approach and the complexity of rehabilitative therapy. We present a case of a patient affected by oligodontia and maxillo-mandibular skeletal alterations, corrected by orthodontic and orthognatic surgical treatment, assisted by prosthetic-presurgical rehabilitation of the lower arch. After surgery the occlusion was finally restored by a definitive prosthesis modeled on the presurgical one and supported by the same residual dental elements. Photographic and cephalometric analysis have shown the stability of the results at 20 years follow-up. The case presented shows that the final prosthesis on the residual teeth in patients affected by oligodontia may represent a possible alternative to implanto-prosthetic rehabilitation, presenting lower cost and requiring less time for definitive occlusal rehabilitation.

Clinical experience with spiramycin in bisphosphonate-associated osteonecrosis of the jaw.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) consists of an exposure of the jaw bone that persists for over 8 weeks in patients with positive history for bisphosphonates. Symptomatology is characterized by dull and ceaseless pain, and in advanced stages, the exposure of necrotic bone is evident, which is frequently associated with purulent secretions and faetor oris. Despite many different studies on BRONJ, there are no general guidelines to treat this disease. In this work, the authors present their experience in BRONJ conservative therapy with spiramycin by comparing the results achieved with amoxicillin and clavulanic acid. From January 1, 2008 to June 30, 2008, our department received 25 patients who were affected by osteonecrosis secondary to bisphosphonates. Thirteen had taken bisphosphonates for osteoporosis and 12 for malignancies. We divided the 25 patients into two groups: those who had not received any treatment and those who had received treatment. The first group of 13 patients had been treated only with spiramycin (S). The results from this group were only evaluated to test the efficacy of spiramycin and were not considered in the study. The second group of 12 patients had not undergone any previous treatment. This group was further divided in two groups of 6 patients each; one group was treated with spiramycin and the other with amoxicillin and clavulanic acid (ACA). The following criteria were used to evaluate the results of the study: pain, sensibility deficits, purulent secretion and bone exposure. All group results were evaluated according to the criteria chosen, and positive results were achieved in both groups S and ACA, such as reduction or disappearance of pain, sensibility deficits and purulent secretion and healing of bone exposition, although spiramycin showed itself to be more effective than the combination of amoxicillin and clavulanic acid. Spiramycin is a macrolide antibiotic with a wide spectrum of activity against Streptococci, Pneumococci, Diplococci, Gonococci and Staphylococci, which are typical in BRONJ. No resistance was indicated. Administration of the antibiotics can be intravenous, intramuscular, rectal or oral, which remains the most frequently used since spiramycin elimination also occurs with saliva and the antibiotic reaches high concentrations in the oral cavity where BRONJ is situated. Good compliance to the spiramycin regimen was observed in all three groups, with a general improvement in all of the parameters considered. In only two cases did patients have to undergo surgical curettage. The results showed that spiramycin can be a first choice drug in the treatment of BRONJ, and it should be strongly considered for patients where previous antibiotic therapy did not prove to be effective.

Rigid external fixation and condylar remodeling.

Condylar fractures, instead of other mandibular fractures, play a primary importance role because their high incidence and the historic controversy existent in literature regarding their treatment. Recent studies prove that conservative treatment of condylar fractures, although not determining perfect alignment of the fractured segments, leads to a series of histologic and morphologic healing processes ending with consolidation of the fracture and functional recovery of the TMJ (temporo-mandibular joint). In this study, we observed long-term results of 2 cases of bicondylar fracture treated with surgical reduction and rigid external fixation. Rx orthopantomography control 1 year after surgery showed condylar remodeling bilaterally with good functional recovery. Our school affirms that semirigid fixation system allows optimal function between the articular head and the glenoid fossa, with good tridimensional repositioning of the fractured segments.