The role of PETRA MRI sequences in the diagnosis of chondromatosis of the temporomandibular joint with erosion of the glenoid fossa.

Synovial chondromatosis is a benign condition characterised by the presence of small cartilaginous nodules in the joint; its aetiology is unknown. Only a few cases of temporomandibular chondromatosis are described in the literature. In some cases, the synovial chondromatosis can erode the adjacent bone structures, such as the glenoid fossa, middle cranial fossa, and internal carotid canal. In these cases, besides MRI, the gold standard to verify the erosion of the glenoid fossa is a computed tomography scan. The aim of this study is to report the use of MRI with PETRA (pointwise encoding time reduction with radial acquisition) sequences for the diagnosis and follow-up of temporomandibular joint chondromatosis with suspected erosion of the glenoid fossa.

Temporomandibular joint arthrocentesis: long-term results.

Arthrocentesis is a simple procedure, that may be performed under local anaesthesia and entails low risks of complications. It consists in the lavage of the upper joint compartment of the temporo-mandibular articulation through two transcutaneous needles of entrance and exit. The simplicity of execution, the low costs of the material employed and the excellent results published cause that this technique is beginning to be included in international protocols of treatment of temporomandibular dysfunctions. The clinical study involves 26 articulation in 25 patients. The age of the subjects at the time of the treatment ranged from 16 to 70 years. The follow-up of the patients treated ranges from a minimum of 12 to a maximum of 53 months. The most significant parameters to assess the effectiveness of the articular lavage, performed by the arthrocentesis technique, are the local pain intensity and the millimetre analytic comparison of the mouth opening and the mandibular movements in protrusion and laterality. A Student's "t" test was used to compare pre-treatment and post-treatment differences in level of TMJ pain and maximal mouth opening, in both cases section valve was less then 0.05 and so statistically significant.

Condylar fractures during growth: follow-up of 16 patients.

Fractures of the mandibular condyle represent 20% to 35% of all mandibular fractures. There are several clinical variants of this type of fracture that give rise to different problems in relation to their classification and treatment. A sample of 16 patients (of a total of 280 patients examined and treated from 1985 through 1995) with mono- and bilateral, displaced and decomposed, condylar fractures that occurred during growth were examined by the authors, who assessed, by a 2-year follow-up, the relevant clinical, functional, and instrumental parameters. On the basis of the data gathered by this study, a plan was drawn up for treating these patients that takes into account the different situations, such as either a nonsurgical or surgical treatment (by the use of condylectomy or external rigid fixation), and points out the advantages and disadvantages of each method.

[Arthrocentesis of the temporomandibular joint. Long-term results]. / L'artrocentesi dell'articolazione temporo-mandibolare. Risultati a lungo termine.

BACKGROUND: The studies carried out by Nitzan et al. (1991) to the assumption that the simple washing of the upper compartment of the temporo-mandibular joint, without introducing the arthroscope, associated to the application of a bite at night was sufficient to obtain a pain relieving effect and an improvement in the joint functionality in cases of internal derangement of TMJ. The purpose of this work is to assess the long-term results obtained in our department by using only the arthrocentesis without the association of other therapeutic procedures for evaluating the benefit brought by the simple washing of the upper compartment of the joint. METHODS: A sample of 10 patients subjected to arthrocentesis with an average follow-up of 23.8 months was examined. The evaluation of the patients was based on a clinical analysis and a series of instrumental tests including orthopanoramic X-rays, stratigraphies, RNM in some cases and an electrognatographic test. The parameters taken into consideration were maximum opening, articular noises, local pain in the articular region, the occurrence or not of headache. RESULTS AND CONCLUSIONS: In our opinion arthrocentesis is a method of simple application, well accepted by patients, leading to a clear improvement of symptoms, as far as pain relieving effect and functionality are concerned, thanks to the possibility to drain by washing the constituents of the inflammation and the mediators of pain; this method may be applied routinely, as therapeutic support, in those patients with clinical histories of condilo-meniscal uncoordination and presenting limitations in the opening of the mouth and articular pains.

[Trauma to the anterior cranial base. Report of a case]. / Traumi della base cranica anteriore. Presentazione di un caso clinico.

The authors present a case of foreign body retention, following car accident, localized on superior medial corner of the right orbit. The traumatic impact, involving endo-orbital structures, owing to the peculiar direction of the foreign body, caused a fracture in the anterior cranial base and laceration of the dura madre. As the anatomical structures involved did not concern only the MaxilloFacial district, the choice of the protocol to be applied to the patient was taken in accordance with the neurosurgical équipe. An intra cranial surgical approach has allowed to remove, by retrograding the foreign body on its trajectory path, in order not to injure further the already damaged structures involved. Then the tissues have been reconstructed; in particular, the anterior cranial base was restored through the use of pericranial strip. This technique is the elective surgical treatment in lesions of such small entity, as it is able to grant a solid support to the overhanging cerebral parenchyma. Besides, this reconstruction technique provides a complete protecting isolation of the ocular globe from compressive and pulsative phenomena, due to the neurocranial adjacent structures. With this technique, after a 8 month's follow-up. The patient has obtained optimum functional and aesthetic results.

[The use of the jejunum free flap in the reconstruction of the oral cavity]. / Il lembo rivascolarizzato di digiuno nella ricostruzione del cavo orale.

The rapid development of surgical techniques in the head and neck area has greatly assisted in enabling reconstructive surgery to bring about prompt positive results. Radical tumor excision alone is no longer an acceptable treatment. Through new reconstructive techniques, psychological and social isolation of the patients, due to difficulties in such vital functions as chewing, speech, swallowing and breathing, can be reduced remarkably. In the past numerous techniques which employed myocutaneous flaps in the reconstruction of the oropharynx have been described. During the last ten years, however, many Authors have proposed the use of free flaps for this reconstructive surgery. Our Department presents its personal experience in reconstruction of the oral cavity using the jejunal flap, which facilitates superior physiological and histological adaptation when compared to that had with other flaps. Our histological study shows metaplastic transformation of the columnar epithelium into squamous epithelium (similar to oral cavity epithelium), phenomenon already observed in "cervix uteri" and anorectal area. The primary reconstruction with a free revascularized jejunal loop associated with mandibular replacement offers certain significant advantages such as satisfactory reconstruction of large defects, high flexibility of the flap and a productions of mucous which cleans the surface of transplants. Furthermore, the mesenteric foot tissue serves as good transplant material for extended soft-tissue loss. In agreement with a Study begun by Carrel in 1906 and that of Reuther (1982), we believe that reconstruction of large defects in the oral cavity by means of transplantation of the mucosa is the ideal treatment.