RESUMEN
Canine distemper virus (CDV) is a Morbillivirus (Canine morbillivirus) that greatly impacts domestic and wildlife carnivores worldwide. The CDV RNA genome has high genetic variability, evidenced by several lineages that follow a global geographic pattern. The evolutionary trajectories and population dynamics of CDV lineages are still unclear and debatable, particularly in South America, where relatively few sequences are available. We performed phylogenetic and Bayesian analyses using an updated dataset of the highly variable hemagglutinin (H) gene, including seven South American countries. The time to the most recent common ancestor (tMRCA) of the current CDV lineages was dated to the early 1900s in North America. Maximum likelihood and Bayesian maximum clade credibility phylogenies showed similar topologies with two main branches (L1 and L2) corresponding to the NA1 lineage (L1) and the remaining lineages worldwide (L2). The four circulating lineages in South America (EU1/SA1, SA2, SA3, NA4/SA4) arose from independent migration events from North America and Europe. North American strains colonized most northern South American countries via Ecuador and then Colombia and Peru, originating the SA3 and NA4/SA4 lineages during their spread. The entry and expansion in the southern part of South America (Argentina, Brazil, Chile, and Uruguay) occurred through three independent migration events and gave rise to the EU1/SA1 and SA2 lineages. South American lineages have specific combinations of amino acids under positive selection that constitute signatures of taxonomic and evolutionary relevance. Our findings provide a comprehensive scenario for the origin and migration routes of Canine morbillivirus in South America and highlight the importance of phylodynamics in understanding the geographic patterns of modern genetic variability.
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Virus del Moquillo Canino , Moquillo , Morbillivirus , Animales , Teorema de Bayes , Brasil , Moquillo/epidemiología , Virus del Moquillo Canino/genética , Perros , Morbillivirus/genética , Filogenia , América del Sur/epidemiologíaRESUMEN
BACKGROUND: To reduce the shortage of N95 respirators and surgical masks during the COVID-19 pandemic, stockpiled equipment beyond its expiry date could be released. AIM: Centralized testing of batches of expired surgical masks and N95 for safe distribution to hospital departments saving users time. METHODS: Tests of compliance with health authority directives were developed and carried out on 175 batches of N95 masks and 31 batches of surgical masks from 12th March 2020 to 16 April 2020. Five quality-control tests were performed on batch samples to check: packaging integrity, mask appearance, breaking strength of elastic ties and strength of nose clip test, and face-fit. FINDINGS: Forty-nine per cent of FFP2 mask batches were compliant with directives, 32% of batches were compliant but with some concerns and 19% of batches were non-compliant. For surgical masks, 58% of batches were compliant, 39% of batches compliant but with concerns and 3% of batches were non-compliant. CONCLUSION: The main areas of non-compliance were the breaking strength of the elastic ties and the nose clip but these alone were not considered to make the masks unacceptable. Only mask appearance and face-fit results were decisive non-compliance criteria.
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Infecciones por Coronavirus/prevención & control , Adhesión a Directriz , Máscaras/normas , Exposición Profesional/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Control de Calidad , Dispositivos de Protección Respiratoria/normas , Ventiladores Mecánicos/normas , Betacoronavirus , COVID-19 , Francia , Humanos , SARS-CoV-2 , Factores de TiempoRESUMEN
Fibrous dysplasia is a non-neoplastic, sporadic, slowly progressing disease of the bone in which normal bone is replaced by abnormally overgrowing lesions. There are three different types of fibrous dysplasia: monostotic (affecting a single bone), poliostotic (affecting multiple bones) and syndromic, when it is associated with other diseases (such as McCune Albright syndrome). Fibrous dysplasia affects cranio-facial bones in 10% of the cases. However, its occurrence in the inferior turbinate is extremely rare. To the best of our knowledge, only four cases of monostotic form have been reported so far. Hereafter we describe a case of monostotic FD of the inferior turbinate surgically treated with a trans-nasal endoscopic partial maxillectomy type II.
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Displasia Fibrosa Monostótica , Displasia Fibrosa Poliostótica , Endoscopía , Huesos Faciales/diagnóstico por imagen , Huesos Faciales/cirugía , Displasia Fibrosa Monostótica/diagnóstico , Displasia Fibrosa Monostótica/cirugía , Displasia Fibrosa Poliostótica/diagnóstico , Displasia Fibrosa Poliostótica/cirugía , Humanos , Cornetes Nasales/cirugíaRESUMEN
INTRODUCTION: The objective of this study was to assess medical students' knowledge of "medication related osteonecrosis of the jaws" (MRONJ). METHODS: A questionnaire survey was administered to all the medical students in the last two years of school of medicine at the University of Eastern Piedmont between January 2019 and March 2019. The questionnaire contained a first section regarding demographic and personal data of the student and a second section regarding the knowledge on MRONJ. RESULTS: On the whole, 72 medical students agreed to participate to this study and filled in the questionnaire. As for indications for the use of bisphosphonates 45 students correctly answered "osteoporosis, osteogenesis imperfecta, multiple myeloma, or metastasis of some malignant tumors". Almost all students (71 out of 72) answered that a thorough examination of oral cavity and a dentist screening is needed and fundamental before starting bisphosphonate assumption. As for drugs responsible for MRONJ, only 12 students out of 72 correctly answered "bisphosphonates, denosumab, and antiangiogenic drugs". DISCUSSION: A better level of knowledge and awareness by medical doctors and young physicians may lead, in future, to minimize incidence of MRONJ as well as to a better resolution of ONJ cases. Theoretical and practical initiatives could be promoted to improve and consolidate the knowledge of future physicians about this important issue.
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Osteonecrosis de los Maxilares Asociada a Difosfonatos , Conservadores de la Densidad Ósea , Osteoporosis , Estudiantes de Medicina , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/epidemiología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , HumanosRESUMEN
INTRODUCTION: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). MATERIALS AND METHODS: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). RESULTS: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (P<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (P<.05) and a high FISS score (P<.005) were associated with concomitant body injuries too. CONCLUSIONS: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.
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Traumatismos Maxilofaciales , Fracturas Craneales , Fracturas Cigomáticas , Accidentes por Caídas , Anciano , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/etiología , Fracturas Craneales/epidemiología , Fracturas Craneales/etiologíaRESUMEN
INTRODUCTION: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.
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Fracturas Mandibulares/cirugía , Europa (Continente) , Fijación Interna de Fracturas , Humanos , Mandíbula , Cóndilo Mandibular/cirugíaRESUMEN
OBJECTIVE: The surgical removal of third molars (3 Ms) is often associated with postoperative symptoms such as trismus, edema, and pain. The purpose of this study was to perform a comparative assessment of the effect of dexamethasone by different administration routes. STUDY DESIGN: A randomized, prospective study was carried out including patients undergoing the surgical removal of bilateral impacted mandibular 3 Ms. Patients were grouped according to dexamethasone administration routes Group A (intravenous); Group B (intralesional); Group C (oral administration). After surgery, pain, edema, and trismus were recorded. Postoperative symptoms severity (PoSSE) questionnaires were administered too. RESULTS: 108 patients were allocated to group A, 101 to group B, and 106 to group C. Statistically significant differences (P < .05) with better results were observed as for edema, pain and the results of PoSSe questionnaires by groups A and B. CONCLUSION: A single intralesional administration of dexamethasone seems to be effective in decreasing postoperative pain, edema, and symptoms after third molar surgery.
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Antiinflamatorios , Dexametasona , Tercer Molar , Diente Impactado , Antiinflamatorios/administración & dosificación , Dexametasona/administración & dosificación , Humanos , Estudios Prospectivos , Extracción DentalRESUMEN
Tuberculosis (TB) continues to be a major health problem for the developing world and a rise in the number of cases has been noted in the western hemisphere too. TB can affect most organs in the head and neck region, such as the lymph nodes, larynx, middle ear, oral cavity and pharynx. In particular, as for cervical tuberculosis lymphadenopathy, a predominant involvement of the posterior triangle, supraclavicular, and internal jugular group of nodes bilaterally can be observed. As the early manifestation of Head and Neck TB is often similar to neoplasms, clinical consideration usually occurs only after an ineffective anti-inflammatory treatment, fine-needle aspiration, or biopsy/resection. In fact, this type of presentation often represents a diagnostic and therapeutic challenge to the clinician. Therefore, the aim of the present article is to present and discuss the management of a case of cervical tuberculosis lymphadenopathy.
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Linfadenopatía , Tuberculosis Ganglionar , Cabeza , Humanos , Ganglios Linfáticos , CuelloRESUMEN
Ovine pregnancy toxaemia is a metabolic disorder affecting sheep in their last 6 weeks of pregnancy as a result of their inability to maintain adequate energy homoeostasis. Different alternative treatments are available with variable results. The aim of this research was to evaluate a peroxisome proliferator-activated receptor alpha (PPARα) stimulant as an alternative to treat clinical pregnancy toxaemia. Thirty-three adult sheep, with known gestation date and carrying a single foetus, were fasted from day 130 of gestation until animals showed clinical disease. From that moment onwards, sheep were treated during 6 days with three different therapeutic alternatives: 10 mg/kg of 2-methyl-2-phenoxy-propionic acid; 10 mg/kg of 2-methyl-2-phenoxy-propionic acid + 100 mL of propylene glycol oral; or 100 mL of propylene glycol oral. Glycaemia and serum ß-hydroxybutyrate (BHOB) were determined daily. Liver biopsies were taken at day 130 of gestation, at the beginning and end of treatments and at 5 days postpartum, evaluating the extent and degree of the steatosis lesion. Even though in sheep treated with 2-methyl-2-phenoxy-propionic acid, serum concentrations of glucose and BHOB recovered more slowly, we conclude that 2-methyl-2-phenoxy-propionic acid alone or combined with propylene glycol can be used as an alternative to effectively treat fatty liver, and therefore pregnancy toxaemia.
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Ácidos Fíbricos/uso terapéutico , PPAR alfa/agonistas , Preeclampsia/veterinaria , Propilenglicol/uso terapéutico , Enfermedades de las Ovejas/tratamiento farmacológico , Ácido 3-Hidroxibutírico/sangre , Administración Oral , Animales , Glucemia/análisis , Femenino , Ácidos Fíbricos/administración & dosificación , Preeclampsia/tratamiento farmacológico , Embarazo , Propilenglicol/administración & dosificación , OvinosRESUMEN
BACKGROUND: Ovine pregnancy toxaemia is a common metabolic disorder of ewes due to increased foetal energy requirements in late pregnancy. This pathology is a metabolic condition characterized by hypoglycaemia and hyperketonaemia resulting in the inability of the animal to maintain an adequate energy balance. The response to treatment is effective, if it is started in the early stages of the disease, when irreversible neurological injuries have not yet been established. The aim was to evaluate three therapeutic alternatives to effectively reverse the disease process in its early stages. For this, thirty adult Corriedale ewes, pregnant with a single lamb, were randomly separated in three groups of ten animals each, at day 130 of gestation. From that day onwards, ewes were locked up for forage fasting until glycaemia reached clinical values defining sub-clinical pregnancy toxaemia (1.59 ± 0.24 mmol/L). After fasting, ewes grazed and received a treatment for 4 days: 50 ml i.v. infusions of hypertonic glucose and 20 UI insulin/ewe/day s.c. or 100 ml/sheep/12 h of glycerol together with propylene glycol oral solution or fed with pasture supplemented with two daily intakes 300 g/sheep of cracked corn. Glycaemia and ß-hydroxybutyrate were determined in all the animals from the beginning of fasting until the completion of the treatment. RESULTS: Fasting caused a decline in blood glucose in the 3 groups. This decline continued until fasting was withdrawn and treatment began. Thereafter blood glucose increased in all three groups, although in the group supplemented with glycerol and propylene glycol it started to increase significantly after 12 h. The values of ß-hydroxybutyrate decreased in the 3 groups at the start of treatment, and this decline was more pronounced earlier on and in the group supplemented with glycerol and propylene glycol. We found no significant differences between all experimental groups. No animal showed clinical signs of pregnancy toxaemia throughout the research. CONCLUSIONS: The three treatments administered to sheep affected by sub-clinical pregnancy toxaemia were able to restore normal concentration of glucose and ß-hydroxybutyrate in blood, although per os administration of 100 ml/sheep/12 h of glycerol with propylene glycol, was the most successful treatment, normalizing the aforementioned biochemical parameters in a shorter time.
RESUMEN
Isolated bilateral orbital floor fractures are uncommon and are rarely described in the scientific literature. They are usually seen in association with naso-ethmoidal fractures, zygomatic fractures, or fractures of the middle third. We report our experience in the management of a patient presenting bilateral isolated orbital floor fracture. The difficulties in management of these fractures are due to the lack of an uninjured contralateral side for intraoperative comparison.
Asunto(s)
Fracturas Orbitales/cirugía , Humanos , Fracturas CigomáticasRESUMEN
AIM: To detect early changes in the metabolic profile of pregnant ewes subject to acute feed restriction at 130 days of gestation, and to establish indicators of risk for ovine pregnancy toxaemia (OPT) for diagnostic purposes. METHODS: Twenty Corriedale ewes with known mating dates, carrying a single fetus, were used. Ewes were maintained on meadow grasslands and at 130 days of gestation were randomly divided in two groups of 10 ewes. The control group had ad libitum access to pasture. Ewes in the restricted group were subjected to an acute feed restriction for a maximum of 144 hours (6 days), with free access to water. From the start (0 hours) until the end of feed restriction, blood samples were collected from all ewes to monitor concentrations of cortisol, non-esterified fatty acids (NEFA), ß-hydroxybutyrate (BOHB) daily, and glucose in plasma every 6 hours; urinary pH was also measured. Every 6 hours the food restricted ewes were observed to detect clinical signs of OPT e.g. apathy, grinding teeth, empty chewing movements, head leaning against the wall, tachypnea and not drinking water. RESULTS: In food-restricted ewes, concentrations of glucose decreased and differed from control ewes from 54 to 90 hours (p<0.001), and 96 to 102 hours (p<0.05). Concentrations of BOHB, cortisol and NEFA increased following feed restriction and differed from control ewes after 48 to 144 hours (p<0.01). Eight of the 10 restricted ewes showed clinical signs of OPT after 102-132 hours. Mean concentrations of glucose, BOHB and cortisol differed between control and restricted ewes prior to the onset of clinical signs of OPT, after 48-96 hours of feed restriction (p<0.01). Mean gestational length, and time from birth to placental expulsion was not affected by the feed restriction. CONCLUSIONS: Our results suggest that concentrations of glucose, BOHB and cortisol in plasma may provide a precocious diagnosis of subclinical OPT, using values of 1.59 (SD 0.24) mmol/L, 2.26 (SD 1.03) mmol/L and 15.09 (SD 7.75) nmol/L, respectively. The identification of a potentially harmful metabolic imbalance could lead to the improvement of treatment success.
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Metabolismo Energético/fisiología , Privación de Alimentos/fisiología , Ovinos/fisiología , Ácido 3-Hidroxibutírico/sangre , Animales , Glucemia , Ácidos Grasos no Esterificados/sangre , Femenino , Embarazo , Ovinos/sangre , Ovinos/orina , Factores de TiempoRESUMEN
To assess the effectiveness of maxillomandibular adavancement for treatment of adults with obstructive sleep apnoea, we report the results obtained after maxillomandibular advancement. A group of 16 patients were studied before surgery, at 6 months after surgery and at followup. The analysis included: upper airway endoscopy during Mueller's manoeuvre, lateral cephalometry, polysomnography and Epworth Sleepiness Scale. The results of surgical treatment were divided into "surgical success" and "surgical cure". The former was defined as an AHI < 20 events/hour and a > 50% reduction in AHI after surgical procedure, while the latter was defined as an AHI < 5 events/hour after surgical procedure. At follow-up, all patients had AHI < 20 events/hour with a surgical success rate of 100%. The surgical cure rate was 37.5%, with 6 patients having an AHI < 5 events/hour. Surgical success and long term stability of outcomes confirm the efficacy and safety of MMA for treatment of obstructive sleep apnoea syndrome. However, a continuous follow-up of these patients is necessary to control their lifestyle and to detect possible relapse.
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Avance Mandibular , Maxilar/cirugía , Apnea Obstructiva del Sueño/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Atrophy of the mandible leads to a decrease in the bone mass, making it more vulnerable to fractures. A direct relationship has been demonstrated between the height of the bone in the area of the fracture and the incidence of postoperative complications of bone healing. Basic principles of fracture management in both edentulous and non edentulous patients are open reduction and internal fixation with osteosynthesis of the fracture to achieve restoration in terms of aesthetics and functionality. Several authors have discussed the advantages and disadvantages of the transoral and extraoral approaches. Between January 2007 and June 2011, 13 patients affected by bilateral fractures of atrophic mandibles were treated by extra-mucosal intraoral stabilization with satisfactory results. This approach reduces the risks of damage of the marginalis mandibulae nerve with low operation time, while avoiding unsightly scars.
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Pérdida de Hueso Alveolar/cirugía , Fijación Interna de Fracturas/métodos , Arcada Edéntula/cirugía , Fracturas Mandibulares/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/prevención & controlRESUMEN
In 1997, supported by experimental work, Argenta published a clinical report describing a variety of complicated wounds whose treatment responded successfully to negative pressure dressings using a vacuum-assisted closure system (VAC) (Kinetic Concepts Inc., San Antonio, TX). This system has been successfully used in the fields of orthopaedics and traumatology, general surgery, plastic and reconstructive surgery and gynaecology/obstetrics for a large variety of complicated wounds located in several regions, particularly in the torso and extremities. To the best of our knowledge, the use of the VAC therapy in treating free flaps surgical wounds has not been discussed in the literature. Since 2009 at the Novara Major Hospital, we have been using the VAC therapy in selected cases for difficult and complicated wounds of the maxillofacial region. The purpose of this study is to describe and discuss three cases undergoing VAC therapy followed by loco-regional flaps in the management of exposed bone after fibular free flap. The advantages and disadvantages of VAC therapy in treating complicated wounds have been reported by several studies; compared with conventional wet-to-dry dressings, this system eliminates interstitial oedema, exudates and debrides while increasing blood perfusion leading to a more rapid promotion of wound healing with less bacterial loading. Although surgical debridement, wet-to-dry dressing changes and antibiotic treatment are the mainstay in managing maxillofacial wounds, VAC therapy can be used to obtain primary closure or to prepare the wound bed until definitive reconstruction is carried out. In our opinion, the VAC technique is an innovative therapy, and at our institution represents the standard of care for the majority of complicated wounds.
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Terapia de Presión Negativa para Heridas , Procedimientos de Cirugía Plástica/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The histological changes of the liver in ewes with pregnancy toxemia were characterized. Ten ewes were fed on grass ad libitum, and another ten were starved from day 130 of pregnancy for up to four days. Liver puncture biopsies were performed at days 70, 100, 130, and 140 of pregnancy, and at day 45 in postpartum. Seric hydroxybutyrate (HB), non-esterified fatty acids (NEFA), aspartate aminotransferase, and alkaline phosphatase were dosed. Histological preparations revealed similar incidence and intensity of mild liver steatosis in both groups at day 130. Starved ewes become toxemic (as indicated by HB), and at day 140 exhibited more severe injury in a higher proportion (9/9 vs. 4/10; P<0.01). Almost all of them (7/9) had large amounts of small lipid droplets in almost every hepatocyte over the whole liver acinus, and higher NEFA values. At day 45 in postpartum, both groups had mild steatotic changes as initially. A positive correlation between severity of liver damage seric and only aspartate aminotransferase was observed at day 140 in starved animals (P<0.05). This enzyme could be used to assess liver damage, but not alkaline phosphatase. All samples with degeneration corresponded to the microvesicular type. A short starvation period during late pregnancy in ewes produced reversible liver degeneration.
Caraterizaram-se histologicamente as alterações do fígado de ovelhas com toxemia da prenhez. Dez ovelhas foram mantidas em pasto ad libitum, e outras 10 submetidas a jejum a partir do 130º dia de gestação, por até quatro dias. Biopsias hepáticas foram realizadas aos 70, 100, 130 e 140 dias de gestação e, aos 45 dias pós-parto. Níveis séricos de hydroxibutirato, ácidos graxos não esterificados (NEFA), aspartato aminotransferase e fosfatase alcalina foram determinados. O estudo histológico revelou extensão semelhantes de degeneração nos dois grupos no 130º dia de gestação. No 140º dia de gestação, alta proporção de animais submetidos ao jejum, apresentou intensa degeneração no fígado (9/9 vs. 4/10; P<0,01) e, desses, quase todos 7/9 tinham grande quantidade de pequenas gotas de lipídios em quase todos os hepatócitos, nas diferentes regiões do ácino, além de níveis séricos mais elevados de NEFA. Quarenta e cinco dias pós-parto, os animais dos dois grupos apresentaram degeneração discreta, como no início. No 140º dia de gestação, verificou-se correlação positiva entre a severidade das lesões histológicas e a enzima aspartato aminotransferase, nos animais submetidos a jejum (P<0.05). Todas as amostras com degeneração corresponderam ao tipo microvesicular. Um curto período de jejum, na fase final da gestação da ovelha produz degeneração hepática reversível.
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Animales , Femenino , Hígado/anatomía & histología , Metabolismo , Preeclampsia/veterinaria , OvinosRESUMEN
No disponible
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Bovinos , Animales , Corazón Artificial/veterinaria , Servicio Veterinario Militar , UruguayRESUMEN
BACKGROUND: The increasingly frequent use of orthognathic surgery raises several questions on the results of operations, the resulting morphological and functional modifications, and the long-term three dimensional stability of the arches after surgery. In order to answer these questions a study was carried out using pre- and postoperative casts of the arches in a group of patients to evaluate the three dimensional stability of the correction. METHODS: Thirty-nine patients with different forms of malocclusion were selected who had undergone orthognathodontic surgery at least one year earlier. Twenty-seven patients (69.2%) received postoperative orthodontic treatment, including 9 who had undergone lower jaw surgery (33.3%), 3 maxillary surgery (11.1%) and 15 undergoing combined surgery (55.6%). Twelve patients (30.8%) did not receive postoperative orthodontic surgery, including 2 who had undergone lower jaw surgery (16.6%), 5 maxillary surgery (41.7%) and 5 undergoing combined surgery (41.7%). The two-dimensional reproductions of dental casts were studied using electronic image processing. Five different techniques were used (Bolton, Lundström, Howes, Staley and Reinhardt) to evaluate the dental arches. The study also evaluated whether any difference in results could be ascribed to use or absence of pre or postoperative orthodontic treatment. RESULTS: The results indicate that protocols and surgical techniques used produce dental arches that are three-dimensionally stable and the use of orthodontic treatment gives greater stability one year after surgery compared to cases treated with surgery alone. CONCLUSIONS: Major maxillary surgery should always be considered when assessing the possible solutions to malocclusions in order to correct anomalous bone formation with a reduced risk of recidivation of the correction.
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Maloclusión/cirugía , Humanos , Procedimientos Quirúrgicos Orales , Cuidados PosoperatoriosRESUMEN
A retrospective analysis is presented of 158 patients who sustained frontal sinus fractures and were subsequently treated in the Division of Maxillofacial Surgery, University of Turin, from 1987 to 1998. The fractures were subdivided according to involvement of anterior and posterior walls, and of the nasofrontal duct. While treatment involving only the anterior wall is well standardized and without complications, management of anterior plus posterior wall fractures or involving the nasofrontal duct is still controversial. In dislocated posterior wall fractures, cranialization and obliteration of the remaining dead space and of the nasofrontal ducts using bone grafts, combined with the use of a pericranium flap, allow separation of the nasal cavity from the anterior cranial fossa, preventing ascending infections and thus reducing the rate of complications. When the fracture involves the nasofrontal duct with the posterior wall substantially intact, it is better to re-establish patency of the nasofrontal duct with a drainage tube and preserve the function of the sinus. A protocol used in the management of each group of fractures, clinical and radiological results, timing of operation, surgical procedures, outcomes, and long-term complications are all discussed.
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Seno Frontal/lesiones , Seno Frontal/cirugía , Fracturas Craneales/complicaciones , Fracturas Craneales/cirugía , Adolescente , Adulto , Anciano , Lesiones Encefálicas/etiología , Protocolos Clínicos , Craneotomía/efectos adversos , Femenino , Fijación Interna de Fracturas , Fracturas Abiertas/cirugía , Hematoma Epidural Craneal/etiología , Humanos , Masculino , Persona de Mediana Edad , Neumocéfalo/etiología , Estudios Retrospectivos , Fracturas Craneales/líquido cefalorraquídeo , Infección de la Herida Quirúrgica/etiologíaRESUMEN
BACKGROUND: The aim of this study was to evaluate the main parameters provided by the static stabilometric test (mean X, mean Y, mean velocity, length of tracing, standard deviation of velocity, ellipse area) in the follow-up of patients suffering from skeletal occlusive pathology undergoing orthognathodontic surgery to confirm the re-establishment of postural equilibrium. METHODS: Fifteen patients with skeletal dysgnathia were correlated with a group of 10 healthy subjects. The same parameters were analysed in the dysgnathic subjects at 6 and 12 months after surgical correction. The patients enrolled in this study underwent surgery at the Division of Maxillofacial surgery of Turin University. Student's "t"-test and multivariate statistical analysis (Cox regression) were used for the statistical analysis of results. RESULTS: A significant variability was noted in some of the main parameters analysed (mean X, mean Y, tracing length) between the two populations (healthy and dysgnathic) compared to visual signs (eyes opened-closed). The change in stabilometric values within the group of dysgnathic patients was highly significant 6 and 12 months after surgery, not only in terms of visual signs but also the cervical component (retroflexion of the head), above all the value of mean Y (p = 0.001). CONCLUSIONS: An analysis of these results shows that static stabilometry can be a valuable aid both during the preoperative evaluation and during the follow-up in patients undergoing jaw surgery since it can quantify the improvement of body balance.