Sinus Disventilation and Atrophy of the Upper Maxilla: A Combined Surgical Approach Is Possible?

This study aims to assess the effectiveness and reliability of a new combined approach to treat the maxillary atrophy and chronic rhinosinusitis (CRS) and other rhino-sinusal pathologies. This 1-step procedure consisting functional endoscopic sinus surgery (FESS) and maxillary sinus-lift with simultaneous implant placement for patients with a severe reabsorbed maxillary bone and sinuses' disease. In case of disventilation and maxillary sinuses flogosis, the mucociliary clearance and physiological ventilation have to be aided, in order to make a safer and predictable sinus-lift surgery. This new surgical approach provides the restitution ad integrum of sinus health and at the same time, its grafting. If possible, implants were placed during the same surgical procedures. A 1 center retrospective study was performed in a private clinic of Rome, from January 2006 to November 2013. Seventy-eight adult patients with maxillary atrophy and sinus disventilation no responding to 3-week pharmacological therapy were admitted. All of them underwent to medical history, clinical examination, nasal endoscopies, and computed tomography (CT) scan of nose and paranasal sinuses. Patients were divided in 2 groups using Lund Mackay CT scoring. A 1-step surgery based on FESS and maxillary sinus-lift was performed. Simultaneous implant placement was performed when a crestal thickness of at least 4 mm was present on CT examination. Patient's symptoms scoring was evaluated through visual analogical scale both pre- and postoperatively. Computed tomography scores were usually not in accordance with presurgical clinical condition. Patients with clinical symptoms of disventilatory sinus and low evidence of CRS on CT showed relevant improvements in symptoms' scores after endoscopic surgery. All implants achieved good primary stability; Only 1 patient had lost implant due to peri-implantitis during 1-year follow-up period (1.3%).

Simultaneous options for cleft secondary deformities.

INTRODUCTION: So much has been written by so many about secondary procedures in cleft surgery that testify not only the complexity and variable expression of cleft deformity itself but also the need to find methods of primary surgery that will reduce, if not avoid, adverse effects on all the structures and functions involved and affected. It must be the principal aim of cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible, whether or not true hypoplasia exists. The pathogenesis of secondary deformities is related to specific features as: the presence of scar tissues into the cleft basal bone area, that inhibits alveolar growth; scarring of palatal soft tissue, that inhibits growth and causes palatal orientation of dentoalveolar elements; and the exceeding lip tension, that may inhibits maxillary growth along dentoalveolar structures. MATERIALS AND METHODS: From 2008 to 2011 at the Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome 25 patients (21 males and 4 females) who had undergone previous surgery for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) were enrolled in our study. Diagnosis of deformity was made by means of a cephalometric and photographic analysis (Arnett), gipsometry and a radiological assessment (orthopantomography, lateral and frontal cephalometric X-rays). Moreover, every patient was studied with a temporomandibular joint (TMJ) tomography, TMJ magnetic resonance imaging (MRI) and a computerized gnatography to better evaluate potential TMJ dysfunctions. The surgical procedures adopted simultaneously were: Total or segmental maxillomandibular osteotomies, genioplasty, rhinoplasty, labioplasty, and application of facial prosthesis. Every patient received a postoperative questionnaire to evaluate his/her satisfaction with the surgery performed. RESULTS: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%). A relapse of malformation occurred in 4.5% of cases. Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend. CONCLUSIONS: Simultaneous correction of the deformities is indicated as to avoid several surgical distresses for the patient, to improve facial aesthetic and function in one surgical step, and to reduce risk of psychological consequences.

A rare case of ectopic laterocervical thymoma.

The ectopic cervical thymoma is a rare site for a thymus neoplasm. It is frequently confused with cyst or with later neck mass of uncertain diagnosis until a histological diagnosis is made. Thymic neoplasms normally arise in the mediastinum, causing signs and symptoms of compression of the adjacent structures. Although rare, malignant thymomas may develop from an ectopic thymus, situated in the thyroid gland (Miyauchi et al., 1985; Matsuura et al., 2004), the neck (Yan et al., 2010; Yao et al., 2010; Jung et al., 1999), the lungs (Myers et al., 2007), and the heart (Miller et al., 2005). It is thought to be caused by the persistence of embryological organ portions along its route of physiological descent from the neck into the mediastinum during embryological development. The incidence of ectopic thymoma is around 4%. The thymus is a lympho-epithelial organ that is the centre of the development and maturation of the T lymphocytes. It develops from the ventral portion of the third and fourth pharyngeal pouches and by the sixth week of gestation it descends into the anterior mediastinum. It has a lobular structure with an external or cortical portion, richly populated by immature T cells, thymocyte and an internal medullary part.