[Sports activities and maxillofacial injuries. Current epidemiologic and clinical aspects relating to a series of 379 cases (1982-1998)]. / La pratica sportiva e la traumatologia maxillo-facciale. Attuali aspetti epidemiologici e clinici in merito ad una casistica di 379 casi (1982-1998).

BACKGROUND: The constant improvement in the quality of individual life and growing interest in sporting activities have resulted in an increased use of sport in free time at amateur level. As a result, sports injuries have steadily increased since the late 1980s. The aim of this study was to illustrate our experience in the treatment of injuries in this particular category. METHODS: The series included patients admitted to the Division of Maxillofacial Surgery at Turin University over a 15-year period. A total of 379 maxillofacial fractures caused by sporting activities were recorded out of a total of 2925 cases. The factors examined included: the type of sport, the age and sex of the patient, the cause of the injury, the site of the lesion and the treatment. RESULTS: Sports injuries represent 12.9% of total injuries. The mean age of patients was 32.1 years and the male/female ratio was 5.6:1. A range of 36 sports were examined, but football (43.5%), cycling (23.4%) and skiing (13.9%) represented 80.9%. The injuries observed involved different areas of the face with a prevalence of the orbital/zygomatic complex (47.4%) compared to the mandibular region (42%). The most important forms of treatment and preventive therapy were examined and a comparison was made of their incidence. CONCLUSIONS: The authors conclude by emphasizing the importance of prevention in sports injuries.

Maxillofacial trauma in the elderly.

PURPOSE: This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases. PATIENTS AND METHODS: A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age. RESULTS: The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital. CONCLUSIONS: The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

Rigid fixation with teeth in the line of mandibular fractures.

The treatment results and the incidence of complications were evaluated retrospectively in a group of 68 patients. They all had mandibular fractures with a tooth in the line of fracture and were treated using miniplates for fixation. The follow up ranged from 1 to 6 years (mean 2.6 years) and 90 fracture sites were involved. Results showed that the incidence of complications when the tooth was extracted was higher (3/12) than when it was left in place (8/78). With regard to both healing of the fracture and fate of the tooth in the line of fracture, it is recommended to retain teeth in the line of fracture, unless there is an absolute indication for extraction. It is advisable to monitor the vitality of teeth adjacent to the fracture line for at least one year.

[The validation of stereolithographic anatomical replicas: the authors' own experience and a review of the literature]. / Convalida delle repliche anatomiche stereolitografiche: esperienza personale e revisione della letteratura.

The visual three-dimensional (3D) reconstruction of CT findings has been used since the Seventies to design and plan complex surgical procedures. The availability of such models and the development of computer science have permitted, since the mid-Eighties, the medical use of rapid prototyping for anatomical modelling. We studied the technical steps of CT data processing for rapid prototyping and the dimensional and structural accuracy of replicas of skeletal components relative to the originals. A dried mandible and an arthrotic hip joint were compared with their stereolithographic replicas using the measurements made on CT images. The 3D graphic models were processed with a commercially available software and replicated with an SLA 250 stereolithographer (3D System Inc, Valencia CA, USA). Satisfactory morphologic agreement was found between the original and its replica. The mandibular replica exhibited dimensional errors ranging 0 to 4.03%, z-axis shortening and an increase in gonial angle, but with a reliable reproduction of details. The hip replica exhibited dimensional errors ranging .2% to 8.53%; it appeared to be less affected than the mandibular replica by geometrical distortion but it was less accurate in the reproduction of cancellous bone and arthrosis. The accuracy of the solid replicas depends, in the different manufacturing steps, on several factors, namely: during data acquisition, the accuracy and suitability of original data, depending in turn on equipment and examination parameters--especially the algorithm, acquisition time, gantry tilt and slice thickness; image thresholding and manipulation procedures during graphic model creation; data transfer, creation of the necessary supports and replica finishing during manufacturing; residual polymerization affected by environmental agents and preservation conditions during maintenance.

[Evaluation of the posture of patients before and after orthodontic surgery]. / Valutazione della postura in soggetti disgnatici prima e dopo intervento ortochirurgico.

INTRODUCTION AND AIMS: The term "craniomandibular disorder" is used to describe a series of symptoms and signs that directly affect the stomatognathic apparatus with possible repercussions on the otovestibular and oculomotor apparatus and on the cervical spine that may condition the entire body posture. The aim of this study was to evaluate a series of parameters correlated to the occlusal situation and to verify how these factors are affected by a change following the correction of occulusal ratios. METHODS: The paper reports a series of 15 patients suffering from facial dysmorphia treated surgically in the Division of Maxillofacial Surgery of S. Giovanni Battista Hospital in Turin in which an evaluation was made of posture and symptoms linked to craniomandibular disorders before surgery and six months after. At the preoperative evaluation a high incidence of this type of symptoms and signs was observed, and in particular a high percentage of patients with postural imbalance and asymmetry of the frontal body segments. RESULTS AND CONCLUSIONS: From the results obtained it emerges that the surgical re-adaptation of occlusion is followed by esthetic improvement and also by a good recovery of frontal postural symmetry in conformity with the reduced frequency and intensity of symptoms classified as craniomandibular disorders.

[Tuberculous lesions of the cervico-facial area. A case load of 20 years]. / Lesioni tubercolari del distretto cervico-facciale. Presentazione di una casistica di 20 anni.

BACKGROUND: Tuberculosis is a granulomatous inflammatory process consequent to infection by Mycobacterium tuberculosis (human or bovine type). In the maxillofacial district easily the most frequent localisation is the laterocervical and submandibular lymph nodes. MATERIALS AND METHODS: The series presented here includes cases of specific tubercular infection of the maxillo-facial district observed by the Division of Maxillo-Facial Surgery of the University of Turin during the period 1975 and 1995. RESULTS: 121 surgically-treated benign cervical lesions were examined of which 25 cases were found to be specifically tubercular, representing 21% of the total. In addition to the cases treated surgically during the period in question a further 12 cases of specific tubercular adenopathy were diagnosed which were treated using medical treatment alone. The clinical trend observed in these patients was variable but almost constantly characterised by scarce subjective symptomatology. CONCLUSIONS: Diagnostic ascertainment, according to our experience, must be complete and include an accurate family and individual anamnesis, a careful objective examination, hematochemical tests (hemochrome, ESR), cervical and lung X-rays and bacterioscopic tests using fine needle aspiration. From a therapeutic point of view, in agreement with the majority of papers, the authors affirm that surgery appears to be the most indicated form of treatment.

[Fracture of the glenoid fossa without condylar dislocation and with intact mandibular condyle. Report of a case]. / Frattura della fossa glenoidea senza dislocazione condilare e con condilo mandibolare integro. Presentazione di un caso clinico.

The osteomuscular structure of the cranium presents peculiar anatomic characteristics that aim to preserve the noble organs that are housed inside or are adjacent to them. This is also true of the condylar region which protects the cranial cavity from forces transmitted to the glenoid cavity by the condyle in traumatism to the facial region and above all the genial symphysis. These factors act as "force breakers" to prevent the condyle penetrating the middle cranial fossa. Of these the most important is the presence of a line of minor resistance at the level of the condyle neck which is often the site of a protective fracture. However, the dislocation of the condyle in the middle cranial fossa is an occurrence that is reported in the literature, albeit very rarely; the fracture of the glenoid fossa with an intact mandibular condyle and without evident dislocation of the latter is even more rare. The paper reports the case of a 22-year-old male patient who was injured in the submental area leading to loss of conscience. CT revealed that the left mandibular condyle was intact whereas there was a comminuted fracture of the roof of the glenoid fossa and two fractures at the mandibular level. The patient also presented left otoliquorrhea. The glenoid fracture was not complete and therefore the mandibular condyle did not show evident dislocation nor was it necessary to resort to surgical or non-surgical treatment. After the reduction and restraint of the two mandibular fractures, occlusion was correct and the position of the left condyle was appropriate following X-ray control, even if the glenoid cavity was partially fractured. Otoliquorrhea resolved spontaneously after about three days and did not require any treatment. The case described here, which was recontrolled after some time, presented excellent functional results demonstrating that conservative treatment of the glenoid cavity fracture was the correct therapeutic choice.

[Polyostotic fibrous dysplasia. A clinical case report]. / Displasia fibrosa poliostotica. Presentazione di un caso clinico.

The authors present a severe case of polyostotic fibrous dysplasia in which there was considerable involvement of cranial bone and facial skeleton. Numerous lesions were present at the level of the long bones of limbs. Endocrine dysfunction was also present in the form of a hypophyseal adenoma secreting prolactin and ACTH. The concomitance of acromegaly or gigantism and/or hyperprolactinemia and polyostotic fibrous dysplasia has only been reported to date in a few cases in literature. The authors describe the appearance of the subject, correlating clinical photographs with X-rays. They report the clinical excursus of the patient characterised by the gradual increase in deformities which seriously jeopardized the patient's relational life, in particular the appearance of a bulk on the forehead and checks and the deformation of the symphyseal portion of the mandible with presence of interdental diastemata. The patient also complained diplopia, difficulty in chewing owing to the mobilisation of teeth, and increasing bone pain probably due to nerve compression by exuberant bone. It was not possible to perform corrective surgery owing to the patient's overall poor health conditions. In fact, dilatative cardiomyopathy which continued to worsen in spite of numerous forms of medical treatment resulted in the patient's death owing to cardiac decompensation. Even the attempt to treat the patient's primary endocrine dysfunction using bromocryptine and subsequently octreotide failed to produce positive results owing to the onset of collateral effects which led to the early suspension of treatment.

[Brown tumor of the jaws]. / Tumore bruno dei mascellari.

Brown tumour is one of the forms in which fibrous-cystic osteitis, which represents the terminal stage of the bone remodelling processes during primary or secondary hyperparathyroidism, is manifested. For years brown tumour was regarded as a typical lesion of primary hyperparathyroidism, but cases of brown tumours in patients with hyperparathyroidism secondary to renal failure were increasingly often reported in the literature. From an epidemiological point of view, the frequency of brown tumours in patients with renal insufficiency is extremely variable, as is the bone site affected. Several bone segments can be affected at once, but the ethmoid and frontal sinus are rarely reported. Symptoms are caused by the considerable dimensions of the brown tumour and its localisation: in the jawbones it may present sometimes painful, hard and clearly palpable swellings; if large, the tumour may deform the appearance of the bone segments affected or alter the function of the masticatory apparatus. In other cases, there is a complete absence of clinical symptoms and diagnosis may be totally coincidental during the radiological examinations. In histological terms, brown tumours are made up by a cell population consisting of rounded or spindle-like mononucleate elements, mixed with a certain number of plurinucleate giant cells, resembling osteoclastic cells, among which recent haemorrhagic infiltrates and hemosiderin deposits (hence the brown colour) are often found. The aim of this study was to report three cases from a population of 107 patients undergoing haemodialysis at the Turin University Centre. In conclusion, the localisation of maxillary brown tumours appears to prefer a young, female population; brown tumours are rarely an early sign of hyperparathyroidism in haemodialysis patients, but they often appear in conditions of advanced hyperparathyroidism which have escaped medical control either owing to unsuitable therapy or scant patient compliance; they are rapidly evolving lesions whose regression may be very slow or not occur even after total parathyroidectomy; the severity of the lesion caused by a brown tumour may lead to evident osteolysis in the maxillofacial district, thus suggesting the need for early and regular radiological screening; in the event of lesions which are already present, from the authors' point of view, the choice of treatment must be oriented towards parathyroidectomy.

[Adenophlegmons of the neck area. A case report and review of the literature]. / Adenoflemmoni della regione cervicale. Presentazione di un caso e revisione della letteratura.

Adenopathies in general and cervicofacial adenopathies in particular are a pathology that can affect both medical and surgical disciplines. They may be found in both acute and chronic disorders, in children and in adults, and in local or systemic forms with benign or malignant pathogenesis. It is clear that the differential diagnosis and consequently the therapeutic approach may be complicated at times by the variety of pathological processes. Interest in the case reported her is, in our opinion, justified by the rare finding in the age of antibiotics of such striking symptoms. The severity of local symptoms and the general conditions of the patient resulted in the need for surgery under anesthesia in order to enable the extensive collection of purulent matter to be drained. The postoperative course showed a marked and progressive improvement of the patient's general and local conditions, even a few hours after surgery. Given that several factors contribute to determining the evolution of septic conditions (patient's general and in particular immunological status) and given that, owing to the aspecific nature of symptoms, the diagnosis and relative specific therapy may be delayed, it can be seen that the clinical picture may evolve and be complicated by massive general manifestations, sufficient in extreme cases to endanger the patient's life, in the form of acute and sudden respiratory disorders and or more gradually with generalised septic conditions (encephalitis, mediastinitis and generalised sepsis). The objective to be attained is therefore a careful diagnosis and the immediate implementation of medical procedures in order to remove the cause that has triggered off the pathology.

[Dermoid cysts of the oral floor. A clinical case report and review of the literature]. / Cisti dermoidi del pavimento orale. Presentazione di una casistica clinica e revisione della letteratura.

The authors report two cases of dermoid cysts of the oral floor. The incidence of this pathology in this region is difficult to assess due to the rarity of reported cases. In particular, dermoid cysts appear to derive from the inclusion of epithelial cells on the median line in the fusion point between the first and second branchial arch. Other pathogenetic causes are however reported in the literature, namely traumatic epidermal implants during fetal development in utero. Dermoid cysts are most frequently manifested between the second and sixth decade of life, although cases of younger and older patients have been reported. All the authors agree that there is no sex-related preference. In general, the patient becomes aware of the pathology due to the gradual deterioration of locoregional functional signals: difficulties related to speech, chewing and swallowing. These symptoms are closely correlated to the size of the lesion. The development of the cyst is usually slow and does not involve painful symptoms, but it may become rapid and painful in the presence of concomitant phlogistic processes. In the first case an 18-year-old patient reported the appearance some 4 years earlier of a swelling measuring approximately 4 x 2 cm, involving the entire front portion of the oral floor; the swelling was spontaneously painful. Having been referred to the authors'attention the patient showed a swelling which was localized on the mid oral floor, the size of a tangerine and with a hard elastic consistency and taut, shiny mucous covering; the swelling was apparently normotrophic.(ABSTRACT TRUNCATED AT 250 WORDS)

[Midline granuloma. A clinical case report]. / Midline granuloma. Presentazione di un caso clinico.

Granuloma gangraenescens or "midline granuloma" (Stewart's malignant granuloma, idiopathic midline destructive syndrome) is a rare clinical syndrome. In clinical practice, the destructive process of the facial midline may appear as a symptom of various infective, malignant or autoimmune diseases. In addition to these cases, a number of cases have been reported in the literature since 1896 with the diagnosis of lethal midline granuloma. These subjects underwent a progressive and often fatal destructive process of unknown cause which generally initiated in a nasal cavity (or sometimes on the palate) in the form of a granulomatous lesion with a rapid tendency to necrosis. The lesion affects the nose, paranasal sinuses, palate and soft facial tissue. As it progresses, it involves soft tissue, cartilage and the bone structures of the aforesaid and adjacent areas. A number of systemic symptoms may be present. The age of patients ranges from a minimum of 15 to a maximum of 59 years old. Repeated biopsies are usually necessary before the syndrome is diagnosed. From a histological point of view, it has been reported that the tissues in the nasal cavities are affected by diffuse infiltration of lymphocytes and leukocytes and histiocytic-type cells. The disease lasts between 3 and 20 months and causes death due to secondary infection, hemorrhage caused by the erosion of major vessels in the head and neck, and cachexia. With regard to therapy, the majority of authors appear to agree that local high-dose radiations in the area of the lesion are the best method of treatment for this pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Keratoacanthoma of the lower lip. A review of the literature and clinical case report]. / Cheratoacantoma del labbro inferiore. Revisione della letteratura e presentazione di un caso clinico.

The authors report a case of keratoacanthoma localized on the prolabium of the lower lip. They focus their attention on the difficulty of making a correct diagnosis and on the complexity of differential diagnosis with squamous cell carcinoma. After incisional biopsy of the lesion, treatment took the form of the complete excision of the neoplasm which is indispensable for a definitive diagnosis. The keratoacanthoma, although being an absolutely benign lesion, in fact requires complete exeresis in order to perform an histological examination of the entire neoplastic mass and thus definitively rule put the presence of squamous cell carcinoma. If correctly performed, the operation leaves very little scarring and satisfies the patient's esthetic and psychological expectations.

[Anatomicosurgical comments on the importance of the spinal accessory nerve]. / Considerazioni anatomochirurgiche sull'importanza del nervo accessorio spinale.

The preserved integrity of the spinal accessory nerve plays an extremely important role in cervico-facial surgery since the majority of surgical approaches involve this nervous structure. Following a short historical outline of the surgical method, the Authors illustrate the anatomo-topographical aspects and anatomo-surgical problems. A number of points emerge from a review of the literature which are vital to isolate the spinal accessory nerve: 1) the transversal apophysis of the atlas is particularly prominent in the retrostyloid space and lies half-way across an imaginary horizontal segment connecting the mastoid process with the angle of the mandible; 2) the posterior edge of the sternocleidomastoid muscle at approximately six centimetres from the mastoid process; 3) the nervous point of Erb located at the point where the superficial branches of the cervical plexus emerge from the posterior edge of the sternocleidomastoid muscle (the nerve generally emerges from the posterior edge of the sternocleidomastoid muscle two centimetres above this point and two centimetres below it the nerve meets the anterior edge of the trapezius). This is followed by an analysis of the possible complications deriving from lesions to this vital nervous structure. The resection of the spinal accessory nerve leads to the so-called "shoulder syndrome" mainly due to the denervation of the trapezius. This syndrome is characterised by the onset of regional pain, the typical deformation of the shoulder joint and functional deficit. The deformation is provoked by the decreased muscular strength of the superior and middle portion of the trapezius manifested as the rocking of the shoulder and a higher superointernal angle.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bone clefts of the median facial structures. An anatomical study]. / Schisi ossea delle strutture mediane facciali. Studio anatomico.

After reviewing the literature concerning rare facial fissions, the authors describe the skull of a young woman with an incomplete bone fission of the median facial structures. They focus on the associated bone anomalies observed in the skeleton of the nose and upper jaw.

[A clinical evaluation of the outcome of a bone graft from the iliac crest]. / Valutazione clinica degli esiti di prelievo osseo da cresta iliaca.

The paper examine 40 cases of bone graft from the iliac crest used in maxillo-facial surgery. The immediate and late complications included pain with resulting difficulty of walking and, less frequently, hematoma, sensitivity disorders and dehiscence of the wound. Late complications were most frequently related to esthetic problems as well as a negligible number of persistent cases of difficult walking and neurological deficiencies. The results obtained were comparable to those most recently reported in the literature. The low incidence of immediate and late sequelae at the donor site and the characteristics of the bone graft confirm the suitability of iliac crest bone graft, in particular for use in reconstructive maxillo-facial surgery.