Surgical management of macroglossia: discussion of 7 cases

OBJECTIVE: We present an overview of international literature concerning macroglossia-related etiology, clinical and instrumental diagnoses, surgical treatments, complications, and recurrences. Moreover, we present a series of cases of patients affected by macroglossia who have been treated surgically at the Department of Maxillofacial Surgery of the University of Rome "La Sapienza". METHODS: Between 1990 and 1999, only after attempts to solve this pathologic condition with medical and orthodontic treatment, we treated surgically a total of 7 patients (4 male and 3 female). The surgical techniques used were K?le glossectomy and Dingman and Grabb glossectomy. We analyzed the clinical and instrumental study and the surgical treatment, including possible complications and recurrences. RESULTS: After follow-up of a period from 2 to 9 years, macroglossia recurrences were absent, showing that the K?le and the Dingman and Grabb glossectomies are viable surgical options for treatment of macroglossia. CONCLUSION: The best therapy for each case macroglossia must be carefully evaluated, with the right medical therapy and orthodontic therapy attempted first and surgical treatment performed only when the first and second therapy fail. Moreover, surgical techniques must be chosen in accordance with the functional results that one wants to achieve and must be the most conservative technique to preserve the vascular-nerve bundle.     

Surgical correction of craniosynostosis. A review of 100 cases

PurposeProvide outcome data for open cranial vault reshaping at a single institution by a single craniofacial surgeon treating 100 patients.Methods and subjectsA total of 100 patient records were reviewed. Criteria for selection included patients less than three years of age undergoing primary surgery with open cranial vault reshaping and a minimum follow up time of 2 years.ResultsOf the 100 patients (27 female, 73 male) treated 6 were syndromic and 94 nonsyndromic. Average age and weight were 8.9 months and 9.51 kg, respectively. The oldest child was 30 months and the youngest 5 months at the time of surgery. The estimated blood volume lost was 42.7% of total calculated blood volume ranging from 16.6% to 336%. Average surgical time was 216.7 min. Complications included 2 hematomas, 2 wound infections, 1 subgaleal abscess, 6 dural tears, 3 patients requiring reoperation for residual deformity, 4 cases requiring coronal scar revision, 1 sagittal sinus bleed, and 1 intraoperative death.ConclusionsOur review of 100 open repairs of patients with craniosynostosis demonstrates good long-term results with an overall low complication rate. The outcome data will assist in developing future prospective studies aimed at improving the multidisciplinary care of these patients.     

Surgical parotid disease in Nigeria: a review of 100 cases

100 cases of surgical parotid disease are reviewed. Parotid cyst was the commonest non-neoplastic disease, followed by a parotid fistula. 73% of the cases were neoplastic conditions of which approximately 50% were malignant and the patients were much younger than those reported in other series.     

髁突骨瘤的外科治疗:附3例报告

通过对我院近年收治的3例髁突骨瘤进行回顾分析,探讨髁突骨瘤的手术方式。肿瘤和髁突切除后,同期用患侧增生伸长的冠突或自体肋软骨移植形成颞下颌关节。术后随访3个月～2年,疗效满意。该术式是治疗髁突骨瘤较为理想的方式。     

Surgical approach in severe cases of maxillonasal dysplasia (Binder's syndrome)

Binder's syndrome or maxillonasal dysplasia is a malformation characterized by an extremely flat and retruded nose. Severe cases of the syndrome do also have a retrognatic maxilla often combined with an open bite deformity which demands a combined surgical solution with both maxillary osteotomy and secondary nose correction. The two-stage surgical procedure in the advanced cases of maxillonasal dysplasia has in our opinion been preferable to a Le Fort II osteotomy. Two cases with severe Binder's syndrome where the two-stage procedure has been performed will be presented and the surgical approach discussed.     

Surgical treatment of TMJ ankylosis: our experience (60 cases)

Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint as sequela to trauma, infection, autoimmune disease, or failed surgery.Various procedures have been reported for treatment of temporomandibular joint (TMJ) ankylosis; this article aims to describe the diagnostic protocol and the surgical procedures adopted at the department of Maxillo-Facial Surgery of Rome University "La Sapienza".Between 1980 and 2000, 123 patients affected by TMJ ankylosis came under our observation; 60 of them (25 females and 35 males of 30 years average age) underwent surgery; bilateral TMJ ankylosis was observed in 21 cases, right-sided in 20 cases, left-sided in 19 cases. In 12 cases coronoid processes were involved. Etiopathogenesis was traumatic in 48 cases, septic in 5 cases, auto-immune (RA and seronegative spondyloarthropathies) in 5 cases; after block removing, arthroplasty was performed with pedunculated flap of temporal muscle (10 cases), Silastic material (11 cases), or lyophilized dura mater (2 cases). Simple condylar shaving was used in the remaining 36 cases.All patients under treatment showed a distinctive improvement both in articular functionality and symptoms; secondary surgery was necessary in seven cases due to the onset of articular complications from previous surgery. Silastic removal was necessary in five cases due to its inducement of foreign body granuloma. Follow-up was performed at 12, 24, and 48 months and 5 years postoperatively.In our opinion the gold standard surgery of TMJ ankylosis today is represented by shaving of articular surfaces and subsequent arthroplasty with or without temporal muscle myofascial flap interposition, whereas the use of Silastic as alloplastic material could be associated to an increased persistence of the local symptoms and a higher risk of foreign body granuloma and it may favor ankylosis relapse and hinder rehabilitation.     

颈动脉体瘤手术治疗14例分析

目的：总结1995～2003年期间14例颈动脉体瘤的诊治经验．探讨颈动脉体瘤术前准备、手术方法和并发症的防治。方法：14例颈动脉体瘤患者，13例术前行数字减影血管造影检查．其中11例行球囊阻断试验，1例行彩超检查。2例采用单纯瘤体切除；3例行瘤体与颈外动脉一并切除；3例行瘤体与颈内、外动脉一并切除，未做颈动脉重建：3例瘤体切除，同时行颈内动脉修补术；3例瘤体与颈内、外动脉切除，同时行颈内动脉重建。其中1例为恶性颈动脉体瘤，瘤体侵及颅底，行颈内动脉颅内、外动脉搭桥重建。结果：全部病例获随访，随访期1～9a，无复发病例。2例术后1周分别出现对侧偏瘫和失算，均在半年后康复。结论：颈动脉体瘤第一次手术应尽可能采用单纯剥除术：二次手术或恶性颈动脉体瘤需整块切除时，应尽可能行颈内动脉重建，必要时需行颅内、外动脉搭桥，以减少术后并发症。     

72例腭隐裂修复方式的回顾分析

目的：通过回顾性分析8年的腭隐裂修复治疗，寻求较合适的修复方法及修复时机。方法：1999年9月至2007年1月行腭隐裂修复的患者72例，男37例，女35例，年龄1-35岁，平均11．2岁。术后1个月复诊，检查伤口愈合情况，并进行语音评估。同时将72例患者按所接受的手术方法分为三组：Ⅰ组（腭成形术），Ⅱ组（改良咽后壁组织瓣转移术），Ⅲ组（腭咽成形术）；按手术年龄将其分为：〈4周岁；t〉4周岁、〈8周岁；≥8周岁三组，统计各组的构成比，及比较各组术后的腭咽闭合及语音情况。结果：术后穿孔的患者为3例（4．2％），69例患者术后接受了语音评估，1例（兰氏术后）仍遗留VPI。10例患者语音检测为正常（96．15％±2．11％），余58例患者腭咽闭合功能改善，但仍伴代偿性发音，需语音治疗。手术方式分组：Ⅰ组13例（18．1％），Ⅱ组46例（63．89％），Ⅲ组13例（18．1％）；年龄分组：〈4周岁7例（9．72％），t≥4周岁、但〈8周岁25例（34．72％），≥8周岁40例（55．56％）。〈4周岁的患者采用腭成形术最多，占57．1％，≥4周岁、但〈8周岁及≥8周岁的患者采用改良咽后壁组织瓣转移术的最多，各占68％，和70％。语音评估发现〈4周岁组的患者术后正常语音的比例最高，占71．4％，其次是t〉4周岁、但〈8周岁组，正常语音的比例为该年龄组的19．2％，VP完全，有代偿性发音的占76．9％，而大年龄组（≥8周岁），均伴有代偿性发音而需语音治疗。结论：小年龄组（〈4周岁）的腭隐裂修复术后语音效果较好，大年龄组（≥8周岁）的腭隐裂修复可首选咽成形术或腭咽成形术，术后须辅以语音训练，t≥4周岁、但〈8周岁的患者修复方式的选择可根据具体情况选用。     

Surgical extrusion technique for clinical crown lengthening: report of three cases

Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths < or = 3 mm around the teeth at all sites, without bleeding on probing. The teeth functioned normally, with near-normal mobility. Radiographs showed normal periodontal contour consistent with new bone formation in the periapical area. Radiographic analysis did not show any evidence of root or crestal bone resorption or endodontic problems. The technique presented could constitute an alternative surgical approach to performing crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.     

Surgical timing in orbital fracture treatment: experience with 108 consecutive cases

Orbital fractures can lead to esthetic deformities and functional impairments, and adequate surgical timing is considered important in obtaining good results from surgery. By means of chart review, a retrospective analysis was carried out in 108 consecutive cases of pure orbital fractures to investigate the differences in surgical timing and the correlations with patient age and clinical and radiographic findings. In this analysis, surgical timing of pure orbital fractures was strongly related to the combination of parameters such as anatomical location of the fracture, eventual exposure of the fracture, cerebrospinal fluid (CSF) leakage or penetrating wounds, age of patients, eventual functional impairments or muscle entrapment, and serious conditions of compression or ischemia. As the data confirmed, an urgent approach was considered indispensable in severe orbital apex fractures and in orbital fractures with CSF leakage, penetrating objects, or exposure. Early surgery was necessary within 3 days in children with diplopia (type IIIb) and mainly within 7 days in adults with double vision (type IIIa). Delayed surgery, within 12 days in all cases, was performed orbital wall fractures with no impairments (type II) or in orbital rim fractures (type I). Data from this retrospective analysis confirm the need for an aggressive approach to all orbital fractures. In our experience, surgery was performed within 12 days and most orbital fractures were treated during the first week after trauma, which is earlier than previously reported.     

颈动脉体瘤的手术治疗——附10例临床分析

目的：总结10例11侧颈动脉体瘤的手术经验。方法：术前9例做数字减影血管造影（DSA）检查，其中3例行暂时性球囊阻断试验（TBO）；10例10侧行颈动脉压迫训练（Matas试验）。术中9例9侧先在局麻下阻断颈总动脉30min，边手术边观察患者反应，再改为全麻下手术；单纯瘤体剥除5侧，行瘤体合并颈动脉分权切除的6侧中，颈动脉修补1例、颈动脉重建2例、结扎颈总和颈内动脉3例。结果：随访1～20a，无复发和死亡病例。1例双侧颈动脉体瘤患者右侧术后当天出现左侧偏瘫，1a内恢复；左侧肿瘤术后，患者血压、心率波动过大，给予可乐定等药物治疗．2周后趋于稳定。其余病例术后经过平稳。结论：术前对大脑侧支循环进行综合评估，合理运用Matas试验，尽量选择单纯瘤体剥除，颈动脉缺损时尽可能即刻行修补或重建，术后采取针对防治脑梗死的措施等．是围术期必须认真对待的问题。     

19例复发性鳃裂囊肿和瘘的手术治疗体会

目的 :总结 19例复发性鳃裂囊肿和瘘的手术治疗经验 ,以期提高鳃裂囊肿和瘘的治愈率。方法 :选择适当的瘘管示踪方式 ,第一鳃裂来源病例中 ,4例切除部分外耳道软骨 ,2例行保留面神经的腮腺浅叶和瘘管切除术。第二、三、四鳃裂来源病例中 ,按常规颈清扫术式解剖分离病理组织。对 4例多次复发者采用功能性颈清扫术。结果 :19例手术切口均Ⅰ期愈合 ,最长随访 8年 ,除 1例术后半年复发外 ,其余病例均治愈。再次复发病例经行根治性颈清扫术后痊愈。结论 :充分的术前准备和合理的手术方案是复发性鳃裂囊肿和瘘治愈的关键。     

Surgical treatment of pleomorphic adenoma of the parotid gland: report of 110 cases

One hundred benign and ten malignant pleomorphic adenomas of the parotid gland were analyzed. Follow up ranged from two to 20 years. Of 54 cases of benign pleomorphic adenoma of the parotid gland, recurrence was noted in five cases (9.2%). The five-year recurrence rate was 17.2%. Of the six malignant pleomorphic adenoma, recurrence within the first ten years took place in four patients (66.6%).