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Bilateral coronoid process enlargement diagnosed by three-dimensional-computed tomography. Case report
134 Journal of Cranio-Maxillofacial Surgery radiotherapy in doses from 50 up to 140 Gy. In 67% of all patients in volume of operation were included of mandibular resection and functional or radical neck dissection. Simultaneous plastic operations were executed in 76 patients. The various local complications were of 61% of patients. Dependence of frequency and character of local complications from a dose and kind of radiation, as well as from the interval between the radiation and surgery is shown. Analysis of the material convinces us of the correctness of the active approach to treatment of patients after high doses of radiation. Simultaneous plastic surgery reduces frequency and severeness of postoperative complications.
Bilateral Coronoid Process Enlargement Diagnosed by Three-Dimensional-Computed Tomography. Case Report.
Feller K-U., Piibler L., Schneider M. Department of Maxillo Facial Surgery, Universityof Dresden, Dresden, Germany We admitted a 14-year-old boy with a height of 1.96 m, size of shoes 46 and a III° mouth-opening-restriction. With three-dimensional-computed tomography imaging we diagnosed a bilateral hyperplasia of the coronoid mandibular process. This technique clearly demonstrated the contact of the enlarged coronoid process with the internal aspect of the zygomatic bone. In addition, we found exostoses on the inner surface of the zygomatic bone. The pediatric evaluation showed no evidence for an endocrine disorder. The growth was almost completed and the mental and physical development were within normal limits. The mouth-opening restriction became typically evident during puberty. The patient presented primarily with a mouth opening of 14 mm. Beforehand he was treated conservatively with intraoral stretch device for 1.5 years. This kind of extra-articular reason for mouth-opening-restrictions are rare conditions, which are only occasionally reflected in the literature. In this case, an internal derangement of the temporomandibular joint could be excluded. Therefore, we decided to resect the enlarged coronoid processes. Under general anaesthesia we removed the elongated coronoid processes. This procedure was performed intraorally. Intensive physiotherapy commenced with stretching exercises on the third postoperative day. A 30 mm spontaneous range-of-motion was the result, which had been achieved at the 10th postoperative day. The aetiology of this finding has not been proved finally. We share the opinion that disorders in blood circulation at the tendon insertion during growth favour calcium deposit and reactive bone hyperplasia.
Surgical Treatment of Mandibular Recurrent Dislocation: A Modification of the Lindemann-Norman Technique Fernandez-Sanroman J.
Department of Oral and Maxillofacial Surgery, Povisa Medical Center, Vigo, Spain Eight patients with mandibular recurrent dislocation were studied both clinically, radiographically and with M R | at four different phases: immediately before surgery; 1 week after surgery; 6 months after surgery; and at least 1 year after the initial operation. All the patients were treated with a modification of the Lindemann-Norman technique performing an oblique osteotomy in the articular eminence
with a calvarial graft into the osteotomy line in order to augment the height of the eminence. After 18 months follow-up, no cases of reluxation were noticed. All but one TMJ diagnosed of internal derangement improved after this surgical procedure. Our results and the surgical technique performed is presented.
The Alloplastic Implant of Hydroxyapatite in Reconstructive Surgery of Craniofacial Skeleton Fortunato G. 1, Bonucci E. 2
JDepartment of Maxillofacial Surgery, San GiovanniAddolorata Hospital, Rome, Italy :Department of Experimental Medicine and Pathology, Section of Pathologic Anatomy, University La Sapienza, Rome, Italy The reconstruction of skeletal segments for esthetic and functional needs is a frequent necessity in craniofacial surgery. Since 1985, we have used hydroxyapatite (HA), pasted with human fibrin glue, to fill up bone cavities in, or to rebuild osseous defects of, every segment of the craniofacial skeleton, and to modify the shape of, or to give support to, the soft tissue of the face. Granular H A was preferred because it can be easily moulded in every requested shape. Favourable clinical results were obtained essentially in all cases, including those in which wide bone defects. X-ray examination showed a bone-like radiographic density in the zones of implant. The necessity of surgical revision allowed us to obtain small bioptic specimens from the implanted area in a limited number of cases in which the implant lasted from approximately 35 months to about 5 years. The histological, histochemical and ultrastructural examination showed that the HA granules were surrounded by, and included in, osseous trabeculae of various thicknesses and dimensions, and that bone formation occurred both in intraosseous and soft tissue implants. Bone remodeling was present, suggesting that the initially formed woven bone was gradually transformed into lamellar bone. The morphological results confirmed that H A fibrin glue implantation in followed by bone formation.
A New Degloving Technique for the Surgery of the Cranial Base Fortunato G., Nisil A., Piccolino P., Pistilli R., Fortunato R.
Department of Maxillofacial Surgery, San GiovanniAddolorata Hospital, Rome, Italy Our endoral-endonasal degloving technique for the access to the skull base shows novelty by including the nasal osteocartilaginous skeleton inside the flap. The detachment of soft tissues from the facial bones stops at the frontal apophysis of maxillar bone where we perform a bilateral basal osteotomy until the fronto-nasal suture. The disinsertion of the cartilaginous septum from the anterior nasal spine, from the nasal crest of maxillar and from the osseous septum and the osteotomy of ethmoidal and vomeral lamina under the nasal bones allows for lift of the nasal pyramid with the labio-genial flap. The disinsertion of the internal canthus increases the shift up to show the medial third of superior orbital rim and the glabella. The removal of the osseous septum allowed the approach to the anterior wall of sphenoidal sinus and to the anterior skull base. After removing the tumour, the skeleton is reconstructed by alloplastic implant
Bilateral Coronoid Process Enlargement Diagnosed by Three-Dimensional-Computed Tomography. Case Report.
Feller K-U., Piibler L., Schneider M. Department of Maxillo Facial Surgery, Universityof Dresden, Dresden, Germany We admitted a 14-year-old boy with a height of 1.96 m, size of shoes 46 and a III° mouth-opening-restriction. With three-dimensional-computed tomography imaging we diagnosed a bilateral hyperplasia of the coronoid mandibular process. This technique clearly demonstrated the contact of the enlarged coronoid process with the internal aspect of the zygomatic bone. In addition, we found exostoses on the inner surface of the zygomatic bone. The pediatric evaluation showed no evidence for an endocrine disorder. The growth was almost completed and the mental and physical development were within normal limits. The mouth-opening restriction became typically evident during puberty. The patient presented primarily with a mouth opening of 14 mm. Beforehand he was treated conservatively with intraoral stretch device for 1.5 years. This kind of extra-articular reason for mouth-opening-restrictions are rare conditions, which are only occasionally reflected in the literature. In this case, an internal derangement of the temporomandibular joint could be excluded. Therefore, we decided to resect the enlarged coronoid processes. Under general anaesthesia we removed the elongated coronoid processes. This procedure was performed intraorally. Intensive physiotherapy commenced with stretching exercises on the third postoperative day. A 30 mm spontaneous range-of-motion was the result, which had been achieved at the 10th postoperative day. The aetiology of this finding has not been proved finally. We share the opinion that disorders in blood circulation at the tendon insertion during growth favour calcium deposit and reactive bone hyperplasia.
Surgical Treatment of Mandibular Recurrent Dislocation: A Modification of the Lindemann-Norman Technique Fernandez-Sanroman J.
Department of Oral and Maxillofacial Surgery, Povisa Medical Center, Vigo, Spain Eight patients with mandibular recurrent dislocation were studied both clinically, radiographically and with M R | at four different phases: immediately before surgery; 1 week after surgery; 6 months after surgery; and at least 1 year after the initial operation. All the patients were treated with a modification of the Lindemann-Norman technique performing an oblique osteotomy in the articular eminence
with a calvarial graft into the osteotomy line in order to augment the height of the eminence. After 18 months follow-up, no cases of reluxation were noticed. All but one TMJ diagnosed of internal derangement improved after this surgical procedure. Our results and the surgical technique performed is presented.
The Alloplastic Implant of Hydroxyapatite in Reconstructive Surgery of Craniofacial Skeleton Fortunato G. 1, Bonucci E. 2
JDepartment of Maxillofacial Surgery, San GiovanniAddolorata Hospital, Rome, Italy :Department of Experimental Medicine and Pathology, Section of Pathologic Anatomy, University La Sapienza, Rome, Italy The reconstruction of skeletal segments for esthetic and functional needs is a frequent necessity in craniofacial surgery. Since 1985, we have used hydroxyapatite (HA), pasted with human fibrin glue, to fill up bone cavities in, or to rebuild osseous defects of, every segment of the craniofacial skeleton, and to modify the shape of, or to give support to, the soft tissue of the face. Granular H A was preferred because it can be easily moulded in every requested shape. Favourable clinical results were obtained essentially in all cases, including those in which wide bone defects. X-ray examination showed a bone-like radiographic density in the zones of implant. The necessity of surgical revision allowed us to obtain small bioptic specimens from the implanted area in a limited number of cases in which the implant lasted from approximately 35 months to about 5 years. The histological, histochemical and ultrastructural examination showed that the HA granules were surrounded by, and included in, osseous trabeculae of various thicknesses and dimensions, and that bone formation occurred both in intraosseous and soft tissue implants. Bone remodeling was present, suggesting that the initially formed woven bone was gradually transformed into lamellar bone. The morphological results confirmed that H A fibrin glue implantation in followed by bone formation.
A New Degloving Technique for the Surgery of the Cranial Base Fortunato G., Nisil A., Piccolino P., Pistilli R., Fortunato R.
Department of Maxillofacial Surgery, San GiovanniAddolorata Hospital, Rome, Italy Our endoral-endonasal degloving technique for the access to the skull base shows novelty by including the nasal osteocartilaginous skeleton inside the flap. The detachment of soft tissues from the facial bones stops at the frontal apophysis of maxillar bone where we perform a bilateral basal osteotomy until the fronto-nasal suture. The disinsertion of the cartilaginous septum from the anterior nasal spine, from the nasal crest of maxillar and from the osseous septum and the osteotomy of ethmoidal and vomeral lamina under the nasal bones allows for lift of the nasal pyramid with the labio-genial flap. The disinsertion of the internal canthus increases the shift up to show the medial third of superior orbital rim and the glabella. The removal of the osseous septum allowed the approach to the anterior wall of sphenoidal sinus and to the anterior skull base. After removing the tumour, the skeleton is reconstructed by alloplastic implant