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O.601 Ultrasound examination in thyrolingual duct cysts diagnostic
Oral Presentations
Skull base surgery
S151
occur from the mandible, maxilla, nasopharynx, neck, oral cavity, oropharynx, and temporal bone. Primary parapharyngeal space neoplasms fall into three categories: salivary gland neoplasms, neurogenic tumors, and miscellaneous tumors. Results: All the patients were operated using the previous mentioned approaches with total resection, patient who had malignant tumor underwent either pre-operative or post operative treatment and they are kept in the follow-up. Conclusions: Parapharyngeal tumours, although mostly benign in their histopathology, present a challenge to the surgeon due to the limited access. Multiple approaches have been described in the literature for the removal of these tumors. Although there is general consensus regarding the surgical techniques to remove small tumors. However still there is considerable controversy among different authors with different backgrounds as to how to approach for larger tumors that extend to the skull base.
MRI/MRA made it possible to evaluate SEFH volume and morphological structure. MRI/MRA main advantages: precise definition of SEFH spreading; precise identification of SEFH blood supplying sources (including small collateral vessels); opportunity of contralateral extracranial and intracranial vessels examination (in 29 patients MRI/MRA shown intracranial vessels abnormalities and in 11 patients – intracranial vessels malformations). MRI/MRA main disadvantages: impossibility of the haemodynamic parameters evaluation; long examination time and narcosis necessity for young patients. Conclusion: US and MRI/MRA are important complementary methods of SEFH diagnostics. MRI/MRA should be the basic method of SEFH diagnostics and US must be the method of SEFH local status examination (especially for haemodynamic parameters evaluation) and operative dynamic control of SEFH treatment efficiency.
O.601 Ultrasound examination in thyrolingual duct cysts diagnostic
Tuesday, 9 September 2008, 16.00–17.00
Room 1
A. Nadtochiy, D. Goga, N. Boyarina. Moscow Center of Children’s Maxillofacial Surgery, Moscow, Russia
Skull base surgery
Objectives: to define the capability of ultrasound (US) examination in thyrolingual duct cysts (TLDC) diagnostics. Methods and Materials: 238 patients from 2 days till 47 years with TLDC underwent standard clinical and US examination. (child:adult = 191:47 = 80.3%:19.7%; male:female = 152:86 = 63.9%:36.1%; nonoperated:recurrenced =175:63 = 73.5%:26.5%). In 37 patients (15.5%) TLDC were in partly empting (“nontensional”) stage (with functioning native drainage); in 140 patients (58.8%) – in filling (“tensional”) stage (without functioning native drainage); in 61 patients (25.6%) – in suppuration stage. Clinical diagnoses and ultrasound data has been verified surgically. Results: Different solitary TLDC variants were revealed in 95 patients (39.9%): parahyoid variant – in 44 patients (46.3%/18.5%); suprahyoid variant (radix linguae cyst) – in 13 patients (13.7%/5.5%), prehyoid variant – in 11 patients (11.6%/4.6%), infrahyoid variant – in 27 patients (28.4%/11.3%). Multiple TLDC variant with double or triple (and tetradic!) cysts were revealed in 143 patients (60.1%). In 173 patients (72.7%) TLDC were associated with external (25 cases – 14.5%/10.5%) and internal (170 cases – 98.7%/71.4%) fistulas. In 22 patients with external fistulas (88%) the internal fistulas were revealed. New US pathognomic symptoms of TLDC were described: hyoid bone deformation (191 patients – 80.3%), gas in cyst cavity (64 patients – 26.9%). Conclusion: US examination is considered to be efficient instrument of TLDC evaluation and its individual clinically and surgically important features detection.
O.603 A new method of resorbable osteosynthesis in craniosynostos
O.602 US and MRI in children facial haemangiomas diagnostics A. Nadtochiy, V. Panov, S. Pal¨ıtova, N. Litvakovskaya, I. Limarova. Moscow Center of Children’s Maxillofacial Surgery, Moscow, Russia Purpose: The diagnostic competences of ultrasonography (US) and magnetic-resonance imaging (MRI) with magnetic-resonance angiography (MRA) in children spacious facial haemangiomas (SEFH) evaluation. Methods: 72 patients from 2 weeks till 17 years old with SEFH underwent US and MRI/MRA. Results: US allowed to evaluate SEFH organotopic and haemodynamic parameters, morphological structure variants. US main advantages: safety; simplicity and rapidity in important clinical information receiving; possibility of treatment efficiency dynamic control. US main disadvantages: related subjectivity; inaccessibility of deep facial regions and intracranial vessels evaluation.
S. Ramirez Varela, S. Ramirez, J. Acero, S. Ochandiano, L. Garcia, S. Gonzalez, C. Navarro. Department of Oral and Maxillofacial Surgery, Universitary Hospital Gregorio Mara˜non, Madrid, Spain Craniosynostosis develop from premature fusion of cranial sutures due to disturbances of the condroblasts dividing capacity in the cartilage of the skull base. The consequences are characteristic deformations of the skull, i.e. trigonocephalus, plagiocephalus, oxycephalus, brachycephalus and scaphocephalus. Titanium plates have the disavantage of difficult handling and difficulties at withdrawal. Biodegradable osteosynthesis materials are often used for fixation of bone fragments when repairing craniosynostosis. We use a new sistem in which the osteosynthesis materials are fixed by inserting resorbable pins with the aid of ultrasound. Our aim is evaluate the findings regarding surgical technique, stability of osteosynthesis and individual biocompatibility. We present 11 patients with different craniosynostosis who were operated at our department between 2006 and 2008 by use of a new poly (D, L) lactide (PDLLA) biodegradable osteosynthesis system that was fixed with resorbable pins inserted with the aid of ultrasound. Mean follow-up was twelve months. Pin fixation was estable in all cases. No long-term implant-related complications were seen in any of treated patients. The time required for applying the osteosynthesis materials was reduced by about 50% since handling of the material was easier and no thread cutting was required. Resorbable polylactic and polyglycolic acid plates and screws can be an effective fixation method for children craniosynostosis. Due to fixation in cortical as well as cancellous bone ultrasound aided fixation using resorbable osteosynthesis materials is more stable than screw fixation. The time required for application is shortened as no thread cutting is required. O.604 Anterior skull base: endoscopic approach for malignancies E. Belli1 , C. Matteini2 , G. Rendine1 , N. Mazzone1 . 1 II Faculty of Medicine, University “La Sapienza” Rome, Sant’Andrea Hospital Department of Maxillofacial Surgery, Rome, Italy; 2 Asl Viterbo Belcolle Hospital, Italy Ketcham first reported the approach to sinonasal tumors involving the skull base by anterior craniofacial resection, later refinements of this technique such the subcranial approach were proposed by
Skull base surgery
S151
occur from the mandible, maxilla, nasopharynx, neck, oral cavity, oropharynx, and temporal bone. Primary parapharyngeal space neoplasms fall into three categories: salivary gland neoplasms, neurogenic tumors, and miscellaneous tumors. Results: All the patients were operated using the previous mentioned approaches with total resection, patient who had malignant tumor underwent either pre-operative or post operative treatment and they are kept in the follow-up. Conclusions: Parapharyngeal tumours, although mostly benign in their histopathology, present a challenge to the surgeon due to the limited access. Multiple approaches have been described in the literature for the removal of these tumors. Although there is general consensus regarding the surgical techniques to remove small tumors. However still there is considerable controversy among different authors with different backgrounds as to how to approach for larger tumors that extend to the skull base.
MRI/MRA made it possible to evaluate SEFH volume and morphological structure. MRI/MRA main advantages: precise definition of SEFH spreading; precise identification of SEFH blood supplying sources (including small collateral vessels); opportunity of contralateral extracranial and intracranial vessels examination (in 29 patients MRI/MRA shown intracranial vessels abnormalities and in 11 patients – intracranial vessels malformations). MRI/MRA main disadvantages: impossibility of the haemodynamic parameters evaluation; long examination time and narcosis necessity for young patients. Conclusion: US and MRI/MRA are important complementary methods of SEFH diagnostics. MRI/MRA should be the basic method of SEFH diagnostics and US must be the method of SEFH local status examination (especially for haemodynamic parameters evaluation) and operative dynamic control of SEFH treatment efficiency.
O.601 Ultrasound examination in thyrolingual duct cysts diagnostic
Tuesday, 9 September 2008, 16.00–17.00
Room 1
A. Nadtochiy, D. Goga, N. Boyarina. Moscow Center of Children’s Maxillofacial Surgery, Moscow, Russia
Skull base surgery
Objectives: to define the capability of ultrasound (US) examination in thyrolingual duct cysts (TLDC) diagnostics. Methods and Materials: 238 patients from 2 days till 47 years with TLDC underwent standard clinical and US examination. (child:adult = 191:47 = 80.3%:19.7%; male:female = 152:86 = 63.9%:36.1%; nonoperated:recurrenced =175:63 = 73.5%:26.5%). In 37 patients (15.5%) TLDC were in partly empting (“nontensional”) stage (with functioning native drainage); in 140 patients (58.8%) – in filling (“tensional”) stage (without functioning native drainage); in 61 patients (25.6%) – in suppuration stage. Clinical diagnoses and ultrasound data has been verified surgically. Results: Different solitary TLDC variants were revealed in 95 patients (39.9%): parahyoid variant – in 44 patients (46.3%/18.5%); suprahyoid variant (radix linguae cyst) – in 13 patients (13.7%/5.5%), prehyoid variant – in 11 patients (11.6%/4.6%), infrahyoid variant – in 27 patients (28.4%/11.3%). Multiple TLDC variant with double or triple (and tetradic!) cysts were revealed in 143 patients (60.1%). In 173 patients (72.7%) TLDC were associated with external (25 cases – 14.5%/10.5%) and internal (170 cases – 98.7%/71.4%) fistulas. In 22 patients with external fistulas (88%) the internal fistulas were revealed. New US pathognomic symptoms of TLDC were described: hyoid bone deformation (191 patients – 80.3%), gas in cyst cavity (64 patients – 26.9%). Conclusion: US examination is considered to be efficient instrument of TLDC evaluation and its individual clinically and surgically important features detection.
O.603 A new method of resorbable osteosynthesis in craniosynostos
O.602 US and MRI in children facial haemangiomas diagnostics A. Nadtochiy, V. Panov, S. Pal¨ıtova, N. Litvakovskaya, I. Limarova. Moscow Center of Children’s Maxillofacial Surgery, Moscow, Russia Purpose: The diagnostic competences of ultrasonography (US) and magnetic-resonance imaging (MRI) with magnetic-resonance angiography (MRA) in children spacious facial haemangiomas (SEFH) evaluation. Methods: 72 patients from 2 weeks till 17 years old with SEFH underwent US and MRI/MRA. Results: US allowed to evaluate SEFH organotopic and haemodynamic parameters, morphological structure variants. US main advantages: safety; simplicity and rapidity in important clinical information receiving; possibility of treatment efficiency dynamic control. US main disadvantages: related subjectivity; inaccessibility of deep facial regions and intracranial vessels evaluation.
S. Ramirez Varela, S. Ramirez, J. Acero, S. Ochandiano, L. Garcia, S. Gonzalez, C. Navarro. Department of Oral and Maxillofacial Surgery, Universitary Hospital Gregorio Mara˜non, Madrid, Spain Craniosynostosis develop from premature fusion of cranial sutures due to disturbances of the condroblasts dividing capacity in the cartilage of the skull base. The consequences are characteristic deformations of the skull, i.e. trigonocephalus, plagiocephalus, oxycephalus, brachycephalus and scaphocephalus. Titanium plates have the disavantage of difficult handling and difficulties at withdrawal. Biodegradable osteosynthesis materials are often used for fixation of bone fragments when repairing craniosynostosis. We use a new sistem in which the osteosynthesis materials are fixed by inserting resorbable pins with the aid of ultrasound. Our aim is evaluate the findings regarding surgical technique, stability of osteosynthesis and individual biocompatibility. We present 11 patients with different craniosynostosis who were operated at our department between 2006 and 2008 by use of a new poly (D, L) lactide (PDLLA) biodegradable osteosynthesis system that was fixed with resorbable pins inserted with the aid of ultrasound. Mean follow-up was twelve months. Pin fixation was estable in all cases. No long-term implant-related complications were seen in any of treated patients. The time required for applying the osteosynthesis materials was reduced by about 50% since handling of the material was easier and no thread cutting was required. Resorbable polylactic and polyglycolic acid plates and screws can be an effective fixation method for children craniosynostosis. Due to fixation in cortical as well as cancellous bone ultrasound aided fixation using resorbable osteosynthesis materials is more stable than screw fixation. The time required for application is shortened as no thread cutting is required. O.604 Anterior skull base: endoscopic approach for malignancies E. Belli1 , C. Matteini2 , G. Rendine1 , N. Mazzone1 . 1 II Faculty of Medicine, University “La Sapienza” Rome, Sant’Andrea Hospital Department of Maxillofacial Surgery, Rome, Italy; 2 Asl Viterbo Belcolle Hospital, Italy Ketcham first reported the approach to sinonasal tumors involving the skull base by anterior craniofacial resection, later refinements of this technique such the subcranial approach were proposed by