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Temporomandibular discopexy with Mitek® mini anchor
Free oral communications 99 47 females) aged 20-70-years-old with hearing and equilibrium disturbances were examined. All of them have undergone simultaneous linear tomography (thickness 2 mm, slices interval 2 mm) and 27 patients were examined using computed tomography of temporal bone and TMJ in frontal projection.
Results: According to the diagnosis, patients were divided in 4 groups: middle ear pyogenicotitis - 37 cases (43.5%), epimesotympanitis - 30 cases (35.3%), outer and middle ear tumours 7 cases (8.2%) and patients after radical ear operation - 11 cases (13%). In 21 patients (24.7%), we have found TMJ changes side by side with temporal bone pathology. Twelve of them had unilateral and 2 bilateral arthrosis. Acute arthritis was visualized in 3 cases, chronic arthritis in 2 cases. Joint fossa destruction was seen in 2 cases of ear tumours. Conclusion: Our study has proved that one quarter of patients, suffering from ear disease, has TMJ pathology as well. This is to be taken in account during rehabilitation measures in this group of patients.
Surgical Treatment of the Prominent Ear
Salgarelli A., Magnato R., Noeini P.F. Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy The prominent or divergent ear is a frequent deformity characterized by an increase of the cephalo-auricular angle. This malposition of the ear could be due to the lack or the hypodevelopment of the antihelix, to an excessive dimension of the concha, to an abnormal position of the auricle on the head or to a sum of all these factors. The literature is rich in surgical techniques for the correction of prominent ear. The considerable multitude of the techniques shows the difficulty to achieve good results in all cases. We report our experience with 40 consecutive cases. Our surgical method arises from the knowledge and the elaboration of the various surgical techniques presented in the literature. We suggest to correct the deformity creating a new antihelical-plica following the Stenstr6m and Mustard6 method, to create an anatomical cavity in the mastoid region where the concha can be repositioned following the Furnas method. The tension of the 'cartilage spring' which may be the cause of probable relapse is thus broken by dissecting a cartilage triangle from the root of the inferior crus. We think that this surgical technique originated from the combination of the most suitable methods of otoplasty, could be particularly relevant in the correction of all cases of prominent ear.
Temporomandibular Diseopexy with Mitek® Mini Anchor
Salmerdn J.L, Borja A., Llopis P., Verdaguer J.J., L6pez de A talaya J. Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Mara~6n, Madrid, Spain In cases with temporomandibular joint (TMJ) dysfunction with subluxation or dislocation of the articular disc, traditional methods of surgical repositioning do not obtain predictable results in repositioning the articular disc. Chronic subluxation of the articular disc produces degenerative changes of the disc with the consequences of limited joint movement. Mitek® has developed an anchor system for
attaching soft tissues to bone in ligament repair, it is used in orthopaedic surgery, it is made of a cylindrical titanium body with two wings of nickel titanium with superelastic properties and form memory, with a diameter of 1.8 mm and length of 5.4 mm. LM Wolford in Dallas, Texas, USA has adapted this system for repositioning the TMJ disc, the anchor is inserted into the condyle, any suture material can be threaded onto the anchor eyelet and the suture is then used to engage the posterior band of the disc. We have used this technique of condylar discopexy on 15 patients with anterior dislocation of the articular disc and clinical problems of limited mouth opening and pain, on 3 patients with mandibular condylar hyperplasia, to readapt the disc once the superior portion of the condyle has been removed and on 4 patients with fibrosis ankylosis and degeneration of the disc, in which removal of the disc and its substitution with temporal muscle flap and anchoring the flap with the Mitek. The total number of joints surgery performed has been 26. In no cases has displacement of the Mitek been observed. The repositioning has been checked in many cases with magnetic resonance imaging. In the cases of anterior disc displacement, the clinical results have been good with reduction of their pain symptoms and improved mandibular function, in all the cases of condylar hyperplasia with disc readaptation the results have been favourable with normal mandibular function, in the cases of mandibular ankylosis 50% the results have been favourable and in the other 50% there has been no clinical changes. In this paper the technique and the results are described.
Combined Frontal, Infratemporal and Transfacial Approach to Advanced Malignant Skull Base Tumours
Salvatori P., Solero C.L., Mattavelli F., Pizzi N., Podrecca S., Cantlt G. Department of ENT and Maxillo-Facial Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumouri, Milan, Italy Tumours of paranasal sinuses may spread towards lamina cribra: standard anterior craniofacial resection is then the optimal treatment. However, maxillary tumours may also erode the posterior wall and pterygoid process invading the infratemporal fossa and the sphenoid greater wing at the same time. A three-way approach (transfrontal, transfacial and infratemporal) is then necessary to achieve adequate access for complete resection. This procedure results from combination of the standard anterior craniofacial resection and the pre- or postauricular infratemporal approach; anterior and lateral craniotomies may be either separated or not. Anterior skull base is repaired by a pedicled pericranial flap; temporalis muscle is sometime suitable to fill maxillary and infratemporal defect, otherwise a free flap is used. Fifteen patients underwent this procedure for adenoid cystic carcinoma (6 patients), adenocarcinomas (3 patients), squamous cell carcinoma (3 patients), basal cell carcinoma (2 patients) and mucoepidermoid carcinoma (1 patient). Seven of them are alive and well, 4 patients are alive with disease and 4 patients died due to tumour.
Primary Unilateral Cleft Lip-Nose Repair: A Twenty-Five Year Experience
Salyer K.E. International Craniofacial Institute, Dallas, Texas, USA A 25-year experience with a proven method of repair for unilateral cleft lip-nose which has been used in over 750
Results: According to the diagnosis, patients were divided in 4 groups: middle ear pyogenicotitis - 37 cases (43.5%), epimesotympanitis - 30 cases (35.3%), outer and middle ear tumours 7 cases (8.2%) and patients after radical ear operation - 11 cases (13%). In 21 patients (24.7%), we have found TMJ changes side by side with temporal bone pathology. Twelve of them had unilateral and 2 bilateral arthrosis. Acute arthritis was visualized in 3 cases, chronic arthritis in 2 cases. Joint fossa destruction was seen in 2 cases of ear tumours. Conclusion: Our study has proved that one quarter of patients, suffering from ear disease, has TMJ pathology as well. This is to be taken in account during rehabilitation measures in this group of patients.
Surgical Treatment of the Prominent Ear
Salgarelli A., Magnato R., Noeini P.F. Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy The prominent or divergent ear is a frequent deformity characterized by an increase of the cephalo-auricular angle. This malposition of the ear could be due to the lack or the hypodevelopment of the antihelix, to an excessive dimension of the concha, to an abnormal position of the auricle on the head or to a sum of all these factors. The literature is rich in surgical techniques for the correction of prominent ear. The considerable multitude of the techniques shows the difficulty to achieve good results in all cases. We report our experience with 40 consecutive cases. Our surgical method arises from the knowledge and the elaboration of the various surgical techniques presented in the literature. We suggest to correct the deformity creating a new antihelical-plica following the Stenstr6m and Mustard6 method, to create an anatomical cavity in the mastoid region where the concha can be repositioned following the Furnas method. The tension of the 'cartilage spring' which may be the cause of probable relapse is thus broken by dissecting a cartilage triangle from the root of the inferior crus. We think that this surgical technique originated from the combination of the most suitable methods of otoplasty, could be particularly relevant in the correction of all cases of prominent ear.
Temporomandibular Diseopexy with Mitek® Mini Anchor
Salmerdn J.L, Borja A., Llopis P., Verdaguer J.J., L6pez de A talaya J. Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Mara~6n, Madrid, Spain In cases with temporomandibular joint (TMJ) dysfunction with subluxation or dislocation of the articular disc, traditional methods of surgical repositioning do not obtain predictable results in repositioning the articular disc. Chronic subluxation of the articular disc produces degenerative changes of the disc with the consequences of limited joint movement. Mitek® has developed an anchor system for
attaching soft tissues to bone in ligament repair, it is used in orthopaedic surgery, it is made of a cylindrical titanium body with two wings of nickel titanium with superelastic properties and form memory, with a diameter of 1.8 mm and length of 5.4 mm. LM Wolford in Dallas, Texas, USA has adapted this system for repositioning the TMJ disc, the anchor is inserted into the condyle, any suture material can be threaded onto the anchor eyelet and the suture is then used to engage the posterior band of the disc. We have used this technique of condylar discopexy on 15 patients with anterior dislocation of the articular disc and clinical problems of limited mouth opening and pain, on 3 patients with mandibular condylar hyperplasia, to readapt the disc once the superior portion of the condyle has been removed and on 4 patients with fibrosis ankylosis and degeneration of the disc, in which removal of the disc and its substitution with temporal muscle flap and anchoring the flap with the Mitek. The total number of joints surgery performed has been 26. In no cases has displacement of the Mitek been observed. The repositioning has been checked in many cases with magnetic resonance imaging. In the cases of anterior disc displacement, the clinical results have been good with reduction of their pain symptoms and improved mandibular function, in all the cases of condylar hyperplasia with disc readaptation the results have been favourable with normal mandibular function, in the cases of mandibular ankylosis 50% the results have been favourable and in the other 50% there has been no clinical changes. In this paper the technique and the results are described.
Combined Frontal, Infratemporal and Transfacial Approach to Advanced Malignant Skull Base Tumours
Salvatori P., Solero C.L., Mattavelli F., Pizzi N., Podrecca S., Cantlt G. Department of ENT and Maxillo-Facial Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumouri, Milan, Italy Tumours of paranasal sinuses may spread towards lamina cribra: standard anterior craniofacial resection is then the optimal treatment. However, maxillary tumours may also erode the posterior wall and pterygoid process invading the infratemporal fossa and the sphenoid greater wing at the same time. A three-way approach (transfrontal, transfacial and infratemporal) is then necessary to achieve adequate access for complete resection. This procedure results from combination of the standard anterior craniofacial resection and the pre- or postauricular infratemporal approach; anterior and lateral craniotomies may be either separated or not. Anterior skull base is repaired by a pedicled pericranial flap; temporalis muscle is sometime suitable to fill maxillary and infratemporal defect, otherwise a free flap is used. Fifteen patients underwent this procedure for adenoid cystic carcinoma (6 patients), adenocarcinomas (3 patients), squamous cell carcinoma (3 patients), basal cell carcinoma (2 patients) and mucoepidermoid carcinoma (1 patient). Seven of them are alive and well, 4 patients are alive with disease and 4 patients died due to tumour.
Primary Unilateral Cleft Lip-Nose Repair: A Twenty-Five Year Experience
Salyer K.E. International Craniofacial Institute, Dallas, Texas, USA A 25-year experience with a proven method of repair for unilateral cleft lip-nose which has been used in over 750