Biomedical subjects

A Bedogni

Publications and source records attributed to A Bedogni.

10 recordsLinked to original sources

PubMed2004

Functional rehabilitation of the atrophic mandible and maxilla with fibula flaps and implant-supported prosthesis.

Historically, nonvascularized bone grafts have been the standard treatment for severe mandibular and maxillary atrophy, followed by immediate or delayed implant placement. Extreme atrophy is an unfavorable biological and mechanical location for nonvascularized autologous bone transplants. The authors present the results of a multidisciplinary treatment protocol for rehabilitation of extreme mandibular and maxillary atrophy by use of the vascularized fibular flap. This protocol includes bone augmentation, implant surgery, soft-tissue management, and prosthetic restoration. Since 1993, 18 patients with a mean age of 47.5 years presented with extreme mandibular and/or maxillary atrophy and underwent alveolar crest augmentation with vascularized fibular flaps. Bone healing was achieved in 17 of the 18 patients. Seventy-three osteointegrated implants were inserted in 12 of 17 fibular flaps. Altogether, 62 implants were loaded and 11 dental prostheses were made. Average follow-up of the loaded implants was 41 months. The success rate of loaded implants was 100 percent. The authors strongly recommend the use of the fibular bone flap when dealing with extreme atrophy of the mandible and maxilla and suggest the protocol outlined in this review.

Adult↗

PubMed2003

Fractures of the iliac crest following anterior and posterior bone graft harvesting. Review of the literature and case presentation.

Iliac crest is the most commonly used extra-oral donor site of autologous non-vascularized bone, because of the great amount of bone available and easy access. Bone grafting from the ileum, however, is not without complications. An extensive review of the literature focusing on fractures of the iliac crest and pelvic ring instability due to anterior and posterior bone graft harvesting is reported, and 1 case of anterior stress fracture of the iliac crest is described. Thirty-five of the 37 fractures described up to date in literature were divided in 2 groups depending on the region of bone graft harvesting. Twenty-four fractures - including our case - were related to bone graft harvesting from the anterior region, 12 were due to harvesting from the posterior region. Four out of 24 anterior fractures required further surgical treatment (16.6%). In 8 of the 12 fractures with pelvic ring instability due to posterior bone harvesting, 1 or more additional surgical procedures were performed in order to stabilize multiple fracture sites (66.6%). Anterior iliac crest fractures, even though painful, remain stable and heal spontaneously in most cases without further complications. On the contrary, fractures due to posterior iliac crest harvestings very often require complex surgical treatments and lead to significant disability, which can be permanent.

Fractures, Bone↗

PubMed2002

Lining the mouth floor with prelaminated fascio-mucosal free flaps: clinical experience.

Soft-tissue defects of the mouth floor need thin, foldable, and pliable tissues able to preserve local anatomy as well as chewing, phonation, and deglutition. The oral mucosa is made of a stratified, nonkeratinized, epithelium-secreting mucus, which lubricates the oral cavity and facilitates tongue movements. No flap exists that can reproduce the physiology of the oral mucosa better than the oral mucosa itself. Prefabrication of mucosal flaps may represent the best solution. Therefore, 10 consecutive cases of mouth floor cancer were treated with prelamination of the fascia antibrachialis with mucosal grafts obtained from the healthy cheek, and with subsequent transplantation 3 weeks later. A significant increase in mucosal graft surface was seen in all cases, with a mean size twice the original. All flaps healed uneventfully. Follow-up time ranged between 2-60 months (average, 26.6 months). Morphological and functional results were excellent. Tongue motility, speech intelligibility, and swallowing were reestablished in all treated cases. Mucosal prelamination of the forearm fascia is feasible and allows physiological reconstruction of oral cavity defects up to 6 x 4 cm.

Carcinoma, Squamous Cell↗

PubMed2002

Simultaneous bimaxillary alveolar ridge augmentation by a single free fibular transfer: a case report.

Class VI atrophy according to Cawood still represents a major challenge in pre-prosthetic surgery. Reconstruction of mandibular and maxillary bony defects using microvascular techniques is safe and reliable. The fibula, due to its morphological properties, is ideal for alveolar ridge augmentation and its donor site morbidity is the lowest among vascularized bone flaps. In this paper, we report the first case, to our knowledge, of extreme atrophy of both jaws, successfully treated by simultaneous bony augmentation of the maxillary and mandibular alveolar ridges with just one free fibula flap. Pre-operative planning, surgical technique and prosthetic restoration are discussed in detail.

Alveolar Bone Loss↗

PubMed2000

Intracranial spread of a giant frontal mucocele: case report.

A giant mucocele eroded both the anterior and posterior wall of the frontal sinus and infiltrated the dura mater. Its extracranial growth caused a frontal bony prominence. The tumour and part of the dura were resected. A 12 x 6cm defect in the dura was repaired with a freeze-dried patch. A split-thickness bone graft from the right parietal region was used to repair the anterior frontal bony defect. The result one year later was satisfactory. Spiral computed tomography with thr ee-dimensional reconstructions excluded any recurrence of the tumour and showed good integration of bone grafts.

Aged↗

PubMed2000

[Facial localized cosmetic filling by multiple injections of fat stored at -30 degrees C. Techniques, clinial follow-up of 99 patients and histological examination of 10 patients].

At the end of the 1980's and at the beginning of the 1990's, free fat autografts were abandoned because of the poor long-term results. Two theories supported by hystological studies (the host replacement theory or the cell survival theory) have now been proposed to explain survival of fat tissue. They demonstrate that, when harvested by a correct technique, fat tissue presents the ideal characteristics to be grafted, providing a good soft-tissue substitute with a minimum follow-up of four years up to 6 years. The authors present a multiple stage lipofilling technique in 99 cases of facial rejuvenation by means of lipolayering. Injections are performed every 20 days and fat is stored fat at -30 degrees C with good aesthetic results and minimal morbidity with clinical follow-up at 4 and 6 years. Histological examination of fat stored for 20 days and for 8 months was also performed in 10 patients. Microscopic and ultrastructural examination demonstrated that stored adipocytes retain their anatomical features and, when injected in multiple stages, are adequate to obtain good clinical results. Our histological study combined with the clinical outcomes, suggests the advantage of several stage injection of stored fat (-30 degrees C).

Adipocytes↗

PubMed2000

[Intraoperative lesions of the maxillary artery and its immediate treatment. Presentation of a clinical case].

The authors discuss the possible vascular lesions that may occur during mandibular sagittal split ramus osteotomies with particular regard to the maxillary artery. A case of surgical lesion of the maxillary artery is presented and its course and anastomoses are analyzed. The ligation of the external carotid artery and its principal branches is the treatment of choice in case of maxillary artery lesion which is a life threatening event and needs immediate intervention.

Adolescent↗

PubMedDate not supplied

Retrospective evaluation on the surgical treatment of jaw bones ameloblastic lesions. Experience with 20 clinical cases.

BACKGROUND: Ameloblastoma is a benign but locally aggressive neoplasm of the odontogenic epithelium that causes expansion of the bone and tends to recur. The aim of this article is to present a retrospective evaluation on the management of ameloblastic lesion of the jawbones and to compare them with those reported in literature in order to rule out which surgical approach is likely to be the most appropriate, considering it extremely controversial. METHODS: Data corresponding to 20 patients with ameloblastic lesions involving the maxillary bones, admitted to the O ral and MaxilloFacial Surgery Department of Verona University Hospital, were analyzed in the period between 1984 and 1999. All data were selected for sex, age, site of involvement, histological patterns of the lesions, surgical steps performed concerning both primary pathology and secondary relapses including the reconstructive methods employed. RESULTS: The results showed a male/female ratio of 1.5/1. All the affected patients showed endosseous tumour masses localized in 90% of the cases at the mandible and only in 10% at the maxillary bone. Only one case with soft tissue involvement was observed. Treatment was enucleation and bone courettage in the 65% of cases while in 35% the lesion was excised performing wide bone resection. The histopathological study on the surgical specimens revealed the 50% of the lesions were unicystic 45% were multicystic showing the other 5% a carcinomatous ameloblastic patterns. The recurrence rate in patients managed with enucleation and courettage was 28.57% while in wide bone resection none recurrence was observed. CONCLUSIONS: Simply enucleation and curettage of multicystic ameloblastic lesion of jawbones results in an unacceptable recurrence rate. Conservative surgical treatment should be considered only in presence of unicystic lesion when extraosseous spread has not occurred. Multicystic lesions should be treated with an extended surgical resection.

Adolescent↗

PubMedDate not supplied

[Prune belly syndrome].

The prune belly syndrome consists of congenital absence or deficiency of the anterior abdominal muscle, bilateral cryptorchidism and anomalies of urogenital tract. Neurological problems are common in these patients as respiratory, orthopedic, gastrointestinal and chromosomal anomalies. We have treated 17 cases of prune belly syndrome. Mortality is 23.5%: two patients died in the neonatal period of respiratory failure; one patient, aged two months, died of septicemia in postoperative period, another, 14 years old, died of respiratory failure with normal renal function. Two patients are female without urological anomalies, one male has an incomplete form with normal urinary tract. Two patients with complete syndrome are treated conservatively. Ten patients with vesicourethral reflux or ureteral dilatation for distal obstruction are treated surgically. We performed 20 ureteral reimplantations with 16 tailoring of the ureters. In three patients ureteral reimplantation failed and in these patients we performed successfully a transureteroureterostomy. All patients have adequate complete bladder emptying without surgical procedure. Renal function is normal in seven, slightly reduced in one and reduced but stable in the others. Orchidopexy was performed successfully in eleven patients (10 Fowler-Stephens procedures). Orchiectomy with testicular prosthesis was performed in a patient 12 years old. Five patients have moderate respiratory insufficiency treated with chest physiotherapy. Urinary tract abnormalities are the most common cause of morbidity and mortality in patients with prune belly syndrome. Treatment regimen must be individualized. Respiratory problems are also frequent and is mandatory a precocious chest physiotherapy.

Adolescent↗

PubMedDate not supplied

[Deep hypothermia and cardiocirculatory arrest with the technic of central cooling in patients with simple transposition of the great arteries].

The deep hypothermia and cardiocirculatory arrest are employed mainly for two reasons; to reduce as much as possible the extra corporeal circulation time in patients more suitable to present the deleterious effects of the by-pass circulation, and to have surgical field completely free from the blood, making easier some surgical procedures. In the classic description of Hykasa the deep hypothermia necessary to have a safe cardiocirculatory arrest is obtained by means of surface cooling and an extracorporeal heat exchanger. In our experience deep hypothermia and cardiocirculatory arrest were achieved only by means of core cooling technique; 64 patients with TGA weighing less than 10 kg were operated upon by this method with a mortality rate of 3.1%. The most important mortality risk factors were associated to the low weight of the patients and to the age. The major criticism against core cooling is represented by the thought that this type of cooling can impair cerebral function. In 2 patients we had neurological complications but were unrelated to the technique. We conclude that, when is necessary to perform a cardiocirculatory arrest, the core cooling deep hypothermia is a good, simple and useful technique, with a low danger of neurological complications.

Extracorporeal Circulation↗