Biomedical subjects
Publications and source records attributed to A Tullio.
Soft-tissue chondroma is an infrequent, benign, cartilaginous tumour that is uncommon in the head and neck region. Single-location chondromas rarely evolve into malignant neoplasms. Chondromas are composed of hyaline cartilage with focal calcification. There have been a few reports published of cases of soft-tissue chondroma of the neck and parapharyngeal space. Here is described a new location of this tumour in the masticatory space.
In this article a new method of closing palatal defects by means of buccal fat pad flaps is reported. A double buccal fat pad flap in association with Le Fort I osteotomy approach was adopted to remove tumours of the palate and nasal fossae. The technique is described in a case of adenocarcinoma arising from the nasal septum and its indications and advantages are discussed.
AIM: The study evaluates the repair of residual alveolar cleft through secondary bone graft, consisting in the transplantation of autologous bone to restore the continuity of the maxillary arch and achieve normal functioning and esthetics. METHODS: During 2001-2002, 15 patients (age range 9-26 years; 7 males, 8 females) were submitted to secondary bone graft at the Maxillo-facial Surgery Operative Unit, University Hospital, Sassari. Eleven patients had complete unilateral cleft, 4 had complete bilateral cleft. All patients were operated upon by the same surgeon; they received a graft of autologous bone from the iliac crest. For preoperative and postoperative evaluation at 1 year, the following were utilised: plaster casts of the tooth arches, OPT, photographs and complete clinical documentation. RESULTS: Postoperative results were: 100% formation of a bone bridge between the maxillary segments; 70% closure of oro-nasal fistula; 100% maxillary stability; 80% spontaneous eruption of the canine within the graft; 70% height of alveolar ridge level I, 25% level II, 5% level III; 70% orthodontic closure; 80% optimal periodontal condition and 20% presence of gingival recession. In 1 subject the graft site became infected, in 4 cases an oro-nasal fistula remained. CONCLUSION: This method was found to be the most valid one at present. The best period to intervene is during late childhood (9 years). Results and functional and esthetic recovery were satisfactory and encouraging to continue utilising this technique.
Synovial sarcoma is an uncommon neoplasm accounting between 8 and 10% of all soft tissue malignancies. Involvement of the head and neck region is rare. So far, fewer than 100 cases have been reported in the literature and only a few originated in the soft palate, tongue, larynx, hypopharynx, and cervical oesophagus. We report the case of a synovial sarcoma of the parapharyngeal space in a 72-year-old female, and experience in the behaviour and surgical treatment of this neoplasm is described. The patient has remained disease free for 28 months, with regular follow-up. Based upon this case and the others reported in the literature, synovial sarcoma does not have a good overall prognosis, and on account of its rarity and unpredictable biologic behaviour, surgical excision, and regular clinical and radiographic follow-up for at least 3 years are strongly recommended.
PURPOSE: This study analyzed the prognostic factors for carcinoma of the parotid gland and the role of surgery alone or with radiotherapy in treating these lesions. METHODS: Forty-five patients with malignant parotid tumors were studied retrospectively. Patients were treated by combined surgery and radiation therapy between 1984 and 1995 at the Maxillo-Facial Departments of the General Hospitals of Bologna and Parma. Resection was conservative when possible, depending on the extent of the tumor. The median follow-up time was 54 months. Data regarding incidence, tumor stage and grade, local control, distant metastases (calculated with the Kaplan-Meier method), and survival were analyzed. Cox's multiple linear regression was used to identify patient and tumor characteristics with the greatest prognostic significance. RESULTS: The actuarial 5- and 8-year disease-free survival rates were 81% and 62%, respectively. Multivariate analysis showed that tumor stage was a more prognostic variable than tumor grade. Residual microscopic disease at the excision margins was also an important prognostic variable. Laterocervical metastases affected 4 patients (9%), and distant metastases appeared in 8 patients (18%). CONCLUSIONS: Postoperative irradiation is indicated for patients with stage III and IV disease, patients with positive excision margins, and for patients with lymph node metastases.
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The present paper considers some of the problems linked to the surgical treatment of parotid metastases. The authors base these considerations on their limited personal cases and on the most accredited literature. In the presence of cutaneous malignancies of the upper portion of the face, accurate clinical-radiological evaluation must be made of the parotid and neck region. Elective parotidectomy is performed when the cutaneous carcinoma is quite extensive or located in proximity of the gland or when the case involves a melanoma. Depending on the oncological margins, a sub-total parotidectomy may be enough; however, the facial nerve must be sacrificed if there is a clinical deficit or if it is directly affected by the tumor. As the dimensions of the neoplasm increase, the feasibility of saving the nerve decreases. Prophylactic treatment of the neck is advisable in parotid metastases from cutaneous malignancies, particularly melanoma. Nevertheless, it is possible to perform a selective dissection, avoiding the V level of the neck as the incidence of its involvement is quite low. Prognosis for these tumors is extremely poor. Of the eleven patients surgically treated, only 4 (36%) survived: 2 passed away from other causes not involved in the base pathology; 2 for distant metastases but with no signs of local recurrence and 1 other for recurrence of the primary pathology in the maxillary sinus mucosa. There is no difference in the survival of the two main histological groups: 2 out of 3 of the patients with melanoma (67%) died as did 3 out of 5 (60%) of those with epidermal carcinoma. This does not, obviously, include the two patients who died from other causes.
Myoepithelioma is a rare malignant neoplasm, representing about the 1% of all the salivary gland's tumors. It mainly affects women, particularly in the 7th and 8th decade of life. A case of myoepithelioma of the palate in a 70-year-old woman is described. The tumor was completely excised two years ago. Nowadays, there are no signs of local recurrence and/or distant metastasis. The discrepancy between the histological diagnosis of low-grade malignancy and the clinical aggressive behavior of the tumor is discussed.
We present nine panfacial fractures that were treated during a two-year period in which the first step in treatment was reduction of condylar fractures. There was no evidence of dental or skeletal alterations and measurement of the mandibular ramus and radiographic examination show that posterior facial height as well as projection and width of the inferior lower third of the face, was restored. The correct timing of surgical intervention and the use of rigid fixation allows the restoration of the morphological and functional nature of the face after panfacial fractures.
Dentigerous cysts are one of the most common embryological anomalies of the maxilla and mandible. They are connected with one or more permanent tooth germs. For this reason, therapy is very important to preserve the vitality of the permanent germs and to allow them a complete growth and a functional migration in the alveolar arch. In the present paper, the clinical features and the surgical conservative treatment of a case personally observed, are described.
Drawing from two cases which came under observation, the authors consider the high incidence of retropharyngeal metastases in oropharyngeal carcinoma. The diagnosis is made on the basis of radiographic examinations such as CAT and NMR which reveal the increase in size, the presence of central necrosis of the lateral retropharyngeal lymph nodes and the asymmetry of the long neck muscle. In the presence of advanced oropharyngeal carcinoma, the treatment calls for dissection of this space, even when radiology does not show any evident involvement. Lymph node positivity worsens the prognosis. Because of the marked significance of this involvement, some authors have proposed further N staging. Adjuvant RT completes the therapeutic protocol for such patients.
Fractures of facial skeleton are common in a busy emergency department in often requires careful radiological study before surgical treatment. Radiographic evaluation of facial injuries is especially challenging because the complex facial structure results in a confusing overlapping of densities on the radiograph. Instead Spiral-CT enables obtaining images on different planes so that even subtle or complex fractures may be evaluated in the best way. Moreover, associated lesions of important organs can be diagnosed. Our purpose is to verify the value of Spiral-CT in traumatology of facial skeleton. We have evaluated retrospectively the images of 82 patients admitted for facial trauma. On the basis of our findings we think that conventional radiography should be reserved only for light traumas of superficial structures (nose, zygomatic arch, body of jaw); in the remaining cases Spiral-CT should be the first radiological examination.
Patients affected by some genetic skin defects, for example, dyskeratosis congenita or scleroderma, may present spontaneous or induced chromosomal fragility. Hence we performed a cytogenetic analysis in families of patients affected by lamellar ichthyosis, an autosomal recessive disease not yet fully characterized at the cellular and molecular levels. Chromosomal fragility was assayed in untreated lymphocyte cultures and in those supplemented with aphidicolin or bleomycin. Cells from some affected patients and some of their parents showed hypersensitivity to the radiomimetic agent bleomycin.
In the cranio-facial region the giant-cell reparative granuloma (GCRG) is a typical lesion of the maxillary bones. Because giant-cell reparative granuloma is not strictly a granuloma, clinically and histologically, many authors prefer call it giant-cell lesion (GCL). A review of the literature have along with our experiences is reported. Authors present 17 patients with giant-cell lesion and their results, treated at the Maxillo-Facial Department of Parma. Clinical, radiographic and pathologic features were evaluated and differential diagnosis was considered, showing the real great difficulty in differential diagnosis also and especially for surgical treatment.
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Access osteotomies allowing temporary displacement of various segments of the orbital rim provide direct visualization of deep orbital and paraorbital regions. These marginotomies are classified, according to the orbital region involved, as lateral, medial, superior, or inferior, and they provide adequate exposure of the corresponding orbital wall and its surrounding structures. Since these procedures are without complications and cause no unpleasant cosmetic effects, they are highly recommended for the treatment of various lesions in this area as well as for correction of malformations.
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