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Biomedical subjects

F S De Ponte

Publications and source records attributed to F S De Ponte.

At least 19 recordsLinked to original sources
PubMed2006

Bisphosphonate-associated osteonecrosis of the jaw in patients with multiple myeloma and breast cancer.

Osteonecrosis of the jaw is an unremitting adverse outcome associated with bisphosphonate therapy in patients with multiple myeloma or bone metastases from solid tumors. Twelve patients who presented with exposed bone associated with bisphosphonates were reviewed to determine the type, dosage and duration of their bisphosphonate therapy, presenting findings, comorbidities and the event that incited the bone exposure. The discontinuation of bisphosphonate therapy has not helped reverse the presence of osteonecrosis, and the surgical manipulation of the involved site appears to worsen the underlying bone pathology. Hyperbaric oxygen, which has proven efficacious in other forms of osteonecrosis by establishing an oxygen gradient, is of no definitive benefit to patients with bisphosphonate-induced exposed bone. Antibiotic therapy is useful in controlling pain and swelling but ineffective in preventing the progression of the exposed bone. To date, prevention is the only currently possible therapeutic approach to the management of this complication.

Alendronate↗
PubMed2000

Surgical treatment of frontoethmoidal encephalocele: a case report.

This study reports a patient affected by congenital frontoethmoidal encephalocele. The cause of this malformation is unknown. A preoperative selective diagnosis evaluation is necessary. The workup should include an accurate clinical examination associated with radiological study (two- and three-dimensional computed tomography, magnetic resonance imaging, etc). The aim of the surgical treatment is to restore the functional brain tissue in the cranial cavity, perform dural repair, correct bone lack and other associated facial malformations (hypertelorism, orbital dystopia, etc.). A multidisciplinary team approach is necessary to resolve the brain herniation and to correct splanchnocranium malformations frequently associated with encephalocele. Cranial flap with orbital osteotomies has been performed; this operation permits correction of the hypertelorism and of the orbital dystopia associated with this malformation. In bone reconstructions, miniplates have been used as fixation devices. In adults we generally use titanium, but resorbable devices are required in children because of growing tissues. A restoration of craniofacial malformations with good aesthetic and functional results is achieved with early surgery.

Absorbable Implants↗
PubMed1999

Congenital torticollis in association with craniosynostosis.

The incidence of congenital torticollis in association with plagiocephaly is 1 in 300 newborns, with the torticollis resulting from pathologically sustained contraction of the sternocleidomastoid. Such conditions as facial asymmetries, craniovertebral anomalies, cervical hemivertebra, and mono- or polydysostoses may also be associated with torticollis diagnosed during the neonatal period. With particular reference to synostotic (coronal and/or lambdoidal) plagiocephaly, a clear distinction is made in this paper between posterior neurocranial flattening secondary to the sustained rotation of the skull resulting from torticollis and that seen in synostotic plagiocephaly. The rarity of torticollis with sustained contraction of the sternocleidomastoid muscle relative to the frequency of occipital-parietal flattening in newborn kept in the supine position has not been discussed in the literature and is therefore of clinical importance. In light of the fact that the prognosis and, consequently, the treatment plan vary directly with the presence or absence of synostoses, clinical evaluation also includes cephalometrics, plain skull X-rays, and CT imaging. If the torticollis is associated with neurocranial deformity but synostosis is absent, cervical traction and physiotherapy resolve the symptoms. When, however, the clinical picture is complicated by synostotic plagiocephaly, corrective surgery is necessary, though cervical traction and physiotherapy are essential to provide early and complete cure of the torticollis.

Craniosynostoses↗
PubMed1999

Cephalometric study of posterior airway space in patients affected by Class II occlusion and treated with orthognathic surgery.

The posterior airway space (PAS) is delimited by hard and soft tissues with anomalies that may produce alterations in volume. In patients with severe hypoplasia of the middle and lower third of the face, a decrease in volume of the PAS is present, producing a polysyndromic condition that ranges from snoring to obstructive sleep apnea syndrome (OSAS). The aim of this report is to define PAS variations via a cephalometric study in patients affected by class II occlusion and treated with orthognathic surgery. The authors studied 44 patients affected by class II occlusion who underwent surgery to correct the maxillomandibular malformation. The patient cohort was classified according to the type of surgery performed: Le Fort I osteotomy with or without a sagittal split osteotomy. To evaluate PAS variation, cephalometric analyses were performed by pre- and postoperative lateral teleradiography. This study showed an increase in PAS volume, especially at the hypopharynx and the lower part of the oropharynx, when the sagittal split osteotomy was performed and/or the maxilla was moved anteriorly and/or superiorly. A decrease of PAS can be seen in downward and/or backward maxillary movements. In conclusion, cephalometric studies of hard and soft tissues (such as tongue, pharynx, soft palate, etc.) should be performed in all patients affected by maxillomandibular malformation. This approach may provide data for the diagnosis of respiratory pathologies that vary from snoring to OSAS.

Airway Obstruction↗
PubMed1998

Campus Bio-Medico technique for nasolaryngeal ventilation with reinforced laryngeal mask in dental surgery: a patient report.

The authors report the usefulness of a prototype nasal laryngeal mask airway (LMA) used successfully in a disabled 20-year-old woman with severe psychomotor retardation and a compromised airway with predictable indexes of impossible tracheal intubation in direct laryngoscopy. A 16-ch Foley catheter was inserted through the patient's left nostril and guided through her mouth. A size-3 reinforced LMA was positioned and connected to the distal end of the catheter. The LMA-reinforced tube was removed in a retrograde fashion by pulling the catheter up with the patient breathing spontaneously. The duration of the entire operation was 3 hours 20 minutes, and the patient was able to breathe spontaneously and at a 98% saturation average. Nasal reinforced LMA seems to be an interesting solution in patients undergoing 1-day dental or maxillofacial surgery, but is especially appropriate when nasotracheal intubation is too invasive or technically impossible.

Adult↗
PubMed1998

New approach to the surgical treatment of severe exophthalmos in Graves disease.

In the last few years, various surgical techniques to correct orbital decompression in patients with Graves ophthalmopathy have been proposed. In those patients in whom a high degree of exophthalmos is mainly the result of the hypertrophied endorbital muscles with respect to endorbital fat hypertrophy, lipectomy is insufficient to obtain an acceptable increase of endorbital volume. The authors propose a method that provides for the monobloc bilateral quadrantotomy by extracranial access. Despite traditional methods of decompression, the advantage of this technique is better advancement of the orbital margins. The bicoronal and endoral incisions guarantee no facial scars. Compared with the craniotomy, the extracranial access is also less stressful for the patient.

Adipose Tissue↗
PubMed1998

Prenatal diagnosis: evolution in craniofacial surgery.

Prenatal diagnosis of craniomaxillofacial malformations permits early surgery, before 6 months of life and possibly, in the near future, in utero, thereby obtaining the best aesthetic and functional results. Increased knowledge of embryology has largely improved the diagnosis of craniomaxillofacial anomalies, their classification, and therapeutic protocols. We analyzed nine pregnancies (one twin) in which cleft lip and palate (CLP)--isolated or associated with, for example, holoprosencephaly, hypertelorism, and micrognathia--was diagnosed by ultrasonography. Only one fetus of these pregnancies was later operated on in our unit. This patient, with 7 years follow-up, represents our clinical case. For these cases, early diagnosis of CLP allowed informed parental choice regarding the continuation or termination of the affected pregnancy and planning of surgical procedures to correct the malformation. This is demonstrated by the presented clinical case involving an infant operated on within 6 months with success.

Child↗
PubMed1997

Early and late surgical treatment of orbital dystopia in craniofacial malformation.

Orbital dystopia is one of the most frequent clinical signs of craniofacial malformation. The term dystopia indicates the mono- and bilateral asymmetry of the orbits at least in one of the three-dimensional planes. The diagnosis is based on the clinical test of the patient with the support of diagnostic instruments such as teleradiography in both standard projections, axial computed tomographic (CT) scans at a rate of 1:1 through the neuro-orbital plan, and the three-dimensional CT. Good results of the surgical treatment depend on the patient's age and on adequate programming, which should consider the anomalies in the three spatial planes. The VTO is obtained through a protocol of analysis on cephalometric graphics of the teleradiographics on the CT at a rate of 1:1. The surgical treatment of orbital dystopia is different depending on the age of the patient and the cause of the orbital anomaly. In the case of growing patients, it is preferable to use the fronto-orbital bandeau technique so as not to damage the dental buds, whereas in grown patients Tessier's orbital quadrant technique is used. Even the fixation is quite different between patients who are growing and those who are already grown. In still-growing patients, rigid internal fixation is used only in some cases to avoid the interference with the growth mechanisms.

Adolescent↗
PubMed1997

Surgical planning and correction of medial craniofacial cleft.

In the framework of malformations that concerns the craniofacial area, the orbit is often involved because it represents the border structure between the neurocranium and the splanchnocranium. In these malformations it is very easy to find hypertelorism. Tessier classified clefts rising from the anterior skullbase and involving the maxilla and the alveolar process, as medial or 0 = 14 clefts. We report on a 2-year-old patient, treated with cranial decompression at an early age, suffering from this kind of malformation. To correct it, the surgical technique of facial bipartition was used. This technique, used for the first time by Tessier and then modified by Stricker and colleagues, allows the simultaneous correction of the orbits and maxilla. It is very important to make a correct diagnosis, to plan for surgery carefully for patients suffering from this kind of pathology, and to prescribe the most effective therapy. A computerized analysis system, based on the study of teleradiographic images and on three-dimensional computed tomography, to quantify the extent of the malformation and to define surgical planning was developed.

Child, Preschool↗
PubMed1997

[The interdisciplinary approach and early surgery in the trigonocephaly].

Craniofacial surgery aims to stop the pathological process due to the presence of one or more malformations affecting this part of the body, in order to prevent and reduce the secondary damage caused by wrong development of the stricken structures. However, in order to achieve this goal, it is necessary to abide by some criteria, like the interdisciplinary nature of therapeutic procedures and early surgery. Since craniofacial malformations affect some anatomical areas that need combined approaches for diagnosing, preventing and correcting the existing anomalies or the possible complications, it is extremely necessary to set a collaboration between different medical and surgical disciplines. Surgical "timing", lasting from 4 to 6 months, is the basis of early surgery, which aims to prevent the morphostructural alterations of the part, assuring again the physiological growth of the stricken tissues. For this reason, craniostenosis are the malformation syndromes that mainly fit this kind of therapeutic protocol. In this document the authors describe the application of the above cited principles for the resolution of the stenosis of the metopic suture in 9 patients (3 males and 6 females), admitted to the Department of Maxillofacial Surgery of the University of Rome "La Sapienza".

Craniosynostoses↗
PubMed1996

Subnasal modified Le Fort I for nasolabial aesthetics improvement.

We report our experience with a modified Le Fort I osteotomy developed to avoid nasal tip upturning, alar base widening, and upper lip flattening in anterosuperior repositioning of the maxilla. We compare the aesthetic results obtained with this variation of the surgical technique to those obtained using the more traditional Le Fort I osteotomy combined with the alar cinch suture and the anterior nasal spine reduction procedures on a sample of 20 patients.

Esthetics↗
PubMed1996

[Trauma to the anterior cranial base. Report of a case].

The authors present a case of foreign body retention, following car accident, localized on superior medial corner of the right orbit. The traumatic impact, involving endo-orbital structures, owing to the peculiar direction of the foreign body, caused a fracture in the anterior cranial base and laceration of the dura madre. As the anatomical structures involved did not concern only the MaxilloFacial district, the choice of the protocol to be applied to the patient was taken in accordance with the neurosurgical équipe. An intra cranial surgical approach has allowed to remove, by retrograding the foreign body on its trajectory path, in order not to injure further the already damaged structures involved. Then the tissues have been reconstructed; in particular, the anterior cranial base was restored through the use of pericranial strip. This technique is the elective surgical treatment in lesions of such small entity, as it is able to grant a solid support to the overhanging cerebral parenchyma. Besides, this reconstruction technique provides a complete protecting isolation of the ocular globe from compressive and pulsative phenomena, due to the neurocranial adjacent structures. With this technique, after a 8 month's follow-up. The patient has obtained optimum functional and aesthetic results.

Accidents, Traffic↗
PubMed1995

Firearm injuries in maxillofacial region reconstructive surgery.

Firearms induce severe morphological and structural alterations on both soft and bony tissues of the face. It is therefore essential to restore their previous functionality. In our experience, maxillofacial lesions due to firearm shooting must be divided, from a locational point of view, into those lesions involving the upper third, those involving the medium third, and those involving the lower third of the face. Lesions of soft and bony tissues must be evaluated precisely through instrumental diagnostic examinations and axial and coronal computed tomographic projection, preferably with a three-dimensional construction, to be able to restore the previous functional integrity of the maxillofacial region. At a subsequent surgical time, it may be necessary to plan aesthetic corrections for recovery of the previous facial harmony.

Adult↗
PubMed1995

Aesthetic and functional reconstruction in intraosseus hemangiomas of the zygoma.

The incidence of intraosseus hemangiomas is very low. The mandible, the zygoma, the maxilla, and the frontal bone are the most frequent areas of localization in the craniomaxillofacial region. Surgery, without preoperative embolization, is always the best treatment for intraosseus hemangiomas of the zygoma. The radical removal of the tumor frequently causes a contour defect that has to be corrected. Calvarial grafts provide a good solution to the problem of reconstruction of bone loss. They are easy to prepare, near to the implant zone, and they do not require changes in the patient's position during the operation. The implants fixed by micro- and minifixation systems provide a good functional and aesthetic result. We, after a review of the literature on intraosseus hemangiomas of the craniomaxillofacial region, report two cases of intraosseus hemangiomas of the zygoma in which removal of the tumor and reconstruction with calvarial grafts have been performed.

Adult↗
PubMed1995

[Bicoronal approach in the management of frontal sinus fractures].

The frontal sinus is located at the level of the junction between the naso-ethmoido-orbital region, the cranial vault and the skull base and plays a particularly important role in the biomechanics of the centro-facial region. It represents a locus minoris resistentiae placed between the fronto-orbital frame, whose resistance to trauma is good, and the thin posterior fronto-ethmoidal structures. Fractures of the frontal sinus more frequently involve the anterior wall of the frontal sinus and, occasionally, also the posterior wall and the base of the sinus. Where the fracture involves the anterior sinsu wall alone, surgical reduction is indicated to correct cosmetic defects arising from an altered bone profile, either via bicoronal access or by direct attack when there are skin lesions too. If the fracture extends to the posterior wall of the sinus without causing bone displacement or dural lesion, most authors agree that only the fractures of the anterior wall should be treated to avoid obliterating the sinus cavity. When the fracture of the posterior wall is comminuted with displacement of bone fragments, there are usually dural lesions too; in this event, once dural plasty has been performed, it is necessary to cranialize the frontal sinus by demolishing its posterior wall. Fractures of the skull base, associated with a high frequency of lesion or obstruction of the sinusal ostio and severe infective complication, require cranialization of the sinus that is also separated from the cranial cavity using a median-pedicled pericranial flap. To control the point of fracture, a rigid fixation system can be employed (microplates) or osteosynthesis with metal wires that restore the eurhythm of the frontal-orbital region and simultaneously guarantee good stability of the repositioned fragments.

Accidental Falls↗
PubMed1995

[Simultaneous surgical correction of temporomandibular ankylosis and facial symmetry. Presentation of a case].

The authors stress the fact that the clinical course of a monolateral TMJ ankylosis tends to be more severe in young people. In this paper we analyze the diagnostic procedure for a tridimensional observation of any morphological and spatial alteration. The surgical procedure that permits the simultaneous correction of ankylosis and associated facial deformities is discussed.

Adolescent↗
PubMed1993

[The diagnosis and surgical therapy of maxillofacial malformations. The statistical considerations].

In this report the authors develop a thorough statistic analysis upon the past 12-year activity (1980-1991) of the University of Rome, Department of Maxillo-Facial Surgery, in the field of the diagnosis and treatment of congenital or acquired maxillofacial malformations. They point out, in particular, the high frequency rate of bimaxillary osteotomy use in the surgical treatment of dentoskeletal malformations, that are the most frequent malformations in maxillofacial clinical practice. They also point out how wide the use of the rigid internal fixation technique in this surgical field has become.

Adult↗