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Biomedical subjects

G Bettega

Publications and source records attributed to G Bettega.

At least 19 recordsLinked to original sources
PubMed2006

[Replantation of traumatic amputated ears by Mladick procedure: 6 cases].

UNLABELLED: Traumatic ear amputations are relatively rare. Whenever possible, ear reimplantation should be attempted, however the choice of the surgical procedure must be judicious. PATIENTS AND METHODS: We present 6 cases of partial ear amputation treated by the pocket technique described by Mladick. The series comprises 5 partial amputations severing less than half of the auricule and 1 subtotal amputation preserving the ear lobule. RESULTS: Necrosis of the avulsed fragment occurred in the only case of subtotal amputation. In the 5 other cases the revascularisation of the severed part was successful. Morphological results are often very good when the ear is freed from the pocket before 4 weeks. Beyond this delay skin grafting is necessary and inaesthetic scar retraction occurs. CONCLUSION: The success rate depends on the size and the degree of contusion of the amputated ear. We recommend the Mladick's procedure for reimplantation of fragments less than 1/2 of the auricle with favorable tissue condition. We believe that other procedures described in the literature could offer a good alternative for amputations exceeding half of the ear pavilion.

Adolescent↗
PubMed2006

[Osteonecrosis of the jaws associated with bisphosphonates: five cases].

INTRODUCTION: Bisphosphonates have been recently associated with bone necrosis of jaws. PATIENTS AND METHOD: Five patients were treated, two males and three females. All patients received bisphophonates and chemotherapeutic agents, two for multiple myeloma and three for breast cancer with bone metastasis. Bisphophonates were discontinued. None of the patients had received radiotherapy to the head and neck. The localization was mandibular in four patients and the maxillary area in one with oro-antral fistula. Histological and microbiological studies were performed. RESULTS: Histopathology demonstrated osteonecrosis and ruled out detectable neoplastic disease of the jaws. Four biopsies showed Actinomycosis. Four patients underwent sequestrectomy, but the mucosa did not heal. DISCUSSION: Two mechanisms are involved: the antiangiogenic effect of bisphophonates has recently been described in vivo; as bone mineralization increases, accumulation of microdamage is observed in animals studies. Only the jaws are affected by bone necrosis, suggesting a possible trophism for bisphosphonate uptake? Other risks factors have been found: cancer, use of chemotherapeutic agents or corticosteroids, renal failure, Actinomycosis infection. The only effective treatment is dental prevention before starting treatment.

Actinomycosis, Cervicofacial↗
PubMed2005

[Dacryo-cysto-rhinostomy via an external approach].

The dacryo-cysto-rhinostomy via the external approach is indicated for obstruction of the lacrymal duct. It consists in the creation of short-circuit between the lacrymal sac and the external nasal wall. The operation stages starts by paracanthal incision, the subperiosteal dissection stops anteriorly to the posterior insertion of the medial canthal ligament (to preserve lacrymal function). An ostectomy is performed between the maxillary bone and the unguis. A stomy is created by individualizing two mucosal flaps. The bicanaliculonasal intubation is systematic and maintained for 10 to 12 weeks.

Dacryocystorhinostomy↗
PubMed2005

[Fractures of the mandibular angle: factors predictive of infectious complications].

INTRODUCTION: Fractures of the mandible angle raise the risk of infectious complications. We searched for factors predictive of these complications. MATERIAL AND METHODS: We reviewed retrospective all cases of mandibular angle fracture treated during a 26-month period. We compared two groups: fractures with wisdom teeth and fractures without wisdom tooth. For each group we noted clinical and radiological characteristics of the fractures and infectious complications. RESULTS: The series included 72 mandibular angle fractures, 30 with a wisdom tooth against 42 without. Most of the patients were treated within 2 days, generally using mini-plate screw fixation. In the wisdom tooth group, 16.6% of patients developed infectious complications versus 9.5% in the without wisdom tooth group. All patients of the wisdom tooth group presented a potentially infectious focus on the preoperative x-rays. For without wisdom tooth group, irregular follow-up was found to be the only risk factor. DISCUSSION: The angular localization increases the risk of infectious complications especially if the wisdom tooth is in the fracture. We propose a decision tree to determine when to preserve or not the wisdom tooth.

Adolescent↗
PubMed2004

[Nasopalatine canal cyst: 4 cases and a review of the literature].

OBJECTIVES: Nasopalatine cyst (NPC) is the most common epithelial and non-odontogenic cyst arising in the maxilla. It is nevertheless generally underestimated by ENT surgeons. The purpose of our report was to provide details about the pathophysiology, diagnosis and treatment of NPC. MATERIAL AND METHODS: Our study was based on a retrospective analysis of four cases and a review of the literature. RESULTS: From January 2002 to March 2003, four patients (3 males and 1 female, mean age 43 Years) were treated for NPC at the ENT Department of Grenoble University hospital. One patient had received prior treatment. Symptoms were a palatine mass on the midline of the hard palate behind the central maxillary incisors in two patients, and a superior vestibular mass in the two others. Diagnosis was established on the basis of the CT-scan and histological findings. Excision was performed under general anesthesia in all four patients. Median hospital stay was four days (3-5 days). There was no post-operative complication. Median follow-up was 10 Months. CONCLUSION: NPC is arises from embryological tIssue. It must be differentiated from radicular cyst. Diagnosis is based on radiographic and histological results. Treatment consists in enucleation. Surgical access depends on the size of the cyst and its anterior or posterior extension. Excision must be total to avoid relapse which may occur after five Years. Long-term follow-up is essential.

Adult↗
PubMed2004

Nasopalatine duct cyst (NPDc): one case report.

OBJECTIVES: NPDc arises from embryological tissue. It is classified among the epithelial non-odontogenic cysts according to the 1992 WHO histological typing of odontogenic tumors. The purpose of our report was to provide details about the pathophysiology, diagnosis and treatment of NPDc. CASE REPORT: A 25 year-old male was referred by his practitioner regarding to an intermittent palatal swelling for 6 months. Diagnosis of NPDc was suggested on the basis of computed tomography (CT-scan). Excision was performed under general anaesthesia. There was no post-operative complication. Histological features confirmed an inflamed NPDc. Follow up was 22 months, without relapse. CONCLUSION: NPDc occurs in approximately 1% of the population and forms approximately 12% of all jaw cyst tumors. NPDc may occur at any age, but main cases are seen between 40 and 60 years old. It has a slight male predilection. Black and white people are equally involved. NPDc is normally asymptomatic, unless it is infected. The most common symptom is swelling, usually in the anterior part of palate's midline. Diagnosis is based on radiographic and histological results. Treatment of choice is enucleation.

Adult↗
PubMed2003

[Results of an evaluation of clinical practice in orthognathic surgery in France in 2002].

BACKGROUND: Over the years, orthognathic surgery has become a mainstay of maxillofacial surgery and is the object of many publications and oral communications. However, in spite of well-established methodology, disparities still exist in France basically concerning the way orthognathic surgery is performed. MATERIALS AND METHODS: In relation with the XXXIXth congress of Stomatology and Maxillofacial surgery, a questionnaire was mailed to 100 French maxillofacial surgeons. Questions dealing with some practical points of orthognathic surgery (condylar positioning, osteosynthesis technique, rate of condylar resorption.) were asked. RESULTS: Overall reply rate was 37%. Condylar positioning was performed empirically in 73% of the cases. Mandibular osteosynthesis was achieved by titanium miniplates alone in 70%. Post-operative condylar resorption rate was about 2%. This survey produced numerous astute comments. DISCUSSION: This survey highlighted the interest of maxillofacial surgeons for practical aspects of orthognathic surgery including the questions of condylar positioning or osteosynthesis technique. These points are instrumental in achieving high-quality surgical result.

Bone Plates↗
PubMed2002

[Alveolar and hard palate repair by tibial periosteal graft in complete unilateral cleft lip and palate. Long-term follow-up of 51 cases].

PURPOSE OF THE STUDY: The purpose of this study was double: appreciate the osteogenic and growth capacities of the free tibial periosteal graft concerning the alveolar and hard palate repair in the complete unilateral cleft lip and palate, and evaluate long-term follow-up concerning maxillo-mandibular morphology and palatal air-tight. MATERIAL AND METHOD: This retrospective study concerns 51 patients, of more than 13 years of age, treated for complete unilateral cleft lip and palate. The treatment included a Skoog type cheiloplasty, a tibial periosteal graft between 4 and 6 months (as described by M. Stricker) and a staphyloraphy between 8 and 18 months. Our documentation was: figures, pictures and precise description of the initial cleft, dental casts, teleradiographies, dental panorams performed at different stages of treatment, orthodontic, orthophonic and otologic follow-up. Growth was evaluated using casts during the first 6 years then by profil teleradiographies after puberty. Ossification was evaluated quantitatively by CT scan in 18 patients. RESULTS: Results confirm an ossification of the periosteal graft in 72% of cases and the advantage of periosteal graft in palatal air-tight. 85% of cases show equilibrated squeletal growth with good occlusion, and 13.7% of cases needed deferral osteotomy. CONCLUSION: We propose a method for long-term cleft results evaluation, with the use of periosteal graft.

Adolescent↗
PubMed2002

[Tools available for the diagnosis of obstructive sleep apnea syndrome. Measurements for the evaluation of therapeutic efficacy].

Obstructive sleep apnea syndrome (OSAS) is characterized by the development of repeated episodes of pharyngeal collapse. Respiratory movements attempt to reopen the closed pharynx leading to resumption of ventilation associated with micro-arousals. Three kinds of measurements are needed to establish the diagnosis of OSAS: airflow (reduction or complete interruption), respiratory effort in response to increased airway resistance, micro-arousals associated with the end of the respiratory event. Classically, polysomnography was used to establish sleep architecture using electroencephalography, electromyography and electro-oculography. Air flow was measured by thermistors, chest and abdominal movements and oximetry were monitored. Other more accessible methods can also be used to establish reliable diagnosis. Measuring pulse transit time using ECG and oximeter sensors provide a semi-quantitative measurement of respiratory effort. Likewise, cardiovascular markers (heart rate, blood pressure, pulse time) can be used instead of electroencephalography to establish the arousal pattern. Cardiovascular markers are as sensitive and probably as specific as EEG for identifying micro-arousals. Measuring nasal pressure provides a much less invasive quantitative assessment of airflow than pneumotachography. The shape of the inspiratory signal is also an indirect marker of respiratory effort. These new tools can be used to characterize the three elementary abnormalities observed in OSAS: variations in airflow, increased respiratory effort, fragmented sleep, using a very simplified setting compared with classical techniques. Therapeutic monitoring of OSAS patients, particularly after surgery, should not be limited to physical examination known to lack sufficient sensitivity. It should also include simplified methods or complete polysomnography to obtain a precise measurement of residual respiratory events and sleep pattern after treatment.

Air Pressure↗
PubMed2002

[Surgery and obstructive sleep apnea syndrome: indications and precautions].

Surgery has long been a therapeutic option for obstructive sleep apnea syndrome (OSAS). The first procedures targeted the soft palate but results of isolated uvulo-palatopharyngoplasty (UPPP) were inconstant. A better understanding of the mechanisms involved in pharyngeal collapse incited interest in the role of the tongue and the retropharyngeal space. Surgical procedures were then developed for this level of the upper airways. There are a large number of possibilities. Excepting tracheostomy which court-circuits the collapsed zone, all the other procedures are designed to widen more or less one or more of the upper airway levels. The target can be the nose, the soft palate or the tongue, alone or in combinations. In all cases, the surgical alternative should be balanced against a non-invasive option: continuous positive pressure ventilation. The objective is to minimize the operative risks and sequelae while assuring success equivalent to positive pressure ventilation. It is important to note that sufficiently effective and permanent results have not been proven for any surgical technique, excepting tracheostomy and to a lesser degree bimaxillary advancement osteotomy, due to the lack of objective long-term rigorous evaluation. A considerable effort must be made in this domain.

Humans↗