Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature.

Aims Odontogenic orbital cellulitis represents a complication of root infections of upper pre-molars and molars. The severity depends on the orbital structure involved. The treatment is based on antibiotic therapy associated or not to surgery. Through the presentation of three cases and a review of literature, we purpose as aim of our study to underline the necessity of a timely diagnosis and to provide the correct surgical approach in each different types and stages of orbital infections. Methods We present three patients that were affected by dental infection evolved in orbital cellulitis. In two cases the disease was solved with the extraction of infected tooth and a surgical endoscopic drainage of the abscess through antrostomy of maxillary sinus. In the third patient the disease had already induced a bulbar perforation and endophthalmitis, so an orbit evisceration was necessary. Results Review of literature showed that the standard treatment of orbital cellulitis is the transnasal approach associated or not by a transoral and/or transcutaneous procedure depending on the stage of the disease and on the causes. In our 3 cases these indications were followed without relapses of the disease. Conclusion An early diagnosis is mandatory in odontogenic orbital cellulitis specially to avoid serious complications. Surgical treatment can be simple and effective mostly in early-stage infection: it is based on extraction of infected tooth and on the drainage of abscess. Surgical approach consists in transnasal procedure flanked or not by transoral and transcutaneous procedures based on the stage of the infection considering involved structures.

Aroma components of Cephalanthera orchids.

The SPME-GC-MS analysis of the aroma components of Cephalanthera damasonium, Cephalanthera rubra, and Cephalanthera longifolia were reported. The main components found in C. damasonium were pentadecane, hexadecane, heptadecane and α-farnesene. The same compounds were found in the scent of C. rubra. Although C. damasonium and C. rubra have different pollination mechanisms, their spectrum of volatile compounds surprisingly does not differ significantly. In C. longifolia pentadecane and heptadecane were found together with cis-ß-farnesene. As C. longifolia is allogamous, the differences in scent composition may play a role in pollinator attraction.

Fragrance components of Platanthera bifolia subsp. osca and Platanthera chlorantha collected in several sites in Italy.

Platanthera bifolia subsp. osca sample collected at Grisolia showed as main components linalool (17.8%), benzyl benzoate (55.8%), and benzyl 2-hydroxybenzoate (6.7%). Four samples of P. bifolia subsp. osca were collected at Pignola: the main components of the aroma are lilac derivatives (49.02-79.00%), mainly lilac alcohols B (7.41-13.52%), C (10.10-18.45%), and D (7.50-34.28%). Three samples were analyzed from the site of Marsico Nuovo. The main components of the scent found in this site were linalool (1.54-10.00%), lilac aldehydes (3.98-11.15%), and mainly lilac alcohols (50.68-61.51%). The main components of the sample collected at Palena were methyl benzoate (9.04%) and benzyl benzoate (74.72%). The analysis of the composition of the aroma of a Platanthera chlorantha plant has been performed. The main components were lilac derivatives. The reported behavior could be explained admitting an adaptive modification of the scent considering the nature of possible pollinating agents due to different habitats.

Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases.

OBJECTIVES: Transtentorial brain herniation is a major cause of morbidity and death following severe closed head injury. The purpose of this study was to evaluate the efficacy of selective uncoparahippocampectomy and tentorial splitting as an adjuvant method of treating otherwise uncontrollable elevated intracranial pressure (ICP) while attempting to prevent or minimize the devastating consequences caused by transtentorial herniation. METHODS: The authors retrospectively reviewed data from a series of 80 consecutive cases of severe closed head injury (Glasgow Coma Scale [GCS] score < 8) treated in their neurosurgical unit. All patients had elevated ICP and downward tentorial herniation, as documented with ICP monitoring, and clinical examination and computed tomography, respectively. Given the evidence of acute and ongoing neurological deterioration, all patients were treated with selective uncoparahippocampectomy and tentorial edge incision followed by wide decompressive craniectomy and duraplasty. RESULTS: All injuries were caused by blunt trauma with signs of acute and/or progressive increased ICP causing downward transtentorial herniation. Fifty-eight patients were male and 22 were female with a mean age of 35 years and a mean preoperative GCS score of 5. Based on the current American Association of Neurological Surgeons guidelines for head trauma, an intraparenchymal ICP device (Camino, Integra) was placed in all patients who had a GCS score < 8, and ICP was consistently > 20 cm H2O. Whenever possible, risks and benefits were explained to family members, and then surgery was performed within 3-16 hours (median 6 hours). At a mean follow-up of 30 months, the outcome was favorable (Glasgow Outcome Scale [GOS] score of 4 or 5) in 60 patients (75%) and unfavorable (GOS score of 3) in 8 (10%), whereas the remaining 12 patients (15%) died at some point during the postoperative course. There was no survivor patient in a vegetative state. A younger age had a significant effect on positive outcome (p < 0.0005), as did an earlier operation (p < 0.04). The preoperative neurological status as assessed using the GCS as well as pupillary reactivity had no significant effect on outcome (p = 0.054 and p > 0.05, respectively). CONCLUSIONS: A selective uncoparahippocampectomy with a tentorial edge incision and a wide decompressive craniectomy with duraplasty can be an effective adjuvant form of aggressive treatment to improve outcome in patients with severe closed head injury, especially in those who are younger if they are treated promptly.