Vertical mandibular asymmetry and hand measurements in patients in growth: cross-sectional study.

Objectives: The aim of this study was to determine the relationship between the vertical mandibular ramus asymmetry and the hand measurements asymmetry in growing patients. Material and Methods: Panoramic radiographs and comparative radiographs of the right and left hands of 40 patients (14 males and 26 females) between 6 and 16 years old (mean age of 11.35±1.99 years) were evaluated. The total height of the mandibular ramus was measured, and the asymmetry index was calculated. The lengths of the proximal, middle and distal phalanges and the metacarpals of the five digits of both hands were measured and the absolute differences R-L were calculated for each one. Results: A statistically significant association between the presence of vertical mandibular ramus asymmetry and the presence of phalanges asymmetry FPII (p=0.016), FPIII (p=0.016), FPIV (p=0.033), FMIII (p=0.031) and FMIV (p=0.016) was observed. Conclusions: Mandibular asymmetry appears not to be isolated but also present in other body districts such as the phalanx bones. The total vertical asymmetry of the mandibular ramus showed an association with the asymmetry of the lengths of the FPIII, FMIII, FPIV, FMIV and FPII in growing individuals, with association between the side of mandibular asymmetry and the side of the phalanx's asymmetry. The asymmetry of this phalanges increases with increasing index of vertical mandibular ramus asymmetry.

Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score.

PURPOSE: This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS: We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS: We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS: Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.

Iatrogenic damage to the mandibular nerves as assessed by the masseter inhibitory reflex.

Iatrogenic injury of the inferior alveolar or lingual nerves frequently leads to legal actions for damage and compensation for personal suffering. The masseter inhibitory reflex (MIR) is the most used neurophysiological tool for the functional assessment of the trigeminal mandibular division. Aiming at measuring the MIR sensitivity and specificity, we recorded this reflex after mental and tongue stimulations in a controlled, blinded study in 160 consecutive patients with sensory disturbances following dental procedures. The MIR latency was longer on the affected than the contralateral side (P < 0.0001). The overall specificity and sensitivity were 99 and 51%. Our findings indicate that MIR testing, showing an almost absolute specificity, reliably demonstrates nerve damage beyond doubt, whereas the relatively low sensitivity makes the finding of a normal MIR by no means sufficient to exclude nerve damage. Probably, the dysfunction of a small number of nerve fibres, insufficient to produce a MIR abnormality, may still engender important sensory disturbances. We propose that MIR testing, when used for legal purposes, be considered reliable in one direction only, i.e. abnormality does prove nerve damage, normality does not disprove it.

[Maxillofacial trauma in pediatric age]. / Traumi maxillofacciali in età pediatrica.

The different incidence of various kinds of maxillofacial fractures in children are examined and the causes of such differences are analyzed. The most significant are the variations in morphology of the maxillofacial skeleton during the children's growth and the physical-statistic problems strictly connected. Attention is drawn on the diagnostic difficulties of traumas due to fractures during childhood, sometimes unknown, especially with regard to the heavy functional and aesthetic exits which may occur.

[Maxillo-mandibular fracture outcome. Therapeutic program]. / Esiti di fratture maxillo-mandibolari. Programmazione terapeutica.

The ill-consolidated outcomes of the maxillo and jaw fractures often show ill-positions of the mandible and/or of the jaw in the three space-levels. In order to program a suitable surgical correction of such pathologic pictures it is necessary to make a cephalometric test and a gnathologic one. The result of these tests will guide the therapeutical choise which will be either the re-opening of the surgical treatment to be effected through the usual osteotomy of the mandible.

[Diagnosis and therapeutic programming of mandibular symphysis dysmorphisms in patients with dento-osseous malformations]. / Diagnosi e programmazione terapeutica delle dismorfie della sinfisi mentoniera in pazienti affetti da malformazioni dento-scheletriche.

Alterations in chin position in dentoskeletal dysmorphias are considering with a review of the literature on the prognosis of surgical treatment in dysmorphias of the chin symphysis. The treatment protocol then presented offers the possibility of programming the restoration of the correct physiological relationship between the bone bases and the correction of the aesthetic defects produced by dysmorphias of the chin symphysis on a single pre-operative graph. The problem in such programming lies in the extensive changes necessary to the bone and skin parameters during the functional operation that are difficult to foresee and quantify preoperatively.