Influence of Kinesiologic Tape on Post-operative Swelling After Orthognathic Surgery.

INTRODUCTION: Orthognathic surgery involves making several osteotomies that lead to varying degrees of post-operative swelling. The use of KT may be beneficial for postoperative treatment after head and neck surgery, accelerating drainage of tissue reaction or haemorrhages. The goal of this study was to find out if the application of KT prevents or improves swelling, pain and trismus after orthognathic surgery, improving patients' postoperative quality of life. MATERIALS AND METHODS: In this double-blinded, randomized, control trial, 24 patients in whom bimaxillary orthognathic surgery was indicated, were included. Before surgery each patient alternatively was randomly included in the study group (treated with K-Taping(®) and corticosteroid) or in the control group (treated with corticosteroid). In the present study a MakerBot(®) Digitizer 3D™ was used to assess accurate volume measurements. All swelling measurements were expressed as total 3-D area of the landmarks (cm(2) ) in T0 pre-operative, T1 fourth day after surgery. RESULTS: The differences T0-T1 are highly significant (p < 0.01) between group 1 or study group (treated with K-taping(®)) and group 2 (control group). DISCUSSION: The use of KT appears promising, because it is simple to carry out, less traumatic, economical, can be performed everywhere in the world, free from side effects on the body. Even when swelling persists, KT gives patients the impression of a minor swelling detracting them from their pain and morbidity. Further studies have to be performed to find out if KT can reduce or replace the need for additional medications such as the use of steroids.

A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial Comparing the Efficacy of Anti-edema Drugs for Edema Control in Orthognathic Surgery Using Digitizer 3-D to Measure Facial Swelling.

INTRODUCTION: Orthognathic surgery involves making several osteotomies. Any osteotomies leads to varying degrees of post-operative swelling. The aim of this study was to evaluate the effectiveness of anti-edema drugs for the control of edema, using Digitizer 3D™ for measuring soft-tissue thickness, in patients who underwent bimaxillaryorthognathic surgery. MATERIALS AND METHODS: In this double-blinded, randomized, control trial, 24 patients (study group: 12 patients, control group: 12 patients) in whom bimaxillary orthognathic surgery was indicated, were included in this study. All swelling measurements were expressed as total 3-D area of the landmarks (cm(2)) in T0 pre-operative, T1 first day after surgery, T2 fourth day after surgery, T3 4 months after surgery. For each patient we compared, by adding left and right area, the increase of swelling between T1-T0, T2-T0 and T1-T3. RESULTS: The differences T0-T1 are highly significant (p < 0.01) between group 1 or study group (treated with Venoplant(®)) and group 2 (control group); the differences T0-T2 are significant (p < 0.05) between group 1 (treated with Venoplant(®)) and group 2 (control group). The differences T1-T3 are significant (p < 0.05) between group 1 (treated with Venoplant(®)) and group 2 (control group). DISCUSSION: The present study suggests that Venoplant(®) significantly decreases postoperative edema in orthognathic surgery, thus precluding long-term corticosteroid use.

Psychological aspects of orthognathic treatment.

AIM: The aim of this study was to examine the psychological state of 30 patients subjected to corrective orthognathic surgery and their expectations, as well as the influence of an in-depth psychological evaluation on the success of the operation. METHODS: The study was performed by giving 30 patients (12 men, 18 women), affected by dental-skeletal facial abnormalities and treated with orthognathic surgery, a questionnaire with 19 questions aimed at examining their preoperative emotional state (desired esthetic and functional improvements) and postoperative emotional state (expectations after surgery and associated psychological state of anxiety and depression). RESULTS: All patients (100%) expressed a clearly positive reaction to their experience. Approximately 70% of the patients observed an improvement in their masticatory function following surgery and 96.6% an improvement in esthetic appearance. Almost none of the patients (96.6%) experienced difficulty in adapting to a change in appearance, while as a result of the surgery 66.6% experienced an increase in self-esteem and confidence. In addition, the opinion of relatives and friends of the patients was favorable in most cases (76.6%). CONCLUSIONS: In order to enable the patients to face their therapeutic program with greater confidence, a team of orthodontists, surgeons and psychologist observe the patients from the beginning of treatment, having them interact with other patients who have already experienced the same situation and by showing them pre- and postoperative pictures of other patients subjected to orthognathic surgery.

H3 and H3.3 histone mRNA amounts and ratio in oral squamous cell carcinoma and leukoplakia.

Histone variants (e.g. H3) play an important role in chromatin structure and gene expression regulation of normal cells. Aims of this study were to: (1) estimate H3 and H3.3 histone mRNA expressions and their ratio in oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL); (2) investigate whether H3 and H3.3 variants could play a role in the pathogenesis of OSCC and OL, also conditionally to HPV infection, age, gender, and main habits (tobacco smoking and alcohol drinking) in human beings studied. Twenty-three cases of OSCC and 20 cases of OL were examined in lesion site (LS) and juxtaposed clinically undamaged site (JUS) by RT-PCR for H3 and H3.3 histone mRNA; 13 healthy oral mucosa samples (HS) were investigated in a single site as controls. HPV DNA presence was investigated in the respective exfoliated oral mucosa cells by nested PCR (nPCR: MY09-MY11/GP5-GP6). The data showed that both H3 and H3.3 histone mRNA crude concentrations are higher in OSCC (LS = 2901 +/- 459 ng of H3; JUS = 2699 +/- 658 ng of H3; LS = 3190 +/- 411 ng of H3.3; JUS = 2596 +/- 755 ng of H3.3) than those in OL (LS = 2095 +/- 349 ng of H3; JUS = 2192 +/- 897 ng of H3; LS = 2076 +/- 911 ng of H3.3; JUS = 1880 +/- 654 ng of H3.3) and in HS (2579 +/- 959 ng of H3; 2300 +/- 758 ng of H3.3), although not reaching any statistical significance. Interestingly, ratio of H3/H3.3 mRNA amounts decrease both in OSCC (0.99) and OL (1.009) vs HS (1.121). No association was found for H3 and H3.3 histone mRNA expressions in OSCC and OL with respect to HPV infection and the social-demographical variables considered (P > 0.2). The overall higher expression of H3.3 in damaged tissues up to the ratio inversion in OSCC especially in HPV+ alcohol drinkers (60.0%) represents the most interesting finding, in consideration of the proven ability of alcohol to act as permeability enhancer of human oral mucosa, to alter the mucosal structure and by this dynamics could favour the penetration through the epithelial layers of HPV.

[Squamous cell carcinoma of the lip. Retrospective analysis of 42 cases]. / Carcinoma squamoso del labbro. Analisi retrospettiva di 42 casi clinici.

BACKGROUND: To examine to what extent physicians follow a regional guidelines for the diagnosis, staging, treatment and follow-up of patients with squamous cell carcinoma of the lower and upper lip. DESIGN: retrospective analysis of data from the medical records of 42 patients diagnosed with squamous cell carcinoma of the lower and upper lip during the period 1990-2000. SETTING: Department of head and neck pathology, oral cavity and audio-verbal communication of Naples University. PARTICIPANTS: the data were collected by this Department. RESULTS: In accordance with the TNM system, the 50% of cases was in stage T1, 33% in T2, 14% in T3. In few cases (3%) the lesion was in stage T4. All cases were in M0 and only 8% of cases presented nodal disease at diagnosis (N1). The type of treatment in relation to age was in agreement with the guidelines in 34% of cases. Of the 42 surgically-treated patients, only 4 showed, after 12 months, a local recurrence. CONCLUSIONS: Prognosis is good if squamous carcinoma is diagnosed early.

[Extracorporeal shock wave lithotripsy in the treatment of salivary calculi. Our experience. Note 2]. / La litotrissia extracorporea nella terapia dei calcoli salivari. Nostra esperienza. Nota 2.

In this study the authors, making use of a non-surgical therapeutic method like extracorporeal shock wave lithotripsy, aim to show the advantages of this method compared with surgery, in the therapy of lithiasis of the salivary glands. Seven patients suffering from calculi of the salivary glands were treated. The authors obtained the best result in each patient and in 5 of these obtained the complete disappearance of sialolithiasis. The authors, considering that there is an ever higher number of requests for this treatment, put extracorporeal lithotripsy in the foreground in the therapy of sialolithiasis.

[Extracorporeal shock wave lithotripsy in the therapy of salivary calculi: efficacy, risks and limits. Review of the literature. Note 1]. / La litotrissia extracorporea nella terapia dei calcoli salivari: efficacia, rischi e limiti. Revisione della letteratura. Nota 1.

The authors carry out a review of the international literature on an alternative methodology to surgical therapy of lithiasis of the salivary glands, indicating information, limitations and possible complications. More than fifty papers by international authors were analysed regarding their experience on the use of electro-magnetic waves in the treatment of salivary gland lithiasis. It was observed that extracorporeal lithotripsy is an alternative and valid method to surgery, considering that the complications are negligible. Considering the expectations and the relationship between cost and advantage, extracorporeal lithotripsy can be considered as first treatment with surgery as second therapeutic choice.

Clinical evaluation of patients with squamous carcinoma of the oral cavity.

AIMS: To make a clinical evaluation of patients with squamous carcinoma of the oral cavity. METHODS: The clinical condition of 72 patients with squamous carcinoma of the mouth, hospitalized at the Institute of Oral and Maxillo-Facial Surgery, 2nd University of Naples, Italy, between 1992 and 1996, were examined. The patients were evaluated system by system, staged by TNM-UICC and classified by ASA and by the Karnofsky and Burchenal and the Zubrod et al. Performance status methods. RESULTS: Evaluation by the two methods produced different results. Of the patients examined, 34.5% showed more than one systemic disorder. 51.4% were in ASA classes 3-4. CONCLUSIONS: The presence of a disease with poor prognosis associated with advanced neoplastic stage (stages III-IV; 69.4% of the total) precluded radical surgery in 32% of patients, who were treated with chemotherapy and/or radiotherapy.

[Changes in the mouth mucosa in patients with chronic inflammatory intestinal diseases]. / Alterazioni della mucosa orale in pazienti affetti da malattie infiammatorie croniche intestinali.

BACKGROUND: Oral mucosa and periodontal lesions occurrence in Inflammatory Bowel Disease (IBD), Ulcerative Colitis (UC) and Crohn Disease (CD). METHODS: This study involved 100 patients examined for 5 years (1990/1995), with a clinical and histopathological diagnosis of CD (21 patients) and UC (79 patients). RESULTS: The analysis of the data obtained, from our sample, showed that 5 patients out of 100 presented aphtha minor lesions; in 3 cases the diagnosis was, respectively, of two neoformations of the genian mucosa--which turned out to be a papilloma and a fibroma--and a retro-commissural leukoplakia, degree OIN I. The 50% of our patients presented parodontal lesions, oral candidosis in 15 out of 67 patients who presented a whitish coating on the back of the tongue. CONCLUSIONS: The results of this investigation, lessen the importance of an association between IBD and oral diseases.

[Basaloid squamous carcinoma of the tongue. Clinico-anatomical study of a case]. / Carcinoma basalioide squamoso della lingua. Studio anatomo clinico di un caso.

The basaloid squamous carcinoma was first described in 1986. It is a rare tumor with particular morphologic and biologic features that separate it from the more common squamous cell carcinoma of the head and neck region. A case with histologic diagnosis of basaloid squamous carcinoma of the tongue treated only with radiotherapy, is reported.

[A clinical case of primary malignant melanoma of the oral cavity]. / Un caso clinico di melanoma maligno primario del cavo orale.

A rare case of primary malignant melanoma of the oral cavity is reported and a literature review of etiopathogenesis, biological bases and prognosis is made. The hypotheses to explain the very severe prognosis of malignant melanoma of the oral cavity with respect to that of skin are discussed. The therapeutic approaches are described as well as the frequent difficulty to perform them in relation to the anatomical region and the wide extension of the tumoral lesion.

[A case of parotidomegaly associated with eating disorders (anorexia/bulimia)]. / Su di un caso di parotidomegalia associata a disordini dell'alimentazione (anoressia/bulimia).

A case of parotidomegaly associated with anorexia is described, and the psychoneurological and etiopathogenetic theories of main feed disorders (anorexia/bulimia) are discussed. Particularly, a rare pathology of maxillofacial interest is presented: parotidomegaly associated with anorexia. The diagnosis and differential diagnosis of this pathology is discussed.

[Lip carcinoma. Various therapeutic options]. / Carcinoma del labbro. Differenti possibiltà terapeutiche.

Lip carcinoma is a relatively unique malignant disease because the lip is a junctional structure. The lip is bounded externally by the facial skin and it is in continuity with the buccal mucosa of the oral cavity. The lymphatic drainage of the upper and lower lips is primarily directed to the mandibular group of lymph nodes. To a lesser extent, drainage may go to submental intraparotid, or internal jugular lymph nodes. Lip carcinoma is almost exclusively a squamous cell carcinoma, the major etiologic factor being prolonged iar exposure. Treatment for lip carcinoma is usually surgical, in the form of full-tickness excision. Neck dissection is also performed when clinically palpable lymph nodes are present.

[Border-line headache]. / Cefalee border-line.

BACKGROUND: The authors, after a thorough review of the literature, and on the basis of personal clinical experience, propose a new approach to the resolution of pain symptomology of border-line cephalea (a pathology as much debated as it is diffused). Therefore, they suggest an interdisciplinary therapeutic protocol. METHODS: After a careful examination of the triggering causes of pain symptomology, they examined 24 patients. They were examined at the out-patient clinic of the Institute of Oral and Maxillo-Facial Surgery, Second University of Study of Naples. With the aid of a questionnaire they gathered the anamnestic data; and, after an objective clinical examination the patients were submitted to neurologic examination. Working together with a neurologist, the patients were firstly examined individually and then, based upon differential differences in symptomatology, they were subdivided into three experimental groups in order to facilitate the association of the therapy to the groups and make follow-up easier. RESULTS: The results were encouraging and demonstrated the necessity to study the patients affected by this type of pathology with a pluridisciplinary approach: gnatologic, psychologic, and neurologic. CONCLUSIONS. Therefore, the importance, if not the necessity, of an interdisciplinary approach is underlined. The authors want to emphasize the importance of not focusing on only one aspect of this kind of pathology, but it must be considered in a wider field including more than one discipline.

[Cephalometric evaluation of patients with Turner syndrome. Authors' experience]. / Valutazioni cefalometriche di pazienti affette da sindrome di Turner. Nostra esperienza.

BACKGROUND AND METHODS: The cranio-facial morphology has been evaluated on the basis of cephalometric studies in nine patients with Turner's syndrome. The aim of this study is to identify the growth model and the typical malocclusions of this syndrome. This study has been completed with an evaluation of mesio-distal dimension of permanent teeth. RESULTS: According to the literature, the results show: a flattening of the basal skull; a cross-bite coming from a transversal dimension reduction of the upper maxilla. A Class II malocclusion was found in two patients. All the patients showed a mandibular retrusion associated to maxillary retrusion in eight cases. The growth direction was normal in all the patients. CONCLUSIONS: A reduction of the mesio-distal diameter in all of the permanent teeth, was also found. This last measure was evaluated using the study casts.

[The role of soft tissues in the planning of bimaxillary orthognathic surgery. Review of the literature and two clinical cases]. / L'influenza dei tessuti molli nella progettazione di un intervento bimascellare in chirurgia ortognatica. Revisione della letteratura e presentazione di due casi clinici.

The authors have investigated the clinical role of the soft tissues and of their influence in the planning phase of the orthognathic surgery, with the purpose to emphasize their capital influence in the face armony. Most of the patients really ask for an aesthetic result, that is in a tight relation with the correct prediction of the morphological changes of the soft tissues. The aesthetics excite nowadays the research, especially in all the surgical fields, and so the orthognatic surgery is more than ever from the soft tissues influenced. Subsequently the authors have investigated the principal indications to the bimaxillary surgery and have suggested a personal diagnostic-therapeutic protocol for a correct and opportune evaluation of the soft tissues relations. Finally the authors have described the whole prediction phase and have shown as the maxillary bones influence the whole facial skelett, and as frequently the chin correction and the rhinoplasty are necessary for a better result in the time.

[Enteral nutrition in maxillofacial oncology]. / La nutrizione enterale in oncologia maxillo-facciale.

The authors present a review regarding knowledge of malnutrition in maxillofacial oncology. The causes of nutritional deficit in head and neck tumor derived from metabolic alteration, consequent to the presence neoplasia and antineoplastic therapy. They analyze how to evaluate clinical status in malnutrition patients and they show different therapeutic strategy. The authors emphasise advantages and disadvantages of EN and TPN and present their nutritional forms, based on the EN, analyzing the characteristics.

[Experience with a rigid fixation device in maxillofacial surgery using shape-memory clips]. / La nostra esperienza su di una metodica di fissazione rigida in chirurgia maxillo-facciale mediante clips a memoria di forma.

BACKGROUND: A device of alloy with shape-memorising effect (SME) was utilized in the surgical correction of maxillo-facial fractures. Nitinol, an alloy of equal atomic parts nickel and titanium, is a metal with the unusual property of shape memory. This alloy may be easily bent when cooled in its lower temperature phase and it resumes its original shape when heated in its higher temperature phase. A lot of useful properties of nitinol alloy, such the ability to convert heat energy into mechanical energy, as the biocompatibility and bioinertness, as the anti corrosive stability and high mechanical strength, suggest that it can be useful in the surgical fixation of maxillofacial bone injuries. METHODS: The fixing device of alloy with SME, the indications and the techniques of osteosynthesis and some cases have been discussed by the authors. RESULTS AND CONCLUSIONS: The results of this study showed that the surgical treatment of maxillo-facial bone fractures by devices of shape memory alloys is simple, ensures a good stability of fracture surfaces, reduces the time period of operative procedures and of patients rehabilitation, allowing rapid bone healing.