Ultrasound-guided transhepatic puncture of the hepatic veins for TIPS placement.

PURPOSE: This retrospective analysis was carried out to assess the feasibility and results of transjugular intrahepatic portal systemic shunt (TIPS) performed with ultrasound (US)-guided percutaneous puncture of the hepatic veins. MATERIAL AND METHODS: Over a period of 3 years, 153 patients were treated with TIPS at our centre. In eight cases, a percutaneous puncture of the middle (n=7) or right (n=1) hepatic vein was required because the hepatic vein ostium was not accessible. Indications for TIPS were bleeding (n=1), Budd-Chiari syndrome (n=1), ascites (n=2), reduced portal flow (n=1) and incomplete portal thrombosis (n=3). A 0.018-in. guidewire was anterogradely introduced into the hepatic vein to the inferior vena cava (IVC) through a 21-gauge needle. In the meantime, a 25-mm snare-loop catheter was introduced through the jugular access to retrieve the guidewire, achieving through-andthrough access. Then, a Rosch-Uchida set was used to place the TIPS with the traditional technique. RESULTS: Technical success was achieved in all patients. There was one case of stent thrombosis. One patient died of pulmonary oedema. Three patients were eligible for liver transplantation, whereas the others were excluded due to shunt thrombosis (n=1) and previous nonhepatic neoplasms (n=3). CONCLUSIONS: The percutaneous approach to hepatic veins is rapid and safe and may be useful for avoiding traumatic liver injuries.

Mandibular trauma: a two-centre study.

The aims of this study were to assess and compare epidemiological data on mandibular fractures from two European centres and to perform a review of the literature. Between 2001 and 2010, a total of 752 patients with a total of 1167 mandibular fractures were admitted to a hospital in Turin, and 245 patients with a total of 434 mandibular fractures were admitted to a hospital in Amsterdam. The mean age in Turin was 34.8 years and in Amsterdam was 32 years. The age group 20-29 years showed the highest incidence of mandibular fractures in both centres. The fractures were mainly the result of assaults, in agreement with several articles in the recent literature, followed by falls. The continuous long-term and multicentre collection of data on the epidemiology of maxillofacial trauma is important because it provides the information necessary for the development of preventative measures aimed at reducing the incidence of facial injuries.

[Schwannoma located in the tongue. A clinical case report]. / Schwannoma a localizzazione linguale. Presentazione di un caso clinico.

Schwannoma or neurilemmoma and neurofibroma are two tumors of the peripheral nerves originating in the nerve sheaths. Schwannoma account for just over 1% of benign tumors reported in the oral cavity. The tongue is unanimously considered the most frequent site at this level; however, the tip is the least affected part of the organ. The case of schwannoma reported here is the third observed with a lingual localization in 18 years by the Division of Maxillo-Facial Surgery of The Odontostomatological Clinic of the University of Turin. The case is of interest due the rarity of this pathology and the presence of non-significant symptoms for a presumed initial diagnosis. CASE REPORT. A 21-year-old woman was referred to our attention following the appearance two years earlier of a slowly growing swelling on the tip of the tongue. The patient complained of the fastidious presence, disturbance to mastication and phonation and occasional paresthesia of the tip of the tongue. The small mass, which was clearly evident on examination, was covered with normal mucosa. On palpation it had a hard-elastic consistency; it was slightly painful, smooth and partial mobile on surrounding levels. The patient underwent the surgical removal of the neoplasia under anesthesia. The mass was well capsulated and a good cleavage plane was easily found. The neoformation was yellowy grey, oval bean-shaped, measuring 1.9 x 1.3 x 1.1 cm. The histological diagnosis, confirmed by immunohistochemical tests, was benign Antoni's, type A schwannoma. The postoperative period was good an there was no recidivation during the course of a one-year follow-up. DISCUSSION AND CONCLUSIONS. Benign schwannoma, which are relatively rare in the oral cavity, represent a pathology which are often not taken into account during clinical practice. Symptoms which take the form of slight hypoesthesia and vague paresthesia may lead to the suspected diagnosis of this type of neoplasia. The final diagnosis is always made after a definitive histological examination. Differential diagnosis must be made in relation to malignant tumors (on the basis of anamnestic data relating to the speed of growth and clinical appearance of the neoplasia) and, above all, in relation to numerous benign neoformations based on epithelial and connective tissues (lipoma, fibroma, leiomyoma and adenoma). Treatment is always surgical: in the case reported here, the exeresis of the lesion also allowed its histological characterization (excisional biopsy). Surgery was conservative and did not require local or locoregional prophylactic measures. After the final histological diagnosis of schwannoma, the patient underwent a thorough general objective examination to check the presence of other characteristic signs of Von Recklinghausen's syndrome, have a probability of malignant degeneration ranging between 5 and 16%. Isolated schwannoma hardly ever become malignant and in general, if exeresis is complete, no recidivation occurs after surgery.

[Alveolar bone necrosis as a consequence of surgical intervention for hypophyseal adenoma]. / Necrosi ossea alveolare conseguente ad intervento chirurgico per adenoma ipofisario.

Tumours of the pituitary gland, originating from its anterior lobe, may produce hormones and therefore generate a situation of pituitary hyperfunction or cause the typical problems of endocranial expansive masses which compress residual glandular tissue. Surgery is necessary in order to remove a pituitary tumour and is currently performed in 96% of cases using a trans-sphenoidal route. The surgical approach entails making an incision in the upper vestibular fornix from cuspid to cuspid. The stripping of a full-thickness flap allows the front wall of the sphenoid sinus to be reached, passing through the nasal cavities; it is then eliminated. This allows the floor of the sella turcica to be visualized; the latter is then removed to expose the pituitary gland. Surgical complications arising during the use of the trans-sphenoidal route are rare and the surgical removal of the adenoma ensures a greater probability of recovery compared to radiotherapy in view of the elevated radioresistance of these neoformations. The paper then reports two cases of alveolar bone necrosis in the premaxillary sector following surgery for the removal of pituitary adenoma. Case report--The first patient male, aged 23, presented a sequestrum in the vestibular alveolar wall in correspondence with 1.1 and 1.2. The patient underwent two operations (one using a craniotomy route and the other using a trans-sphenoidal route) to remove a giant pituitary adenoma. The sequestrum was removed, but the radicular surfaces of 1.1 and 1.2 remained exposed. In order to re-cover them, an attempt was made to increase the quantity of keratinized gingiva using the two-stage technique described by Bernimoulin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinico-therapeutic observations on a series of cases of odontogenic abscesses and phlegmons]. / Osservazioni clinico-terapeutiche su una casistica di ascessi e flemmoni odontogeni.

The authors review 561 patients suffering from odontogenic abscesses and phlegmons which were large enough to merit hospitalisation in the Division of Maxillo-Facial Surgery of the Odontostomatological Clinic at the University of Turin during the period from 1972 to 1990. The main features of these septic processes are evaluated: site, size, mode of growth and evolution, tooth responsible. Special attention is paid to the treatment performed: this was essentially based on antibiotic therapy and/or drainage of the abscess via a transcutaneous, transmucous or transdental route. The need to combine medical therapy with surgical drainage of purulent material was noted in the treatment of large infections; in many cases medical therapy alone was unable to guarantee the resolution of the pathology; on the other hand, surgical drainage alone in some cases led to the patient's recovery.

[Odontogenic keratocysts: the anatomicopathological characteristics and the clinical and therapeutic aspects. A review of the literature]. / Le cheratocisti odontogene: caratteristiche anatomo-patologiche e considerazioni cliniche e terapeutiche. Revisione della letteratura.

The paper contains an extensive review of the literature on keratocysts, a variety of odontogenic cysts with unique clinical features. The anatomo-pathological, radiological and clinical characteristics of the cysts are examined in order to aid diagnosis, which remains however solely histological. In addition, the paper discusses various therapeutic solutions which appear to offer the greatest guarantee that relapses typical of these cystic formations do not occur.

[Primary reconstruction of the anterior sublingual sulcus with a nasolabial flap after the resection of a malignant neoplasm]. / Ricostruzione primaria della pelvi sublinguale anteriore con lembo nasogenieno dopo resezione di neoplasia maligna.

The reconstruction of the loss of substance from the oral floor following demolitive cancer surgery aims to guarantee adequate tongue movement and the consequent preservation of phonatory and swallowing functions, as well as the possibility of using prosthetic rehabilitation. Large defects are resolved using musculocutaneous or free vascularised flaps, whereas smaller defects may be closed by first intention using alveolo-lingual suture. There are a number of drawbacks to this method: occurrence of fistulas immediately after surgery and secondary ankyloglossia. It is then necessary to resort to a second operation using dermoepidermic graft and plastic surgery of the oral floor to liberate the tongue. These problems may be resolved using a nasolabial flap. The flap can be prepared using either an upper or lower peduncle, it is relatively simple to perform and does not significantly prolong operating times. The contemporary dissection of the neck with ligature of the facial artery does not in our experience significantly influence flap vascularisation. The main drawback is the limited size of the flap (on average it is 6-7 cm long with a maximum width of 3-4 cm at the base. The upper edge is equally placed 7-10 mm from the medial side). The flap must be sufficiently thick to ensure an adequate blood supply to subcutaneous tissue, but the dissection plane must be sufficiently near the surface to preserve the facial nerve. It is important to prepare the graft bed so as to avoid creating tension after suture.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of Lyodura in fractures of the orbital floor]. / L'uso della Lyodura nelle fratture del pavimento orbitario.

After a brief review of reported techniques for the reconstruction of substance losses of slight or modest proportions at the orbital floor using autogenic, homogeneous, heterogeneous and alloplastic grafts, personal experience with this type of surgery employing lyophilised human dura mater is reported. It is considered that Lyodura can be considered the material of choice by virtue of its strength, handiness and the absence of tissue reactions. 38 fractures of the orbital floor were treated from 1980 to 1986 with osteosynthesis of the border and insertion of lyophilised dura mater to make up for bone loss. In the immediate postoperative period and in later controls, there was no evidence of complications or phenomena of intolerance to the material. The patients treated were followed up a short time later. Clinical and X-ray data confirmed the validity in time of the technique and material employed long-term.

[Clinico-surgical evaluation of supernumerary dental anomalies]. / Valutazione clinico-chirurgica delle anomalie dentarie in sovrannumero.

The pathology of extra teeth is evaluated on the basis of clinico-operative statistics for the years 1981-1985 and comprising 88 patients for a total of 115 treated teeth. The data obtained confirm the higher frequency of extra teeth in male patients. The most frequent site is easily the frontal sector of the upper arch. At that level, especially in males, two more or less symmetrical extra teeth are not infrequent. These data are in substantial agreement with the epidemiological data reported in the literature. Extra teeth are usually treated by surgical removal followed by orthodontic treatment to correct malformations caused by them and to recover the functional and aesthetic role of the upper front teeth.

[Bone clefts of the median facial structures. An anatomical study]. / Schisi ossea delle strutture mediane facciali. Studio anatomico.

After reviewing the literature concerning rare facial fissions, the authors describe the skull of a young woman with an incomplete bone fission of the median facial structures. They focus on the associated bone anomalies observed in the skeleton of the nose and upper jaw.

[The clinico-radiological assessment of dental anomalies with real and apparent numerical defects]. / Valutazione clinico-radiologica delle anomalie dentarie di numero in difetto reali ed apparenti.

Dental anomalies involving real shortfall in the number of teeth (agenesis) or apparent deficiency (impaction) have been studied in a population sample including 700 national servicemen aged between 19 and 26, in the period April-August 1989. The study was carried out by means of careful objective examination and the systematic performance of orthopantomography showed that 5.14% of the population examined is affected by dental agenesis. The tooth most often involved in agenesis is the lateral maxillary incisor followed by the third mandibular molar, the second mandibular premolar and the second maxillary premolar. As regards apparent agenesis, the upper and lower wisdom teeth were the most frequently involved in physiological or pathological bone impaction (this event occurs in almost 50% of third molars). The maxillary cuspid is also impacted with some frequency. The data obtained were compared with those in the world literature.

[Germectomy of the lower third molars. Follow up studies on 71 patients]. / Germectomia dei denti del giudizio inferiori. Controllo clinico a distanza di 71 pazienti.

The clinical research was carried on in the department of Oral Surgery of the Maxillo-Facial Surgery Division of Turin University and concerned patients of an average age of 15 years. All the patients underwent the operation for orthodontic reasons. About two years after operation patients were called and underwent a check-up to see the surgical scar and to examine the health of lower second molars that could have been damaged during surgical operations for germectomy. Periodontal probings were effected around all lower second molars, therefore their mobility level an vitality were observed. Nervous alterations were researched and the authors effected a radiographic check-up to look for possible bone-loss after germectomy. According to the results obtained, the authors assert that the health of lower second molars isn't damaged by germectomy of lower third molars. So although not welcome by the young patients, the authors affirm that preventive germectomy of lower third molars compared to correct indications is a justified treatment.

[Chondrosarcoma of the maxilla. A clinical case report]. / Condrosarcoma del mascellare superiore. Presentazione di un caso clinico.

Chondrosarcoma are malignant tumour originating in cartilaginous cells which tend to preserve their essentially cartilaginous nature throughout their evolution. They are rare at the level of the maxilla and mandibular. When localized in facial bone, chondrosarcoma follow a more aggressive pattern compared to those localized in long bones. They mainly affect individuals aged between 30 and 60 and show no sexual preference. In the majority of cases, chondrosarcoma have a relatively slow rate of growth. The only valid treatment is radical surgical removal. In overall terms, the prognosis in these patients is not good since the 5-year survival rate is less than 40%. During the period 1980-1992 only 5 cases of chondrosarcoma were diagnosed by the Division of Maxillo-Facial Surgery of the University of Turin. The authors considered it worthwhile to report the last case observed in a premaxillary localization given the advanced age of onset and the typical course of the pathology and treatment received. CASE REPORT. A male 83-year-old patient was referred to use due to a slow growing neoformation in the premaxillary region which had appeared approximately 5-6 months earlier. The patient had previously undergone the avulsion of residual upper teeth due to suspected "toothache". The neoformation filled the premaxilla, deforming the anterior middle portion of the palate and spreading towards the floor of the anterior nasal cavity. The gingiva of the upper alveolar crest presented ulceration with irregular edges and sanious bottom. On palpation the consistency was hard-ligneous and swelling, in continuity with the bone, was slightly painful. Incisional biopsy enabled the diagnosis of chondrosarcoma to be confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tumors and the histogenesis of Schwann cells of maxillofacial competence]. / Tumori ed istogenesi dalle cellule di Schwann di competenza maxillo-facciale.

After a brief review of published data relating to the clinical and anatomicopathological characteristics and therapeutic problems of tumours deriving from the nerve sheaths of the oromaxillofacial area, the paper reports 13 cases of these neoplasias observed from 1975 to 1988 in the maxillofacial surgery ward of the Dentistry Clinic at the University of Turin. The group include 6 schwannomas (neurinomas), 6 neurofibromas and 1 malignant schwannoma. Clinical symptoms and methods of diagnosis are described.

[Keratoacanthoma of the lower lip. A review of the literature and clinical case report]. / Cheratoacantoma del labbro inferiore. Revisione della letteratura e presentazione di un caso clinico.

The authors report a case of keratoacanthoma localized on the prolabium of the lower lip. They focus their attention on the difficulty of making a correct diagnosis and on the complexity of differential diagnosis with squamous cell carcinoma. After incisional biopsy of the lesion, treatment took the form of the complete excision of the neoplasm which is indispensable for a definitive diagnosis. The keratoacanthoma, although being an absolutely benign lesion, in fact requires complete exeresis in order to perform an histological examination of the entire neoplastic mass and thus definitively rule put the presence of squamous cell carcinoma. If correctly performed, the operation leaves very little scarring and satisfies the patient's esthetic and psychological expectations.

[Clinico-surgical evaluation of dental elements in bone inclusions]. / Valutazione clinico-chirurgica degli elementi dentari in occlusione ossea.

Dental inclusions are assessed on the basis of clinical and operating statistics relating to the years 1981-1985 and comprising 815 patients and 1445 treated teeth. The results confirm the predominance of inclusions among female patients and the prevalence of the mandibular site; the most frequently included teeth are the lower eighths followed by the upper eighths, the upper canines and the second lower premolars. Inclusions are bilateral in most cases. These findings are in substantial agreement with the epidemiological data recorded in the literature. The operating series shows that the type of surgical treatment varies with the localisation of the tooth (anterior or posterior), its relationship with contigous teeth and with the surrounding anatomical structures and the age of the patient. Teeth in the posterior sector are usually extracted. At young age, germectomy is carried out for orthodontic purposes; at mature age, teeth are extracted to prevent the formation of periodontal pockets and the aggravation of caries and their complications. On the other hand, for teeth in the anterior sector, surgery is usually merely the first stage in treatment and is followed by treatment of orthodontic type with traction, in view of the important aesthetic and functional role of the labial teeth.

[Relationship between injury dynamics and site of maxillofacial fractures. Comparative study of 100 cases]. / Rapporto fra dinamica del trauma e sede di frattura del massiccio facciale. Studio comparativo su 100 casi.

One hundred cases of facial mass fractures observed in the period April-September 1988 have been assessed using a clinico-anamnestic type investigation. Among trauma patients there is a prevalence of male patients aged between 10 and 30. Fractures located at the middle third and mandible occur in a practically equivalent number. Most traumas are the result of road accidents, following by falls. A good degree of correlation was observed between trauma aetiology and dynamics on the one hand and type and gravity of fractures on the other. Direct fractures, with greatest comminution of fragments prevail in high speed traumas; indirect fractures are most frequent in low speed traumas (cyclists and accidental).

[Hemorrhagic cyst of the mandible. A case presentation]. / Le cisti emorragiche della mandibola. Presentazione di un caso.

Haemorrhagic mandibular cysts are quite rare and generally considered sequelae of an earlier trauma causing an overflow of blood into the bone, though a number of pathogenic theories have been put forward. Since few of these cysts involve subjective symptoms, most are discovered accidentally during radiography, while a sure diagnosis is only likely to be obtained during surgery on the discovery of a nonepithelialized cavity. The paper presents a typical case of haemorrhagic mandibular cyst which was treated by opening the cavity and scraping its walls in order to cause bleeding that would promote the growth of new bone tissue.

[Cystic lesions of the mucosa of the maxillary sinus. Clinical considerations and differential diagnosis]. / Lesioni cistiche della mucosa del seno mascellare. Considerazioni cliniche e diagnosi differenziale.

The various pathogenic, radiological and clinical aspects of cystic lesions of the maxillary sinus mucosa (pseudocysts, retention cysts, mucocells) are examined together with related problems of differential diagnosis. Such lesions are sometimes found accidentally in the course of routine X-rays or on the basis of clinical indications not directly attributable to the presence of a cyst. Often they are completely asymptomatic so that they are less often recognised than their true incidence and are sometimes confused with maxillary sinus lesions of a totally different origin. In the personal experience described sinusoscopy proved a valuable adjunct to clinical and radiological investigations for the purposes of differential diagnosis and may in some cases form the first stage of treatment. The value of sinusoscopy is also enhanced by the possibility it offers for targeted biopsies at the same time.

[The oral health status in a sample of recruits form different regions of Italy]. / Stato di salute orale in un campione di reclute delle varie regioni d'Italia.

The present epidemiological study was carried out 700 national servicemen doing service at the barracks Carlo Alberto Dalla Chiesa of Fosano (Cuneo) in the period April-August 1989, for the purposes of determining the state of oral health in a large sample of the Italian young male population and the diffusion of actions aimed at caries prophylaxis. The DMF index of the group in question is 7.14. 83.44% of DMF teeth were subjected to conservative dental treatment, 5.58% were extracted and 10.98% presented ongoing processes of caries requiring treatment. The results obtained show that, although caries is still very widespread in Italy in relation to other European countries and the United States, considerable progress has been made compared to the past as regards the secondary prevention of the pathology. Nevertheless, much remains to be done for the primary prophylaxis of caries. These data were confirmed by those obtained on periodontopathies. Although, the serious forms of periodontal disease in youth are very rare, very few conscripts are aware of the most elementary principles of oral hygiene.