Biomedical subjects

E Belli

Publications and source records attributed to E Belli.

At least 55 records · Page 3Linked to original sources

PubMed1997

Schwannoma of the mandible.

Schwannoma is a benign neoplasm originating from Schwann's cell. It involves neurons and axons of peripheral nerves. This tumor has a predilection for the head and neck region, and often occurs as soft tissue lesion. Intraosseous sheath tumors are rare, comprising less than 1% of all bone tumors; the mandible is the most common site. The literature reports only 30 acceptable cases of schwannoma of the mandible. We report a new case of schwannoma that is unusual in its intraosseous localization and the patient's comparatively young age.

Child↗

PubMed1997

[Dissection of the cranial base en bloc with the infratemporal fossa].

A high incidence of morbidity and mortality was related with skull-base neoplasm surgery. Several advances have permitted, in recent years, the total excision of such neoplasms with minimal patient morbidity. Due to an improved understanding of the surgical anatomy of the skull-base and to the collaboration of the neurosurgeon and maxillofacial surgeon and, moreover, to the improvements of imaging (CT and MR) in the past decades new combined approaches were planned and performed to allow en bloc resections of extensive lesions. Extensive exposure of the tumor, improved management of the internal carotid artery, preservation of cranial nerves not involved by tumors and improved cranial base reconstruction techniques (by free flaps) have resulted from this progress. The aim of the present work is to show the main anatomical landmarks of infratemporal fossa and medium skull base that help the surgeon to achieve an en bloc resection.

Dissection↗

PubMed1997

[A statistical study of 206 patients suffering from malignant neoplasms of the cervicofacial area].

This study focuses on the importance of early diagnosis in the oncological resolution of neoplasia of the cervico-facial district. In a sample of 206 patients suffering from neoplasia of the cervico-facial district, the authors found a greater incidence of pathology between the 6th and 7th decades of life, a finding that confirms the enhancement of etiopathogenetic factors over time. The oral cavity represents the site predominantly affected by this neoplasia with an incidence of 57.3%. Epidermoid carcinoma represents 61.7% of the histological types examined. The treatment protocol used in 167 patients depending on the clinical stage and the general conditions of the patient was as follows: multimodal in patients at stage 3 and 4 with a minimum survival rate at 12 months of 75% and 58% respectively, predominantly surgical in patients at stage 1 and 2 with a survival rate of 94.4 and 89.7% respectively.

Adolescent↗

PubMed1997

[Initial results of mitral valvuloplasty using the Physio-Carpentier-Edwards ring].

The Physio-Carpentier-Edwards ring is a new prosthetic ring developed to allow mitral annuloplasty associating remodelling and flexibility of the native mitral annulus. The object of this study was to assess the feasibility and reliability of mitral valvuloplasty with the Physio ring. Between December 1992 and October 1995, 100 patients with an average age of 56.8 years suffering from mitral insufficiency underwent mitral valvuloplasty with a Physio ring. The mitral insufficiency was degenerative in 94% of cases. The degree of regurgitation was scored 3+ or 4/+4/+ in 94 patients. Mitral valve prolapse was observed in 83 patients. Mitral reconstruction was undertaken using Carpentier's techniques. One patient died in the immediate postoperative period. Two patients were reoperated for valve replacement because of systolic anterior motion (SAM). One patient had SAM which regressed with medical treatment. There were no deaths after the hospital period. There were no late reoperations of thrombo-embolic complications. The average follow-up period was 19 +/- 8 months; 77 patients were followed up for over 1 year and all underwent control Doppler echocardiography. Sixty-one patients had no residual mitral insufficiency: 15 patients had grade 1/4 regurgitation and one patient had grade 2/4 regurgitation. The average mitral valve surface area was 2.8 +/- 0.3 cm2. The average left ventricular end diastolic volume decreased from 186 +/- 59 cm3 before surgery to 129 +/- 37 cm3 at the last control (p < 0.001). The authors conclude that the Physio ring enables reliable and effective mitral valvuloplasty with excellent short term results. The benefits of the flexibility of the Physio ring remain to be evaluated by a randomised trial.

Aged↗

PubMed1997

Colour stability of three esthetic laminate materials against to different staining agents.

The purpose of the present study was to evaluate the colour stability of three laminate veneer materials against to tea, coffee and cigarette smoke. 72 discs prepared by using two different type composite materials and a dental porcelain were divided into groups and immersed into distilled water, tea, Turkish coffee solutions. The last group was exposed to cigarette smoke. Colour differences were measured by colorimeter at the beginning and then in the period of 1 day, 1 week and 1 month respectively. As a result, it was found that cigarette smoke was the most staining agent, porcelain material was the most colour stable material, and indirect composite material was more colour stable than the direct one.

Bisphenol A-Glycidyl Methacrylate↗

PubMed1996

Infratemporal fossa surgery for malignant diseases.

The improvement in the knowledge of the main anatomical landmarks permits an evolution in the safety of the surgical treatment and a conceptual development of the geometrical anatomico-surgical characteristics of the infratemporal fossa. This conceptual evolution determines surgical and oncological advantages: firstly, improved comprehension of the anatomico-surgical limits of the resection and secondly the safeguarding of the oncological "en-bloc" dissection. The lateral approach of the infratemporal fossa gives a wider exposure of the surgical field, a shorter depth of work, a good control over the vessels and the possibility of carry out a microsurgical transfer. The surgical approaches correspond to the topographical location and the biology of the neoplasm in cases with infratemporal fossa and inferior compartment location the lateral transfacial approach is indicated. In cases with involvement of the superior compartment a lateral transcraniofacial subtemporal approach is necessary in order to remove the skull base. In cases with a neoplastic invasion of the skull base where the dura mater is the anatomical plane free from disease it is necessary to utilize an intradural approach. In patients with a secondary spread into the inferior compartment from the maxilla a combined antero-lateral transfacial approach is indicated. Finally, an orbitomaxillary involvement with secondary spread in the upper compartment of the infratemporal fossa necessitates an antero-lateral transcraniofacial subtemporal subfrontal approach.

Adult↗

PubMed1996

Surgical treatment of subaortic stenosis after biventricular repair of double-outlet right ventricle.

Out of 180 patients who underwent biventricular repair of double-outlet right ventricle between 1980 and 1995, 9 (5%) required reoperation because of subaortic stenosis. Two other patients who initially underwent operation elsewhere underwent reoperation at our institution because of subaortic stenosis. The median age at biventricular repair was 4 months. Repair consisted of tunnel construction from the left ventricle to the aorta in nine patients; the remaining two patients received an arterial switch operation with ventricular septal defect closure. Subaortic stenosis developed with time: the mean postoperative left ventricle-to-aorta gradient after repair was 10 +/- 19 mm Hg (range, 0 to 50 mm Hg) and became 84 +/- 27 mm Hg (range, 40 to 124 mm Hg) in a mean delay of 45 +/- 66 months (range, 1 to 213 months). At reoperation, the obstruction was caused by the protrusion of the inferior rim of the ventricular septal defect into the left ventricular outflow tract associated with subaortic hypertrophied muscle and membrane. The 11 patients underwent 15 reoperations. Surgical technique consisted of an extended septoplasty in 6 reoperations. In this technique an incision was made in the septal patch and was extended into the muscle toward the apex until a large opening of the left ventricular outflow pathway was obtained. A new patch was then secured to streamline the left ventricular outflow tract. None of the patients who underwent extended septoplasty had to undergo reoperation. There were no early or late deaths. At 115 +/- 85 months after biventricular repair, all patients were in New York Heart Association functional class I or II and the mean postoperative left ventricle-to-aorta gradient was 20 +/- 24 mm Hg (range, 0 to 60 mm Hg). We conclude that after biventricular repair of double-outlet right ventricle, the subaortic region is at risk for the development of stenosis. Surgical treatment adapted to the anatomy of the obstruction can offer good early and midterm results. It seems that an aggressive approach by an extended septoplasty avoids multiple reoperations.

Adolescent↗

PubMed1996

[Perioperative drug management in surgery using revascularized flaps].

The success of free flap tissue transfer firstly depends on the correct surgical technique. Taking off from the donor site tissue for the reconstruction provokes a chain of physiopathological events that could evolve in truly pathological phenomena. The pharmacological treatment is aimed to miss and control the eventual local complication, and also to support the general conditions of the patient. Numerous pharmacological protocols have been proposed on experimental studies, and also on clinical practice to control local complications. It is necessary to eliminate the reactive vasospasm present in the vessels during anastomosis, and to reduce the risk of vascular pedicle thrombosis and to maintain rheological qualities of blood so to reactivate and sustain microcirculation functionality. Many authors have proposed anticoagulant and antiplatelet therapy, associated with vasodilatator drugs and drugs acting on blood viscosity and tissue metabolism, even if the latter have been primarily studied in experimental applications. The authors report their own experience on 29 patients that underwent 31 free flap tissue transfers from January 1992 to January 1995. The pharmacological therapy activated on the test can be divided into two different periods, one intraoperative and one postoperative. ASA is administered one hour before anastomosis, and vessels are irrigated with heparin or lidocaine solutions during the adventectomy and anastomosis. Antiplatelet therapy together with administration of low molecular dextran is performed in the first 3 to 4 postoperative days; afterwards, the dextran-40 administration is stopped while the ASA therapy is continued in smaller dose.

Adolescent↗

PubMed1996

[The role of SMAS in the prevention of Frey's syndrome].

Frey's syndrome is the most common postoperative complication in the parotid gland surgery. The authors report their own experience with 80 patients who underwent surgical operation of superficial or total parotidectomy. In 45 of them was performed the SMAS flap, no SMAS flap performed in the remaining 35 patients. The follow-up was performed by interviewing the patients about their symptoms. The purpose of this work is to show the role of SMAS flap, that minimize the frequency and the intensity of symptoms of the Frey's syndrome.

Adolescent↗

PubMed1995

The "physio-ring": an advanced concept in mitral valve annuloplasty.

BACKGROUND: A new annuloplasty ring has been developed with the aim of adding flexibility to the remodeling annuloplasty concept. Here we report its clinical use with special emphasis on segmental valve analysis and valve sizing. METHODS: From October 1992 through June 1994, 137 patients aged 4 to 76 years (mean age, 49.1 years) were operated on. The main causes of mitral valve insufficiency were degenerative, 90; bacterial endocarditis, 15; and rheumatic, 13. The indication for operation was based on the severity of the mitral valve insufficiency (90 patients were in grade III or IV) rather than on functional class (60 patients were in class III or IV). At echocardiography 6 patients had normal leaflet motion (type I), 119 leaflet prolapse (type II), and 12 restricted leaflet motion (type III). Surgical repair was carried out using Carpentier techniques of valve reconstruction. In 3 patients, inadequate ring sizing was responsible for systolic anterior motion of the anterior leaflet diagnosed by intraoperative echo. The valve was replaced in 2 patients. There were three hospital deaths, no late deaths, one reoperation for recurrent mitral valve insufficiency due to chordal rupture 1 month after repair, one reoperation for atrial thrombus formation 5 months after repair, one anticoagulant-related hemorrhage, and one thromboembolic episode. RESULTS: Mid-term follow-up between 6 and 18 months was available in 94 patients. Echocardiography showed trivial or no regurgitation in 93.2% of the patients and minimal regurgitation in 6.8%. The average transmitral diastolic gradient was 3.55 +/- 1.93 mm Hg. Left ventricular end-systolic diameter and volume decreased postoperatively, demonstrating an improved left ventricular function. CONCLUSIONS: This preliminary experience has provided promising results and allowed us to define the indications of the Physio-Ring versus the classic ring. It has also shown that valve sizing and proper ring selection are of primary importance.

Adolescent↗

PubMed1995

[Reconstruction of the oral cavity: the free radial forearm flap versus the free jejunal flap].

The concentration in a restricted area such as the oral cavity of the essential anatomic structures for mastication, deglutition, speech, salivary drainage and respiration makes it indispensable to ensure not only the structural reconstruction of the region but also, and above all, a functional reconstruction of the anatomic unit affected by resection. The use of revascularised flaps has extended both the quantity and quality of reconstructive methods available. In the context of the oral cavity the most widely used flaps are the radial forearm free flap and jejunum free flap. In this paper the authors report their personal experience in a group of 13 patients (6 radial forearm and 7 jejunum) undergoing oral cavity reconstruction using free flap. For each flap the authors describe the microsurgical procedure, the clinical characteristics of the post-operative period, the locoregional complications, the donor site and lastly the long-term clinical, anatomopathological and functional modifications 6-12 months after primary treatment. Moreover, they highlight the varying characteristics of the two flaps and make a critical assessment of the advantages and disadvantages of using one or other method. Lastly, in the light of their experience and a review of international literature, the authors underline the importance of making a careful choice and personalized reconstruction, and finally outline their own criteria of choice.

Adult↗

PubMed1995

[Complications of reconstructive surgery using free flaps in the maxillofacial region].

The subject of our investigation was a group of twenty-nine patients with cervico-facial malignant neoplasms. The 29 patients, whose ages ranged from 12 to 68, with a mean age of 40, underwent surgery between January 1992 and January 1995. Cranial base and/or maxillo-facial defects were restored by free flap tissue transfer. Thirty-one micro-surgical free flaps were performed and post-operative monitoring was carried out for about 15-20 days. The aim of the present study is to show the importance of clinical semeiology which permits an early diagnosis of post-operative complications. Furthermore, post-operative monitoring of microsurgical free tissue transfer enables an etiological diagnosis and surgical vascular salvage of the flap to be made at the most opportune time. Many Authors report microsurgical transfer success at 95%-96% because timely detection and resolution of complication can minimize flap failure. We report our experience with 31 free flaps performed in 29 patients. Three of the patients needed a second transfer due to the failure of the first. Two underwent free flap transfers, while a pedicle flap was carried out on the other. In fourteen, latissimus dorsi free flaps were used (in 2 cases the procedure had to be performed twice), the forearm and the jejunum were employed in eight patients and the rectus abdominis in one.

Adolescent↗

PubMed1995

[Indications for mandibular periosteotomy in the treatment of cancer of the oral cavity].

Marginal mandibulectomy is a compromise between preserving the mandibular structure and radical oncological surgery. In order to evaluate the correctness of the indications for this operation, a group of 47 patients with oral carcinoma underwent direct surgery or associated chemoradiotherapy and surgery. Surgery was programmed on the basis of clinical and radiological examinations and the specific evaluation of the distance of the tumour mass from the mandibular surface. This approach was justified by the lack of correlation, in anatomic and clinical terms, between tumoral infiltration of the mandible and metastatic recurrence in the cervical lymph nodes. Lastly, the varying pattern of tumoral invasion of the various mandibular regions (thickness of cortical bone, presence of foramen) induced the authors to distinguish the indications for conservative treatment by segments. According to international literature and on the basis of the authors' past experience, marginal mandibulectomy represents an extremely interesting method since it associates a satisfactory aesthetic-functional level with a radical oncological approach, in particular with regard to the symphyseal and parasymphyseal region owing its structural characteristics and reconstructive importance. The indications for this type of surgery are therefore in theory based primarily on oncological aspects, and subsequently on the various anatomic and reconstructive aspects of the various mandibular segments.

Adult↗

PubMed1995

[Diagnostic and surgical problems in a case of post-traumatic retention of a foreign body in the submandibular gland].

We report a particular case of a traumatically introduced foreign body in the sub-mandibular gland. A breaking object (plastic pen) penetrated, through the anterior oral floor, the submandibular gland. Such foreign bodies should be removed before suturing the wounds, as they can disturb healing and cause problems long after the accident. An adequate history, clinical and imaging studies should reveal the possibility of foreign body penetration and its localization, when it isn't previously removed. We compare the use of ultrasound detection of foreign bodies in soft tissue and conventional plain radiography, computed tomography, and magnetic resonance imaging. The usefulness of US in this kind of research does not justify TC or RM studies and allows a less invasive surgical operation.

Child↗

PubMed1995

Posterior maxillary ostectomy for mandibular implant insertion.

Posterior maxillary ostectomy was performed for a patient who had extruded left maxillary molars into the edentulous mandibular region. With this procedure, enough interarch space was obtained, and one screw implant was simultaneously inserted in the edentulous mandibular posterior ridge.

Adult↗

PubMed1994

The surgical approaches to nasopharyngeal angiofibroma.

After a short summary of the aetiopathogenesis, the routes of extension and the diagnostic features of nasopharyngeal angiofibroma, the importance of early diagnosis and careful surgical planning is underlined. In particular the extension and topographic localization allows the choice of the best approach to optimize surgical radicality--the prime concern in the treatment of nasopharyngeal angiofibroma. Different surgical approaches are proposed for the tumour removal according to our experience in 17 patients.

Adolescent↗

PubMed1994

[The indications for reconstruction of the oral cavity using a pedicled flap of the musculus pectoralis major].

The reconstruction of postoperative or post-radiotherapeutic losses of substance in the oral cavity must respond to a number of basic requirements, such as lingual motility, the conservation of the labiogingival groove and adequate drainage of saliva towards the pharynx. This study reports the authors' experience of the reconstruction of the oral cavity using a pectoralis major myocutaneous flap. The identification of anatomic structures, such as the interpectoral compartment which separates the deep folium of the pectoralis major muscle from the clavi-coraco-axillary fascia covering the smaller pectoral muscle. Is indispensable for the correct preparation of the flap. Using an oblique incision along the lateral margin of the pectoralis major muscle the edge of the muscle is revealed and the muscle is separated from the pectoralis minor and from the costosternal structure. The cutaneous island is formed using the deep level of the muscle, and after tunnelling into the subcutaneous plane of the superficial fascia in the deltopectoral region, the flap is overturned to reach the part of the surgical reconstruction. The transposed tissue is sutured at various levels so as to reduce traction on a single component of the flap and to preserve the integrity of the perforating vessels. A total of 16 reconstructions of the oral cavity were performed by the authors using a pedunculated flap from the pectoralis major muscle. Fourteen of these cases were advanced stages of cancer and two were the outcome of radiotherapy. A myofascial flap was used in one case due to the excessive thickness of the subcutaneous panniculus of fat, whereas in the other cases it was not necessary to involve the cutaneous component which guarantees better functional adaptation. The following results were obtained: the metaplasia of the cutaneous surfaces of the flap into a multi-stratified non-keratinized epithelium and the contemporary reduction of cutaneous adnexa. The best functional recovery was observed using myocutaneous flaps compared to the case with the myofascial flap. Other results included: flap versatility in the reconstruction of the region of the retromolar trigonum and antero-lateral oral floor, and lastly the difficulty of performing a correct plastic surgery of the soft palate in those cases with damage in the tonsillar region and consequent rhinolalia. Complications observed, attributable to lesions of the perforating vessels, included two cases of total necrosis of the cutaneous component of the flap and four cases of partial necrosis which were resolved using local reclamation and medication.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed1993

Cranio-facial approaches for tumours involving the anterior half of the skull base.

Teamwork between neurosurgeons and head and neck surgeons has increased the possibility of managing tumours involving the skull base. The authors distinguish the anterior half of the skull base into a median and two lateral portions and describe the surgical approaches utilized to expose it. The authors present their clinical experience in 27 patients with extensive lesions of the anterior half of the skull base and their results.

Cavernous Sinus↗