Biomedical subjects

G Iannetti

Publications and source records attributed to G Iannetti.

At least 37 records · Page 2Linked to original sources

PubMed1998

New approach to the surgical treatment of severe exophthalmos in Graves disease.

In the last few years, various surgical techniques to correct orbital decompression in patients with Graves ophthalmopathy have been proposed. In those patients in whom a high degree of exophthalmos is mainly the result of the hypertrophied endorbital muscles with respect to endorbital fat hypertrophy, lipectomy is insufficient to obtain an acceptable increase of endorbital volume. The authors propose a method that provides for the monobloc bilateral quadrantotomy by extracranial access. Despite traditional methods of decompression, the advantage of this technique is better advancement of the orbital margins. The bicoronal and endoral incisions guarantee no facial scars. Compared with the craniotomy, the extracranial access is also less stressful for the patient.

Adipose Tissue↗

PubMed1998

Prenatal diagnosis: evolution in craniofacial surgery.

Prenatal diagnosis of craniomaxillofacial malformations permits early surgery, before 6 months of life and possibly, in the near future, in utero, thereby obtaining the best aesthetic and functional results. Increased knowledge of embryology has largely improved the diagnosis of craniomaxillofacial anomalies, their classification, and therapeutic protocols. We analyzed nine pregnancies (one twin) in which cleft lip and palate (CLP)--isolated or associated with, for example, holoprosencephaly, hypertelorism, and micrognathia--was diagnosed by ultrasonography. Only one fetus of these pregnancies was later operated on in our unit. This patient, with 7 years follow-up, represents our clinical case. For these cases, early diagnosis of CLP allowed informed parental choice regarding the continuation or termination of the affected pregnancy and planning of surgical procedures to correct the malformation. This is demonstrated by the presented clinical case involving an infant operated on within 6 months with success.

Child↗

PubMed1998

[A primary pleomorphic adenoma of the parapharyngeal space].

The rarity of benign primary neoformations in the parapharyngeal space associated with aspecific clinical symptomatology often leads to the identification of large size lesions with deformation of the lateral wall of the pharynx and homolateral hemiplate. The improved diagnostic specificity of radiological instruments like CT and NMR allows a precise topographical localisation of the mass and the diagnosis of its nature in 90% of cases. The deep position of the neoplasia makes it necessary to search for the most conservative surgical approach possible that enables a sufficiently broad operating field to be obtained for complete exeresis and the control of neck vessels. This paper describes the therapeutic protocol used and makes a critical revision of the surgical approaches in an exemplary case of primary pleomorphic adenoma in this region.

Adenoma, Pleomorphic↗

PubMed1998

[Parapharyngeal involvement in neoformation of the deep parotid lobe].

The parapharyngeal space can be often interested by the extension of neoplasms starting at the deep lobe of the parotid gland level. According to many international authors, usually benign neoplasm originating at the parotid gland, tend to grow in the above mentioned area, while malignant tumors invade more easily the infratemporal fossa. Several diagnostic methods and ways of approaching the benign tumors of the parapharyngeal space have been proposed over the years. Personal experience at the Maxillo-Facial Department of the University of Rome "La Sapienza" and a typical clinical case for the diagnostic approach and surgical technique used by the authors, is described.

Adenoma, Pleomorphic↗

PubMed1998

[Maxillofacial fractures in children].

BACKGROUND: Facial traumas in the younger population involve esthetic and functional matters. According to the international bibliography these problems are due to the fixation technique employed and to a delayed surgical treatment. METHODS: This article contains a list of 68 pediatric facial fractures treated at the Maxillofacial Department of the University of Rome "La Sapienza" including diagnosis and therapy over a period of 16 years (January 1981-October 1997). RESULTS: The results of this research show that the ability to treat such traumas is based on the early and careful identification of the fracture and on the choice of the best therapy to carry out according to the patient's age and with the fracture site pattern. RIF fixation is good to obtain healing in adults, but it may be responsible of disturbances in bone tissues growth. Hence, it was used in selected cases only, in order to avoid bone growth restriction as stressed in international bibliography. CONCLUSIONS: A delayed surgical repair of pediatric facial fractures does not guarantee the return to a correct functionally and to an appropriate esthetic feature.

Adolescent↗

PubMed1997

Early and late surgical treatment of orbital dystopia in craniofacial malformation.

Orbital dystopia is one of the most frequent clinical signs of craniofacial malformation. The term dystopia indicates the mono- and bilateral asymmetry of the orbits at least in one of the three-dimensional planes. The diagnosis is based on the clinical test of the patient with the support of diagnostic instruments such as teleradiography in both standard projections, axial computed tomographic (CT) scans at a rate of 1:1 through the neuro-orbital plan, and the three-dimensional CT. Good results of the surgical treatment depend on the patient's age and on adequate programming, which should consider the anomalies in the three spatial planes. The VTO is obtained through a protocol of analysis on cephalometric graphics of the teleradiographics on the CT at a rate of 1:1. The surgical treatment of orbital dystopia is different depending on the age of the patient and the cause of the orbital anomaly. In the case of growing patients, it is preferable to use the fronto-orbital bandeau technique so as not to damage the dental buds, whereas in grown patients Tessier's orbital quadrant technique is used. Even the fixation is quite different between patients who are growing and those who are already grown. In still-growing patients, rigid internal fixation is used only in some cases to avoid the interference with the growth mechanisms.

Adolescent↗

PubMed1997

Surgical planning and correction of medial craniofacial cleft.

In the framework of malformations that concerns the craniofacial area, the orbit is often involved because it represents the border structure between the neurocranium and the splanchnocranium. In these malformations it is very easy to find hypertelorism. Tessier classified clefts rising from the anterior skullbase and involving the maxilla and the alveolar process, as medial or 0 = 14 clefts. We report on a 2-year-old patient, treated with cranial decompression at an early age, suffering from this kind of malformation. To correct it, the surgical technique of facial bipartition was used. This technique, used for the first time by Tessier and then modified by Stricker and colleagues, allows the simultaneous correction of the orbits and maxilla. It is very important to make a correct diagnosis, to plan for surgery carefully for patients suffering from this kind of pathology, and to prescribe the most effective therapy. A computerized analysis system, based on the study of teleradiographic images and on three-dimensional computed tomography, to quantify the extent of the malformation and to define surgical planning was developed.

Child, Preschool↗

PubMed1997

Paranasal sinus mucocele: diagnosis and treatment.

Several controversies still exist regarding the etiopathogenesis, diagnosis, and type of surgical treatment used in response to paranasal sinus mucocele. We wish to contribute to the standardization of therapeutic treatment for paranasal sinus mucocele by reporting our clinical experience in "open surgery." This analysis considers 53 patients--23 males and 30 females (age range: 11-80 years)--affected by frontoethmoidal or sphenoidal sinus mucocele whom we have surgically treated. Patients were classified according to age, sex, previous surgical treatment in the nasal area, symptoms, and acute visual difficulties; 15 patients showed disease in the frontal area, 28 in frontoethmoidal area, and 10 in the posterior ethmoidal or sphenoidal area (or both); in 18 patients the disease had reached the intracranial region. Transfacial approaches were used in all patients who did not show evidence of disease in the intracranial region. Of all the incisions performed 18 were coronal, 16 were paralateral, and 4 were through upper eyebrow approaches; a transnasal endoscopic approach was used in only 1 patient in whom the intracranial region was affected by disease. All patients showed satisfying functional and aesthetic results during and after recuperation.

Adolescent↗

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

[The interdisciplinary approach and early surgery in the trigonocephaly].

Craniofacial surgery aims to stop the pathological process due to the presence of one or more malformations affecting this part of the body, in order to prevent and reduce the secondary damage caused by wrong development of the stricken structures. However, in order to achieve this goal, it is necessary to abide by some criteria, like the interdisciplinary nature of therapeutic procedures and early surgery. Since craniofacial malformations affect some anatomical areas that need combined approaches for diagnosing, preventing and correcting the existing anomalies or the possible complications, it is extremely necessary to set a collaboration between different medical and surgical disciplines. Surgical "timing", lasting from 4 to 6 months, is the basis of early surgery, which aims to prevent the morphostructural alterations of the part, assuring again the physiological growth of the stricken tissues. For this reason, craniostenosis are the malformation syndromes that mainly fit this kind of therapeutic protocol. In this document the authors describe the application of the above cited principles for the resolution of the stenosis of the metopic suture in 9 patients (3 males and 6 females), admitted to the Department of Maxillofacial Surgery of the University of Rome "La Sapienza".

Craniosynostoses↗

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

Functional therapy in hemifacial microsomia: therapeutic protocol for growing children.

PURPOSE: This study evaluates the skeletal response to functional orthodontic therapy in growing children with hemifacial microsomia (HM). A method of classification for mandibular growth subsequent to treatment is also suggested. MATERIALS AND METHODS: Sixteen growing children with unilateral HM were treated. Each patient was graded according to the skeletal, auricular, tissue (SAT) classification. Patients graded S4-S5 were excluded because the severity of the malformation made them unsuitable for functional orthodontic treatment. All patients initially underwent a period of treatment with an asymmetrical functional activator (AFA). RESULTS: In 7 of 16 cases (43.7%) classified as S1-S2/T1, regardless of the value of A, functional therapy brought about mandibular growth greater on the side of the malformation (G3-G4), re-establishing structural and functional harmony of the entire stomatognathic apparatus. Of the five cases (31.2%) classified as S2/T2, four required surgical intervention at about 10 years of age after an initial period of functional therapy that produced mandibular growth classified G1-G2. In the other case, functional treatment was sufficient to correct the malformation. In four patients (25%) classified as S3/T3 or S3/T2, it was necessary to combine surgical treatment with functional therapy. CONCLUSION: Use of the AFA in growing children with HM makes it possible to induce harmonious maxillomandibular growth. Statistically, in S1-S2/T2 cases, functional therapy brings about an overall resolution of the malformation whereas in more severe cases (S2/T2), it needs to be combined with orthodontics using fixed appliances and surgical intervention.

Activator Appliances↗

PubMed1996

Study and planning of the surgical procedure for the orbital district in patients affected by craniofacial malformations.

Orbital surgery is of critical importance within the framework of craniofacial surgery. The conical conformation of orbits requires analysis and surgical procedure planning methods involving all three dimensions. We present our protocol for the analysis and our three-dimensional surgical procedure plan to treat orbital malformations using teleradiography and two- and three-dimensional computed tomographic imaging. A number of clinical cases treated according to this approach are also presented.

Adolescent↗

PubMed1996

Subnasal modified Le Fort I for nasolabial aesthetics improvement.

We report our experience with a modified Le Fort I osteotomy developed to avoid nasal tip upturning, alar base widening, and upper lip flattening in anterosuperior repositioning of the maxilla. We compare the aesthetic results obtained with this variation of the surgical technique to those obtained using the more traditional Le Fort I osteotomy combined with the alar cinch suture and the anterior nasal spine reduction procedures on a sample of 20 patients.

Esthetics↗

PubMed1995

Use of rigid external fixation in fractures of the mandibular condyle.

In this article the use of a rigid external fixation system is proposed for the early treatment of condylar fractures. This method offers the advantage of not damaging the articular structures during reduction and allows early mobilization for a rapid recovery. In our Centre 28 patients have been treated with the rigid external fixation system, with good functional results. Of these 15 men and 13 women, 22 had a monocondylar fracture and 6 had a bicondylar fracture. In all the cases there was complete recovery of the occlusal stituation and of the mouth opening; no patient surgically treated with this method has ever presented problems of a local or general nature. The purpose of this report was to evaluate the use of external fixation for the treatment of extracapsular condylar fractures with luxation of the fragment out of the glenoid cavity.

Adolescent↗

PubMed1995

Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus.

A transmaxillosphenoidal approach was used to remove sellar tumors invading the cavernous sinus. This procedure, a widening of the standard transsphenoidal approach to the sella turcica, uses the sublabial or transnasal route in which the medial wall of the maxillary sinus is laterally dislocated. This method provides good exposure of the prominences of bone above the carotid artery which lies on the posterolateral wall of the sphenoid sinus. This bone area is the key to opening the cavernous sinus inferomedially and removing lesions within its medial compartment. The inferomedial approach takes an entirely extracerebral route so that tumors invading the cavernous sinus through its medial wall are approached inferomedially following the direction of tumor growth. It also allows direct visualization of the intracavernous carotid artery during tumor removal, thus sparing the cranial nerves, which run on the opposite side. Adequate surgical exposure of a pituitary adenoma is achieved with a custom-made sphenoidal retractor with asymmetric blades, the shorter blade holding aside the thin medial wall of the maxillary sinus. Between October, 1989, and July, 1993, 11 patients with tumors invading the cavernous sinus underwent surgery via this approach; 10 had pituitary adenomas and one had a craniopharyngioma. Eight tumors were treated by primary operation: four tumors were totally and four subtotally (> 80%) removed; one tumor already operated on elsewhere was totally removed; and of two tumors already operated on and irradiated, one was subtotally removed and the other only partially (approximately 40%) removed owing to marked postirradiation scarring. None of the patients suffered permanent cranial nerve deficit and all but one showed marked clinical improvement.

Adenoma↗

PubMed1995

Short- and long-term omeprazole for the treatment and prevention of duodenal ulcer, and effect on Helicobacter pylori.

OBJECTIVE: This study analyzes the effect of short- and long-term omeprazole (OM) on duodenal ulcer healing, recurrence, and H. pylori status. METHODS: Patients affected by active duodenal ulcer were randomly allocated to treatment with OM 20 mg or 40 mg once daily for 4 wk. Subsequently, patients with healed duodenal ulcer were randomly assigned to one of the following three groups: OM 20 mg once daily for 12 months, OM 20 mg alternate days for 12 months, and no treatment. Endoscopy was performed at entry, at 4 wk, and after 4, 8, and 12 months. Two biopsy specimens from antrum, body, and fundus were taken for histology and search for H. pylori. One hundred and eighty patients with active duodenal ulcer were admitted. Ninety-one were treated with OM 20 mg once daily and 89 with OM 40 mg for 4 wk. RESULTS: The results at 4 wk show 92.8% patients healed with OM 20 mg and 95.1% at 40 mg (NS). In the second part of the study, 96 of the patients who healed at 4 wk (45 with OM 20 mg, and 51 with OM 40 mg) entered the long-term study. Thirty-six patients received OM 20 mg daily for 12 months, 35 OM 20 mg on alternate days for 12 months, and 25 patients no treatment. The results show a healing rate of 100%, 100%, and 95% with OM 20 mg daily, of 97%, 95%, and 93% with OM 20 mg on alternate days, and of 81%, 50%, and 40% (p < 0.01) with no treatment at 4, 8, and 12 months, respectively. H. pylori that was found in 97% of patients at entry, at 4 wk was found in 92.8% of patients treated with OM 20 mg and in 97.5% of patients treated with OM 40 mg (NS). In one-third of the patients, H. pylori disappeared from the antrum but was found in the fundus. A 30% reduction in the presence of H. pylori was seen in the group treated with 20 mg daily for 12 months. CONCLUSIONS: We conclude that both continuous and alternate-day long-term OM treatment at 20 mg are similarly efficacious in the prevention of duodenal ulcer recurrence. Healing active duodenal ulcers with 20 or 40 mg does not influence subsequent treatment. Long-term OM at 20 mg daily for 12 months suppresses H. pylori temporarily in one-third of the patients. In these patients however, H. pylori reactivates after the end of treatment.

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↗