Biomedical subjects
Publications and source records attributed to J Ferri.
The incidence of osteomyelitis of the jaw has declined. Outcome is favorable with antibiotic therapy and surgery. We report a case in a women who experienced an unfavorable course with massive progressive diffusion, complicated by neoplastic conversion.
BACKGROUND: An increase in masseter muscle tone in response to halothane or succinylcholine anesthesia (or both) can be observed in healthy persons. Thus the authors compared the fiber-type halothane and succinylcholine sensitivities in human masseter and vastus lateralis muscles. METHODS: Masseter and vastus lateralis muscle segments were obtained from 13 and 9 healthy persons, respectively. After chemical skinning of a single fiber and loading the sarcoplasmic reticulum with Ca++ 0.16 microM solution, halothane (0.5-4 vol% bubbled in the incubating solution), succinylcholine (0.1 microM to 10 mM), or both sensitivities were defined as the concentration inducing more than 10% of the maximum tension obtained by application of 16 microM Ca++ solution. The myofilament response to Ca++ was studied with and without halothane by observing the isometric tension of skinned masseter fibers challenged with increasing concentrations of Ca++. Muscle fiber type was determined by the difference in strontium-induced tension measurements. RESULTS: A significant difference in halothane sensitivity was found between type 1 masseter fibers (0.6+/-0.2 vol%; mean +/- SD) versus type 1 (2.7+/-0.6 vol%) and type 2 vastus lateralis muscle (2.5+/-0.4 vol%). Succinylcholine did not induce Ca++ release by the sarcoplasmic reticulum. In the masseter muscle, 0.75 vol% halothane decreased the maximal activated tension by 40% but did not change the Ca++ concentration that yields 50% of the maximal tension. CONCLUSIONS: The very low halothane threshold for Ca++ release from the masseter muscle usually could be counteracted by a direct negative inotropic effect on contractile proteins. However, halothane may increase the sensitivity of the sarcoplasmic reticulum Ca++ release to succinylcholine-induced depolarization, leading to an increase in masseter muscle tone.
Ewing's sarcoma is the second most common malignant bone tumor of childhood, yet it is a rare tumor. Primary maxillary localization is unusual and occur in only 1-2% of cases, mostly in the mandible. The prognosis of Ewing's sarcoma has been improving considerably since the introduction of combined modality treatment. The estimated overall survival at 4 years is 75%. It is widely accepted that prompt chemotherapy is necessary to treat occult micrometastasis, present in over 80% of cases at time of diagnosis, and to reduce the tumor size. Prognostic factors correlated with a poor overall survival are large tumor size and poor histologic response to initial chemotherapy. Adequate local control of Ewing's sarcoma can be achieved after chemotherapy, with radical or conservative surgery and radiotherapy. Surgery was recommended whenever possible. Radiation dosage and fields are based upon the quality of surgery and histological response to chemotherapy. Concern has been raised, however, regarding deleterious late effects of radiation in this young population. Conservative surgery and reconstruction are often used to improve functional outcome. We report four cases of Ewing's sarcoma localized to jaw bone and mandible, successfully treated by combined modality treatment.
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The Cook airway exchange catheter is mainly used in ICU patients to exchange endotracheal tubes. We report three cases where this device was used during anaesthesia in patients with damaged tubes in critical circumstances (oropharyngeal bleeding, head and neck surgery). It allowed a fast and atraumatic exchange of the tubes.
Gardner's syndrome is a very rare hereditary disease resulting from an embryo genesis disorder involving all three ectodermal, mesodermal and endodermal layers. Generally non-digestive tract signs disclose the syndrome. Underlying silent digestive anomalies should be investigated. Endodermal anomalies may have a fundamental effect on prognosis. Manifestations in our case were severe, with ectodermal and mesodermal anomalies occurring late. Maxillofacial management was required because of the critical esthetic and functional implications.
We report the case of a 75-year-old woman who consulted for suppurative gingivitis and maxillary deformation with slow progression and associated severe joint disorder. The patient suffered both esthetic prejudice and functional impairment. Clinical signs and radiographic findings suggested the diagnosis of fibrous dysplasia, in its leontiasis ossea form, rarely reported in the literature. Primum non nocere guided our management. Abstention, a simple remodeling resection, or extensive resection and reconstruction would have been inappropriate in this elderly patient. We opted for an orthognatic attitude in spite of the vascular risk inherent in the orthodontic preparation and the osteotomy on an abnormal dystrophic bone. Outcome was satisfactory.
This study discusses the morphologic evolution of the cranio-facial and cervical bone structures throughout life. A cephalometric study was made on lateral radiographs. The population studied included 84 males and 102 females. Ages ranged from 21 to 101. The cranial structures, superior facial structure, mandible and cervical vertebral column were successively examined. The anteroposterior diameter of the calvarium does not seem to undergo any modification during life. On the other hand, a highly significant increase of the thickness of this structure can be noted. The upper facial structure presents some modification, namely a significant increase of its posterior height. The palatine processus seems to change direction and pivot downwards and forwards. The maxillary sinus does not undergo any changes. The mandible, which is stable in its major axes, shows more malleable sectors which are more especially situated at the level of its body. The study of the cervical vertebral column reveals a loss of overall height, and an increase in the lordosis. The most numerous and most evident morphologic modifications were observed around the age of fifty in both males and females. The fact that these transformations are always commoned and greater in the latter reveals the plausible influence of the menopause. It appears that bone structures of membranous origin are the site of significant modifications compared with structures of endochondral origin, which benefit from a greater stability.
PURPOSE: The authors analyze the advantages and disadvantages of mandibular reconstruction with a fibula free flap in a retrospective study of 29 cases, and make comparisons with the iliac free flap and the lateral brachial free flap. MATERIAL AND METHODS: Twenty-nine patients (22 male, 7 female) aged 5 to 70 years were studied. Functional and esthetic evaluations were performed together with radiologic examination of the bony calluses. RESULTS: The fibula free flap has advantages for mandibular reconstruction, such as the length of bone available, low morbidity of the donor site, and the possibility of using a skin paddle. However, there is the disadvantage of not being able to reconstruct large soft tissue defects. In addition, bone vascularization is reduced when a large number of osteotomies are required. CONCLUSION: This reconstruction technique is satisfactory for mandibular defects measuring over 20 cm.
Although sutures have been identified as being important growth sites of the craniofacial complex, some points are still debated. The aim of our work was to analyze coronal suture response after immobilization in 24 New Zealand White rabbits. This immobilization was induced by an adhesive that bridged the coronal suture under investigation. Contrary to the reports of several authors, our procedure did not promote craniostenosis. The sutural space remains present even if it appears considerably reduced. Our cytometric examination clearly demonstrates that growth reduction localized on the external cortex of the calvaria whereas the internal cortex have a subnormal evolution. These findings favor a different evolving profile of both tables of the calvaria. They also suggest that one should be very careful before considering this procedure, as it may induce craniostenosis.
Local or block anesthesia can be used satisfactorily in many implant procedures. However, when advanced implant techniques or pre-prosthetic reconstruction surgery of the maxillofacial bones are required, local or regional anesthesia is insufficient. The "day-hospital" concept is a rational approach which meets the requirements for anesthesia and deep sedation with criteria for patient safety and comfort while guaranteeing optimal operating conditions. Intravenous sedation, both "conscious" and "deep" sedation, is a very well adapted form of anesthesia for implant recipients. Local or block anesthesia is enhanced or reinforced prior to surgery by the intravenous administration of a sedative and anxiolytic agent (single-drug concept), such as a benzodiazepine, associated or not with a morphinomimetic agent and an antihistaminic substance (multiple-drug concept). The main goal is to maintain spontaneous respiration while obtaining postoperative amnesia of the entire procedure. Mandatory use of a pulse oximeter has greatly contributed to improved safety of intravenous sedation, essentially indicated for operations not lasting more than 2 and a half hours in patients in good general health (scoring 1 or 2 in the American Society of Anesthesiology (ASA) classification) and with a low risk of postoperative complications. This concept requires an adapted technical facility. The operating theatre should have all the equipment necessary for cardiovascular, neurological and respiratory emergency care. The postoperative recovery room should also be equipped with cardiovascular monitoring devices and be able to accommodate an intensive care unit. Under these strict rules, short duration surgical procedures (< 150') can be performed : 1) with the best conditions of medical safety, 2) with improved operating conditions for the implant surgeon (the patient responds immediately to vocal orders when necessary) while asepsis is maintained as easily as with general anesthesia, 3) with better conditions for postoperative care and patient comfort (the anesthetist is continuously present). 4) better psychological conditions for the patient who will be discharged the same day, 5) with total amnesia of the entire surgical procedure, 6) elimination of a usually disproportionately long hospitalization. Day hospitalization also helps contain health care costs by cutting out the need for overnight care and accommodation. We underline the safety of current intravenous sedation techniques and present two series of data related to the use of this technique by an anesthetist and an operating surgeon in a day hospital from 1986 to 1995.
A case of immature teratoma involving mandible in a 56 year old woman is reported. This teratoma is composed of ameloblastoma structures mixed with some usual components of teratoma: osseous and cartilaginous foetal tissue, indifferenciated blastema, neuroblastic structures, acinous glands and melanotic cells. A lymph node is involved by metastatic mature glial tissue. This patient is treated by pelvimandibulectomy and irradiation. Histogenesis of this teratoma unusual by this ameloblastic component and this mandibular localization is reviewed.
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We report a case of metastasis in the masseter muscle secondary to stomach carcinoma. Second neoplastic invasion in skeletal muscle is an exceptional phenomenon. And this frequency is paradoxical against corporeal muscular mass. Immune hypothesis is conjure up for explain this fact. Symptoms are not specific and the diagnosis is not often recognized. However, systematic postmortem investigation is positive in one per cent of the cases. Consequently, every painful and nodular induration involved in carcinoma supervision must do perform a systematic biopsy.
The persistence of a residual communication between mouth and nose, is an important sequela a after primary closing of cleft palate. This retrospective study reports twenty-one cases of a new technique (retro-incisive flap) used for closing this residual communication. This flap is an easy and reliable method with an 85% success rate, so we recommend it as the first choice in this indication.
We report an osteotomy technique for the maxilla using an iliac graft and simultaneous implantation for correction of atrophic class III dysmorphosis of the maxilla. The advantages and disadvantages of this technique are discussed on the bases of a 3-year experience.
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Though clinic examination gives us much information, radiology still is essential in head trauma. Many standard radiographic projections have been described in the past and yet since the eighties it appears that C.T. scanner (C.T.) has become absolutely necessary to a great number of us. In fact, C.T. is indispensable when there is a matter of vital urgency or when a functional problem appears (diplopia). But most of the time high quality standard radiographic projections are sufficient. We have selected five radiographic projections: the occipito-mental's such as Mahoney's or Blondeau or Louisette, the submento-vertical's, the rotated occipito-mental's. For each of these radiographic projections we have specified the angular definition, the realization techniques, the criterions of quality and the results. The use of conventional radiology gives us images of which the quality is high enough to allow a precise topographical diagnosis and is far cheaper than C.T. So we can assert that standard radiographic projections are necessary and sufficient and that the use of C.T. becomes indispensable only in the few cases of diplopia or enophthalmia or complicated maxillary fracture. In the case of a lateral head trauma, our strategy of radiographic exploration will be represented as indicated on picture n degrees 20.