Biomedical subjects
Publications and source records attributed to R Brusati.
To remove an endonasal tumour an access osteotomy has been designed which can be used for tumours of the nasal cavity. This approach allows for a safe and adequate tumour resection without appreciable morphological and functional consequences for the patient.
In the treatment of the severely damaged TMJ structural components (ankylosis, arthrosis, tumour, perforation or degeneration of the disc), it is advisable to insert a biological interposition between bony articular surfaces. The temporal muscle, due to its anatomical, topographical, and functional properties, can be successfully employed for this purpose. Based on the experience of Tessier, Delaire and Rowe, a temporalis muscle flap, inferiorly based, is rotated downwards and medially to the zygomatic arch, interposed and then fixed to condyle and capsule. Using this surgical technique, 12 patients and 13 temporo-mandibular joints were treated with good functional results and without any complication.
In oncological surgery of the pterygomaxillary fossa it is essential to achieve a wide access. For this purpose we have employed the old Jaeger's incision extended posteriorly in association with access osteotomies (zygoma and coronoid). In our experience (9 cases) the jugal access has provided good results without noticeable cutaneous scars. The technique is described with the presentation of 2 cases.
The maxillo-malar osteotomy is one of the osteotomies developed over the years to correct the deformities of the midface without modifying the nasal projection. After having for many years approached the osteotomy through the classic double access, intraoral and subciliary, we verified the feasibility of this osteotomy via an intraoral route only. For this purpose we modified slightly the classic osteotomy lines, however still including in the mobilized fragment the most prominent and therefore the most aesthetically important portion of the zygoma. At the lower orbital rim the medial osteotomy cut is performed with a fissure bur, the lateral one with an oscillating saw. Both the osteotomies are extended posteriorly in the orbital floor with a fine osteotome. Then, after having performed all other osteotomy cuts, the maxillo-malar complex is down-fractured. The residual thin bone structures which connect the maxillo-malar complex to the cranio-facial skeleton are broken during a careful downfracture, avoiding fracture between the maxilla and zygoma. The complex is advanced and stabilized with intermaxillary fixation, osteosynthesis and bone grafts. A bone graft to the orbital floor is unnecessary.
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The authors have made a study of 100 consecutive cases in whom a pectoralis major myocutaneous flap was employed for reconstruction after surgical ablation of advanced malignant tumours in the head and neck. The results obtained show that primary healing took place in 74% of cases with a relatively low incidence of complications. The authors therefore confirm the reliability of the pectoralis major myocutaneous flap, which, owing to its rich blood supply, offers the possibility of providing large cutaneous islands, and its proximity to the site of ablation provides a simple and reliable method which may be used in the majority of cases of immediate or delayed reconstruction of the cervico-maxillo-facial area.
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A series of 100 surgical procedures on the parotid gland affected by tumours is reported, with a detailed analysis of facial nerve function after parotid surgery. A low percentage of temporary lesions (28%) affecting only one branch of the facial nerve, all of which regressed in a short time, and only one case of a permanent lesion affecting the whole nerve, anatomically intact, however, was observed. The authors confirm the safety of parotidectomy, if correctly performed.
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When cancer of the tongue reaches a large size (T3, T4) it is almost impossible to treat it successfully with radiotherapy. The only therapeutic possibility in such cases is, therefore, total glossectomy. This may be effected without laryngectomy and with immediate reconstruction using musculo-cutaneous flaps. Such an operation allows total removal of the tumour and is followed by an acceptable though impaired functional result. Eight cases subjected to total glossectomy without laryngectomy are presented and aspects of ablative and reconstructive surgery are discussed. A report is made of postoperative complications and of functional rehabilitation: mastication is certainly impaired. However, swallowing is regained rapidly and phonation, although altered, is still comprehensible. An acceptable quality of life and good possibilities for a return to a working life result.
Pedicled tongue flaps have proved to be an effective method of repairing defects due to tissue loss in the oral cavity. No histological investigations have been done in respect of the longterm fate of these flaps after section of their nutrient pedicle. The histological pattern of the re-innervation process of heterotopically transposed lingual flaps in the oral cavity is evaluated in this paper. Two cases are reported: in the first, the tongue flap was used to repair the vermilion of the lower lip and in the second, for the closure of a post-traumatic defect of the hard palate. The histological findings are similar in the two cases: myelinated and unmyelinated fibres, free nerve endings and encapsulated receptors are present.
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The high frequency of permanent functional disturbance of the inferior alveolar nerve after sagittal osteotomy of the mandibular ramus is a disadvantage to which attention is always drawn in the different operating statistics. The authors, on the basis of previous experimental research, and in order to reduce the incidence of this disadvantage, have carried out sagittal osteotomy of the ramus in a series of patients by performing the splitting of the two cortical plates using a thin cement spatula as a chisel. The results have been extremely encouraging as the authors have observed only one case of permanent functional deficit of the inferior alveolar nerve and they have even noticed a very low incidence of temporary impairment.
The case report illustrates the microscopical and ultrastructural findings obtained in a case of Abrikossoff's tumor. On the basis of the light and ultrastructural data a neural histogenesis is suggested.
Repair of the labial commissure following tumour removal is performed with a U-shaped posteriorly based cheek advancement flap. With such a method a very good reconstruction of this delicate area can be achieved and it has no tendency to dehiscence or scar contracture at the vermillion border of the lip. Best results are of course obtained when reconstruction is performed in three layers (skin, muscle, mucosa).
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The authors describe a method which, according to the site of the lesion, permits the removal of a segment of the internal or external mandibular cortex en bloc with the primary tumour and with the satellite lymph nodes. This method, which retains the continuity and height of the mandible, offers the advantage of a greater radicality and at the same time avoids those impairments of the endoral morphology which are an obstacle to a subsequent prosthetic rehabilitation. Its advantages are compared with other surgical techniques proposed for the treatment of paramandibular cancer.