Contemporary Management of Vascular Malformations Colletti, Giacomo, MD; Valassina, Davide, MD; Bertossi, Dario, MD ...
Journal of oral and maxillofacial surgery,
03/2014, Volume:
72, Issue:
3
Journal Article
Peer reviewed
Purpose To review the literature on vascular malformations and to clarify their diagnosis, clinical presentation, and treatment options. Material and Methods The authors reviewed the current ...literature on vascular malformations looking for more innovative and credited diagnostic criteria and treatment protocols. Results The review is divided in 4 sections (capillary, venous, arteriovenous, and lymphatic malformations). In each section, the clinical presentation, radiologic features, and treatment options for each kind of vascular malformation are described. The experience and results of the authors also are presented. Conclusions Vascular malformations are a heterogeneous group of diseases. Each type of malformation has unique features that make it largely different from the others. Only a clear and correct diagnosis can lead to optimal results.
Purpose Arhinia is a very rare malformation, and only 41 cases are described in the literature. Given its rarity, there is no standardized surgical protocol. This article describes our preferred ...treatment, which underlines the importance of maxillary osteotomy for obtaining satisfactory results. Methods We observed 3 girls with arhinia, 2 of whom were treated by a 2-step surgical protocol. During the first phase, the patients underwent maxillary osteotomy with the creation of a new epithelium-lined nasal cavity. A skin expander was also placed in the forehead. During the second step, an external nose was created in both patients from the expanded forehead flap with local perinasal flaps and costochondral grafts. Results Both reconstructions were viable and esthetically acceptable. No internal nose restenosis was observed. Conclusions On the basis of our experience, maxillary osteotomy should be considered part of an integrated approach in treating arhinia.
Summary Since 1988, the Milano surgical protocol has included lip, nose and soft palate repair at 6–9 months of age and closure of the hard palate at 18–36 months together with an Early Secondary ...Gingivo-Alveolo-Plasty (ESGAP). Prior to 1988 the alveolar cleft was repaired in a third step by bone grafting at 9–11 years of age. The goal of this study was to evaluate the long-term maxillary growth in unilateral cleft lip and palate (UCLP) patients who have undergone ESGAP. Alveolar ossification after ESGAP was also studied in the permanent dentition. Growth assessment was carried out comparing lateral X-ray cephalograms of a UCLP ESGAP sample (15 consecutive patients with a mean age of 18.2 ±1.2 years) and of the UCLP bone graft sample (10 consecutive patients with a mean age of 18.7 ±1.1 years) and a sample from the Oslo cleft lip and palate (CLP) centre sample (15 patients with a mean age of 18.1 ±0.8 years). Alveolar ossification in the sample which had undergone ESGAP was evaluated through a sample of panoramic X-rays of UCLP in the permanent dentition. Alveolar bridging was assessed using a modified Bergland's scoring system. From the results it seems that ESGAP allows for an excellent alveolar ossification, but patients show an inhibition of maxillary growth compared with the secondary bone graft group and with the Oslo group. Although ESGAP allows for early repair of the alveolus together with palate repair, thus eliminating in all patients the need for secondary bone grafting, it seems to have an inhibiting influence on maxillary growth which increases the need for Le Fort I osteotomies. It is however fair to recall, that, even with an adjunctive Le Fort I osteotomy, ESGAP enables the total number of operations to be reduced to three, instead of most European protocols (4–5 procedures).
