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This study evaluates the effectiveness of maxillo-mandibular advancement (MMA) in patients with obstructive sleep apnea syndrome (OSAS), even those without skeletal anomalies, indicating the possibility of extending this procedure to more patients. Two groups with different skeletal patterns were studied pre- and post-surgery. Group 1 (11 patients) had severe or moderate OSAS and maxillo-mandibular hypoplasia and/or mandibular deformities (SNA angle 78° or less or SNA angle > 78° but with SNB < 65° and severe skeletal class II malocclusion). Group 2 (11 patients) had severe or moderate OSAS without maxillo-mandibular hypoplasia or deformity (SNA angle > 80°, dental class I occlusion). Analysis comprised: apnea hypopnea index (AHI), posterior airway space (PAS), SNA and SNB angles, Epworth sleepiness scale (ESS), body mass index (BMI), and a subjective standardized questionnaire about aesthetic appearance. All patients had increased PAS width and complete remission of objective and subjective OSAS symptoms evaluated by AHI and ESS. Results in both groups are comparable. Data were analysed using t-test; p < 0.005 was statistically significant. All patients were satisfied with the functional and aesthetic results. MMA is effective in patients with severe or moderate OSAS, even in those without skeletal and/or occlusal anomalies and can be considered in more patients. © 2010 International Association of Oral and Maxillofacial Surgeons.

In the majority of cases small bowel diverticula are asymptomatic. As a result, the diagnosis is frequently incidentally made either by radiographic examination or upon laparotomy due to complications. Enteroclysis, Tc-99m scintigraphy, video capsule and double balloon enteroscopy are useful diagnosing small bowel disorders, but their utility in emergency situations is limited. The clinical data from three consecutive patients surgically treated in our hospital for acute complications related to small bowel diverticula were retrospectively analyzed. Small Bowel Diverticula are a rare pathology and the clinical presentation is usually non-specific, even with acute or chronic complications. Some diagnostic examinations such as X-ray and ultrasound scan could not be useful to verify the existence of the pathology even in acute presentation but, in our experience, the computed tomography of the abdomen is the most helpful examination in localizing the disease and guiding the appropriate approach even when it doesn't suspect a definite diagnosis. CT findings are able to bring to a correct pre operative evaluation in presence of intestinal perforation, necessary to plan patient management

In the majority of cases small bowel diverticula are asymptomatic. As a result, the diagnosis is frequently incidentally made either by radiographic examination or upon laparotomy due to complications. Enteroclysis, Tc-99m scintigraphy, video capsule and double balloon enteroscopy are useful diagnosing small bowel disorders, but their utility in emergency situations is limited. The clinical data from three consecutive patients surgically treated in our hospital for acute complications related to small bowel diverticula were retrospectively analyzed. Small Bowel Diverticula are a rare pathology and the clinical presentation is usually non-specific, even with acute or chronic complications. Some diagnostic examinations such as X-ray and ultrasound scan could not be useful to verify the existence of the pathology even in acute presentation but, in our experience, the computed tomography of the abdomen is the most helpful examination in localizing the disease and guiding the appropriate approach even when it doesn't suspect a definite diagnosis. CT findings are able to bring to a correct pre operative evaluation in presence of intestinal perforation, necessary to plan patient management

Hepatic resection of liver metastases of non-colorectal, non-neuroendocrine, and non-sarcoma (NCNNNS) primary malignancies seems to improve survival in selected patients. The aims of the current review were to describe long-term results of surgery and to evaluate prognostic factors for survival in patients who underwent resection of NCNNNS liver metastases. Methods: We identified 30 full texts (25 single-center and 5 multicenter studies) published after year 1995 and published in English with a total of 3849 patients. For NCNNNS liver metastases, 83.4 % of these subjects were resected. Results: No prior systematic reviews or meta-analyses on this topic were identified. All studies were case series without matching control groups. The most common primary sites were breast (23.8 %), genito-urinary (21.8 %), and gastrointestinal tract (19.8 %). The median 5- and 10-year overall survival were 32.3 % (range 19-42 %) and 24 % (indicated only in two studies, range 23-25 %), respectively, with 71 % of R0 resections. Conclusions: There is evidence suggesting that surgery of NCNNNS metastases is safe, feasible, and effective if treatment is part of a multidisciplinary approach and if indication is based on the prognostic factors underlined in literature analysis.

Hepatic resection of liver metastases of non-colorectal, non-neuroendocrine, and non-sarcoma (NCNNNS) primary malignancies seems to improve survival in selected patients. The aims of the current review were to describe long-term results of surgery and to evaluate prognostic factors for survival in patients who underwent resection of NCNNNS liver metastases. Methods: We identified 30 full texts (25 single-center and 5 multicenter studies) published after year 1995 and published in English with a total of 3849 patients. For NCNNNS liver metastases, 83.4 % of these subjects were resected. Results: No prior systematic reviews or meta-analyses on this topic were identified. All studies were case series without matching control groups. The most common primary sites were breast (23.8 %), genito-urinary (21.8 %), and gastrointestinal tract (19.8 %). The median 5- and 10-year overall survival were 32.3 % (range 19-42 %) and 24 % (indicated only in two studies, range 23-25 %), respectively, with 71 % of R0 resections. Conclusions: There is evidence suggesting that surgery of NCNNNS metastases is safe, feasible, and effective if treatment is part of a multidisciplinary approach and if indication is based on the prognostic factors underlined in literature analysis.

Il presente lavoro analizza e valuta il ruolo svolto dalla chirurgia nel trattamento delle apnee ostruttive del sonno di grado severo; in particolare mette in evidenza i risultati ottenuti con l’avanzamento maxillo-mandibolare. Scopo Gli Autori analizzano su base statistica i dati ricavati dall’applicazione di un protocollo chirurgico che vede l’avanzamento maxillo-mandibolare quale indicazione al trattamento dell’OSAS grave associata a dismorfie cranio-facciali. Vengono confrontati i dati ottenuti dalla propria esperienza clinica con quelli della letteratura internazionale. Vengono poste le indicazioni cliniche sul tipo di paziente candidato all’avanzamento maxillo- mandibolare e le relative competenze necessarie per affrontare questi casi. Metodi Sono stati studiati 15 pazienti affetti da OSAS conclamata. I dati sono stati ricavati dall’analisi del monitoraggio cardio-respiratorio ridotto (Mesam IV), della cefalometria, dalle valutazioni cliniche pre e post operatorie. In particolare sono stati valutati: media dell’indice delle desaturazioni (ODI), la media dei picchi minimi di saturazione di ossigeno (Min. Sa.O2%), percentuale di russamento, spazio aereo posteriore faringeo (PAS), angoli cefalometrici SNA e SNB, scala di Epworth per valutare la sonnolenza diurna (Epworth Sleepiness Scale, ESS), cefalea mattutina. Risultati In tutti i pazienti si è registrato un aumento del PAS (raddoppiato in undici casi) e si è inoltre evidenziata una completa remissione della sintomatologia soggettiva. Il numero delle desaturazioni di O2 è drasticamente diminuito in tutti i pazienti (ODI da 48,1 a 7,8), anche la percentuale di russamento si èipertensiosensibilmente ridotta fino a sparire quasi completamente in sei pazienti (percentuale inferiore al 10%). Tutte queste variazioni sono risultate statisticamente significative. La remissione della sintomatologia è stata in tutti i casi repentina con abbandono della pressione positiva continua per via nasale (nCPAP) dopo l’inter, Background: This work analyzes and evaluates the role carried out by surgery in the treatment of severe obstructive sleep apnea syndrome (OSAS), particularly referring to the results obtained by maxillo-mandibular advancement. Aim: The Authors statistically analyse data from a surgical protocol consisting of maxillo-mandibular advancement as indication in the treatment of severe OSAS associated to cranio-facial abnormalities. Results from our clinical experience are compared with those from the international literature. Clinical indications of candidates to maxillo-mandibular advancement and the ability to face these cases are illustrated. Methods: Fifteen patients affected by OSAS were studied. Data from cardiorespiratory monitoring (Mesam IV), cephalometry, pre- and post-surgery clinical examinations were considered. Particular evaluations have been carried out concerning: oxygen desaturation index (ODI), lowest Sat. O2 %, snoring time (%), posterior airway space (PAS), SNA and SNB angles on cephalometry, Epworth sleepiness scale, morning headache. Results: All patients showed an increase in width of PAS (doubled in 11 cases) and a complete remission of subjective OSAS symptoms. Events of desaturation significantly decreased in all patients (ODI from 48.1 to 7.8) as well as the percentage of snoring which almost disappeared in 6 patients (< 10%). OSAS symptoms rapidly relieved in all patients, with discharge of nasal continuous positive airway pressure (nCPAP) after surgical operation. Conclusions: The primary goal of the surgical therapy of the OSAS must be the complete recovery from the syndrome, or at least a significant improvement of the clinical picture. Our results are similar and concordant with those from the literature. Therefore, we believe that, at present, maxillo-mandibular advancement is an effective and reliable surgical choice in the treatment of severe OSAS.

Drawing on more than 30 years of clinical experience, the author presents an integrated esthetic and functional approach to the treatment of dentofacial anomalies. From the initial planning through the orthodontic and surgical stages and finally to the postoperative phase. The accompanying DVD contains video footage of the treatment of an actual patient from start to finish, following the integrated approach presented in the book and with specific emphasis on surgical aspects.

Maxillo-facial surgery in adult patients affected by OSAS. In this paper, the Authors highlight the efficacy of maxillo-mandibular advancement in the treatment of obstructive sleep apnea syndrome (OSAS). After describing the evolution of the surgical technique, they provide a detailed description of their own approach. A statistical analysis of the results obtained in 12 patients showed that these were in line with those published in the international literature. andibular advancement sleep apnea syndrome rial surgery The Authors are of the opinion that, in sure and selected cases, characterised by considerable and vertically extended PAS restriction and marked diurnal symptoms, it is counter-productive to have recourse to surgical attempts that are unlikely to be successful. In such situations, maxillo-mandibular advancement is the best surgical option and can resolve the problem in a high percentage of cases. They also believe it is the most reliable approach to patients with severe OSAS who have specific clinical and cephalometric characteristics because it is capable of resolving both subjective and objective symptoms in almost 100% of cases.