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Gazzetta Medica Italiana Archivio per le Scienze Mediche 1998 October-December;157(5-6):141-8

language: Italian

Eval­u­ating the quan­tity of ­bone pro­duced in the ­site of ­schisis ­using 3D cat in ­patients ­with chei­log­nath­o­pal­a­tos­chisis under­going max­il­lary recon­struc­tion ­using ­Massei’s ­three ­layer per­i­os­tio­plasty

Gatti G. L. 1, Abruzzese A. 2, Massei A. 1

1 Azienda Ospedaliera Pisana - Pisa, UO di Chirurgia Plastica e Sezione di Microchirurgia;
2 Azienda Ospedaliera Pisana - Pisa, UO di Neuroradiologia


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Back­ground and ­aims. The ­authors com­pare two ­sample ­groups of ­patients ­with chei­log­natho-­pal­a­tos­chisis under­going cor­rec­tive sur­gery ­using the ­same pro­tocol in ­order to eval­uate the quan­tity of ­newly ­formed ­bone in the ­site of max­il­lary ­schisis ­after ­early per­i­os­tio­plasty ­using ­Massei’s tech­nique. 3D CAT was ­used to eval­uate the quan­tity of ­newly ­formed ­bone ­both ver­ti­cally (­from the pir­i­form aper­ture to the den­toal­ve­olar por­tion of the jaw), and in an ­antero-pos­te­rior ­sense (­from the ves­tib­ular ­cortex to the pal­atal ­cortex). The ­authors pro­pose a new clas­sifi­ca­tion of ­bone pro­duc­tion.
­Methods. Two ­sample ­groups of ­patients ­were ­studied ­using 3D CAT ­with ­axial ­scans of the ­site of ­schisis: the ­first ­group com­prised 19 ­schisis ­treated ­between 1977 and 1980, and the ­second ­included 8 ­schisis ­treated ­between 1984 and 1988. All ­patients ­were oper­ated by the ­same sur­geon ­with ­early per­i­os­tio­plasty per­formed ­under the age of two ­months. Oxid­ised and regen­er­ated cel­lu­lose (Tab­o­tamp) was ­always ­used in the ­first ­group, ­inserted in the per­i­os­teal ­flap, and one or two sur­gical con­trols of the jaw­bone ­were per­formed; Tab­o­tamp was ­never ­used in the ­second ­group and no ­long-­term sur­gical con­trols ­were per­formed.
­Results. In the ­first ­group ­bone pro­duc­tion was ­good and ­bone ­grafts ­were not ­required in 89.4% of ­cases; in 10.6%, ­bone pro­duc­tion was ade­quate but a tar­geted ­graft of a mod­erate ­size was ­required. No ­cases ­were ­observed ­where no ­bone was pro­duced ­after ­early per­i­os­tio­plasty. In the ­second ­group, ­bone pro­duc­tion was ­lower: ­bone ­graft was not ­required in 12.5% of ­cases, ­whereas a min­imum ­bone ­graft was nec­es­sary in 62.5% of ­cases, and in 25% ­there was no ­bone pro­duc­tion.
Con­clu­sions. The quan­tity of ­newly ­formed ­bone ­after ­early per­i­os­tio­plasty was ­optimal in the ­first ­sample ­group, con­firming the ­value of ­this tech­nique. Fur­ther ­studies ­will be car­ried out to estab­lish ­whether the sta­tis­ti­cally sig­nif­i­cant dif­fer­ences ­between the two ­sample ­groups ­should be ­ascribed to the use of Tab­o­tamp and/or ­long-­term sur­gical con­trols car­ried out on ­patients in the ­first ­group.

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