Effectiveness of Piezoelectric Surgery in Preparing the Lateral Window for Maxillary Sinus Augmentation in Patients with Sinus Anatomical Variations: A Case Series

Purpose: The present article sought to evaluate the effectiveness of a piezoelectric surgical unit for maxillary sinus augmentation surgeries in avoiding perforation of the sinus membrane and other possible procedural complications in patients with anatomical variations of the sinus. Materials and Methods: Twenty-five patients presenting sinus anatomical variations, who were indicated for a total of 40 sinus grafting procedures performed by the lateral window approach with a piezoelectric device, were analyzed. After 6 months of healing, implants were placed. Information collected included clinical and computed tomographic information on anatomical variations in the sinus bone walls, in the size of the sinus, and in the thickness of the sinus membrane. Occurrence of sinus membrane perforation and computed tomographic measurements of the amount of bone height gained with the grafting procedures were also recorded. Results: Only two patients presented a small perforation (less than 5 mm in diameter) of the sinus membrane, which occurred only after osteotomies of the lateral windows and did not compromise the surgical outcome. No implants were lost during a mean follow-up period of 19 months. Conclusion: The use of piezoelectric surgery allowed for the accomplishment of all rehabilitation treatments within the follow-up period of this study. INT J ORAL MAXILLOFAC IMPLANTS 2012;27:1211-1215

Evaluation of a Maxillary Sinus Floor Augmentation in the Presence of a Large Antral Pseudocyst

Sinus floor augmentation has been established as a predictable technique to overcome maxillary bone loss. Antral cystic lesions may lead to intrasurgical complications and should be accurately diagnosed. However, antral pseudocysts have recently been described not to be contraindicated for sinus-grafting procedures. The current article sought to report clinical, cone beam computed tomographic, and histologic results of a maxillary sinus floor augmentation, performed with piezoelectric surgery, in the presence of a large antral pseudocyst. Success of graft maturation was confirmed with histologic analysis, which also indicated the absence of inflammatory infiltration in the tissue evaluated. On the basis of our findings, it is possible to perform a predictable treatment based on sinus floor augmentation in the presence of antral pseudocysts. Graft maturation can also be achieved 6 months after sinus-lifting surgeries.

Using Mitrofanoff's principle and Monti's technique as a surgical option for bladder augmentation with a continent stoma: a case report

Abstract Introduction Hydronephrosis, reflux and renal failure are serious complications that occur in patients with neurogenic bladder associated with myelomeningocele. When the bladder compliance is lost, it is imperative to carry out surgery aimed at reducing bladder storage pressure. An ileocystoplasty, and for patients not suitable for intermittent catheterization, using the Mitrofanoff principle to form a continent stoma and the subsequent closure of the bladder neck, can be used. We report here, for the first time to the best of our knowledge, an association between two previously described techniques (the Mitrofanoff principle and the technique of Monti), that can solve the problem of a short appendix in obese patients. Case presentation A 33-year-old male Caucasian patient with myelomeningocele and neurogenic bladder developed low bladder compliance (4.0 mL/cm H2O) while still maintaining normal renal function. A bladder augmentation (ileocystoplasty) with continent derivation principle (Mitrofanoff) was performed. During surgery, we found that the patient's appendix was too short and was insufficient to reach the skin. We decided to make an association between the Mitrofanoff conduit and the ileal technique of Monti, through which we performed an anastomosis of the distal stump of the appendix to the bladder (with an antireflux valve). Later, the proximal stump of the appendix was anastomosed to an ileal segment of 2.0 cm that was open longitudinally and reconfigured transversally (Monti technique), modeled by a 12-Fr urethral catheter, and finally, the distal stump was sutured at the patient's navel. After the procedure, a suprapubic cystostomy (22 Fr) and a Foley catheter (10 Fr) through the continent conduit were left in place. The patient had recovered well and was discharged on the tenth day after surgery. He remained with the Foley catheter (through the conduit) for 21 days and cystostomy for 30 days. Six months after surgery he was continent with good bladder compliance without reflux and fully adapted to catheterization through the navel. Conclusion The unpublished association between the Mitrofanoff and Monti techniques is feasible and a very useful alternative in urologic cases of derivation continent in which the ileocecal appendix is too short to reach the skin (i.e., in obese patients).