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Chirurgia Plastica Pediatrica Chirurgia Plastica Pediatrica Sebastiano Franchella Franchella Andrea Andrea Franchella Sebastiano Franchella Chirurgia Plastica Pediatrica Chirurgia Chirurgia Plastica Pediatrica Le malformazioni congenite della faccia e del collo ISBN 978-88-944190-5-4 9 788894 419054 Chirurgia Plastica Pediatrica STAMPA cover.indd 1 17/12/19 19:39 CHIRURGIA PLASTICA PEDIATRICA Le malformazioni congenite della faccia e del collo a Tommaso Franchella Andrea Franchella già Direttore Unità Operativa di Chirurgia Pediatrica, Azienda Ospedaliero Universitaria di Ferrara Sebastiano Franchella Ricercatore Unità Operativa di Otorinolaringoiatria Azienda Ospedaliera Università di Padova Chirurgia Plastica Pediatrica Le malformazioni congenite della faccia e del collo OdV Associazione Ferrarese per lo sviluppo della Chirurgia Pediatrica http://chirurgoebambino.org/ I Edizione 2019 © Edizioni STC Tipografico ISBN 978-88-944190-5-4 È assolutamente vietata la riproduzione totale o parziale di questo libro, così come l’inserimento in circuiti informatici, la trasmissione sotto qualsiasi forma e con qualunque mezzo elettronico, meccanico, attraverso fotocopie, registrazioni o altri metodi, senza il permesso scritto dei titolari del copyright. Hanno collaborato: Roberto Bovo Manlio Galliè Professore Associato di Audiologia Direttore Unità Operativa di Chirurgia e Foniatria, Unità Operativa Maxillo-Facciale, Azienda Ospedaliero di Otorinolaringoiatria, Azienda Universitaria di Ferrara Ospedaliera Università di Padova (capitolo 3) (capitolo 3) Maria Elena Michelini Alessandra Cazzuffi Direttore f. f. Unità Operativa Dirigente Medico Unità Operativa di Chirurgia Pediatrica, Azienda di Chirurgia Pediatrica, Azienda Ospedaliero Universitaria di Ferrara Ospedaliero Universitaria di Ferrara (capitoli 2, 3, 8) (capitoli 2, 3) Cristian Succi Eleonora Cesca Dirigente Medico Unità Operativa Dirigente Medico Unità Operativa di Chirurgia Pediatrica, Azienda di Chirurgia Pediatrica, Azienda Ospedaliero Universitaria di Ferrara Ospedaliero Universitaria di Ferrara (capitolo 5) (capitolo 8) Claudio Vella Doretta Chendi Dirigente Medico Struttura Complessa già Dirigente Medico Unità Operativa di Chirurgia Pediatrica, Ospedale di Chirurgia Pediatrica, Azienda dei Bambini “V. Buzzi” Milano Ospedaliero Universitaria di Ferrara (capitolo 7) (capitoli 1, 4, 6) Illustrazioni a cura di: Nicoletta Bertolotti, Doretta Chendi, Sara Marchetto, Valentina Regano, Paola Gonzalez Ruiz, Cristian Succi. Prefazione La chirurgia plastica pediatrica ha cominciato ad acquisire una sua autonomia attorno agli anni sessanta del secolo scorso, sviluppandosi in particolare negli ospedali pediatrici dell’Europa e della America del Nord. Nel 1971 è stato pubbli- cato il primo libro consacrato esclusivamente a questa specialità, Plastic Surgery in Infancy and Childhood di John Clark Mustardè. Nel gennaio 2007 ho curato la pubblicazione del Manuale di chirurgia plastica pediatrica a conclusione di un percorso clinico e di ricerca che la chirurgia pedia- trica ferrarese aveva realizzato nel corso di quarant’anni. Questo volume rappresenta una revisione ed un approfondimento in partico- lare della parte dedicata alle malformazioni congenite della faccia e del collo, che costituiscono la maggioranza delle lesioni che alterano l’aspetto del bambino. Sono patologie che richiedono oggi un approccio dedicato come sta avvenendo nel mondo anglosassone dove emergono figure di chirurghi dedicati esclusiva- mente al trattamento delle schisi labio-maxillo-palatine o di medici che si occu- pano quasi esclusivamente di anomalie vascolari. Va quindi sottolineata l’importanza di un approccio multidisciplinare, dove i diversi specialisti danno il loro contributo per il raggiungimento del pieno recu- pero estetico e funzionale del bambino in un distretto, quello cervico facciale, fondamentale per la vita di relazione. Questa esigenza ha reso necessaria l’acquisizione di competenze specifiche in ambito otorinolaringoiatrico, specialità che ha sempre dimostrato rilevanti affini- tà con la chirurgia pediatrica, ed ha avuto, grazie alla disponibilità del Professor Alessandro Martini e dei suoi collaboratori dell’Università di Padova, una rispo- sta competente e precisa. Un sentito ringraziamento a tutti coloro che hanno collaborato alla stesura di questo volume. Ferrara, 29 settembre 2019. Andrea Franchella Introduzione Il libro affronta le problematiche diagnostiche e terapeutiche che la chirurgia pla- stica deve affrontare nel trattamento delle malformazioni congenite della faccia e del collo. Una parte del volume, piuttosto corposa, è dedicata alle labiopalatoschisi, le- sioni in assoluto di più frequente riscontro, dove viene riaffermata la necessità di un approccio multidisciplinare che veda coinvolti diversi specialisti così da poter garantire un percorso ricostruttivo e riabilitativo dalla nascita all’adolescenza. Ampio spazio viene dedicato anche agli emangiomi ed alle anomalie vascolari, anch’essi frequenti, in cui il corretto inquadramento è essenziale ai fini di una te- rapia appropriata. I capitoli relativi ai linfangiomi ed alle lesioni pigmentate, dopo un’introduzione di carattere generale, sono dedicati all’approfondimento delle le- sioni del distretto cervico-facciale. Un capitolo è stato riservato alle orecchie prominenti, mentre i rimanenti af- frontano le tematiche malformative della faccia e del collo nel bambino, descri- vendo le patologie più comuni, ma anche quelle che, seppur rare, vanno ricordate nella diagnostica differenziale. Il volume ha un carattere eminentemente pratico e vuole fornire uno strumen- to di facile consultazione a tutti coloro che si trovano ad affrontare queste mal- formazioni. Ferrara, 29 settembre 2019. Andrea Franchella, Sebastiano Franchella Indice 1. Orecchie prominenti ...................................................................... 15 Introduzione .............................................................................................. 15 Definizione ................................................................................................ 16 Embriologia ............................................................................................... 16 Anatomia chirurgica e semeiotica ............................................................. 17 Classificazione delle malformazioni del padiglione ................................... 21 Criteri terapeutici ...................................................................................... 21 Alternative alla correzione chirurgica ......................................................... 22 Correzione chirurgica delle orecchie prominenti ....................................... 23 Bibliografia ................................................................................................ 43 2. Schisi labio-maxillo-palatine ........................................................ 47 Definizione ................................................................................................ 47 Epidemiologia ........................................................................................... 47 Eziopatogenesi ......................................................................................... 48 Embriologia ............................................................................................... 51 Classificazione delle schisi oro-facciali ...................................................... 54 Caratteristiche morfologiche delle schisi oro-facciali ................................. 56 Gestione multidisciplinare del bambino affetto da labiopalatoschisi ......... 60 Timing chirurgico ...................................................................................... 66 Correzione della schisi unilaterale del labbro ............................................ 67 Tecniche chirurgiche .................................................................................. 68 Correzione della schisi bilaterale del labbro .............................................. 77 Tecniche chirurgiche .................................................................................. 78 Correzione chirurgica della schisi del palato .............................................. 82 Tecniche chirurgiche .................................................................................. 84 Correzione della schisi alveolare ............................................................... 94 Sequenza di Pierre Robin .......................................................................... 98 Bibliografia .............................................................................................. 103 3. Labiopalatoschisi, chirurgia secondaria ..................................... 105 Introduzione ............................................................................................ 105 Deformità secondarie del labbro ............................................................. 106 Fistole oro-nasali ...................................................................................... 111 Insufficienza velo-faringea .......................................................................113 Iposviluppo del mascellare e chirurgia ortognatica ..................................119 Disturbi della funzione uditiva ................................................................. 122 Chirurgia secondaria delle deformità nasali ............................................ 127 Bibliografia .............................................................................................. 132 4. Malformazioni del cavo orale ....................................................
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