iatrogenic benign paroxysmal positional vertigo
TRANSCRIPT
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126
Vestibology
Iatrogenic benign paroxysmal positional vertigo:
review and personal experience in dental andmaxillo-facial surgeryVertigine parossistica posizionale benigna iatrogena: revisione della letteratura
ed esperienza personale in chirurgia odontoiatrica e maxillo-facciale
G. CHIARELLA, G. LEOPARDI1, L. DE FAZIO2, R. CHIARELLA, C. CASSANDRO, E. CASSANDRO
Chair of Audiology and Phoniatrics, Regional Centre for Cochlear Implants and Otorhinolaryngologic Disorders, Dept.
Experimental and Clinical Medicine G. Salvatore, Magna Graecia University, Catanzaro; 1 ENT Unit, USL 11, Em-
poli; 2 Dept. Maxillo-facial Surgery, University of Perugia, Perugia, Italy
Summary
Th pst-tt f b pxs pst t s th st k, f pth-phs pt f
. B pxs pst t t s ts hs b sb th tt. a
t ps xp, ths t ss pst pssbt b th sq f s tts
ff t th t stt s thq pf. Th tp tshp th th
s t fts b s f ths ss, f t s t pssb t s-f-
ft k. Hth s ss f pxs pst t sb, st h t b f t , fs
t x-f s s sk fts f b pxs pst t.
Key wordS: B pxs pst t at S t dt s
riaSSunTo
Lorigine post-traumatica della vertigine parossistica posizionale benigna (VPPB) rimane la pi comprensibile da un punto di
vista siopatologico. In letteratura vengono descritte forme di VPPB successive a traumi chirurgici. Nella nostra esperienza
questi casi iatrogeni rappresentano unevenienza non frequente e possono essere conseguenza di interventi chirurgici diver-
si per distretto anatomico interessato e modalit di esecuzione. Il rapporto temporale con latto chirurgico ed il quadro clinico
sono fortemente suggestivi in alcuni casi per unipotesi del genere, anche se non possibile stabilire con certezza un nesso di
causalit. Nel presente lavoro verranno presentati alcuni casi di vertigine posizionale parossistica a forte sospetto iatrogeno,
focalizzando lattenzione allambito della chirurgia odontoiatrica e maxillo-facciale quali fattori di rischio per la VPPB.
Parole cHiave: Vertigine parossistica posizionale benigna Etiologia Trauma chirurgico Chirurgia odontoiatrica
Introduction
Th tt f b pxs pst
t (BPPv), pst th st fqt s
f bth t 1 2, pps t b th st k,
f pth-phs pt f . c
h ts t th spt f t bs
f th th pssb stt s
f th s s. Shft f ths p-
ts, t th ts f th h th k,
ps -pht st hh stts
th p pts st tp BPPv sp-
tt 3 4.
Pst-hpsh t h ts t -
ts ft th s f ths ss. o th
th h, s spts f pst-t BPPv s-
st th s t h b pt th
tt 5-8. a t xp, th s ps-
sbt f BPPv f s ps th
s- t ss t fqt (4.2% f
stps s pf ut). Fth, th
f fft s tts, -
p th t stt th s th-
q. i pt sts, sh pts
pssb, f st th s f t x-f-
s. m, t x-f s
ss t b f th st fqt ss f t
BPPv t th t fts f th stts -
tt ptt f th s thq.
Ths hpthss s st sppt b th tp -
tshp th th s t b fts,thh t s t pssb t s-fft
k. i p, ths pssbt s t th hpthss
f BPPv b pssb, thh t fqt, p-
t f s tts, sh s t x-
f s.
acTa oTorHinolaryngologica iTalica 2007;27:126-128
Acta Otorhinolaryngol Ital 2007;27:126-128
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vPPB x-f s
127
Review of the literature
F ss f BPPv, f tht ttt
t x-f s, h b pt th
itt tt. Pz gs t . 9 pt
s f BPPv f tht s tt
th sp x. Th s sb b Kp t .10s pt tst: bt pst s
(PSc) pth f t pt ttt.
i ft, th bt t s, s ths
, th . az, whttt l-
11pt s f BPPv sbsqt t s
f pt st, s sb th tt
f th b h hs, f t
px . n t . 7 th ths hpthss:
ft, th sb s f BPPv f x-f
s f th f s f th
sp x, th ptt f x psth-
ss. F 12sbs th st f BPPv sst th
stt t f tp t pts, sst-
t f stts thqs t pt ths
pt. g t . 13pt th s f BPPv
55-- ptt sbtt t pt s
th 2.3 . S t . 14h sb t ss f
BPPv f stht s th s.
Personal experience
F ths st, st BPPv ss, f ths bs
bt J 2003 Sptb 2005, hh th
st f spts t ft t
x-f s. Ptts th s ttt fps ts x, s s ths fft
b BPPv, s tht 7 s ft th s
ttt fft b th tt ps
ss f th pst bth.
m, h x ptts th BPPv sk -
ts (sp, hh hst s, s
pbs, ss, p-ps ,
t, t ss, ) 4s
s s th f 45 s fs 40.
Th ss f BPPv hs b , --
sp t, s th tp pst s
dx Hpks 15f th PSc P mcs (s
pst th ss) f th t s (lSc) 16 17. Th t s f th ss ths
pp f ths pth t: p-
xs sts th bf t, p b
t, xhstb, ptb, ftb. Th fts f
th sts, th s psts, t t th -
s hs, ths sb th tt 2 18.
BPPv s tt th eps th pst -
20
. vstb ftt f ptts, t th f th ttt, s t s Ftz
Hpks 19 tsts t x -
tt pst bth s. ltt ttt s p t
th t sts s t h -
ts f th h stt.
Fts f st ptts t Tb i.
a ptts t s xtt f pt tth
thh th s f th t b th th
f tt t.
Th st ptt, ft ps xtt f s tth (2
p, 1st-2ht pp s), t tht
ttt sst f t t p t sppt
th psthss t pp-x , th ht s. o f sh ht lSc BPPv. i th th sb-
jts, th pst s s fft.
vstb pth hs b , ss, th
s sbtt t s ttt. Th s
f bt pth sts t f -
tp s s. Th st t f ths p-
th s 4.1 s. Th st p st s pt
8 hs ft s ttt th st t ft
7 s.
Th ttt s f PSc s eps 20 -
pst , th hks b ft 15
ts th 7 s f ttt. i th s
th lSc, f pst th ppst hp21
hs b st. a th ss s th th
st ttt.
F-p f ptts s sh f 3, 6 12 ths
ft ttt: t ptt s
ss.
Discussion
Bs th tt tt th stt -
s t pt, ss pt tst
s f s s th hpthss f t f
BPPv f t x-f s.
i th ss bs b s b th aths, th k pthphs hs s pst b
t t f th pst bth t th s
Table I. Features of sample examined.
Age
(yrs)Sex Pathology
Onset
(days after surgery)Affected side
35 M Implant 1 PSC ipsilateral
22 M 3.8-4.8 Dysodontiasis 3 PSC ipsilateral
24 M 4.8 Dysodontiasis 7 PSC ipsilateral
30 F 3.8 Dysodontiasis 4 PSC ipsilateral
36 F 2.8-3.8-4.8 Dysodontiasis 8 hours PSC ipsilateral
35 F 3.8-4.8 Dysodontiasis 7 PSC ipsilateral
25 F 4.8 Jaw cyst 4 PSC ipsilateral
21 F 3.8-4.8 Dysodontiasis 3 LSC ipsilateral
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g. ch t .
128
f tt ts h hs th x
b stts t t th s pxt t th
tp b. vbts ppt thh th
b stts thss, p t th pst bth.
at ths , h b tsf t
th pht qs st t bt t th t spt. it s s k tht
th h ts f th f b ppt
thh pft s, hh th tp b s
ft .
mbs stts f th , t h-
bs th s f hh spt b th
pph, pt sbjt t tt ss
t th sp ppt f h -
th tp b. Ts, f t pt-
ts bt pt, sp f t b
tt stts th bt f hh s p
t, pst th s t f th s.
ath hpthss s th tt f th h, p-t ptts h x s
ths q tbt sths.
w th hptht xst f fb
t fts f BPPv ptt tk t
st t-ft ss. o th th h,
pth BPPv fs pbb sh t b-
b t th xt hs tht hs pk
th. as t, pst-tt fs
ths hh t s sp t hpthsz th pthphs-
hs. i p, th pssbts t b tk t st, th s
ts, t s. it s pssb t
hpthsz tht th s tt t ts s t-
ft p-xst sbstt. Bt, t st
ss, s st tht sk ts f
BPPv, th s-fft tshp pps s.
Ths stsss th t s ths pt,
f t fqt, sp s stts
tt b tt th th bth. it
sh t b ftt tht BPPv , ,
pst-t t, psts, t, f th s enT
ss, tht hh s sbjt t pst
ts, h pt sbt f ppx-t 2% 5%. dsss BPPv s pssb
pt f t x-f s,
th ptb - sqs, thf -
s p.
ass f sp: d. g. ch, ctt a
Ft ust m g ctz, / cps
ust gt, ep, 88100 ctz, it.
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r: ast 2, 2006 - apt: Fb 16, 2007