[Alveolar bone necrosis as a consequence of surgical intervention for hypophyseal adenoma]

Tumours of the pituitary gland, originating from its anterior lobe, may produce hormones and therefore generate a situation of pituitary hyperfunction or cause the typical problems of endocranial expansive masses which compress residual glandular tissue. Surgery is necessary in order to remove a pituitary tumour and is currently performed in 96% of cases using a trans-sphenoidal route. The surgical approach entails making an incision in the upper vestibular fornix from cuspid to cuspid. The stripping of a full-thickness flap allows the front wall of the sphenoid sinus to be reached, passing through the nasal cavities; it is then eliminated. This allows the floor of the sella turcica to be visualized; the latter is then removed to expose the pituitary gland. Surgical complications arising during the use of the trans-sphenoidal route are rare and the surgical removal of the adenoma ensures a greater probability of recovery compared to radiotherapy in view of the elevated radioresistance of these neoformations. The paper then reports two cases of alveolar bone necrosis in the premaxillary sector following surgery for the removal of pituitary adenoma. Case report--The first patient male, aged 23, presented a sequestrum in the vestibular alveolar wall in correspondence with 1.1 and 1.2. The patient underwent two operations (one using a craniotomy route and the other using a trans-sphenoidal route) to remove a giant pituitary adenoma. The sequestrum was removed, but the radicular surfaces of 1.1 and 1.2 remained exposed. In order to re-cover them, an attempt was made to increase the quantity of keratinized gingiva using the two-stage technique described by Bernimoulin.(ABSTRACT TRUNCATED AT 250 WORDS)