Bedsores successfully treated with topical phenytoin.

Phenytoin is normally used in epilepsy treatment. One of the side effect affecting a significative part of the treated patients is the gingival overgrowth. It could surely be a correlation between this stimulatory effect and the assessment of phenytoin in wound healing. In fact, some studies of the literature have shown that topical phenytoin promotes healing of traumatic wounds, burns and ulcers by decubitus or stasis (diabetic or venous) and we emphasize, in vitiligo, a particular attention into repigmentation. The related mechanism of action seems to be multifactorial. In the present paper topical phenytoin has been used as wound-healing agent in 19 documented cases of bedsores, divided in treated and placebo group. The used concentration of phenytoin was 5 mg/L dissolved in a water solution of 9 g NaCl /L (0.9% P/V of NaCl). Patches soaked with phenytoin solution were applied over the bedsores along 3 hours every 12 hours. Results showed that phenytoin treated patients healed their wounds significantly before (p<0.001) with respect to controls.

Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy.

INTRODUCTION: Grafting of autologous adipose tissue can be recommended in some cases of facial plastic surgery. Rhabdomyosarcoma is a type of cancer that can also affect the orbit. Enucleation of the eye can cause atrophy of the corresponding hemiface and decreased orbital growth. CASE REPORT: We report a case of a female patient with a medical history of surgical enucleation of the right eyeball, who had received rhabdomyosarcoma radiation therapy in her youth. The patient presented with a depression in the right zygomatic region. We took a dermal-fat flap from the abdominal region, which had been previously treated. RESULTS: The surgical outcome, 48 hours, and much clearly 31 days after the surgery, revealed that the right zygomatic region had returned to its proper anatomical shape, although there were still signs of postoperative edema. DISCUSSION: Very damaged tissues, like those exposed to radiation therapy, are generally not suitable for grafting of adipose tissue. CONCLUSIONS: In the described case, we achieved a technically and aesthetically satisfying result despite the patient's medical history involving several perplexities about the use of autologous dermal-fat tissues, because of prior radiation therapy exposure. The clinical case shows that even a region exposed to radiation therapy can be a valid receiving bed for dermal-fat grafting.

Simple technique for augmentation of the facial soft tissue.

Due to the request of numerous patients to improve the aspect of the perioral area in combination with other types of cosmetic and reconstructive surgery, we started to use autologous fillers. In fact, there are numerous potential fillers that can be utilized during various operations executed in many bodily areas, such as the breast, abdomen, and face. The muscular fascia as well as the dense connective tissue which the surgeon encounters in various bodily areas during some stages of the operation, in fact, can be removed and replaced both by themselves or superimposed in order to increase their thickness. The insertion of the grafts is carried out by using a needle, but other methods can also be used with the same success. The consistency of the area treated, after a few days of edema, is very similar to the host area, and the volume obtained remains uniform in time (our followup is after 24 months). The time utilized for the removal and the insertion in the chosen area was only a few minutes. The result was extremely satisfactory in all the 30 patients treated, and there was no complication or side effects.

Semi-open rhinoplasty: a new maxillofacial technique.

BACKGROUND: Rhinoplasty "open" represents a surgical technique to access to the internal structures of the nose; it is an alternative to more traditional "closed" rhinoplasty. However, both these techniques have some advantages and some disadvantages. In this work the authors describe a case that shows the steps of a new surgical technique: the "semi-open" rhinoplasty. METHODS: The "semi-open" technique is performed by making an incision to access on the mucosa of both the nostrils, and through this access we separate the cartilages of the columella from the alar cartilages, debriding them at the domus. With such access we can perform any type of rhinoplasty surgery with functional or aesthetic purposes. DISCUSSIONS: Traditional techniques have undoubtedly some advantages and some disadvantages. The "semi-open" technique has the several advantages of the open technique, and it does not involve the presence of post-surgical scars. CONCLUSIONS: This innovative technique provides great predictability and minimal postoperative discomfort, with no aesthetic damage.

Clinical case-study describing the use of skin-perichondrium-cartilage graft from the auricular concha to cover large defects of the nose.

BACKGROUND: The composite graft from the conchal cartilage is a graft that is often used, especially in surgery on the nose, due to its capacity to resolve problems of cover and tissue deficit, arising from the removal of neoplasms or as the result of trauma, burns or following over-aggressive rhinoplasty. We have started to use skin-perichondrium-cartilage graft from the ear to cover large areas of the nose with very satisfying results as well as we describe in the reported clinical case. METHODS: The operation consisted of reconstruction of the cartilaginous nasal septum, which had previously been removed, using two vestibular labial mucosa flaps to reconstruct the mucosa, and cartilage from the ear conch for the cartilaginous septum. After this, the skin edges of the fistula were turned to recreate the inner lining of the nose and form a vascular base of wide area to accept the composite graft. The case concerns a female 74-year old patient who had undergone several oncological surgery for a relapsing basal cell carcinoma on the dorsum of the nose. The operation consisted of reconstruction of the cartilaginous nasal septum using two vestibular labial mucosa flaps to reconstruct the mucosa, and cartilage from the ear conch for the cartilaginous septum. RESULTS: The perichondrial cutaneous graft has shown in this surgical case very favorable peculiarities that make it usable even in facial plastic surgery. CONCLUSIONS: We believe that the positive experience that we achieved in the use of composite grafts for the reconstruction of large areas of the nose could be interesting for others surgeons.

Oral piercing and oral diseases: a short time retrospective study.

Body piercing indicates the puncturing of a part of the body in which jewelry may be worn. In recent years, oral piercing is increasingly popular especially among young people. Body piercing has to be considered as a surgical procedure to all intents and purposes and, as such, has to be performed only by qualified personnel able to assure high standards of professionalism in facilities subject to sanitary inspections.The aim of the present work is to verify what risks patients may be exposed to and what complications may occur after a healthcare professional performs oral piercing.Our retrospective study includes 108 patients (74 males and 34 females) aged between 14 and 39 years, who had oral piercing done 12±4 months earlier. All the patients underwent clinical examination to reveal the possible presence of late complications. After piercing, none of the 108 patients developed widespread complications.Although all patients said they had followed the piercers' instructions, 96% of them reported postoperative local complications such as bleeding within 12 hours of piercing (90%), perilesional edema for 3±2 days after piercing surgery (80%), and persistent mucosal atrophy (70%).

Use of a diode laser in an excisional biopsy of two spoonlike neoformations on the tongue tip.

The 810 nm diode laser, due to its high affinity with haemoglobin (elective chromatophore) revealed, by itself, as elective instrument for surgical excision of the tongue, an organ highly vascularized and sensitive to the laser cutting action. The advantages for its use, with respect to the traditional cold blade surgery, are its haemostatic effect (which avoids to close wounds by stitches) and, not less important, the decontaminant effect of the laser ray, due to either the thermal raising created on cutting line and/or the specific selective action exerted on the bacterial membrane by its wavelength. Finally, the analgesic effect of the diode laser contributes to consider this kind of procedure more comfortable for the patient who often roundly requires its use.

Short report of an unusual ballistic trauma.

INTRODUCTION: Portable firearms have a relevant medico-legal interest, being a major cause of injury. Bullet entry wounds generally have a particular appearance, including contusion, skin introflection, and simple or excoriated ecchymosis. The skin wound is typically a hole with frayed margins, whose diameter is smaller than that of the bullet. PRESENTATION OF CASE: We report the case of a 19-year-old man with ballistic trauma. Examination of the patient's lesions indicated that the bullet had entered from the left mandibular parasymphysis, creating a small hole without the typical bullet wipe and blackening. Subsequently, the bullet seemed to have fractured the left chin region immediately below the lower alveolar process, and it finally stopped in the submandibular area in the suprahyoid region of the neck. DISCUSSION: This case is peculiar because the distinctive features of a firearm injury were absent; the lack of bleeding and edema made the case difficult to interpret without additional diagnostic investigations. CONCLUSION: Ballistic trauma can manifest in different ways; therefore, internal trauma should be suspected even in the absence of clear external signs. This case report shows how an unusual bullet entry hole can mask quite serious injuries.

Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study.

INTRODUCTION: Today, we frequently find patients taking oral anticoagulant therapy (OAT), a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications. MATERIALS AND METHODS: A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76) undergoing OAT for more than 5 years were managed with a standardized management protocol and a 2-months follow-up. The aim of the present study was to apply a protocol, which could provide a safe intra- and postoperative management of patients on OAT. RESULTS: Among the 193 patients, only 2 had postoperative complications. CONCLUSIONS: We think that the protocol used in the present study can be used for complete safety in the treatment of this type of patients.

Surgical treatment of depressed scar: a simple technique.

Scar formation is a process consequent to the healing of soft tissues after a trauma. However, abnormal or disturbed collagen production can cause anomalies of the cutaneous surface and textural irregularities. In the presence of a depressed scar in deep tissue, we began to use a new simple technique. In the presence of adherent scars, a small incision is performed so that an undermining scissor can enter inside. The entire cicatricial area is undermined on a subcutaneous plane which, by separating the deep scar from the superficial one, completely frees it from the present adhesions so that the existing depression is totally eliminated. In order to avoid the recreation of relapses, stitches formed in a U-shape are made in Nylon or Monocril 2-3/0 are made with a large needle and are placed close together so that a wide aversion is achieved at the margins of the scar and a deep wound closure is obtained by adhering to the undermined tissue. These stitches will then be removed about 2 weeks later.

Non-Hodgkin lymphoma affecting the tongue: unusual intra-oral location.

INTRODUCTION: The expression non Hodgkin lymphoma is used to cover a wide group of lymphoid neoplasias unrelated to Hodgkin's disease, due to the huge histological variety and the tendency to affect organs and tissues that does not physiologically contain lymphoid cells.The intraoral location is not frequent (3 - 5 percent of cases) and the initial manifestations of the disease rarely take place here. CASE PRESENTATION: We describe the case of a 73 years old Italian caucasian male who came to our attention with a tongue lesion. The clinical manifestation was macroglossia and bleeding, probably deriving from the tongue-bite injuries. The patient had been complaining of dyspnea for 48 hours. CONCLUSION: A tongue affected by non-Hodgkin's lymphoma rarely occurs. In spite of this, this possibility should always be considered for the differential diagnosis of benign and malignant lesions affecting such area.A rapid diagnostic assessment, together with an adequate histopathologic verification, are indeed essential to improve the management and the prognosis of this disease.

Fish-hook injuries: a risk for fishermen.

Fishing is one of the best known and practiced human activities. However, you should remember that, when casting the hook from the riverbank or grasping it to add bait, fishermen run a real risk of injury if the hook punctures the skin.Briefly we describe a case where a young, 32-year-old fisherman who was reeling the hook back to shore when it hit him in the face and embedded itself in his upper eyelid. Upon examination, the eye was found to be unharmed and the hook was removed through a small incision and the aid of a local anesthetic.In the light of this case report, we think it a good idea to advise our friends and patients who we know to be fishermen to wear some form of eye protection as a precaution.

Surgical Removal of lipoma from an area with tattooed skin.

The presence of tattoos on the skin of people of all ages is on the rise. On occasion, the tattoo is in close proximity to an area which has to undergo a surgical operation, therefore why not using the tattoo itself to cover the cicatrix?The case we treated was that of a 39 year old female who, for a couple of years, had a large lipoma on her right shoulder which she never treated because it was beneath a large tattoo. During the surgical treatment of the lipoma, we followed the exact lines of the tattoo itself thus obtaining precise access for lipoma removal which minimized visible post operative cicatrix while maintaining the original tattoo design.No similar case was found in literature.

Non-syndromic multiple supernumerary teeth in a family unit with a normal karyotype: case report.

Introduction. Hyperdontia is an odontostomatologic anomaly characterized by an excess in tooth number. It seems to occur more often in patients with hereditary factors concerning this anomaly: this case represents a rare form of hyperdontia, with bilateral multiple supernumerary teeth, with evident penetrance of the phenotype in the family unit engaged in the present study. The karyotype determination excludes a pathogenesis on chromosomal basis.Case report. A 30 years old patient came to our observation with five impacted teeth (1.8, 2.8, 3.8, 4.7 and 4.8), as well as with the presence of an impacted supernumerary tooth (distomolar 4.9). The patient was suggested to allow us to perform a radiologic screening to his two sisters aged 17 and 13 years.The X-ray photography showed that the elder sister had nine impacted teeth; these were 1.8 - 1.9 - 2.8 - 2.9 - 2.10 - 3.8 - 3.9 - 4.8 - 4.9; while the youngest sister had four impacted teeth, that is 1.8 - 1.9 - 2.8 - 2.9.Conclusions. The value of the present case report can be used as a paradigm for the assessment of the hereditary factors predisposing the onset of hyperdontia, and for the consequent management by oral surgeon of family units in which the odontostomatologic anomaly was detected without any syndromic forms.

Severe anisocoria after oral surgery under general anesthesia.

INTRODUCTION: Anisocoria indicates a difference in pupil diameter. Etiologies of this clinical manifestation usually include systemic causes as neurological or vascular disorders, and local causes as congenital iris disorders and pharmacological effects. CASE REPORT: We present a case of a 47-year-old man, suffering from spastic tetraparesis. After the oral surgery under general anesthesia, the patient developed severe anisocoria: in particular, a ~4 mm diameter increase of the left pupil compared to the right pupil. We performed Computed Tomography (CT) in the emergency setting, Nuclear magnetic resonance (NMR) of the brain and Magnetic Resonance Angiography of intracranial vessels. These instrumental examinations did not show vascular or neurological diseases. The pupils returned to their physiological condition (isocoria) after about 180 minutes. DISCUSSION AND CONCLUSIONS: Literature shows that the cases of anisocoria reported during or after oral surgery are rare occurrences, especially in cases of simple tooth extraction. Anisocoria can manifest in more or less evident forms: therefore, it is clear that knowing this clinical condition is of crucial importance for a correct and timely resolution.

A hypothetical correlation between hyaluronic acid gel and development of cutaneous metaplastic synovial cyst.

Thousands of patients receive hyaluronic acid filler injections, and the effects are generally considered acceptable. The acid rarely causes cutaneous reactions, which are only occasionally reported in the literature.The aim of the present work is to analyze a clinical case that has never been reported in the literature to our knowledge. This case is of a 26-year-old woman who presented with a cyst in the infrazygomatic region that was injected with non-animal stabilized hyaluronic acid at another centre a few months ago.Consequently, we made an external incision to remove the neoplasm: histological examination of the capsule revealed it to be a cutaneous metaplastic synovial cyst.

Eyelid bags.

Eyelid bags are considered a sign of ageing, but they often appear prematurely due to the variety of causes that favor them. This brief report describes the case of a patient who was referred to us for the correction of a second degree bilateral palpebral ptosis that the patient had suffered from for several years and that in recent months had worsened to the point of interfering with vision and who, aside from modest eyelid bags, presented a massive protrusion of "preocular" fatty tissue. Despite the indication of classic blepharoplasty through a lower lid incision and, therefore, the possibility of removing excess skin, the patient opted instead only for the removal of the bulging fat. The patient's postoperative results were normal and the patient was extremely satisfied with both the correction of the ptosis and the "rejuvenating" effect of removing the protruding orbital fat in the eyelid.

Comparison between traditional surgery, CO2 and Nd:Yag laser treatment for generalized gingival hyperplasia in Sturge-Weber syndrome: a retrospective study.

AIM: Sturge-Weber syndrome is a rare congenital disorder that belongs to the group of neuroectodermal development anomalies called "phakomatoses". Hyperplastic lesions affect the gingiva, causing massive spontaneous bleeding. METHODS: We report a retrospective study of 11 patients affected by Sturge-Weber syndrome, with generalized gingival hyperplasia and angiomatous lesions of the oral cavity. Traditional scalpel surgery was performed in three patients; the remaining eight underwent laser gingivectomy. Specifically, four were treated with electrosurgery and a CO2 laser, and the remaining four patients were treated with a neodymium-doped yttrium aluminium garnet laser at 1.06, with a power of 4 or 6 W. In order to measure the patients' pain response, we used a visual analog scale. We clinically evaluated the tissue response and the possible presence of relapse in the surgically-treated areas. RESULTS: The three patients treated with traditional surgery had a relapse between 17 and 24 months after surgery. The four patients treated with the CO2 laser had a relapse between 36 and 42 months after surgery in 75% of cases. CONCLUSIONS: The most encouraging results were achieved using the neodymium-doped yttrium aluminium garnet laser; patients treated with this procedure had a relapse 5 years and 4 months from surgery in only 25% of cases.

Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn.

While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging. This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle.