A monolateral TMJ replacement under intraoral endoscopic assistance for jaw osteomielitis: a modified approach.

Alloplastic replacement has become a valid treatment for TMJ endstage disease. The Alkayat and Bramley pre-auricular approach combined with the submandibular incision are the current surgical approaches for TMJ surgery. The present study shows a modified approach using intraoral endoscopic assistance. A female patient affected by jaw osteomielitis with condylar detachment was treated with total left TMJ alloplastic replacement combined with a right TMJ arthroplasty. No subamandibular incision was performed and, subsequently, the risks for permanent or temporary damage to the marginalis mandibulae nerve and surgical submandibular scar were avoided. Postoperative CT-Scan evidenced a good prosthesis position. No complications occurred after two years of follow-up.

Circumscribed myositis ossificans of the masseter muscle: report of a case.

Myositis Ossificans (MO) is an unusual pathological entity still largely unknown, characterized by dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue. The masticatory muscles are exceptionally involved. Four distinct types of myositis ossificans have been described: MO Progressiva, which is a genetic disorder involving several muscular groups; MO Circumscripta, limited to a single muscle and generally due to calcification of an intramuscular haematoma following severe trauma and progressive ossification; MO Pseudo-malignant limited to soft tissue and not associated to any trauma; MO associated to paraplegia. A case of circumscribed myositis ossificans of the masseter muscle in a 62 years-old woman is reported.

[A statistical study of 206 patients suffering from malignant neoplasms of the cervicofacial area]. / Studio statistico su 206 pazienti affetti da neoplasie maligne del distretto cervico-facciale.

This study focuses on the importance of early diagnosis in the oncological resolution of neoplasia of the cervico-facial district. In a sample of 206 patients suffering from neoplasia of the cervico-facial district, the authors found a greater incidence of pathology between the 6th and 7th decades of life, a finding that confirms the enhancement of etiopathogenetic factors over time. The oral cavity represents the site predominantly affected by this neoplasia with an incidence of 57.3%. Epidermoid carcinoma represents 61.7% of the histological types examined. The treatment protocol used in 167 patients depending on the clinical stage and the general conditions of the patient was as follows: multimodal in patients at stage 3 and 4 with a minimum survival rate at 12 months of 75% and 58% respectively, predominantly surgical in patients at stage 1 and 2 with a survival rate of 94.4 and 89.7% respectively.

[Perioperative drug management in surgery using revascularized flaps]. / Presidi farmacologici perioperatori nella chirurgia mediante lembi rivascolarizzati.

The success of free flap tissue transfer firstly depends on the correct surgical technique. Taking off from the donor site tissue for the reconstruction provokes a chain of physiopathological events that could evolve in truly pathological phenomena. The pharmacological treatment is aimed to miss and control the eventual local complication, and also to support the general conditions of the patient. Numerous pharmacological protocols have been proposed on experimental studies, and also on clinical practice to control local complications. It is necessary to eliminate the reactive vasospasm present in the vessels during anastomosis, and to reduce the risk of vascular pedicle thrombosis and to maintain rheological qualities of blood so to reactivate and sustain microcirculation functionality. Many authors have proposed anticoagulant and antiplatelet therapy, associated with vasodilatator drugs and drugs acting on blood viscosity and tissue metabolism, even if the latter have been primarily studied in experimental applications. The authors report their own experience on 29 patients that underwent 31 free flap tissue transfers from January 1992 to January 1995. The pharmacological therapy activated on the test can be divided into two different periods, one intraoperative and one postoperative. ASA is administered one hour before anastomosis, and vessels are irrigated with heparin or lidocaine solutions during the adventectomy and anastomosis. Antiplatelet therapy together with administration of low molecular dextran is performed in the first 3 to 4 postoperative days; afterwards, the dextran-40 administration is stopped while the ASA therapy is continued in smaller dose.

[A longitudinal analysis of dysfunctional TMJ pathology: an assessment of a sample of patients undergoing nonsurgical therapy]. / Analisi longitudinale della patologia disfunzionale dell'ATM: valutazione di un campione di pazienti sottoposti a terapia non chirurgica.

One the different interpretation of the pathological and clinical evolution of TMJ dysfunctions, the most-common of these pathologies is the condyle-disk uncoordination. This study analyzes the evolution of the treatment on the sample of patients affected by TMJ dysfunction and examined at the maxillo-facial department of the University of Rome "La Sapienza". After the TMJ dysfunction has been diagnosed the patients were informed of the individual therapeutic program which consisted of a temporary and definitive occlusal therapy. The aim of this scientific work is to control the efficiency within this therapeutic program in relation to the uncoordination of TMJ. In order to validate this approach the study was compared with another that considered the evolution of TMJ pathology in patients examined at the first diagnostic, visit but who had not undergone any treatment.

[Surgical and local treatment in a case of fungal sinusitis in a patient with bone marrow aplasia]. / Trattamento chirurgico e locale in un caso di sinusite fungina in un paziente con aplasia midollare.

We report a clinical case of severe medullary aplasia complicated by fungal antritis. The treatment adopted for this patient consists in a clean operation of the infective focus and the local instillation of Amfotericina B during the post operative period. In this way the systemic circulation is not interested by the use of Amfotericina B, which is extremely important to avoid the inevitable onset of several unwanted side-effects; besides, we avoid the progression of the infective focus and its systemic diffusion.

[A longitudinal analysis of dysfunctional pathology of the TMJ: an assessment of a sample of patients not undergoing therapy]. / Analisi longitudinale della patologia disfunzionale dell'ATM: valutazione di un campione di pazienti non sottoposti a terapia.

Concerning the different interpretation on the pathological and clinical evolution of the TMJ dysfunctions, the most common of these pathology is the condyle-disk incoordination. This study analyzed the evolution of TMJ dysfunctions examined at the maxillo-facial department of the University of Rome "La Sapienza". The non therapeutic approach does not consider an addition al control-sample of the non treated being itself a control-sample of a parallel work whose aim was to analyze patients who had undergone a complete therapeutic cycle.

[Role of integrated imaging (computerized tomography and echography) in the surgical reconstruction of the external ear]. / Il ruolo dell'imaging integrato (tomografia computerizzata ed ecografia) nella ricostruzione chirurgica dell'orecchio esterno.

Three-dimensional Computed Tomography (3DCT) imaging methods of the skull and ribs by axial and contiguous slices allow the selective rendering of the involved structures. The possibilities given by variable threshold ranges allow 12-bit density structures (Hounsfield Units) to be obtained within threshold limits. Imaging has been optimized by shading solids. Such methods, together with US (duplex-Doppler) techniques, offer new diagnostic possibilities relative to the treatment planning of patients with either congenital malformations or acquired abnormalities of the external ear and in the evaluation of associated abnormalities of craniofacial areas. In the reconstruction of the earlap by autograft of modelled rib cartilage, after preparing an expanded otomastoid skin flap, the above methods allowed accurate preoperative planning with consequently significant reduction of surgical time and better clinical results. Six patients with earlap abnormalities (four with microtia due to complete hemifacial microsomia syndrome, one with anotia and one with post-traumatic loss of the earlap) were studied for reconstruction. High-quality 3DCT images of the rib and auricolar cartilage were obtained in real-scale representation (1:1 ratio) the evaluation of the donor site and of the autograft size. Useful pieces of information on the development and vascularization of an expanded otomastoid flap, after gradual and constant expansion, were given by duplex-Doppler US, which allowed easy monitoring in both surgical planning and follow-up.

[PTFEe in the treatment of facial wrinkles]. / II PTFEe nel trattamento delle rughe facciali.

The first signs of skin aging appear quite early, around 30 years of age, and show as glabella and facial wrinkles particularly pronounced around the eye, lips and nasolabial area. None of these imperfections can be expressively modified through a cervicofacial rhytidectomy (facelift). The use of PTFEe in reconstructive surgery has been established by years of positive experience; therefore, the well known characteristics of such material suggested the idea of extending its use to aesthetic surgery. The corrections performed with this material are carried out mostly as day hospital surgery in local anaesthesia, requiring, however, technical skill to obtain satisfying results.

[PTFE in reconstructive surgery on the face]. / Il PTFEe nella chirurgia ricostruttiva del volto.

The employment of synthetic materials instead of autologous tissues (cartilaginous, adipose tissue, etc.) is already well codified and widely spread: the only restraint to their use is represented by biocompatibility which is not always satisfactory. Prosthesis should be clinically inert and inalterable with time, easy to sterilize, intraoperatively mouldable, and, from the aesthetic point of view, unrecognizable at touch. Since PTFE is widely used in general surgery (vascular prosthesis, aortobifemoral bypass, ect.) we have employed it in plastic surgery obtaining good results in the correction of malar depressions, and in harmonizing the final result of a rhinoplasty or of a labial plasty. All patients showed to well tolerate the material employed without any evident inflammatory reaction and with stable results at long-term follow-up.