Maxillary post-traumatic outcome correction. Literature review and personal experience. Part II: loss of maxillary substance (free grafts of autologous bone).

Loss of maxillary substance following trauma varies significantly in relation to the dimensions, site and type of tissue involved. Anatomical maxillary interruptions, loss of dental elements and consequent bone re-absorption give rise to altered chewing, swallowing and speech functions. Treatment of pathological conditions over the years has seen the development of surgical protocols designed to achieve simultaneous aesthetic and functional restoration of the stomatognatic apparatus. The advent of osteointegrated implantology and continual progress in pre-prosthesis surgical techniques have undoubtedly revolutionised established approaches to prosthetic rehabilitation by introducing the concept of supported implant prostheses. The implantation protocols used are a safe and reproducible treatment method suitable for adequate anchorage of such prosthetic implants; the application of such protocols in any case is subordinated to the presence of adequate morpho-volumetric bone at the skeletal bases. Depending on the entity of maxillary loss of substance, the reconstruction methods we propose, in agreement with numerous other authors, are based on the use of free and free-revascularised autologous bone grafts or, even more recently, the application of osteogenetic distraction techniques. The purpose of this article is to evaluate treatment of loss of maxillary substance following trauma by means of non-revascularised free flaps. The use of free grafts of autologous bone is elective in patients presenting bone deficits less than 6 cm with and/or without upkeep of maxillary and mandibular cortical bone continuity but without compromise to the integrity and trophism of the soft tissues.

Retrospective evaluation on the surgical treatment of jaw bones ameloblastic lesions. Experience with 20 clinical cases.

BACKGROUND: Ameloblastoma is a benign but locally aggressive neoplasm of the odontogenic epithelium that causes expansion of the bone and tends to recur. The aim of this article is to present a retrospective evaluation on the management of ameloblastic lesion of the jawbones and to compare them with those reported in literature in order to rule out which surgical approach is likely to be the most appropriate, considering it extremely controversial. METHODS: Data corresponding to 20 patients with ameloblastic lesions involving the maxillary bones, admitted to the O ral and MaxilloFacial Surgery Department of Verona University Hospital, were analyzed in the period between 1984 and 1999. All data were selected for sex, age, site of involvement, histological patterns of the lesions, surgical steps performed concerning both primary pathology and secondary relapses including the reconstructive methods employed. RESULTS: The results showed a male/female ratio of 1.5/1. All the affected patients showed endosseous tumour masses localized in 90% of the cases at the mandible and only in 10% at the maxillary bone. Only one case with soft tissue involvement was observed. Treatment was enucleation and bone courettage in the 65% of cases while in 35% the lesion was excised performing wide bone resection. The histopathological study on the surgical specimens revealed the 50% of the lesions were unicystic 45% were multicystic showing the other 5% a carcinomatous ameloblastic patterns. The recurrence rate in patients managed with enucleation and courettage was 28.57% while in wide bone resection none recurrence was observed. CONCLUSIONS: Simply enucleation and curettage of multicystic ameloblastic lesion of jawbones results in an unacceptable recurrence rate. Conservative surgical treatment should be considered only in presence of unicystic lesion when extraosseous spread has not occurred. Multicystic lesions should be treated with an extended surgical resection.