Maxillary ameloblastoma.

Maxillary ameloblastoma is a rare odontogenic neoplasm that is histologically benign and originates from epithelial cells present in bone tissue. If excised through conservative surgery, this tumour has a high relapse rate and is locally aggressive. The risk, in particularly extensive forms, that the ameloblastoma will invade extra-maxillary structures such as the orbit, the pterygomaxillary fossa, the infratemporal fossa and the base of the skull, means that surgical treatment is difficult if it is to be oncologically radical while respecting function and aesthetics. Thus, in these cases a complete and in-depth diagnostic work-up and careful planning of surgical treatment are needed: surgery entails an ablative phase with en-bloc resection of the neoformation to margins free of neoplastic infiltration, and a reconstruction phase that, within a short time-frame, will re-establish functionality and provide a good aesthetic result. Our experience in treating 2 cases of maxillary ameloblastoma is reported.

[Radial forearm free cutaneous flap. Evaluation of the level of damage to the donor site]. / Lembo libero fascio-cutaneo di radiale. Valutazione degli esiti a livello del sito donatore.

BACKGROUND: After more than a decade of experiences, the radial forearm fasciocutaneous free flap has proven to be a well standardized surgical technique, widely used for its easy application and versatility. The review of the literature shows that most of the contraindications to the use of this flap concern mainly the donor site morbidity. Aim of this work is to evaluate the complications of this surgical technique, to study the functional impairment and the scars secondary to the harvesting of the flap, in order to point out which techniques can contribute to their reduction. METHODS: Seventeen patients submitted consecutively to oral cavity reconstruction using a radial forearm flap, whose donor site has been reconstructed with a full-thickness skin graft have been studied. The postoperative complications have been examined, the functional and aesthetic alteration at the donor site analyzed, with a medium follow-up of 17.5 months. RESULTS: The study of this series has pointed out not relevant early and middle term postoperative complications, no significant hand or finger motility and sensorial deficiencies associated with a percentage of full aesthetic and functional satisfaction of patients for this treatment higher than 80%. CONCLUSIONS: On the basis of personal clinical experience, even if on a small series of cases, the conclusion is drawn that the functional and aesthetic outcomes depend significantly on the surgical techniques used to harvest the flap and to cover the donor site.

[Maxillo-mandibular fixation by mono-cortical screws. Clinical indications and surgical methods]. / Il bloccaggio intermascellare con viti transfisse monocorticali. Indicazioni cliniche e note di tecnica chirurgica.

BACKGROUND: Intermaxillary fixation is one of the most reknown and widely used techniques in maxillofacial traumatology. It's carried out usually by means of direct criss-cross teeth wiring or through the wiring of a metallic archbar on the upper and lower jaws. These techniques are time-consuming operations, they can produce dental or periodontal damages, and are not well tolerated by the patient, even under local anesthesia. Recent experiences in oral implantology and in the use of miniscrews for rigid internal fixation suggest the experimentation of new, easy to use and better tolerated systems for bone-anchored intermaxillary fixation. METHODS: 1-0 stainless steel wires and titanium monocortical screws, 2 mm of diameter and 12 and 15 mm of length, have been used as alveolar-bone anchorages for the intermaxillary fixation of 10 mandibular fractures. The fixations have been performed either under general or local anesthesia, with 2, 4 or 6 points of alveolar bone anchorage, maintaining the fixation for 15 days in condylar fractures and for 40 days in all the other cases. RESULTS: A really good compliance of the patient towards all the procedures performed under local anesthesia, with a clear reduction of postoperative discomfort has been observed. Infection or rejection of the implanted screws did not occur as well as cases of alveolar or dentoparodontal damages. CONCLUSIONS: This preliminary report on a new intermaxillary fixation technique didn't point out any significant complication of the procedure, showing at the same time that this technique can be easily performed under local anesthesia on out-patients with a better compliance, lower postoperative discomfort and good skeletal stability.

Subnasal modified Le Fort I for nasolabial aesthetics improvement.

We report our experience with a modified Le Fort I osteotomy developed to avoid nasal tip upturning, alar base widening, and upper lip flattening in anterosuperior repositioning of the maxilla. We compare the aesthetic results obtained with this variation of the surgical technique to those obtained using the more traditional Le Fort I osteotomy combined with the alar cinch suture and the anterior nasal spine reduction procedures on a sample of 20 patients.

[Osteo-hypertrophic angiodysplasia with oromaxillofacial localization. A report of a clinical case and a review of the literature]. / Angiodisplasia osteo-ipertrofizzante a localizzazione oro-maxillo-facciale. Presentazione di un caso clinico e revisione della letteratura.

The authors report a case of oro-facial port-wine stain angiomatosis with cutaneous and mucosal lesions localized in the first and the second branch surface distribution areas of the left trigeminal nerve in association with left upper lip, cheek and hemimaxillary true hypertrophy leading to a severe dento-skeletal malocclusion with open-bite and facial asymmetry. The authors through a revision of the literature locate nosologically this case among the rare congenital angiodysplastic syndromes affecting the maxillo-facial district as the Sturge-Weber and the Klippel-Trenaunay syndromes. They debate also about etiopathogenetic, clinical, differential diagnosis and therapeutic aspects concerning the management of patients affected by this kind of malformation.

[The diagnosis and surgical therapy of maxillofacial malformations. The statistical considerations]. / Diagnosi e terapia chirurgia delle malformazioni maxillo-facciali. Considerazioni statistiche.

In this report the authors develop a thorough statistic analysis upon the past 12-year activity (1980-1991) of the University of Rome, Department of Maxillo-Facial Surgery, in the field of the diagnosis and treatment of congenital or acquired maxillofacial malformations. They point out, in particular, the high frequency rate of bimaxillary osteotomy use in the surgical treatment of dentoskeletal malformations, that are the most frequent malformations in maxillofacial clinical practice. They also point out how wide the use of the rigid internal fixation technique in this surgical field has become.

[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.