Preliminary Results of Bone Regeneration in Oromaxillomandibular Surgery Using Synthetic Granular Graft.

Traumatic, neoplastic, inflammatory, or infective dental removal promotes a gradual resorption process of bone which leads to a "nonuse" atrophy of the alveolar ridges. Many techniques allows restoring an appropriate bone thickness, but nowadays the attention is focused on the use of natural or synthetic grafts. Numerous studies have been conducted to develop and test new synthetic materials. In this article, the authors report their experience using a synthetic bone substitute in combination with Platelet Rich Fibrin (PRF). This technique was applied in different zones of the maxillomandibular district. The procedure showed a very satisfying bone regeneration without important complications.

Reconstruction of Extended and Morphologically Varied Alveolar Ridge Defects with the Titanium Mesh Technique: Clinical and Dental Implants Outcomes.

A sample of 24 patients with varied morphologic defects were treated with 34 titanium meshes and particulate bone and rehabilitated at least 8 to 9 months thereafter with the placement of 88 implants. Of the 34 meshes, 4 had to be removed before implant placement (11.76% total failure) and 20 were exposed due to soft tissue dehiscence (58.82% of complications): 4 (11.77%) prematurely (within 4 to 6 weeks) and 16 (47.05%) delayed (after 4 to 6 weeks), with no compromise in implant placement. None of the 88 implants was lost (100% implant survival), and 15 demonstrated increased bone loss, yielding a cumulative implant success rate of 82.9%. This technique appears useful in treating extended and morphologically varied alveolar defects.

Schwannoma of the facial nerve: indications for surgical treatment.

There is no preoperative diagnostic modality that can identify facial nerve schwannoma with certainty. Difficulty in locating the facial nerve intraoperatively raises suspicion of a neurogenous tumor of the facial nerve, and this may prevent unnecessary damage to the nerve. Not every facial nerve schwannoma should be resected.

Sphenoidal-clival neoformation: an endoscopic approach.

The cranial base has distinct embryologic origins. The anterior cranial base is derived solely from the neural crest, similar to other facial bones, whereas the posterior cranial base is formed by the paraxial mesoderm. Both these parts also develop and grow with distinct features. Unlike other craniofacial bones that are mostly formed through intramembraneous ossification, the cranial base is formed through endochondral ossification, in which a cartilage plate, known as the chondrocranium, is formed first and soon replaced by bones. Individual bones are then connected by cartilaginous structures, termed synchondroses, which are morphologically similar to long-bone growth plates.These processes justify the presence of a disembryogenic cyst in the sphenoid bone. The authors present a case of a clival-sphenoidal region neoformation treated with a transnasal-endoscopic approach.

Osteosarcoma radioinduced after adenoid cystic tumor of the parotid gland.

Osteosarcoma can develop secondary to malignant transformation within a preexisting benign bone lesion, such as Paget disease, osteonecrosis, fibrous dysplasia, and chronic infection, or it can arise in previously irradiated areas. This article presents the case of a 36-year-old woman who was affected by a radioinduced osteosarcoma after radiotherapy for an adenoid cystic carcinoma of the left parotid gland treated when she was 24 years old.

Lip reconstruction with local m-shaped composite flap.

The primary management of lip malignancies is radiotherapy or complete surgical resection. Surgical resection brings a full-thickness defect of lip tissues, and management of the resulting lip defect needs a surgical technique that maximizes functional and cosmetic outcomes. The use of local tissue flaps forms the basic concept of lip reconstruction. There are many techniques reported using the remaining lip and local adjacent tissues. Almost all of these techniques emphasize the innervated sphincter function after lip reconstruction. Authors present their experience in lip reconstruction by an M-shaped local composite flap. An M-shaped flap presents an incision line lying on the labiomental sulcus of the lower lip; on this line, 2 half-thickness Burrow triangles are created. The Burrow triangle allows tissue transposition to close the postsurgical defect. A similar surgical technique is presented also for the upper lip. Functional sphincteric recovery is assured by the integrity of the orbicularis oris muscle because of minimal alteration in the orientation of the muscle and the reconstruction muscular anatomic plane; moreover, such flap preserves the integrity of the corner of the mouth, preserves the sensibility of the lip, and has minimal aesthetic impact due to the camouflage of scar on the labiomental sulcus.

Malignant ethmoidal neoplasms: a cranionasal endoscopy approach.

Craniofacial resection has been adopted worldwide as the standard therapy for tumors of the paranasal sinuses involving the anterior skull base. Recent refinements in endoscopic techniques together with the development of related surgical instruments allow complete radical resection of complex anatomic structures through combined transcranial and endonasal approaches without compromising any oncological principles. We use a transcranial nasoendoscopic approach for ethmoid malignant tumors in stage I and II according to the Instituto Nazionale Tumori, Milano staging. With this technique, no cutaneous incisions and no approaching osteotomies of the facial skeleton were performed. This approach reduces the period of hospitalization and speeds recovery. Furthermore, intraoperative endoscopy facilitates placement of the osteotomies in the optimal position and improves the likelihood of achieving a complete en bloc resection with removal of all disease hitherto obscured from vision. It represents the choice indication to increase precocious postsurgery radiotherapy possibilities.

Concha bullosa: endoscopic treatment.

AIM: To assess the frequency and the endoscopic treatment of the middle turbinate pneumatization or concha bullosa. MATERIALS AND METHODS: Forty-nine patients (26 males and 23 females) with sinusitis and headache symptoms and axial and coronal computed tomographic scans of the paranasal sinuses and who had an endoscopic examination visit in the outpatient department between January 2005 and July 2007 were included in this study. Functional endoscopic sinus surgery was performed. Nasal tampons were removed 3 days after surgery, and endoscopic examination visits were performed 7, 15, 30, and 60 days after surgical treatment. RESULTS: All the patients presented complaints of chronic nasal obstruction. Eleven patients (5 males and 6 females; 22.4%) presented either a unilateral or a bilateral middle turbinate pneumatization. The surgeons recorded the surgery and each examination visit. In remote controls (12 mo at least), the patients showed a total remission of symptoms. There were no important complications.

Ameloblastoma relapse after 50 years from resection treatment.

Ameloblastoma is a slow-growing, locally invasive, epithelial odontogenic tumor of the jaws with a high rate of recurrence if not removed adequately but with virtually no tendency to metastasize (World Health Organization Classification of Tumors: Pathology and Genetics of Head and Neck Tumours, 2005). This paper presents a case of a woman who was treated in 1961, when she was 25 years old, for an ameloblastoma in the right posterior region of the mandible. After 50 years, the ameloblastoma relapsed, and another surgical treatment was necessary.

Temporomandibular joint disorders and maxillomandibular malformations: role of condylar "repositionin" plate.

Even if the relationship between condylar position and/or temporomandibular disorders (TMDs) and dentofacial deformity is controversial in literature, several patients presenting malocclusion refer to pain and TMDs as the main trouble. There are also various opinions concerning the alterations or improvements of temporomandibular joint symptoms after orthognathic surgery. In agreement with the experience of Universität Würzburg, the purpose of this study was to evaluate the validity of splint technique to reproduce centric condyle positioning in bimaxillary osteotomy surgeries for the patients with skeletal-facial disorders and coexisting TMDs. The present study is based on a sample of patients with maxillomandibular malocclusion and coexisting TMDs who underwent bimaxillary osteotomy surgeries with splint technique. All patients underwent a protocol consisting of various steps: Pretreatment evaluation consisted of a questionnaire on subjective symptoms, clinical examinations, photographs of the occlusion, plaster casts, bite registrations, examination of the posture; instrumental examinations; panoramic, teleradiography, and cephalometric analysis; stratigraphy of TMD; and electromyography. Presurgical treatment consisted of therapy by modified Farrar splint associated with a pharmacologic therapy for the acute symptoms; orthodontic treatment associated with a global reeducation of the posture and a pompage of the masticatory muscles; and manufacturing of an occlusal splint in the most posterior asymptomatic position. Surgical treatment consisted of bimaxillary osteotomies performed after registering condyle position by a "repositioning" plate. The condyle position is guided by the intermaxillary fixation with the interposition of the occlusal splint. Surgery on maxillary is performed through Le Fort I osteotomy and fixation. Later, sagittal splint osteotomy of mandible is performed. Position of ramus and TMD complex is guided by the positioning of the plates modeled previously and fixed to maxillary and ramus in the same relationship registered with the splint. Finally, fixation of mandibular osteotomies is performed. Postsurgically patients underwent orthodontic treatment (to stabilize occlusal and articular changes) and physical therapy. After the end of treatment, stability of results was investigated with clinical, radiologic, and electromyographic valuations. The authors' experience suggests that, as in orthognathic surgery, identification of a correct condyle-fossa relationship (achieved by splint and repositioning plate) is essential to guide osteosynthesis after sagittal split osteotomy in patients affected by TMDs and ultimately affects the stability of the procedure.

Cold therapy in maxillofacial surgery.

BACKGROUND: Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities used in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established (BMC Musculoskelet Disord 2007;8:125). PATIENTS AND METHODS: From January 2008 to July 2008, 10 patients (4 men and 6 women) affected by dental-skeletal classes II and III were treated. Considering the biologic effects and the low temperature achieved, in this study, a cooling and compression system, at fixed temperature and adjustable for maxillofacial cutaneous tissues, called Hilotherapy system (Hilotherm GmbH, Ludwigsburg, Germany) was used. RESULTS: With the use of Hilotherapy system, the swelling and pain decrease in intensity and time, allowing a quicker path to recovery of mandibular dynamics, a better comfort for patients, and an easy management of patients by medical attendants. CONCLUSIONS: The Hilotherapy system has been proven to have a safe and effective use as a cold therapy to control postsurgery course.

Evolution in diagnosis and repairing of orbital medial wall fractures.

In the last decades, diagnostical imaging, surgical techniques, alloplastic materials, and surgical instruments development allowed a great progress in management of orbital fractures; the aim of the present study was to focus on the progress and changes in the management of orbital medial wall fractures. Isolated medial wall fractures are not a common clinical evidence, and those necessitating surgery is relatively rare. Diagnostical refinements allowed to detect such fractures more commonly than suspected, and the indications to surgical treatment had been increased by the progresses that minimized morbidity of patients and allowed better restoration of the functional anatomy. Mainly, the endoscopic surgery as an alternative to open reduction allowed to manage such fractures with less unwanted sequelae; endoscopy decreases morbidity and improves the results with respect to open reductions. In literature, currently, it can be noticed that there is an increased trend in surgical treatment of the patients with orbital medial wall fracture because endoscopy decreased perisurgical morbidity and improved long-term results. Endoscopic repair of orbital blowout fractures represents an innovative and highly successful and safe alternative to external repairs owing to its introduction in orbital trauma management; actually, indications for surgical intervention are in the course of revision. New deal is important for the future treatment of patients sustaining orbital trauma. The authors present their experience.