Dermal Regeneration Templates in Maxillo-Facial District: A Multipurpose Aid.

ABSTRACT: Since 1980s, the use of dermal regeneration templates (DRT) for reconstructive purposes has been described in Literature.1 The authors present their experience of 13 patients treated with integra dermal regeneration template and a single-stage surgery for different indications like oncologic reconstruction, trauma injuries, and preprosthetic surgery in the maxillo-facial district.The authors retrospectively reviewed a total of 13 patients treated with DRT at Maxillo-Facial Department of S. Maria Hospital in Terni.Inclusion criteria included the presence of a defect nonapproachable primarily or by secondary intention with an easy locoregional flap reconstruction, a complete clinical record, and a minimum 6 months follow-up.A total of 12 patients underwent surgical reconstruction with DRT at the S. Maria Hospital from June 2018 to February 2020.During follow-up, all patients in which intraoral reconstruction was performed showed first signs of re-mucosization and neovascularization after 10 days.Only in 1 patient (8%) a seroma underneath the silicon sheet was observed. Afterward, the patient healed correctly with no other complications.Dermal regeneration template represents an option that should be considered in the head and neck district reconstruction, especially for intraoral defects where, thanks to its long-term functional results and limited alternatives, should represent a relevant choice.

Disk repositioning surgery of the temporomandibular joint with bioabsorbable anchor.

The most common temporomandibular joint (TMJ) pathologic disease is anterior-medial displacement of the articular disk, which can lead to TMJ-related symptoms.The indication for disk repositioning surgery is irreversible TMJ damage associated with temporomandibular pain. We describe a surgical technique using a preauricular approach with a high condylectomy to reshape the condylar head. The disk is anchored with a bioabsorbable microanchor (Mitek Microfix QuickAnchor Plus 1.3) to the lateral aspect of the condylar head. The anchor is linked with a 3.0 Ethibond absorbable suture to fix the posterolateral side of the disk above the condyle.The aims of this surgery were to alleviate temporomandibular pain, headaches, and neck pain and to restore good jaw mobility. In the long term, we achieved these objectives through restoration of the physiological position and function of the disk and the lower articular compartment.In our opinion, the bioabsorbable anchor is the best choice for this type of surgery because it ensures the stability of the restored disk position and leaves no artifacts in the long term that might impede follow-up with magnetic resonance imaging.

Rigid versus semirigid fixation for condylar fracture: experience with the external fixation system.

PURPOSE: Although mandibular condylar fractures are very common, the treatment remains controversial. Many techniques of reduction and many devices have been suggested. The purpose of this study was to evaluate the advantages and drawbacks of semirigid fixation compared with rigid fixation using an external fixation system. PATIENTS AND METHODS: Between 1990 and 2005, 137 patients (83 males, 54 females; median age, 24.2 years; 116 with monocondylar fracture and 21 with bicondylar fracture) were treated with an external fixation system (Mand-X-Fix, Leibinger, Germany). In these cases, the distal fragment was dislocated medially and out of the glenoid cavity (stadium IV of MacLennan). RESULTS: At the 12-month follow-up, 91% of treated patients regained their pretrauma occlusion with good functional results (maximum mouth opening: 100% >30 mm, 81% >35 mm, 59% >40 mm; articular pain: <2%; clicking: <7%) and morphostructural results (fragment overlap significant in 2% of cases, light in 53% of cases, and absent in 45% of cases) and a very low rate of complications in the immediate postsurgical period (temporary paresis of the facial nerve: <7%; infection of the surgical wound: <2%). No long-term facial palsy was noted. CONCLUSION: Our findings indicate that a semirigid fixation technique, represented by the external fixation system, seems to be a better approach to treating condylar fractures with luxation out of the glenoid fossa.

Chondrocalcinosis: rare localization in the temporomandibular joint.

In this paper introduces a rare case of chondrocalcinosis of the temporomandibular joint secondary to hyperparathyroidism, diagnosed in a 64-year-old man. The patient complained of symptoms characterized by the presence of a swelling in the left pretragic preauricular region, accompanied by a limitation of the mandibular movements. Radiographic examinations suggested a diagnosis of synovial chondromatosis. Subsequently definitive histological analysis removed mass stated for a chondrocalcinosis of the left temporomandibular joint. The differential diagnosis is very hard, in this case it has been difficult for the rarity of the pathology described in literature; the exact diagnosis can be only formulated on histologic and citologic examination of the mass excised.

Maxillofacial traumas.

Craniofacial traumas often involve the orbital region. This report describes an unusual case of penetration of an object into the left upper oral vestibule up to the left medial-upper orbital wall. The object was an indicator switch. A multidisciplinary approach was necessary to make a correct diagnosis and to apply the best surgical treatment. The object was surgically removed, and rigid internal fixation was used to reconstruct the inferior and medial orbital walls. The aesthetic and functional results were good. One year later, the patient showed a slight enophthalmos with normal ocular motility.