1,721,710 research outputs found
Surgical therapy of oral cancer
No full textTreatment of squamous cell carcinoma, 90% of oral cancers, is unimodal (surgery vs. radiotherapy) for small tumors, multimodal (surgery and radiotherapy or chemoradiotherapy) for big ones. If a patient undergoes surgical treatment for an oral cancer, this implies two equally important phases: the resection of the tumor and reconstruction of the operated region. The sole eradication of the tumor, though extremely important, cannot be considered the single goal of the treatment. Indeed, negative functional and esthetic outcomes of surgery, affecting negatively the quality of life of the patient must be avoided as much as possible. In order to achieve this result, it is fundamental to utilize surgical accesses that allow the safe and complete removal of the lesion, minimizing at the same time esthetic and functional impact. It is also necessary to reconstruct the amputated region to the best of actual possibilities. Modern surgery aims to restitutio ad integrum of operated regions. That is particularly important in tumor surgery of the maxillo-facial area, where mutilations may worsen patients' quality of life. All these concepts apply, excluding only rare exceptions, also in advanced cases, cases with poor prognosis, patients with suboptimal general conditions, older people independently to the residual life expectancy. On the contrary, if prognosis is unfavorable and life expectancy brief, residual time should be as livable as possible. Reconstructive microsurgery, widely spread during the last 20 years, led to the full implementation of this concept and to the accomplishment of surgical operations once not even conceivable
Facial reanimations: part II long-standing paralyses
No full textLong-standing facial paralyses are those in which fibroadipose metaplasia of mimetic musculature has grown because of the time that has lapsed since the onset of the palsy: generally more than 18-24 months. Unlike the treatment of recent paralyses, to provide a neural input to reactivate the mimetic musculature is not enough. New healthy muscles must be transferred to the face. Operations may be subdivided into free-flap transplantations or masticatory muscle transpositions. The principles of treatment are correction of the asymmetry of the face by static means, and restoration of movements. Static correction of ptosis is achieved by deep-lifting, suspensions of fascia lata, and other procedures. Among movements, most efforts are concentrated on the restitution of smiling and closure of the eyelids. One of several techniques may be chosen after careful examination of the patient and paying close attention to their needs and expectations. Closure of the eyelids is generally achieved by a transposition of a double-belly temporalis flap or implantation of a gold/titanium lid plate. Other procedures are less used. Restoration of blinking remains impossible in most cases. The most popular techniques to restore smiling are rotation of a temporalis flap and transfer of a gracilis free flap with double innervation: both pros and cons must be considered. Surgery of the lower lip palsy is mainly based on limiting evident dragging upwards during smiling, because depressor function is difficult to achieve. Symmetry may also be reached by paralysing the lower lip on the other side. Movement of the forehead is a neglected area: reconstruction is possible, although the extent required seems disproportionate to the deficit. The need for ancillary surgery must be stressed. Only rarely are optimal results achieved without further fine-tuning of details
Transmasseter approach to condylar fractures by mini-retromandibular access
No full textPURPOSE: The published data are full of evidence that surgical treatment of condylar fractures, performed through an intraoral or extraoral approach, leads to better results than nonoperative treatment. Intraoral surgery can be technically demanding, and an extraoral approach presents risks of facial nerve injuries and visible scarring. The mini-retromandibular approach we have described allows the treatment of condylar fractures at any level in a simplified and rapid manner while reducing the risk of complications common to the other techniques. PATIENTS AND METHODS: A total of 33 patients with 38 condylar fractures were treated with a 20-mm mini-retromandibular approach. The mean operative time was 33 minutes (range 17 to 56). One patient in the present study was only 14 years old at surgery, which was performed 25 days after the associated trauma. RESULTS: Correct anatomic reduction and occlusion were achieved in all cases. Additionally, all patients showed normal articular function. Infection of the surgical site occurred in the first 2 surgical cases. In another patient, an additional operation was necessary to fix an erroneously reduced fracture, which had occurred because of insufficient surgical access (15 mm). No facial nerve injury was observed, and all surgical scars were barely visible. CONCLUSIONS: We suggest that the mini-retromandibular approach outlined in the present study should be the technique of choice for condylar fracture management, because it allows for easy, fast reduction and synthesis while minimizing the risk of facial nerve injury and visible scar
Facial reanimations: part I-recent paralyses
No full textUnilateral facial paralysis is a common condition: 1 in every 60 people will experience Bell's palsy during the course of their life, and the residual deficits are particularly problematic for those who do not spontaneously recover the function of the facial nerve. Functionally the most relevant defect is lack of corneal lubrication because of inability to close the eyelid or blink. Morphologically, this presents as obvious ptosis caused by absence of the muscle tone at rest. "Restitutio ad integrum" of a paralysed face by operation is currently impossible, but realistic targets are improvement of facial symmetry and partial recovery of closure of the eyelids and smiling. Movements of the forehead and lower lip tend to be neglected targets for intervention because they are of less functional importance. Recent paralyses are those in which the mimetic musculature may be reactivated by provision of neural input, and the time limit is generally 18-24 months. Electromyography helps to detect it by assessing the presence of muscular fibrillations. If those are not detectable paralyses are considered to be long-standing, and new musculature must be transferred into the face, generally by transplantation of a muscular free flap or of the temporalis muscle in several different ways. When the facial nerve has been severed by trauma or during operation, immediate reconstruction must be considered and the simplest and most efficient is direct neurorrhaphy. If an appreciable part of the nerve is missing and the proximal and distal nerve stumps do not meet, an interpositional nerve graft must be placed to guarantee neural continuity. When reconstruction of the total extracranial branch of the facial nerve is required, the thoracodorsal nerve has proved to be highly effective. In case immediate reconstruction cannot be accomplished and the trunk of the facial nerve is not available as a donor nerve, mimetic musculature may be reactivated by provision of new neural input. Strong inputs from the masseteric or hypoglossus nerves may be mixed with those that arise from branches of the contralateral facial nerve after 2 cross-face nerve grafts have been placed, and good functional recovery is generally obtained. Several ancillary procedures are required to improve the end results in most cases
Mini-retromandibular access to the condyle in panfacial fractures
No full textSurgical management of panfacial fractures can be extremely challenging. The many fracture lines and lack of landmarks make it difficult to restore the facial skeletal morphology. Extracapsular fractures of the mandibular condyle require open reduction and internal fixation to restore the vertical and sagittal dimensions of the mandible, representing the base for further facial skeleton reconstruction. Six patients with panfacial fractures, including a bilateral extracapsular condylar fracture, were treated between January 2006 and November 2009. One patient underwent surgical procedure 60 days after the injury. The condylar fractures were treated via a mini-retromandibular access. Overall, the bone morphology restoration was good. In particular, all of the condylar fractures were reduced satisfactorily. No complication was detected, and no facial nerve lesion was observed. The literature contains many proposals for surgically accessing panfacial fractures. Open reduction and internal fixation of condylar fractures are crucial for restoring face height. The mini-retromandibular access is especially suitable, because it allows safe, rapid surgical management
Diagnosi e terapia delle lesioni nervose del cavo orale
No full textLa lesione delle branche trigeminali che innervano le strutture del cavo orale possono
essere un’importante complicanza dell’attività chirurgica ambulatoriale, piuttosto che dei
trattamenti endodontici. A fronte di numerosi pazienti che presentano una spontanea
ripresa della sensibilità nell’arco di alcune settimane o mesi, vi sono casi in cui la lesione è
tale da comportare deficit permanenti. Se il danno residuo consiste in un difetto di sensibilità
del nervo linguale, è corretto eseguire un intervento di microchirurgia ricostruttiva. Questo è
invece spesso sovradimensionato, se la lesione riguarda il nervo alveolare inferiore, in quanto
la ripresa funzionale a lungo termine è generalmente discreta. I tempi di intervento sono
fondamentali: si consiglia la chirurgia in tempi brevissimi in caso di sintomatologia dolorosa,
indipendentemente dal nervo interessato. L’intervento esplorativo è invece indicato a tre
mesi dal trauma in caso di anestesia completa oppure dopo 8 mesi in caso di ripresa della
sensibilità molto modesta. I risultati della chirurgia sono molto soddisfacenti, benché mai
completi, in caso di deficit di sensibilità, meno soddisfacenti in caso di algia. Nei pazienti
con perdita della sensibilità, l’intervento chirurgico non è più indicato se il tempo trascorso
dall’evento lesivo supera i 24 mesi. In caso di sintomatologia algica non si esegue l’intervento
dopo 12 mesi. Ciò perché i risultati sono molto scadenti oltre i limiti temporali indicati. In
questi casi la terapia antalgica specifica e la terapia psicologica di supporto possono
migliorare la qualità di vita del paziente
An easy access to retrieve dental implants displaced into the maxillary sinus : the bony window technique
No full textAim of the study: To present the authors' experience concerning the removal of dental implants displaced in the maxillary sinus via an intraoral approach consisting of the creation of a bony window pedicled to the maxillary sinus membrane. Materials and methods: Thirty-six systemically healthy patients, presenting with oral implants displaced into the maxillary sinus, but with no signs of acute or chronic sinusitis, were consecutively treated between 2002 and 2012 via an intraoral approach with the bony window technique. Results: Removal of oral implants from the maxillary sinus was achieved in all patients, and postoperative recovery was uneventful in all of them. Computed tomographies performed after surgery showed no signs of residual sinus infection in all patients and a complete ossification of the bony window margins. Twelve of the 36 treated patients were treated with a sinus grafting procedure 12-18 months after in the same areas previously treated with the bone lid technique. Seventeen implants were placed in the grafted areas 6-9 months later and, after a further waiting period needed for osseointegration, the treated patients were rehabilitated with implant-supported prostheses. The survival rate of implants was 100%, and no complications related to the sinuses and implants were recorded. Conclusion: Results from this study seem to demonstrate that the bony window technique is a safe and easy way to remove oral implants from the maxillary sinus under local anesthesia. The surgical access is hardly visible 6-12 months after surgery, and maxillary sinuses appeared free from residual pathology in all treated patients. Finally, this procedure allows a second-stage sinus grafting procedure via a lateral approach as in a previously untreated maxillary sinus, thus allowing an implant-supported prosthetic restoration
V to VII Nerve Transfer for Smile Reanimation
No full textUsing the wording "facial reanimation," surgeons mean restoring movements to the paralyzed face. According to the condition of mimic muscle, facial palsy can be classified as recent (mimic muscle still alive) and chronic (atrophy of mimic muscle) palsy. The treatment is quite different because in the former group the mimic muscles can be still used so long as a new motor source would be connected to the damaged facial nerve. In the latter group, muscular transplantation is needed to substitute the atrophied mimic muscles of the middle part of the face. In both cases, the neural impulse that makes the muscles (mimic muscle in the former, transplanted muscle in the latter) move come from a new motor nerve. Nowadays, the masseteric nerve is widely used as a new motor source in recent facial reanimation; the same nerve has also a main role in the treatment of both chronic facial palsy where it is used as the new nervous stimulus for the new transplanted muscle and facial paresis where the nervous stimulus coming from the masseteric nerve is used to empower the stimulus coming from the injured facial nerve. The masseteric nerve can be usually connected directly to the facial nerve without the interposition of a nerve graft, with a faster reinnervation. Moreover, the use of the masseteric nerve gives no morbidity to the masticatory functions
Squamous carcinoma arising in a parotid Warthin's tumour
No full textWarthin's tumour is the second most common benign neoplasm to affect the salivary glands. It virtually affects the sole parotid gland. A sudden increase in a tumour's size is usually due to a malignant transformation of the tumour. The transformation of the lymphoid stroma into malignant lymphoma is relatively common, while an epithelial malignancy is extremely rare. In this paper, the authors present a case of squamous cell carcinoma arising in Warthin's tumour. The patient underwent enucleoresection of the tumour. Intraoperative frozen section revealed the presence of a cystic component associated with the squamous cell carcinoma areas. In consideration of the result of the intraoperative consultation, the surgeons decided to enlarge the previous resection by removal of a 30×25 mm cuff from the surrounding parotid tissue. Close follow-up was carried out and 12 months after surgery there was no evidence of recurrence or metastatic neoplasm
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