57 research outputs found
Repair of cocaine-related oronasal fistula with forearm radial free flap
No full textBACKGROUND: Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions. MATERIALS AND METHODS: From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication. RESULTS: In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved. DISCUSSION: Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness
Partial and total lower Lid reconstruction : our experience with 41 cases
No full textPurpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30-60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results
Surgical access to condylar fractures in panfacial traumas. [L’accesso chirurgico al condilo nei fracassi facciali]
No full textObiettivo. L’accesso al condilo nel contesto delle fratture panfacciali è un argomento particolarmente complesso e dibattuto. Il presente lavoro propone un protocollo applicabile nei fracassi facciali dove è necessario accedere al condilo.
Metodi. Lo studio comprende 10 pazienti (8 maschi e 2 femmine) con fratture panfacciali comprendenti 16 fratture extracapsulari di condilo associate a 3 fratture sinfisarie, 7 parasinfisarie, 1 frattura di angolo mandibolare, 6 fratture mascellari tipo LeFortII, 3 fratture orbito-maxillo-zigomatiche e 5 fratture zigomatiche. La riduzione e sintesi delle fratture di condilo veniva effettuata mediante accesso mini-retromandibolare in 6 pazienti per un totale di 10 fratture di condilo mentre in 4 pazienti per un totale di 6 fratture extracapsulari veniva effettuato attraverso un accesso tipo lifting come estensione caudale di un accesso emicoronale o coronale necessario per il trattamento delle fratture coesistenti.
Risultati. In tutti i pazienti venivano ottenuti buoni risultati morfo-funzionali. Nessuna complicanza relativa agli accessi ed al trattamento delle fratture di condilo.
Conclusioni. Il protocollo che proponiamo potrebbe guidare nella scelta dell’accesso chirurgico al condilo mandibolare nelle fratture panfacciali.AIM:
Surgical access to the condyle in panfacial fractures is a delicate and debated issue. The aim of the study was to propose a protocol which would apply in the treatment of panfacial fractures requiring access to the condyles.
METHODS:
A case series of 10 patients (8 males and 2 females) with panfacial fractures consisting of 16 extracapsular mandibular condylar fractures associated with 3 symphyseal, 7 parasymphyseal, 1 mandibular angle, 6 Le Fort II, 3 orbitomaxillomalar, 5 zygomatic arch fractures were included in this study. Reduction and fixation were achieved using the mini-retromandibular access in 6 patients with 10 extracapsular condylar fractures while in 4 patients with 6 extracapsular condylar fractures access to the condyles consisted in a face-lift-type preauricular access, as a caudal extension of a coronal or hemicoronal incision required for the reduction and fixation of other fractures of the upper and middle thirds.
RESULTS:
A good morphological and functional outcome was achieved in all patients. No surgical complication associated with access to the condyles or treatment of the condylar fractures was registered.
CONCLUSION:
The proposed protocol could be used as a guide in choosing access to the condyles in panfacial traumas
Surgical access to condylar fractures in panfacial traumas
No full textSurgical access to the condyle in panfacial fractures is a delicate and debated issue. The aim of the study was to propose a protocol which would apply in the treatment of panfacial fractures requiring access to the condyles. A case series of 10 patients (8 males and 2 females) with panfacial fractures consisting of 16 extracapsular mandibular condylar fractures associated with 3 symphyseal, 7 parasymphyseal, 1 mandibular angle, 6 Le Fort II, 3 orbitomaxillomalar, 5 zygomatic arch fractures were included in this study. Reduction and fixation were achieved using the mini-retromandibular access in 6 patients with 10 extracapsular condylar fractures while in 4 patients with 6 extracapsular condylar fractures access to the condyles consisted in a face-lift-type preauricular access, as a caudal extension of a coronal or hemicoronal incision required for the reduction and fixation of other fractures of the upper and middle thirds. A good morphological and functional outcome was achieved in all patients. No surgical complication associated with access to the condyles or treatment of the condylar fractures was registered. The proposed protocol could be used as a guide in choosing access to the condyles in panfacial traumas
Maxillary reconstruction and placement of dental implants after treatment of a maxillary sinus fungus ball
No full textA fungus ball is one of the fungal diseases that can affect the paranasal sinuses. It requires surgical treatment. Because there is only one previously reported case of dental implant placement after treatment of a maxillary sinus fungus ball, the authors here report on a case of a maxillary sinus fungus ball with bone erosion that was treated surgically with a combined endoscopic endonasal and endoral (Caldwell-Luc) approach. One year later, a graft from the ilium was obtained and a sinus elevation was performed to allow the placement of dental implants. Three months later, the dental implants were placed, and they were all osseointegrated at the 9-month follow-up
Repair of cocaine-related oronasal fistula with forearm radial free flap.
No full textBACKGROUND: Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions. MATERIALS AND METHODS: From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication. RESULTS: In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved. DISCUSSION: Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness
New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction
No full textIn the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique
Risultati morfologici e funzionali dopo trattamento delle anomalie vascolari cervico-cefaliche
No full textLa classificazione ISSVA del 1996 suddivide le anomalie vascolari in tumori, caratterizzati da proliferazione endoteliale, e malformazioni, determinate da alterazioni dello sviluppo vascolare con un turnover endoteliale stabile. Dati clinici e strumentali sono fondamentali per la diagnostica di tali patologie e consentono di distinguere ulteriormente le malformazioni in forme a basso flusso (capillari, linfatiche e venose) e forme ad alto flusso ( fistole arteriore e malformazioni artero-venose). Per la fase diagnostica sono fondamentali l’ecocolordoppler, l’angioTC o l’angioRM; inoltre nelle forme ad alto flusso, in fase preoperatoria, è necessaria l’angiografia per embolizzare i vasi afferenti. La forma tumorale più frequente è l’emangioma, il cui trattamento si basa oggi quasi esclusivamente sulla somministrazione di propranololo, con eccellenti risultati. Rara è la necessità di ricorrere al trattamento chirurgico, che viene riservato a casi di grandi dimensioni con impedimenti funzionali o ulcerazioni e rischio di emorragie o a casi che non hanno risposto al trattamento medico. Le malformazioni interessanti i capillari generalmente non richiedono chirurgia, quelle venose e linfatiche vengono trattate con laser, radiofrequenze o sostanze sclerosanti o mediante invece l’intervento chirurgico, radicale (nelle forme localizzate che consentono un ottimo risultato estetico) o conservativo (le forme più estese richiedono un approccio attentamente bilanciato tra la radicalità dell’exeresi e la preservazione di strutture funzionalmente fondamentali, quali il nervo facciale o il contenuto endorbitario). Le malformazioni ad alto flusso vengono sempre trattate chirurgicamente, generalmente previa embolizzazione della lesione; esse hanno infatti un comportamento analogo a quello di una neoplasia, con tendenza a crescere e a invadere i tessuti circostanti e presentano elevato rischio emorragico. Vengono qui presentati i risultati ottenuti nella chirurgia delle anomalie vascolari, ponendo particolare attenzione alle tecniche utilizzate per ottenere i migliori risultati da un punto di vista estetico e funzionale
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