1,721,004 research outputs found
Reconstruction after total parotidectomy using a de-epithelialized free flap
No full textINTRODUCTION: Total parotidectomy has aesthetic and functional sequelae, including Frey' syndrome and soft tissue depression of the region. The aim of repair is to reduce these problems, importing tissue into the surgical field to fill the region and to avoid Frey's syndrome. The soft tissues to use are those which are not resorbed in order to have a stable aesthetic result. OBJECTIVE: To propose a new method for avoiding negative functional and aesthetic sequelae of total parotidectomy. PATIENTS: Two patients underwent total parotidectomy because of recurrent sialoadenolithiasis in one case and for adenocarcinoma in the other. Immediate repair was obtained with a de-epithelialized parascapular free flap: both cases required thinning of the flap secondarily under local anaesthesia. RESULTS: Aesthetic results were good in both cases. No patient developed Frey's syndrome. CONCLUSION: Among the many techniques that have been proposed for this purpose, the de-epthelialized parascapular free flap guarantees an adequate amount of tissue with good vascularization and leads to a pleasing and stable result
La Sindrome di Eagle
No full textLa Sindrome di Eagle è una possibile, anche se infrequente, causa di dolore facciale
atipico. Essa è causata dalla presenza di un processo stiloideo allungato. La diagnosi
di tale alterazione anatomica è agevole se ne viene sospettata la presenza sulla base
dell’esame obiettivo e della storia clinica. Il trattamento è più frequentemente di
tipo chirurgico e prevede la rimozione dell’apice del processo stiloideo mediante
un accesso intraorale. Viene qui presentato il protocollo diagnostico e terapeutico
utilizzato presso la nostra Unità OperativaEagle Syndrome
Eagle Syndrome is a potential, although quite rare, source of atypical facial pain. It is
caused by an elongated styloid process. Syndrome is an unusual source of atypical facial
pain. This anatomic feature is easily diagnosed if its presence is suspected. Treatment is
more often by means of surgery by removal of styloid process apex trough an intraoral
approach. We present the diagnostic and therapeutic protocol used in our department
Maxillary setback osteotomy with fracture of pterigoid processes
No full textIn rari casi un'eccessiva crescita mascellare sagittale può
causare una deformità del volto che si caratterizza per un angolo
naso-labiale acuto, un'eccessiva protrusione del labbro superiore
ed un sorriso gengivale. L'occlusione in questi pazienti è
tipicamente di seconda classe come nell'iposviluppo mandibelare,
condizione clinica con caratteristiche del tutto differenti.
La soluzione chirurgica più comunemente adottata nell'eccesso
mascellare sagittale consiste nell'estrazione dei primi
premolari e nel retroposizionamento della prernaxìlla. Questa
come altre tecniche simili presenta rischi intrinseci come sofferenze
parodontali e radicolari, necrosi della polpa dentaria,
pseudoartrosi e, raramente, necrosi avascolare dei frammenti
osteotomizzati. In letterattura vi sono pochi articoli riguardanti
l'osteotomia di LeFortI con riposizionamento posteriore dell'ntero
mascellare. Questa procedura permette la contemporanea correzione della malocclusione ed è libera dalle complicanze
delle altre procedure. Il riposizionamento posteriore
può essere ottenuto dislocando posteriormente il mascellare
posteriore dopo aver fratturato i processi pterigoidei.
Quest'ultima viene descritta come una metodica rischiosa ma
nella nostra esperienza, se effettuata con particolari accorgimenti
tecnici, può essere considerata veloce e sicura. Gli autori presentano
la loro esperinza clinica di casi selezionati trattati
mediante questa proceduraIn some cases a sagittal maxillary overgrowth can cause a facial deformity characterized by an acute nasal-labial angle, a protruded upper lip and a gummy smile. The patient typically present a 2nd class occlusion as is in mandibular hypoplasia, a condition with totally different clinical manifestations. The most commonly adopted surgical correction for a maxillary sagittal excess consist in a LeFortI osteotomy associated with bilateral first premolar extraction and bone segmentations. This as well as other similar techniques have inherent risks such as radicular lesions, periodontal resorptions, teeth pulp necrosis, pseudoarthrosis and avascular necrosis of the osteotomized bone. There are only few reports in the literature regarding the LeFortI osteotomy with posterior repositioning of the entire maxilla. This procedure allows the correction of the occlusal disturbance and does not present the risks of the other procedures. Posterior repositioning can be obtained by fracturing and posteriorly dislocating the pterigoid processes. This is described as a risky procedure but, in our experience, if performed trough particular technical steps, is to be considered as safe and quick. The authors present their clinical experience in selected cases treated by means of this technique
Transthoracic hernia after harvesting a costal and latissimus dorsi flap
No full textRibs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral graft is easy and safe. The main complications are related to pneumothorax and chest-wall deformity in children. A complication is described in a patient who underwent an orbito-zygomatic reconstruction with two contiguous ribs and a latissimus dorsi free flap, and who subsequently developed a transthoracic hernia that required reconstruction with polypropylene mesh
Masseteric-facial nerve anastomosis associated with cross face nerve graft: a reliable solution for incomplete facial palsy
No full textIntroduction:
One of the most common causes of incomplete facial palsy is Bell’s palsy. Although in most cases this idiopathic condition evolves towards complete restoration, almost 30% of these patients report some degree of functional and morphological sequelae, including, but not limited to, facial synkinesis and paresis. Different surgical techniques have been proposed to reanimate complete facial palsy this kind of facial weakness: neural neurorrhaphy between the hypoglossus nerve and the injured facial nerve, cross face nerve grafting, mini -temporalis flap rotation and free muscle transfer to restore facial symmetry and mimic movements. Others prefer to symmetries the face by injecting botulin toxin on the healthy side.
Materials and Methods:
Between 2011 and 2016, twenty -four patients (17 females; 7 males) affected by an incomplete unilateral facial palsy underwent surgical treatment in the Maxillofacial Surgery Department of the San Paolo Hospital of Milan (Italy) to restore the symmetry of the face at rest and during smiling. 20 patients were affected by an incom plete facial palsy of the middle third of the face. In these patients, a neural anastomosis between the masseteric nerve and a branch of the injured facial nerve directed to the zygomatic muscle was created to give new contractile strength to the midface mimic muscles. 4 patients were affected by an incomplete facial palsy of the lower third of the face. In these patients, a neural neurorrhaphy between the masseteric nerve and the marginalis mandibulae nerve was created. Furthermore, all patients received a cross face sural nerve graft to restore the spontaneity of smile: nerve graft was directed to the middle third of the face in 20 patients, while in 4 patients to the lower third, according to the paresis localization.
Results:
Surgery was uneventful in all cases. Follow up time ranged from 3 months to 5 years (only 4 patients, operated during the current year, have a follow up time lower than 18 months). A significant improvement of facial movement was achieved in all evaluated patients. Facial recovery began within 2 and 12 months after surgery with the restoration of facial symmetry at rest. All patients had to clench their teeth while smiling in the beginning. After 2 to 4 months of exercising with a physiotherapist, the patients had to think about smiling if they wanted to do it, but clenching was no longer necessary. From 6 to 12 months after the onset of paralysis, smiling became automatic. Spontaneous smile was restored through the use of the contralateral facial nerve.
Conclusions:
The nervous anastomosis between the masseteric nerve and a branch of the facial nerve represents a valid choice for the reanimation of the incomplete facial palsy; in addition, its association with a cross face nerve grafting allows not only to achieve an excellent symmetry during the voluntary movement but also to restore the emotional smile
The free fibula flap for treating benign mandibular lesions
No full textLa mandibola può essere interessata da lesioni benigne che vengono per lo più trattate in modo conservativo. Qualora tali lesioni presentino caratteristiche di elevata aggressività locale, quale lo sconfinamento nei tessuti molli perimandibolari o recidivino coinvolgendo gran parte dello spessore della mandibola, l’approccio deve essere più radicale, con la resezione mandibolare e contemporanea ricostruzione tramite innesti ossei, principalmente rappresentati dalla cresta iliaca se si tratta di resezioni a tutto spessore o anche di calvaria in caso di resezioni non interruttrici. Questi presentano importanti limiti legati alla possibilità di infezioni e all’imprevedibilità del loro riassorbimento. L’avvento dei lembi microvascolari, in particolare della fibula, rappresenta una svolta nella ricostruzione dei difetti mandibolari. Tale metodica presenta infatti una morbilità del sito donatore sovrapponibile a quella degli innesti tradizionali garantendo al contempo la capacità dell’osso di difendersi da un’eventuale infezione oltre ad un limitatissimo riassorbimento. A fronte di questi vantaggi i tempi operatori sono aumentati di circa un’ora, in presenza di un’equipe microchirurgica esperta. Gli Autori riportano la loro esperienza nell’impiego del lembo microvascolare di fibula nella ricostruzione mandibolare conseguente a resezione per lesioni benigne in 7 pazienti. Tutte le ricostruzioni hanno avuto esito positivo. La morfologia del viso successivamente alla ricostruzione ha mostrato il ripristino della simmetria del profilo del terzo inferiore del volto in tutti i pazienti operati. I risultati funzionali sono stati molto soddisfacenti, con la ripresa della completa funzionalità mandibolare in tutti i casi trattati. Tutti i pazienti sottoposti a un follow-up medio di 24 mesi non presentano attualmente segni clinici di recidiva di malattiaA variety of benign lesions that are typically treated conservatively can affect the mandible. The treatment must be radical when these lesions are locally aggressive and involve the perimandibular soft tissues or involve most of the thickness of the mandible. The main treatment is mandibular resection and reconstruction with bone grafts, mainly iliac crest bone grafts for segmental mandibulectomy or a calvaria bone graft for resection without interruption of the mandible body. These grafts are limited due to the possibility of infection and the unpredictable long-term resorption. Free flap surgery, particularly with fibula free flaps, represents a new era in mandibular reconstruction. This technique has similar donor site morbidity, while the transferred bone resists infection and bone resorption. These advantages are achieved at the cost of a procedure that is about 1 h longer when performed by an experienced microsurgical team. We report our experience with mandibular reconstruction following the surgical resection of benign lesions in 7 patients. All the reconstructions had good RESULTS: After reconstruction, the facial morphology showed restored symmetry of the lower third profile in all patients. The functional results were satisfactory, with restored mandibular function in all cases. No signs of recurrence have appeared in any patient after a mean follow-up of 24 month
Cross-tongue: a clinical answer to long-standing lingual anaesthesia
No full textLingual nerve (LN) lesions may occur during several oral and maxillo-facial procedures. Prompt surgical nerve repair is mandatory in case of certain LN damage, since the sooner the repair procedure, the better the functional recovery. Furthermore, there is no literature consensus for surgical repairs taking place after 18 months or more, due to extremely variable results. Since employing a motor nerve source other than the proximal stump has proven effective for nerve regeneration in other clinical situations, the Authors proposed using the contralateral healthy LN to add a strong axonal sprouting source to treat 3 patients affected by long standing LN lesion. 30% of the contralateral LN fibres were co-opted by surgical side-to-end neurorrhaphy. Axonal regeneration was achieved on the pathological side of the tongue by a reverse sural nerve graft (cross-tongue procedure). Distal end-to-end neurorrhaphy was accomplished in the free half of the distal stump of the pathological LN.During the postoperative period the sensitivity of the hemi-tongue on the repaired side increased progressively, almost equating normal side levels, as evidenced by sensory and pain-potential registration results. Sensitivity restoration was demonstrated by sensory threshold testing, while improved taste, temperature and static/dynamic two-point discrimination also emphasized good recovery
Primary intraosseous hemangiomas of the orbit
No full textIntroduction: Primary intraosseus orbital hemangiomas are rare vascular anomalies, of which only 23 cases have been previously reported in the literature. We here describe a further two cases. Materials and Methods: An anterior approach was used to remove a mass located in the inferior orbital rim in one case, and in the orbital floor in the other. Results: Good restoration of the orbital walls with no signs of recurrence. Discussion: Intraosseous hemangiomas of the orbit are usually located anteriorly, and can be removed by anterior surgical approaches. The main surgical problem is due to the removal of the involved areas of the orbital walls because resection without reconstruction may cause functional impairments and secondary deformities that are more damaging for the patient than the tumour itself. In order to avoid defects, the integrity of the orbital walls must be immediately restored by means of autologous bone or alloplastic grafts
Intraoral surgical reduction of mandibular condylar fractures with and without rigid fixation
No full textObiettivo. Il trattamento delle fratture deI condilo mandibolare
è dibattuto tra i chirurghi maxillofacciali. Il trattamento non
chirurgico è indicato in certi casi ma non permette il rìposizìonamento
anatomico dei frammenti fratturati e nelle fratture più
dislocate i risultati sono poco soddisfacenti. Viceversa, gli
approcci esterni chirurgici al condilo presentano rischi chirurgici
e un frequente riassorbimento a lungo termine. L'approccio
intraorale è una procedura più sicura ma che può essere tecnicamente
difficile. L'utilizzo dell'endoscopio, che aumenta la
visione chirurgica, può allargare le indicazioni per il trattamento
chirurgico di queste fratture.
Metodi. Tra gennaio 1999 e luglio 2003, 11 pazienti sono stati
trattati con riduzione chirurgica intraorale per Il fratture di condilo.
In 5 casi l'endoscopio è stato utilizzato per migliorare la
visione. In 2 casi è stata effettuata una coroidotomia per la stessa
ragione. In 5 pazienti l'osteosintesi è stata effettuata dopo la
riduzione; in 6 pazienti è. stata effettuata solo una riduzione
autoritentiva. Un periodo di riabilitazione funzionale intensiva
è imperativo.
Risultati. Una buona guarigione anatomica e buoni risultati
funzionali sono stati osservati in tutti i pazienti eccetto uno che
non ha potuto effettuare la riabilitazione funzionale. In un
paziente si è dovuto aggiungere l'accesso extra orale .
Conclusioni. La riduzione chirurgica intraorale delle fratture
di condilo mandibolare, con l'ausilio dell'endoscopio e della
coronoidotomia in casi difficili, è una procedura sicura ma non
sempre facile.Aim. Treatment of mandibular condylar fractures is debated among maxillofacial surgeons. Nonsurgical management is indicated in certain cases but does not allow anatomical repositioning of fractured fragments and in more dislocated fractures results are less than satisfactory. Converely, external surgical approaches to the condyle present surgical risks and frequent long term resorption. Intraoral approach is a safer procedure but can be technically demanding. The use of endoscope, increasing surgical view, can widen the indications for surgical treatment of these fractures.
Methods. From January 1999 to July 2003 11 patients have been treated by means of intraoral surgical reduction for 11 condylar fractures. In 5 cases endoscope was used to improve view. In 2 cases coronoidotomy was performed for the same reasons. In 5 patients osteo-sinthesis was performed after reduction; in 6 patients only self retentive reduction was performed. A period of intensive functional rehabilitation was mandatory.
Results. Good anatomical healing and functional results have been observed in all patients except one who could not follow functional rehabilitation. In one patient extraoral access had to be added.
Conclusion. Intraoral surgical reduction of mandibular condylar fractures, with the aid of endoscope and coronoidotomy in difficult cases, is a safe but not always easy procedure
Vertical increase in mandibular reconstructive surgery with fibula flap : double barrel and osteogenetic distraction
No full textAim. The free fibula flap is today considered the gold standard for mandibular reconstructions, and provides an adequate length of bone of the correct consistency for this procedure. The disadvantage is the lack of thickness, which does not offer an adequate vertical dimension for the newly constructed mandible, in particular when the procedure must be followed by osseointegrated tooth implants. Two methods have been developed to increase the vertical dimension of the new mandible: the double-barrel method and osteogenetic distraction.
Methods. Between April 1995 and October 2003 at the Division of Maxillofacial Surgery, San Paulo Hospital, Milan, 63 fibula free flaps were positioned; 17 were at the maxilla and 46 at the mandible.
Results. Among the mandibular reconstructions, in 4 cases the double-barrel technique was applied, with the intent of optimising the vertical dimension of the reconstructed mandible. In 2 cases in which the double-barrel technique could not be applied, osteogenetic distraction was performed on the new mandible in order to achieve a vertical increase in the various bone sectors.
Conclusion. Application of these techniques made it possible to achieve adequate bone thickness in the new mandible, so as to optimise future prosthetic rehabilitation of the tooth arch
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