Total facial rehabilitation: the evolving concept of reconstructive surgery.

none2Total facial rehabilitation requires an understanding of the contributing components of the so-called aging face syndrome. This syndrome may be due to atrophy of the jaws or may result from ablative surgery for cancer. The aging face requires correction of every anatomic component (i.e., facial skeleton, dentoalveolar processes, and soft tissue). The surgical armamentarium includes maxillofacial osteotomies, autogenous bone grafts, biomaterials, internal rigid fixation, and other ancillary procedures. The introduction of osseointegrated implants has allowed the surgeon to use a stable base on which a prosthesis can be built with functional and aesthetic long-lasting results. Last, but not least, repositioning of the facial mask is the "final touch" for these complex reconstructive procedures. The concept of total facial rehabilitation may be considered an evolution of reconstructive surgery. Surgical strategies, new technologies, as well as clinical cases will be presented.noneL. Clauser;C. CurioniClauser, Luigi; C., Curion

Osteoma of the frontoethmoidal sinuses: craniofacial resection and reconstructive strategy.

none3Frontoethmoidal involvement by benign tumors may lead to aesthetic and functional sequelae. The key for removal of such lesions is a proper planned craniofacial approach based on the preoperative evaluation. If total extirpation requires resection of part of the forehead or orbit, immediate reconstruction is mandatory. In recent years, craniofacial techniques and strategies have become popular. Among these are the use of split cranial bone, rotation of skull bones, the use of galeal-pericranial flaps, and the introduction of internal rigid fixation. We present a case of frontoethmoidal osteoma treated with a combined craniofacial approach. For the reconstruction, modern principles of craniofacial surgery have been applied.noneL. Clauser;F. Meneghini;D. CurriClauser, Luigi; F., Meneghini; D., Curr

Palpebral ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview.

none3Palpebral ptosis indicates the abnormal drooping of the upper lid, caused by partial or total reduction in levator muscle function. It may be caused by various pathologies, both congenital and acquired. Based on a review of the available literature and on our own clinical experience, a classification is proposed as well as a differential diagnosis between ptosis and pseudoptosis. Some basic surgical guidelines related to age of onset and etiopathogenesis are drawn. Ptosis is divided into neurogenic, myogenic, aponeurotic, and mechanical. The aim of surgery is two fold: functional, to correct the limit in the visual field; and also aesthetic. From January 2000 to January 2004, 42 patients were referred and treated at the Unit of Cranio-Maxillofacial Surgery-Centre for Orbital Pathology and Surgery, Hospital and University, Ferrara, Italy. Of these, 12 cases were congenital and 30 acquired (13 were monolateral and 29 bilateral, for a total of 71 cases). The most widely used surgical techniques were levator muscle recession and frontalis suspension. In congenital forms, these techniques were often associated with techniques to correct oculo-muscular imbalance (i.e., strabismus).Seventy-one upper eyelids were treated, 5 of which were mild, 35 moderate, and 31 severe. Regarding levator muscle function, 60 were fair and 11 poor.Surgical treatment followed the indications and timing with good morphologic and aesthetic results. Complications included two cases of hypocorrection, two asymmetries, and two cases of hypercorrection. Surgical treatment of palpebral ptosis is complex and requires precise diagnosis and indications for surgery related to clinical examination and pathogenesis. Even if these indications are strictly followed, in some cases, the outcomes are unpredictable.noneL. Clauser;R. Tieghi;M. GalièClauser, Luigi; R., Tieghi; Galiè, M

Treatment of macroglossia in Beckwith-Wiedemann syndrome.

none3A case of macroglossia caused by Beckwith Wiedemann syndrome is reported. Beckwith-Wiedemann Syndrome is an overgrowth disorder characterized by a constellation of congenital anomalies. The most common manifestations are omphalocele, macroglossia, gigantism, and visceromegaly. When the tongue reaches a huge dimension, clinical symptoms are represented by dysphagia, alterations in speech, difficulty in chewing, obstruction of the upper airways, and psychologic consequences derived from the patient's physical appearance. The authors describe the surgical strategy performed in the reported case.noneL. Clauser;R. Tieghi;J. PolitoClauser, Luigi; R., Tieghi; J., Polit

Neurofibromatosis of the orbit and skull base.

Von Recklinghausen's disease is characterized by multiple neurofibromas, pigmentations, and pachydermatoceles of the skin depending on the disorder of the neural crest derivative. We report on a 25-year-old patient suffering from neurofibromatosis localized in the cranio-orbital region, whose main problem was a pulsating right exophthalmos caused by herniation of the frontotemporal lobe through a defect of the greater wing of the sphenoid. The lesion was approached through a combined route (i.e., transfrontally and transfacially [upper eyelid incision]). Surgical strategy and associated problems are discussed

Use of the microsystem in craniomaxillofacial surgery: preliminary report.

The last few years have been astonishing technological advances in craniomaxillofacial surgery, with particular regard to the introduction of internal rigid fixation. This technique has allowed craniomaxillofacial surgeons to achieve more precise preoperative planning and use of modern techniques of fixation during surgery. As a result, rigid internal fixation has become popular and currently represents a keystone in maxillofacial surgery for trauma, deformities, orthognathic surgery, as well as reconstruction procedures following tumor resection. We review a 2-year experience with the use of microsystem in 45 patients

Dislocation of the mandibular condyle into the middle cranial fossa.

none4Dislocation of the mandibular condyle into the middle cranial fossa is an uncommon event. A case report is presented based on a patient (32-year-old female) who sustained a traumatic left condyle fracture with superior dislocation into the middle cranial fossa due to a high-speed car accident. The diagnosis was done four months after trauma. Via a preauricular approach, left condylectomy and transposition of temporal muscle flap was performed. Postoperatively, the patient stayed for two weeks with intermaxillary fixation and four months of physical therapy.noneL. Clauser;R. Tieghi;J. Polito;M. GalièClauser, Luigi; R., Tieghi; J., Polito; Galiè, M

Giant mucocele of the frontal sinus.

none4Giant mucocele of the frontal sinus is a rare pathology of benign entity caused by retention of mucous secretions in the sinus. It may expand and erode the surrounding structures such as bones and cerebral parenchyma. The authors describe a patient with frontal giant mucocele involving the orbit, the ethmoid, and intracranial portion of the dura. The main presenting symptoms were diplopia and proptosis. A computed tomography scan and magnetic resonance imaging were performed to permit differential diagnosis from other pathologies such as ossifying fibroma, fibrous dysplasia, and other neoplasms. A single stage maxillofacial and neurosurgical approach to treatment was taken consisting in the removal of the mucocele and reconstruction of the eroded bones with cranial bone grafts. The dura was repaired with temporalis muscle fascia sealed with fibrin glue. Two years after surgery, the patient shows no recurrence and satisfactory morphologic and functional results.noneM. Galiè;S. Mandrioli;R. Tieghi;L. ClauserGaliè, M.; S., Mandrioli; R., Tieghi; Clauser, Luig

Haemangioma of the zygoma: case report.

none4Haemangioma of bone in the zygoma is extremely rare. We report two cases presenting with swelling of the zygomatic region. The literature is reviewed and CT, angiographic and MRI findings are discussed.noneV. Pinna;L. Clauser;M. Marchi;L. CastellanV., Pinna; Clauser, Luigi; M., Marchi; L., Castella

Bilateral hyperplasia of the coronoid processes: Clinical report

none4Monolateral or bilateral hyperplasia of the coronoid processes of the mandible is a rare disorder resulting in reduction of mouth opening because of the unnatural contact of the coronoid process with the zygomatic bones. The authors describe two cases of bilateral hyperplasia of the coronoid processes that were successfully treated.noneR. Tieghi;M. Galiè;L. Piersanti;L. ClauserR., Tieghi; Galiè, M.; L., Piersanti; Clauser, Luig