Bilateral SMAS rhytidectomy in parotid recurrent pleomorphic adenoma

A case is presented of a young female with parotid recurrent pleomorphic adenoma and skin infiltration treated with subtotal parotidectomy combined with a bilateral superficial muscular aponeurotic system rhytidectomy

Microcystic adnexal carcinoma of the centrofacial region: a case report

Microcystic adnexal carcinoma is a rare, locally aggressive neoplasm with both eccrine and follicular differentiation and a high probability of perineural invasion of the centrofacial region. Given the histopathological features of this tumour, early diagnosis is essential for adequate management. This report refers to a case of microcystic adnexal carcinoma of the nasogenial region, with infiltration of the deep planes extending to the anterior wall of the maxillary sinus. Surgical treatment involved wide demolition of the centrofacial region followed by reconstruction using four locoregional flaps: an Indian flap and a Mustardé flap were used for cutaneous reconstruction; a septal flap to support the maxillogenial region; a mucosal flap to separate the nasal cavities

Valutazione tridimensionale dei movimenti mandibolari dopo ricostruzione con lembo libero di fibula

In questo studio sono stati analizzati sette pazienti a cui è stata ricostruita la mandibola utilizzando un lembo libero di fibula. Un paziente è stato operato medialmente e gli altri sul lato destro o sinistro. I pazienti sono stati riabilitati con protesi su impianti, ed hanno eseguito una serie di movimenti limite mandibolari (massima apertura e chiusura della bocca, laterotrusioni destra e sinistra, protrusione), che sono stati registrati nelle tre dimensioni dello spazio da un sistema non invasivo di analisi del movimento. I relativi parametri cinematici dell’articolazione temporomandibolare sono stati confrontati con quelli ottenuti in un gruppo di soggetti sani di controllo utilizzando gli z-score. La massima apertura della bocca è risultata ridotta in tutti i pazienti, con z-scores compresi tra -2.742 e -0.106, ed è stata effettuata con una minore rotazione mandibolare sul piano sagittale. In tutti i pazienti salvo uno si è rilevata una riduzione del movimento del punto interincisale durante la protrusione. Nei pazienti, i movimenti del punto interincisivo in laterotrusione e i movimenti condilari durante l’apertura della bocca sono risultati molto variabili e talvolta asimmetrici. Anche la rotazione mandibolare è risultata molto variabile, con z-scores compresi tra -1.265 e - 1.388. Insieme all’ampiezza dei movimenti, sono state indagate alcune caratteristiche biomeccaniche dell’articolazione, che possono fornire informazioni relativamente ai capi articolari senza sottomettere i pazienti a procedure pericolose. Le valutazioni possono essere eseguite longitudinalmente durante il follow-up. I dati forniti da questo studio indicano quali aree facciali e quali strutture devono essere attentamente valutate durante la pianificazione preoperatoria, nell’illustrazione dei problemi al paziente e durante la riabilitazione

Custom made/patient specific alloplastic total temporomandibular joint replacement in immature patient: a case report and short review of literature

OBJECTIVE: Temporomandibular joint reconstructive surgery in a growing patient represents a challenging situation. Autogenous and alloplastic reconstructive options are being studied in literature; however, there are still some limitations. The objective of this case report is to evaluate a novel custom-made prosthetic system in a 12-year-old TMJ ankylosis patient. CASE PRESENTATION: The patient had complaints of temporomandibular joint ankylosis and hypoplasia. The patient had already been operated two times with autogenous grafts. Swelling and tumefaction were apparent on the right side of the face. Mouth opening was 1.5 centimeters, with limitations in lateral and protrusive movements of the jaws. Hypertonic muscles and pain upon palpation were registered. There were no signs of luxation, fracture, or traumatic avulsion. After examination, unilateral TMJ ankylosis was apparent on TC scans. Revision surgery was planned with the use of true plastic temporomandibular joint customized prosthesis. The patient underwent a TMJ reconstruction surgery using CADCAM custom-made patient specific prosthesis. The follow up period of this patient was 46 months and showed successful healing with no complications. CONCLUSIONS: Replacement of TMJ with custom made alloplastic material that is reported can be considered as a safe and useful option for growing young individuals in selected cases

Clinical outcomes of fully and partially threaded zygomatic implants in a cohort of patients with minimum 7.5-year follow-up

OBJECTIVE: The aim of this retrospective case series report was to evaluate the results of oral rehabilitation with extra-sinus zygomatic implant surgery with a minimum follow-up of 7.5 years. PATIENTS AND METHODS: A total of 35 patients with 87 zygomatic implants were included. The mean follow-up period of the patients was 93 months. The zygomatic implant survival and complications were evaluated as criteria for success. RESULTS: There were no implant failures. Overall success rate without complications for zygomatic implant was 88.5%. Complications developed in 4 patients (1 cutaneous fistula and 3 mucositis). According to the results on an implant basis, patients with previously failed conventional implants had greater probability of complications. Patients with quad zygomatic implants had higher incidence of complications than those with two zygomatic implants. Fully threaded implant design was associated with higher incidence of mucositis than partially threaded design. No relation was found between implant success and smoking, prosthesis type, and antagonist dentition. When conducting the analysis using the patient as unit, only the antagonist dentition showed significant difference, the worst outcome being associated with the Toronto resin prosthesis. CONCLUSIONS: Zygomatic implants can be considered as a safe alternative to conventional implant insertions and bone grafting procedures in oral rehabilitation of patients with severely atrophic maxillary bone

Solitary fibrous tumor of parotid gland: a case report and short review of literature

OBJECTIVE: This case report represents a solitary fibrous tumor, which is a very rare neoplasm in the parotid gland. CASE PRESENTATION: 80-year-old Caucasian female patient with palpable, immobile, painless, slow growing, semi-rigid-elastic neoplasm in the left parotid gland, that was existing for four months. There were no signs of inflammation and facial paralysis. The tumor was initially interpreted as a salivary gland neoplasm of uncertain origin. Fine needle aspiration was performed 2 times; however, the precise diagnosis was challenging. The tumor was excised, regional lymphadenectomy was performed. Morphological and immunophenotypical findings were consistent with solitary fibrous tumor of parotid gland. Currently, the patient is under regular follow-up period at 9 months with no evidence of metastasis or recurrence. CONCLUSIONS: Although very rare, solitary fibrous tumor (SFT) should be suspected in cases of slow growing, solid, well-defined nodules of the parotid gland. The SFT of the parotid gland are usually benign tumors, however there is a low risk of recurrency and malignant behavior with metastatic potential. Complete resection of the tumor should be performed since it is crucial for management without any recurrence

Analysis and comparison of quality of life and patients’ satisfaction between dental-skeletal dysmorphisms and Obstructive Sleep Apnea (OSA) patients following orthognathic surgery

OBJECTIVE: The aim of this study was to evaluate the impact of orthognathic surgery on the patients’ satisfaction and quality of life (QoL) in patients with dental skeletal dysmorphisms and Obstructive Sleep Apnea (OSA). SUBJECTS AND METHODS: Patients were grouped into two cohorts, patients with OSA (G1) and patients with dento-skeletal dysmorphisms (G2). SF-36 questionnaire was obtained from all subjects before interventions. A standardized follow-up protocol, including a second SF-36 questionnaire was planned as at least 6 months after surgery. The impact of surgery on satisfaction was evaluated by post-operative patient satisfaction-based survey. RESULTS: 61 patients were included as: 21 OSA (G1), 12 Class II (G2-a) and 28 Class III (G2-b) patients. The mean post-operative follow-up was 65.47±26.36 months. In the SF-36 results, when pre and post operative surveys were compared, the quality of life increased significantly for G1 in all items except for body pain. In G2, when pre and post operative surveys were compared, the quality of life increased significantly in items related to emotional well-being, health transition, role limitations due to emotional problems, while other parameters did not significantly change. When groups were compared, there was no difference among them except for physical functioning which was improved for OSA patients. According to the Rustemeyer results, overall post-operative satisfaction score was 84.92±14.72%. There was a significant difference for patient satisfaction considering facial aesthetics in both groups. For chewing function there was no difference for patient satisfaction in G1, but there was a significant difference in G2 patients. CONCLUSIONS: Orthognathic surgery seems to be beneficial in terms of patients’ satisfaction and patients’ satisfaction for both dental skeletal dysmorphism and OSA patients

Il dispositivo medico GOCCLES® è in grado di individuare displasie e cancro orale se impiegato nel setting odontoiatrico. Risultati da uno studio multicentrico

Scopo di questo studio è dimostrare che il dispositivo medico GOCCLES® permette di condurre l’esame dell’autofluorescenza del cavo orale nel setting odontoiatrico. Si tratta di uno studio multicentrico non randomizzato su pazienti consecutivi a rischio di cancro orale. I pazienti sono stati sottoposti ad ispezione del cavo orale ad occhio nudo seguita dall’esame dell’autofluorescenza condotto indossando gli occhiali GOCCLES® mentre una lampada fotopolimerizzante illuminava la mucosa orale. Le lesioni sono state definite come qualunque lesione precancerosa del cavo orale visibile ad occhio nudo o area di perdita di fluorescenza visibile con GOCCLES®. Tutte le lesioni persistenti sono state sottoposte a biopsia escissionale o incisionale. Sono stati reclutati 61 pazienti e analizzati i dati da 64 lesioni. Delle 62 lesioni identificate dal dispositivo, 31 erano veramente positive. Il dispositivo ha identificato 31 delle 32 lesioni veramente positive. Una lesione (un carcinoma invasivo) non era visibile ad occhio nudo. Tutte le lesioni classificate come displasia tra moderata e severa e ogni carcinoma sono stati correttamente identificati dal dispositivo. Nel Il 56,7% delle lesioni identificate dal dispositivo mostrava margini più ampi rispetto a quelli visibili ad occhio nudo. Il dispositivo medico GOCCLES® permette di osservare il fenomeno della perdita di fluorescenza in pazienti affetti da displasia o cancro del cavo orale. Ha permesso di effettuare l’esame dell’autofluorescenza con ciascuna lampada fotopolimerizzante testata. I risultati suggeriscono di impiegare GOCCLES® come esame complementare rispetto all’ispezione ad occhio nudo del cavo orale su pazienti a rischio per cancro orale. Il dispositivo permette di identificare lesioni altrimenti visibili o i cui margini sono sottostimati dall’ispezione ad occhio nudo

Oral rehabilitation of oncology patients with dental implants after reconstruction surgery with autogenous flaps

OBJECTIVE: Reconstruction after radical cancer surgery in terms of function and esthetics can be quite demanding. The aim of this study was to evaluate oral rehabilitation with autogenous flaps and dental implants for maxillofacial reconstruction in oncologic patients after implant insertions. MATERIALS AND METHODS: The study consisted of 19 patients diagnosed with either squamous cell carcinoma, fusocellular carcinoma, or mucoepidermoid carcinoma. The reconstruction of the maxillofacial defects was done with autogenous flaps (free fibular flap, antero-lateral thigh flap, radial forearm flap, or rotational pedicled temporal muscle flap). Implants were inserted on the average 32.03±19.51 months after reconstructive operations. A total of 82 implants were inserted. Mean follow-up after maxillo-facial surgery was 7.2 years (mean 86.56±22.04 months). Mean follow-up after implant insertions was 4.5 years (mean 54.6±21.82). Primary outcome was implant survival. Secondary outcome was evaluation of post-surgical complications. RESULTS: There were surgical revisions in seven patients after reconstructive surgery with flaps, mainly due to tumor relapse. Complications were seen in 11 patients. There was one implant failure. Overall implant survival rate was 98.8%. No relations were found between implant survival rate and gender, type of tumor, type of microvascular free flap, radiation therapy, chemotherapy, and prosthesis type. CONCLUSIONS: According to the results of this study, oral rehabilitation with dental implants inserted in free flaps for maxillofacial reconstruction after ablative oncologic surgery can be considered as a safe treatment modality with successful outcomes