TUSC (TUrbinate Surgery Classification): A Novel Classification Proposal for Turbinate Surgery

Aim of this manuscript is to propose a clear and easily applicable classification for turbinate surgery, based on the use of a numerical model, which could be introduced in the practice of Otolaryngologists and Maxillo-Facial surgeons.Applying this classification, it will be possible to offer an easy format when describing which turbinates are involved in a procedure, and to offer a quick method to record and analyse clinical data, also for scientific purpose

Transnasal endoscopic approach for the treatment of medial orbital wall fractures

The aim of this study is to report a case series of blowout fractures of the medial orbital wall that were treated endoscopically. Isolated fractures of the medial orbital wall are uncommon and can be asymptomatic. Various surgical methods for repairing medial orbital wall fractures have been described. The standard approach for the treatment of medial orbital wall fractures is the transcutaneous approach or the transconjunctival with retrocaruncular approach. In the last years, the attention on the use of minimally invasive techniques such as transnasal endoscopic approach is growing. This was a retrospective study of six cases completely managed endoscopically. In the presented case series, the endoscopic endonasal approach represented a safe and effective procedure for the reduction of medial wall orbital fractures. © 2019 Wolters Kluwer Medknow Publications. All rights reserved

Fat Grafting in OrbitoCranial and MaxilloFacial Restoration: from Surgery to Regeneration

Autologous fat grafting is not a new technique. In the past many surgeons avoided its use because the results were poor and unpredictable.1,2 However, in the 1980s, structural autologous fat grafting was developed, with well-defined indications, refined techniques, and predictable results. Fat grafting was introduced as a way to improve facial aesthetics. In recent years it has evolved into applications in more complex reconstructive procedures. Fat grafting can be used particularly on any facial area with a lack of soft tissue resulting from posttraumatic sequelae, following tumor resections, and as a refinement in craniofacial deformities. Its use has become widespread because it produces natural, long-lasting results with minimal donor site morbidity

Endocrine orbitopathy: 11 years retrospective study and review of 102 patients & 196 orbits.

Endocrine Orbitopathy (EO) is the most frequent and important extrathyroidal stigma of Graves' disease. In the active stage of the orbitopathy fibrosis and hypertrophy of the extra-ocular muscles can lead to visual impairment and diplopia. In the stable phase of the disease surgical treatment by orbital expansion and/or orbital decompression can improve the quality of life and it is indicated for morpho-aesthetic and functional reasons.From 1998 to 2009 a consecutive series of 131 patients (251 orbits) with endocrine orbitopathy underwent surgery by different techniques. The medical records of 102 patients (78\%) and 196 orbits were available to be assessed retrospectively. Ninety-four patients had bilateral involvement of the orbits and eight unilateral. A total of 556 operations were performed.Mean pre-operative exophthalmos was 24.7 ± 2.5 mm (max-min 20-34), mean post-operative exophthalmos was 21 ± 1.8 mm (max-min 18-26), and mean differential exophthalmos was 3.9 ± 1.7 mm (max-min 1-9). The reduction in exophthalmos after surgery had a mean value of 3.8 mm (min 1, max 9). Kaplan Meier algorithm demonstrates that intra-operative cortisone injection had an adverse effect on post-operative diplopia.The surgical technique used should be adapted to the individual patients' needs. In severe cases intraorbital fat removal and bony decompression can be and carried out in one surgical procedure. An integrated global approach by a multidisciplinary team is strongly recommended. Strabismus surgery is a significant part of the overall treatment. The Authors suggest general surgical guidelines and an algorithm of treatment in EO

Management of temporomandibular joint reankylosis in syndromic patients corrected with joint prostheses: surgical and rehabilitation protocols

Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success

Craniomaxillofacial Fibrous Dysplasia: Conservative Treatment and Maxillary Osteotomy Using the Schuchardt-Kufner Technique

Fibrous dysplasia (FD) is a disturbance of the mesenchymal tissue that accounts for 2.5% of all bone tumors and more than 7% of nonmalignant bone tumors. In the craniomaxillofacial region, FD affects the calvaria, skull base, zygoma, and jaws, the prevalent site being the maxilla (50% of cases). Therapy for craniomaxillofacial FD is surgical. The goals of surgery are to prevent functional disorders and restore facial symmetry, volume, and contour. In this article, we present a case of a young female patient affected by right orbital-zygomatic-maxillary FD. She had developed facial asymmetry and malocclusion that were corrected using the Schuchardt-Kufner osteotomy technique

Selective augmentation of stem cell populations in structural fat grafts for maxillofacial surgery.

Structural fat grafting utilizes the centrifugation of liposuction aspirates to create a graded density of adipose tissue. This study was performed to qualitatively investigate the effects of centrifugation on stem cells present in adipose tissue. Liposuction aspirates were obtained from healthy donors and either not centrifuged or centrifuged at 1,800 rpm for 3 minutes. The obtained fat volumes were divided into three layers and then analyzed. The results demonstrate that centrifugation induces a different distribution of stem cells in the three layers. The high-density layer displays the highest expression of mesenchymal stem cell and endothelial markers. The low-density layer exhibits an enrichment of multipotent stem cells. We conclude that appropriate centrifugation concentrates stem cells. This finding may influence the clinical practice of liposuction aspirate centrifugation and enhance graft uptake

Gene expression profile of stemness markers.

<p>Gene expression profile of stemness markers in the LDL (white bars), MDL (grey bars), and HDL (black bars). The results are reported as ratios (R) with respect to the mRNA expression levels of non-centrifuged fat (not shown).</p

List of genes analyzed by real-time PCR.

<p>List of genes analyzed by real-time PCR.</p

Gene expression profile of genes associated with mesenchymal stem cell markers.

<p>Gene expression profile of genes associated with mesenchymal stem cell markers in the LDL (white bars), MDL (grey bars), and HDL (black bars). The results are reported as ratios (R) with respect to the mRNA expression levels of non-centrifuged fat (not shown).</p