Management of free flap failure in head and neck surgery

Lutilizzo dei lembi liberi è oggi considerata lopzione di prima scelta nella ricostruzione dei difetti testa-collo, con una percentuale di successo di circa il 95%. La gestione del fallimento di un lembo libero e quale soluzione, tra un secondo lembo libero e un lembo peduncolato, sia più sicura è ancora controversa. Lobiettivo del presente lavoro è descrivere le opzioni adottate dagli Autori e confrontare le scelte e i risultati ottenuti con quelli riportati in letteratura. Dal Gennaio 2012 al Gennaio 2016, presso lUO di Chirurgia Maxillo-Facciale dellOspedale Casa Sollievo della Sofferenza, sono stati allestiti 149 lembi liberi per la ricostruzione di difetti interessanti il distretto testacollo. Di questi, 6 lembi sono stati persi a causa della comparsa di una necrosi totale nel post-operatorio. In 5 casi si è scelto di allestire un secondo lembo libero, nel restante paziente invece è stato utilizzato un lembo di muscolo temporale. Tutti i lembi liberi di salvataggio allestiti hanno avuto successo, senza complicanze e con un buon recupero estetico e funzionale dei pazienti. Analizzando i dati ottenuti e confrontandoli con quanto riportato in letteratura, è possibile concludere come lallestimento di un secondo lembo libero costituisca una procedura sicura e ideale come salvataggio dopo necrosi totale di un precedente lembo

Trismus and TMJ disorders as first clinical manifestations in an intracranial acquired cholesteatoma

Intracranial extension of acquired cholesteatoma is a rare occurrence that can develop secondary to trauma, chronic otitis media or acquired aural cholesteatoma. The most commonly observed symptoms are headache and hearing loss. The authors report on a rare case of intracranial cholesteatoma presenting with atypic symptoms: swelling and temporomandibular joint disorders

Inferior alveolar nerve reconstruction in extensive mandibular resection: Technical notes

The inferior alveolar nerve (IAN) is a sensitive branch of the mandibular nerve innervating the lower lip, the chin, the buccal mucosa and the teeths. Lesions of the IAN are reported to occur in the 64,4% of maxillo-facial procedures, leading to anesthesia, hypoestesia and/or neurogenic discomfort. An extensive segment of the nerve can be moreover removed during mandibular resection for benign or malignant pathologies. Nervous grafts can be used in these cases to restore the nerve continuity. In order to optimize the procedure and to allow a concomitant mandibular osseous reconstruction, the Authors identified several standardized steps. The technique described allows to perform confortable and safe nervous anastomoses and to reduce the risk of damage and tension during the flap insetting phases. (C) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

Inferior alveolar nerve reconstruction in extensive mandibular resection: Technical notes

The inferior alveolar nerve (IAN) is a sensitive branch of the mandibular nerve innervating the lower lip, the chin, the buccal mucosa and the teeths. Lesions of the IAN are reported to occur in the 64,4% of maxillo-facial procedures, leading to anesthesia, hypoestesia and/or neurogenic discomfort. An extensive segment of the nerve can be moreover removed during mandibular resection for benign or malignant pathologies. Nervous grafts can be used in these cases to restore the nerve continuity. In order to optimize the procedure and to allow a concomitant mandibular osseous reconstruction, the Authors identified several standardized steps. The technique described allows to perform confortable and safe nervous anastomoses and to reduce the risk of damage and tension during the flap insetting phases

Dyskeratosis congenita and squamous cell carcinoma of the mandibular alveolar ridge

Dyskeratosis congenita is a rare disease caused by telomerase dysfunction classically characterised by the triad: skin pigmentation, nail dystrophy and mucosal leukoplakia. Few cases are described in literature regarding patients with head and neck squamous cell carcinoma affected by dyskeratosis congenita, and the therapeutic decisions are not yet well defined. A review of the literature of the last 20 years (2001-2021) was performed, and it was analysed the case of a 38-year-old male patient affected by dyskeratosis congenita diagnosed with a squamous cell carcinoma of the inferior alveolar ridge, treated with surgery. The absence of complications and the good postoperative recovery of the patient comfort in saying that resection and reconstructive surgery can be safely performed. The occurrence of disseminated disease 6 months after the treatment warns about the extreme aggressiveness of the pathology, its often systemic nature and the necessity of a multidisciplinary approach as well as further studies

Osteonecrosis of the maxilla with zygomatic bone exposure by zolendronic acid: A case report

Bisphosphonates are a class of drugs extremely important in the treatment of several pathologies such as bony metastases, malignant hypercalcaemia, multiple myeloma, osteoporosis, and Paget's disease. Since necrosis in the maxilla and jaw area is often associated to treatment with Bisphosphonates, the present study wants to assess any possible relation between Bisphosphonates therapy and osteonecrosis. Here, we report on a patient affected by multiple myeloma (MM) who developed necrosis of the maxilla and exposure of the zygomatic bone during bisphosphonates therapy (BT). In literature, to our knowledge no cases with so huge extension of necrosis have been reported to date. He refused any surgical treatment. After a 5-year follow-up, the disease is now well controlled without progression, with long term or intermittent courses of penicillin-type antibiotics. Bisphosphonates, such as pamidronate and zoledronate, play a determinant role in the treatment of several oncological diseases. Nevertheless, they could pose a risk for osteonecrosis in the maxilla and jaw region. Furthermore, the treatment of bisphosphonates-related osteonecrosis is still a challenge due to the extreme aggressiveness of the syndrome. Hence, the conservative or the aggressive approaches have to be carefully considered each time, case by case

Pott's Puffy Tumor and Intranasal Cocaine Abuse

Pott's puffy tumor (PPT) is a rare subperiosteal abscess of the frontal bone with osteomyelitis, which most commonly affects adolescents as a complication of frontal sinusitis or head trauma. The Authors describe a case of development of a PPT in a woman who abused of cocaine for at least five years and presented with a gradually enlarging mass of the forehead. The patient was treated surgically through combined endoscopic and open approach and medically with antibiotic therapy. The PPT, as rare complication of intranasal cocaine abuse, was described until now in four patients. Even rare it can be a fearsome complication, making of fundamental importance an early diagnosis and a correct management

Anatomic landmarks for masseteric nerve identification: Anatomic study for a new reference point

The masseteric nerve is often used as a donor nerve in the treatment of facial paralysis. Even if several anatomical studies described landmarks for its identification, their main disadvantages are the anatomical variability and the changes due to surgery. Sixteen dissections were performed on cadaveric specimens. The masseteric muscle (MM), the zygomatic arch (ZA), the masseteric nerve (MN) and the zygomatic branch of the facial nerve (ZB) were identified and their relationships were measured. The relationships between MN and ZB resulted to be constant, with MN intersecting ZB at a depth of 0,78 cm in the muscle, 1,6 cm below ZA and 0,8 cm from the posterior border of MM. The measures obtained demonstrated as the main zygomatic branch of the facial nerve can be a suitable landmark for the identification of the masseteric nerve, with no variations due to the surgical procedure or patient characteristics