External osteotomy in rhinoplasty: Piezosurgery vs osteotome

Purpose: To achieve the desired outcome in rhinoplasty depends on many factors. Osteotomy and surgical reshaping of nasal bones are important steps that require careful planning and execution. The availability of different tools raises the question of which one provides significant advantages for both technique and surgical outcome. Our prospective randomized pilot study compared the outcome of post-traumatic rhinoplasty performed with two different external techniques: ultrasound osteotomic cut using the Piezosurgery Medical Device (Mectron, Carasco, Italy) and traditional external osteotomy. Material and methods: Forty-four lateral osteotomies of the nasal wall were performed in twenty-two patients. In twelve patients the osteotomies were conducted with a 2-mm traditional osteotome (control group), while in the remaining ten patients these were done with the Piezosurgery Medical Device (experimental group). Results: At the postoperative evaluation, significantly lower pain, edema and ecchymosis were noticed in the experimental group (p < 0.05). Moreover, the endoscopic evaluation showed fewer mucosal injuries in the experimental group (p < 0.05), whereas bleeding, symmetry of the pyramid and presence of external scars, were similar in the two groups. Conclusions: In the present study, Piezosurgery Medical Device allowed for safe lateral osteotomies in rhinoplasty preliminarily demonstrating the potential to reduce some of the most frequent complications of rhinoplasty

Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth

There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit-Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality

In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training

Clinical signs, telemedicine and online consultations in head and neck diseases during the SARS CoV-2 pandemic: an Italian experience

SUMMARY Objective. The aim of this paper is to describe the application of a telemedicine (TM) syn-chronous model designed to deliver care during the Coronavirus Disease 2019 (COVID-19) pandemic to patients with head and neck disease. Methods. The first step was to identify the classes of patients eligible for tele-examination. Mild, flu-like symptomatology represents the characteristics of the typical patient who is a candidate for tele-examination. The standard requirements for TM include a computer associated with a digital camera, alternatively a smartphone or tablet. The TM platform is based on the Lifesize™ software, which can be freely downloaded. Results. The overall number of teleconsultations was 178, of which 163 (91.5%) were man-aged at home, while 15 (8.5%) were invited for in-presence examination. The number of patients coming from general practitioners was 98 (55.1%), from spoke units 52 (29.2%), patients needing prompt stabilisation and transfer to the hub centre were 20 (11.2%,) while 8 (4.5%) were immediately fast-tracked in the spoke unit after multi-professional tele-con-sultation. Conclusions. Telemedicine improves organisational models, and provides a scalable solu-tion to overcome problems of overcrowding, resources and time. Should these develop-ments continue, we could face to a gradual transition to a more digital and efficient health-care system

Volumetric Analysis of Fat Injection by Computerized Tomography in Orthognathic Surgery: Preliminary Report on a Novel Volumetric Analysis Process for the Quantification of Aesthetic Results

Background: Integrated approaches to orthognathic surgery should include accurate volumetric evaluation of the skull and soft tissues. In patients with dentofacial deformities, the most frequent aesthetic deficits are attributable to an underdevelopment of hard and soft tissues. Traditional osteotomic procedures often fail to guarantee a stability of soft tissues over time. For this reason, in selecting a surgical strategy, the surgeon should consider not only traditional osteotomies, but also soft-tissue improving procedures, such as lipofilling. Preoperative surgical planning systems, such as the Virtual surgical planning (VSP) protocol, are based mainly on skeletal movement prediction. Quantitative estimation of soft-tissue modifications is not part of common clinical practice. Most commonly, the evaluation of soft-tissue modifications after orthognathic procedures is instead performed by clinical qualitative means. The purpose of this study was to describe a novel computed tomography (CT)-based volumetric analysis process for the quantification of injected autologous adipose tissue in patients who have undergone simultaneous orthognathic and lipofilling procedures. Methods: This was a retrospective review of consecutive patients who underwent combined orthognathic surgery and lipofilling from June 2016 to May 2017 for malocclusion with functional and aesthetic impairments. Preoperative planning included clinical evaluation and virtual osteotomy planning according to the VSP protocol. The volume of fat to be injected was estimated clinically by comparing virtual renderings with preoperative clinical photographs. The surgical technique involved Le Fort I and sagittal split mandibular osteotomies, combined with autologous fat injection in the malar and perioral regions. Postoperative evaluation was performed with a novel imaging process based on CT image segmentation to quantify the exact volume of injected fat. Skeletal stability was also evaluated at 3 months. Results: Sixteen patients were enrolled in the study, all females, with a mean age of 24.5 years (range, 18-36 years). The mean difference between the fat tissue injected and that quantified postoperatively was 6.01 cm 3. All patients had clinically satisfactory facial convexity, with complete restoration of the cheekbone contour, at 3 months. Conclusion: This study introduces a novel CT-image based technique to quantitatively assess the contribution of injected fat to the postoperative soft-tissue volume increase after combined orthognathic surgery with autologous lipofilling. In the future, this CT-based volumetric analysis technique could be the gold standard for evaluating facial lipofilling outcomes, and for assessing clinical aesthetic outcomes based on the injected volume of fat

Feasibility of preoperative planning using anatomical facsimile models for mandibular reconstruction

BACKGROUND: Functional and aesthetic mandibular reconstruction after ablative tumor surgery continues to be a challenge even after the introduction of microvascular bone transfer. Complex microvascular reconstruction of the resection site requires accurate preoperative planning. In the recent past, bone graft and fixation plates had to be reshaped during the operation by trial and error, often a time-consuming procedure. This paper outlines the possibilities and advantages of the clinical application of anatomical facsimile models in the preoperative planning of complex mandibular reconstructions after tumor resections. METHODS: From 2003 to 2005, in the Department of Maxillofacial Surgery of the University of Udine, a protocol was applied with the preoperative realization of stereolithographic models for all the patients who underwent mandibular reconstruction with microvascular flaps. 24 stereolithographic models were realized prior to surgery before emimandibulectomy or segmental mandibulectomy. The titanium plates to be used for fixation were chosen and bent on the model preoperatively. The geometrical information of the virtual mandibular resections and of the stereolithographic models were used to choose the ideal flap and to contour the flap into an ideal neomandible when it was still pedicled before harvesting. RESULTS: Good functional and aesthetic results were achieved. The surgical time was decreased on average by about 1.5 hours compared to the same surgical kind of procedures performed, in the same institution by the same surgical team, without the aforesaid protocol of planning. CONCLUSION: Producing virtual and stereolithographic models, and using them for preoperative planning substantially reduces operative time and difficulty of the operation during microvascular reconstruction of the mandible

Distraction osteogenesis: a method to improve facial balance in asymmetric patients

Abstract: Distraction osteogenesis is a well-established surgical procedure to elongate the maxillofacial skeleton. The authors propose a new method to balance facial asymmetry by means of distraction of the inferior borders of the mandible, without change of the occlusion, using an alveolar device. Nine patients with asymmetry were treated. Records included panoramic radiographs and computed tomographic scans. Preoperatively, stereolithographic models and virtual-reality surgery were performed to have a precise surgical planning. The surgical procedure was based on segmental inferior osteotomy and simultaneous positioning of the alveolar device upside-down. Postoperative clinical evaluation demonstrated that a very impressive elongation of the inferior bony border with simultaneous expansion of the soft tissues had been achieved, resulting in a satisfying facial balance. The postdistraction radiographs showed the ossification of the gap, and the new bone formation was observed and confirmed by biopsy. Distraction osteogenesis of the inferior border of the mandible and the chin represents a new method to correct facial asymmetry and is a valid alternative to the traditional techniques. In addition, surgical virtual reality and stereolithographic models are, without a doubt, an advantage in defining the vector of distraction and in simulating the final result

Ultrasound endoscopic bone cutting for rapid maxillary expansion

Purpose: This study evaluated the feasibility and morbidity of ultrasound endoscopic rapid maxillary expansion. Patients and Methods: Thirteen consecutive patients (7 women and 6 men; mean age at time of surgery, 22 yr 10 months; range, 15 yr 4 months to 26 yr 3 months) who required surgically assisted rapid palatal expansion were included in this study. Eight patients had Class III malocclusion and 5 had Class II malocclusion. All osteotomies were performed using ultrasound bone-cutting instruments under direct visualization with a rigid 30! 2.7-mm-diameter endoscope connected to a video system, with access through 3 small vertical incisions. Results: Satisfactory maxillary expansion was achieved in all patients, with minimal postsurgical sequelae. The average operative time for the 13 cases was 74 minutes (standard deviation, 11 minutes) and was not dependent on the quality of bone. Postoperative pain was measured using a visual analog scale ranging from 0 to 10 andwas found to be 1.5 "0.8 on the first postoperative day, which decreased to 0.9 " 0.4 on the second day. Mucosal healing was excellent and none of the patients had excessive edema, hematoma formation, or nerve injury. Conclusion: The procedure described is minimally invasive and has advantages over the usual technique in providing direct vision, creation of a precise and safe osteotomy, minimal bleeding risk, and decreased dissection