Bilateral reconstruction of the mandibular body with symphyseal preservation using a single fibula free flap: operative technique

Mandibular osteonecrosis may occur in 5% of the patients who undergo radiotherapy for the treatment of head and neck malignancies. Resection and microvascular reconstruction is the treatment of choice in complicated osteoradionecrosis, however multifocal presentation may complicate the management of the disease given the poor quality and limited availability of adequate recipient vessels

An unusual case of gardening ocular injury during Covid-19 lockdown

NTRODUCTION: Facial trauma are an important cause of serious ocular morbidity. In particular domestic trauma are a small part of total. COVID-19 pandemic has been influencing our life in a way never seen before, people need to remain at home due to lockdown restrictions. In this scenario we are seeing an increase in the percentage of domestic facial trauma. In other hand pandemic has influenced the possibility of hospitalization, so daily based procedures increased their importance in global treatment planning. CASE PRESENTATION: A 58 yo man presented to our ward with a foreign body in left eyebrow. Trauma happened during gardening. CLINICAL DISCUSSION: The importance of imaging to perform the right procedure has become more important during pandemic to reduce time of hospitalization. CONCLUSION: CT scan and ophtalmology consult have been the guideline to avoid a more invasive treat- ment which was performed in an outpatient regimen with local anesthesia

Complications and management after a nonsurgical rhinoplasty: A literature review

Nonsurgical rhinoplasty with injectable fillers has become an increasingly popular option in recent years. Their rise in popularity has been driven by a number of factors, including their minimally invasive nature and the cost lower than surgical option. Physicians should keep in mind that there are many possible complications, especially in the hands of a novice injector. Fortunately, most complications are minor and transient in nature, although the patient may consider them aesthetically displeasing and unacceptable. Major complications are rare; however, an inadequate treatment can produce transient to permanent damage for the patient. A review of the medical literature from 2002 was performed to gather information on main complications after nasal injections using the databases of the National Library of Medicine, Ovid MEDLINE, and Cochrane Library. Understanding the basic anatomical knowledge of the midface, especially the vascular system, is fundamental to prevent the appearance of complications. However, recognize immediately the symptoms and know the correct treatment in case of complications is the only way to minimize permanent bad outcome

Nonsurgical genioplasty

Chin contributes to facial balance and harmony. Appropriate treatment of aesthetic deformities of the will often improves the appearance of the mouth, lips, and nose. Augmentation of the chin can be performed with injectable fillers or autologous fat, placement of an alloplastic chin implant, or with chin's bony osteotomy. Determining the best procedure for a patient requires careful consideration of his anatomy, as well as the risks and benefits of each treatment. Fillers offer a nonsurgical, nonpermanent method of correction of chin retrusion in the appropriate patient

A Snapshot of Knowledge about Oral Cancer in Italy: A 505 Person Survey

Objectives: Patients' knowledge about oral squamous cell carcinoma (OSCC) plays an important role in primary prevention, early diagnosis, and prognosis and survival rate. The aim of this study was to assess OSCC awareness attitudes among general population in order to provide information for educational interventions. Methods: A survey delivered as a web-based questionnaire was submitted to 505 subjects (aged from 18 to 76 years) in Italy, and the answers collected were statistically analyzed. Information was collected about existence, incidence, features of lesions, risk factors of oral cancer, and self-inspection habits, together with details about professional reference figures and preventive behaviors. Results: Chi-square tests of independence with adjusted standardized residuals highlighted correlations between population features (age, gender, educational attainment, provenance, medical relationship, or previous diagnoses of oral cancer in family) and knowledge about oral cancer. Conclusions: Knowledge about OSCC among the Italian population is limited, and it might be advisable to implement nudging and sensitive customized campaigns in order to promote awareness and therefore improve the prognosis of this disease

The skin rejuvenation associated treatment-Fraxel laser, Microbotox, and low G prime hyaluronic acid: preliminary results

Minimally invasive facial rejuvenation procedures reached an all-time high in the 2016. This reveals a growing interest in a smoother, younger, and tighter look accessible using the esthetic medicine tools like botulinum toxin and dermal filler injections, laser, and microdermabrasion. Forty-five patients from 35 to 52 years old (medium age 43.8), 38 women and 7 men underwent 5 sessions of Fraxel laser, 1 session of very low G prime HA, and Microbotox injection treatments from January 2016 and January 2017, were included in this study. In this study, we demonstrated that the usage of three treatments together, like mBTX, Volite, and Fractional laser, have a better result despite every single technique alone. The clinical result showed 98% (44 patients, 6 males, 38 females) of the patients had a smoother skin surface, brighter, more hydrated, and elastic skin; 68% of our patients (31 patients, 5 males, 26 females) showed less skin defects and staining as well as less small wrinkles, thanks to Fraxel laser treatment; 98% (44 patients, 6 males, 38 females) showed tighter skin with less sebaceous gland secretion. The aim of this study was to demonstrate that the combination of three techniques acts better and faster than single treatment to contrast facial aging and to improve skin texture and quality

"Dynamic Canthopexy" Drill Hole Canthal Repositioning

Background: Canthopexies can be performed to modify the eye slant, both when the lateral canthus is lower than the medial one (congenital defect) or in case the patient asks for an almond-shaped eye (cosmetic indication).Objectives: This peculiar type of canthopexy can be defined as "dynamic canthopexy," meaning that the lateral canthus is released from its original insertion and raised to a higher position. The goal of this study is to demonstrate the differences and the efficacy of the dynamic cantoplasty.Methods: The authors reviewed 30 patients treated with a "dynamic canthopexy" between January 2005 and March 2015. Eighteen patients were affected by true downslanting palpebral fissure, and 12 patients had a normal eye shape but were wishing for a more "Asian" look. Dynamic canthopexy involves a total modification of the canthal suspension system and its careful reconstruction at a higher level inside the orbital rim. To obtain a permanent result, canthal ligament and tendon had to be anchored to drill holes in the orbital rim bone with nonabsorbable sutures. Symmetry was very carefully assessed. The average surgical time was 1 hour.Results: This surgery proved extremely effective in all cases. Patients must be warned, though, that an initial hypercorrection is necessary to achieve the desired canthal position. About 6 months after surgery the result of this operation can be considered permanent. Severe complications are rare.Conclusions: Dynamic canthopexy can provide stable correction of anti-Mongolian slant. It can also be effectively employed to obtain permanent slant eyes when required by purely cosmetic patients. If precisely carried out, this technique can yield very rewarding outcomes

Authors' response

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Response to a Comment on “Malignant transformation evidences of Oral Lichen Planus: When the time is of the essence”

Dear Editor, We want to thank Desai et al. [1] for the comment and discussion on our article “Malignant transformation evidences of Oral Lichen Planus: When the time is of the essence” [2]. Firstly, we are pleased to inform you that our extended work about Oral Lichen Planus (OLP) and malignant transformation was recently published, which allows us to better understand unclear issues [3]. However, regarding the letter by Desai RS et al., some clarifications deserve to be provided. We are in agreement with Guan et al. [4] who highlighted that OLP malignant transformation occurred also in not smokers patients. Our findings, indeed, showed a significant malignant transformation rate associated with localization of OLP lesions (especially on tongue margins, OR = 3.55 and P = 0.04) and with features of them (particularly erosive and ulcerative lesions, OR = 2.48 and P = 0.1). Regarding habits, smoking was found to be significantly associated with cancer transformation with an Odds Ratio (OR) of 3.29 (IC 0.58–18.37) and P = 0.18; on the other side, it was difficult to estimate the role of alcoholic consumption, due to uncertain answers of patients interviewed. Nevertheless, in our opinion, the important focus to evaluate is the observation period of patients when OLP is diagnosed and lesions. Our work showed the great importance of extending follow-up to early diagnose malignant transformation; indeed some of them occurred later than 4 years of observation, meaning that the cancer transformation rate of OLP lesions is a significant risk during the life as Guan et al. suggested in their research. Considering our results, we can conclude that clinical features of OLP lesions must be carefully evaluated for the correct timing of the follow-up, which must be as long as possible for them. We sincerely thank Desai RS et al. for the discussion about our work

The 'Alternating Osteotome Technique': a surgical approach for combined ridge expansion and sinus floor elevation. A multicentre prospective study with a three-year follow-up

The aim of this multicentre prospective study was to evaluate the efficacy and safety of a surgical approach based on a novel osteotome technique, in order to obtain both alveolar ridge expansion and sinus floor elevation. Partially edentulous patients requiring an implant-prosthetic rehabilitation with a fixed prosthesis in the posterior maxilla were included in this study according to pre-established inclusion and exclusion criteria. All implants were placed after site preparation with the 'Alternating Osteotome Technique', which consists of the use of alternating concave and convex osteotomes. After a 4 to 6-month healing period, all implants were restored with a definitive fixed prosthesis. Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol. Statistical analysis was used to detect any significant differences or correlations (P = 0.05). Seventy-six patients were consecutively treated with a total of 120 implants in three different centres. The mean ridge expansion and sinus floor elevation were 1.8 ± 0.3 and 2.5 ± 0.7, respectively. After three years of functioning, the implant success rate was 99.1% since one implant had failed and the mean marginal bone loss was 0.6 ± 0.3 mm. No complications occurred during the intraoperative and postoperative periods. All parameters analysed were stable and steady throughout the three-year follow-up. The 'Alternating Osteotome Technique' enables the dental surgeon to achieve an adequate implant osteotomy with limited ridge expansion and sinus floor elevation, increasing modestly the vertical and horizontal dimensions of the alveolar crest but reducing significantly the risk of surgical complications