Valutazione dell’applicabilità e stabilità a medio e lungo termine delle tecniche ricostruttive e riparative con biomateriali nella traumatologia orbito-mascellare

La fissazione rigida con placche e viti in titanio nella traumatologia maxillo-facciale ha consentito di ottenere notevoli miglioramenti nel consolidamento dei capi ossei, riducendo i tempi di contenzione e conferendo una maggiore stabilità degli stessi. Recentemente, abbiamo assistito ad una vera e propria evoluzione dei materiali di osteosintesi che ha portato all’utilizzo di materiale riassorbibile ovvero biodegradabile in chirurgia maxillo-facciale. Le prime ricerche sull’impiego di materiale bioassorbibile in chirurgia maxillo-facciale furono effettuate all’inizio degli anni ’70 ad opera di Cutright ed il materiale utilizzato erano omopolimeri, molecole costituite da acido poli L-lattico (PLLA), acido poliglicolico (PGA), polidiossannone (PDS). Oggi sono introdotti sul mercato copolimeri che garantiscono una buona stabilità per 6-8 settimane ed hanno un tempo di riassorbimento compreso tra 9 e 15 mesi. I copolimeri presi in esame sono sempre il PLLA e il PGA assemblati in varie percentuali in base all’industria produttrice. Questi polimeri bioassorbibili sono costituiti da macromolecole che, messi in un sistema biologico, vengono coinvolti in una reazione chimica che porta alla formazione di frammenti a più basso peso molecolare, attraverso una rottura progressiva dei legami della catena principale per polimeri lineari ed, eventualmente, attraverso la frammentazione dei punti di reticolazione. Gli obiettivi di questo studio sono stati la valutazione a medio e lungo termine sulla stabilità dei mezzi di fissazione bio-assorbibili che vengono utilizzati nella fissazione dei segmenti ossei osteotomizzati nel trattamento dei pazienti affetti da malformazioni dento-scheletriche

Use of suborbicularis oculi fat flap to cover peri-orbital bone exposure

Wide resection of recurrent basal cell carcinoma (BCC) in the peri-orbital-infraorbital-nasal area may include periosteum resection with maxillary or nasal bone exposure. The absence of vascularized periosteum makes the defect ungraftable and local flaps are often required. As an alternative to a large single flap or a combination of flaps, it is possible to turn the ungraftable portion of the defect into a graftable one. The suborbicularis oculi fat (SOOF) flap is an advancement flap that is used in aesthetic surgery for midface rejuvenation. The use of the SOOF flap along with a full-thickness skin graft, as an alternative to the use of other standardized flaps to cover defects in the peri-orbital-infraorbital-nasal area with avascularized tissue or noble structure exposure, is reported herein. As an immediate single-stage reconstruction, this procedure leaves other flap options intact in the event of re-operation for a recurrent tumour

Autologous fat grafting in facial volumetric restoration

The authors reported their surgical experience about structural fat grafting in the management of facial volumetric deficit. The purpose of this study was to assess the real indications, cosmetic results, complications, and global patient satisfaction of the Coleman technique in redefining facial contours in congenital and postoperative deformities. A retrospective analysis of 32 patients grafted according to Coleman's technique was performed, and the long-term outcomes and patient satisfaction were evaluated. The mean postoperative clinical follow-up was 14 months. The morphological changes were analyzed by comparing the photographic presurgical facial contour and the postoperative correction of soft tissue defects. All consecutive cases reported showed a progressive fat resorption for 3 months after surgery and its stable integration only after this period. Best results were performed in the treatment of genetically determined syndromes, such as the Franceschetti and Romberg syndromes. The authors suggest this surgical technique also for the treatment of unaesthetic cutaneous abscess cavity after incision and drainage. Unsatisfactory outcomes were obtained in the treatment of the posttraumatic facial scar, which needed more surgical procedures

Neck dissection versus “watchful-waiting” in early squamous cell carcinoma of the tongue our experience on 127 cases

Background Early oral squamous cell carcinoma (EOSCC) represents about 90% of the oral cancers especially in older males. The etiology is multifactorial, strongly related to tobacco and alcohol abuse, but also infective agents, Human papillomaviruses (HPV16-18), genetic factors and pre-neoplastic lesions seem to be implicated. There is no consensus in the literature for the treatment of early squamous cell carcinoma of the tongue (stages I–II); both an elective neck dissection policy and a watchful-waiting policy have their proponents in the different centers. Methods The records of 127 patients with EOSCC of the tongue treated in our Department between 2007 and 2011, with cN0 neck staging, who underwent resection of the primary tumor with or without elective neck dissection, were reviewed. Results We divided the patients into two groups, in Group 1 the 66 patients who received an elective neck dissection 30 days later from the primary surgery have been included, and in Group 2 the 61 patients undergoing “watchful waiting” observation for the development of nodal metastases have been collected. Statistical calculations were performed using Chi-square and t student test. Conclusions A significant difference was found between the two groups as concerns tumor stage and pathologic tumor classification (p < 0.001). No significant differences were present between the two groups as concerns mean follow up (P = 0.2), relapse rate (p = 0.3) and relapse-free survival time (p = 0.2). In T1 stage tumors with depth of infiltration ≤4 mm, or low grade (G1-G2), the “watchful waiting” strategy for cervical metastases is appropriate, given the low regional recurrence rate (15%) and overall survival of 100%. In case of T2 lesions with depth of infiltration ≥4 mm or high grade (G3) we prefer to perform the elective neck dissection, with 13% of local recurrence and 100% of survival at 6 years

Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly

Oral and oropharyngeal squamous cell carcinoma (Scc) occur most commonly in middle-aged and elderly individuals.Free flaps are commonly used for reconstruction of extensive tumor resection defects in the oral cavity. Age alone is not an independent variable for increased risk in microvascular reconstruction; however operative time and ASA risk score correlated with medical complications but not with surgical complications.The submental island flap has proven to be a reliable alternative in reconstruction of composite oral cavity defects for its thinness, pliability and versatility in design, shared by the radial forearm free flap, and its advantageous donor site. The submental flap can be easily raised and involves shorter operative time and hospital stay compared to the free-flap procedure. It can be an excellent choice in patients with a high ASA risk score, moreover in elderly patients, where the potential complications linked to microsurgical procedures are avoided. © 2016 IJS Publishing Group Ltd

PIEZOELECTRIC BONE SURGERY IN THE TREATMENT OF AN OSTEOMA ASSOCIATED WITH AN IMPACTED INFERIOR THIRD MOLAR: A CASE REPORT

Operative removal of impacted mandibular third molars is a common and not riskless surgical procedure. We present an emblematic case of an osteoma closely associated with an impacted third left mandibular molar treated by Mectron Piezosurgery medical ultrasonic device

A comparison of a SARS-CoV-2 rapid-test and serological-test in a Public Health Hospital

Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage