Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes

Tumour-induced osteomalacia: A case report of craniofacial localization

Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome. It is caused by a variety of small, slow-growing mesenchymal tumors (phosphaturic mesenchymal tumour, PMT) that can produce fibroblast growth factor 23 (FGF23). FGF23, through its effect on the renal reabsorption of phosphates, causes marked phosphaturia and hypophosphatemia which, if persistent, cause bone demineralization.The vague and non-specific symptomatology (diffuse musculoskeletal pains, asthenia and frequent fractures) often makes diagnosis difficult and therefore delays treatment.Typically TIO are single tumors of mesenchymal origins which behave benignly, while the malignant histological variants are very rare. Furthermore, they favour soft tissues, and cranio-facial localization occurs in only 10–15% of cases.We report a case of TIO located in the left pterygopalatine fossa. The patient was a 68-year-old man who had been suffering from diffuse osteomuscular pain and frequent bone fractures for about two years. Biochemical testing showed elevated levels of phosphates and of 1,25 dihydroxyvitamin D, an increase in alkaline phosphatase, and hyperphosphaturia.Gallio-DOTA-octreotate somatostatin receptor positron emission tomography/computed tomography (DOTATATE PET/TC) demonstrated uptake in the left nasal sinus area. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a left pterygopalatine fossa mass. The patient underwent surgical resection of the mass, and the histology was consistent with a mesenchymal tumour. His serum phosphate levels normalized in about 3 months after surgery, and his hip pain had resolved completely in 6–8 months. Our case highlights the importance of recognizing this disease to avoid severe disability for patients. Keywords: Tumour-induced osteomalacia, Hypophosphatemia, Fibroblast growth factor 23, Paraneoplastic disorder, Alkaline phosphatas