COVID-19 and the impact on the cranio-oro-facial trauma care in Italy: An epidemiological retrospective cohort study

The coronavirus disease 2019 (COVID-19) has deeply modified the organization of hospitals, health care centers, and the patient’s behavior. The aim of this epidemiological retrospective cohort study is to evaluate if and how the COVID-19 pandemic has determined a modification in cranio-oro-facial traumatology service. Methods: The dataset included hospital emergency room access of a six-month pre-pandemic period and six months into pandemic outbreak. The variables collected were: patient age, gender, type of emergency access with relative color code, Glasgow Coma Scale Score, type of discharge. Results: 537 vs 237 (pre-pandemic vs pandemic) patients accessed the hospital emergency room and the mean age decreased from 60.79 ± 25.34 to 56.75 ± 24.50 year. Yellow and green code access went from 28.9% and 66.1% to 37.5% and 57.7% (pre-pandemic vs pandemic). Glasgow Coma Scale (GCS) shows an increase of 16.6% vs 27.8% of 15 grade score, a 28.7% vs 28.5% of the 14 grade score and reduction of 13 and 12 grade 40.2% and 14.5% vs 37.1 and 9.7% (pre-pandemic vs pandemic). Conclusions: Since the COVID-19 outbreak continues, epidemiological data are still necessary to perform public health intervention strategies and to appropriately predict the population needs, in order to properly manage the COVID-19 related to oral pathologies as well as the most common health problems

Hydroadenocarcinoma, a rare tumor to be kept in mind

Background: Nowadays, the incidence of skin cancer has increased, especially in the elderly population, probably due to increasing longevity and lifestyle changes. Sun exposure plays a pivotal role in the development of the skin tumors, among these basal cell carcinoma (BCC) is the most frequent with an incidence 4 times higher than that of squamous cell carcinoma (SCC) and it is 20 times more common than melanoma. On the other hand, skin adnexal tumors are extremely rare and hydroadenocarcinoma (HC) is generally considered a malignancy of eccrine cutaneous sweat glands. It occurs in 0.01% of skin cancers and often it can mimic other skin cancers, particulary BCC. Case presentation: An 84-year-old woman come to our attention for a neoformation on the upper lip. Seeing as she had previously undergone operations for removal of basaliomas on the face, the lesion was believed to be a recurrence. Facial and neck MRI and CT-scan analysis revealed that the lesion appeared in correspondence of the midline and paramedian site of the upper lip with extension into the left nasal cavity, not dissociable from the surrounding tissues. For this reason, the patient underwent an \u201cen bloc\u201d resection instead of Mohs' surgery. The definitive histological diagnosis concluded that the lesion was a hydroadenocarcinoma. Conclusion: In front of a nodular lesion of the skin it is always advisable to perform a biopsy to type the neoformation and also exclude rare tumors such us hydroadenocarcinoma

Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

Background: One of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry. Methods: Thirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed. Results: No complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection. Conclusions: Hyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome. Level of evidence: Level IV, therapeutic study

Facial artery myomucosal flap vs. Islanded facial artery myomucosal flap viability: A systematic review

The aim of this study was to estimate the overall viability of the islanded facial artery myomucosal flap (iFAMM) compared to the facial artery myomucosal flap (FAMM). A systematic review of English articles was performed on PubMed and Cochrane Library electronic databases. Search terms included every nomenclature variant for FAMM flap and iFAMM flap. A total of 373 articles were identified, and 20 articles were considered eligible for inclusion in the review. A total of 486 flaps were evaluated (350 FAMM and 136 i-FAMM flaps). In all studies, the primary outcome assessed was flap viability, collecting the rate of total and partial flap necrosis and then comparing FAMM to i-FAMM. Overall reported partial/total necrosis rate for FAMM flap was 9.7%, 1.4% as total and 8.3% as partial necrosis. Overall partial/total reported necrosis rate for iFAMM flaps was 2.2%, 1.5% as total and 0.7% as partial necrosis. FAMM flaps, both as classical or islanded variants, are an effective option for intraoral small/medium sized defect reconstruction. Outcomes from the present review show a higher partial/total survival rate when this flap is harvested as islanded flap

Italian immunization calendar implementation: Time to optimize number of vaccination appointments?

In the Italian vaccination schedule, at least six vaccination appointments are scheduled in the first year of life. This implies more discomfort for both the patient and the parents. This was particularly evident during the COVID-19 pandemic, during which several appointments were missed. A UK experience with three injectable vaccines and an oral one co-administered at the same appointment (4-in-1) at 2 and 4 months of age showed interesting results. The vaccination coverage was high, consistent with previous practice, and no relevant increase in adverse events was reported. Translating the UK experience into the Italian context would not be immediate, due to several organizational and social issues. Nevertheless, this option warrants some further considerations, which are discussed in this manuscript

Botulinum toxin type a reconstituted with lidocaine: A report of 1000 consecutive cases

(1) Background: There is an increasing demand for a reversal of the aging process and, nowadays, more patients are seeking minimally invasive methods instead of surgery to meet this goal. The purpose of this paper is to evaluate the predictability of the off-label aesthetic use of botulinum toxin type A (BoNTA) reconstituted with lidocaine. (2) Methods: One thousand treatments, between January 2010 and January 2020, with BoNTA reconstituted with lidocaine for the rejuvenation of the upper third of the face, were performed and retrospectively evaluated. (3) Results: A few seconds after the BoNTA injections, the effect of muscle paralysis was seen in all cases; this allowed providing an optimal symmetric result with no need for a touch-up procedure at the control after three weeks. A burning sensation during the injections was claimed by almost all patients. Major complications were not registered. No touch-up procedures were required. (4) Conclusions: The results of this study show how the reconstitution of BoNTA with lidocaine may avoid imperfect results after the injections; the immediate feedback on the extent of paralysis to be expected from the chemodenervation action of BoNTA allows the physician to have immediate control of the final result