Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty

Aim: The aim of this study was to determinate how orthognatic surgery aids to cure many skull and face abnormalities and to help re-establishing the correct occlusive relation thanks to the repositioning of the maxillo-mandibular skeleton basis. Methods: The study included 183 male patients and 338 female patients, with an average age of 23 years. The sample series was divided according to specific pathologies. All patients underwent surgical procedures and the therapeutic strategy was determined based on the anomalies presented. Results: 113 patients had a II class dental skeletal occlusion, 180 patients had a III class dental-skeletal occlusion and 222 patients had skull-facial abnormalities. 5 patients underwent only a genioplasty, 82 patients underwent a genioplasty associated with BSSO, 175 patients underwent a genioplasty associated with Le Fort I osteotomy and the remaining 253 patients underwent a genioplasty associated with BSSO and Le Fort I osteotomy. Conclusion: The experience shows that genioplasty has been successfully introduced in orthognathic surgical therapeutic procedures, for dental-skeleton abnormalities and mandibular asymmetries treatment. In recent years, the evolution of computer systems has allowed an accurate assessment and programming, by means of the three-dimensional display, which are of great help in the course of diagnosis and evaluation of the displacements to be carried out, in order to obtain optimal aesthetic results

Management and treatment of sinonasal inverted papilloma

Aims: The aim of this paper is to describe the surgical experience of 35 patients with Inverted Papilloma (IP) of paranasal sinuses and its recurrence rate after a year of follow-up. Materials: A retrospective chart review was performed on patients presenting with IP of paranasal sinuses. Thirty-five patients comprised the focus of this study. For all patients was performed a pre-surgery TC, and for more 5 patients it was necessary to perform a Magnetic Resonance (MR) with gadolinium. Results: Among 35 patients selected, 18 patients underwent to open surgery, 4 patients had a combined approach with endoscopy and open surgery, while 13 patients were managed only with an endoscopic approach, with a minimum of 1 year of follow-up. Our results highlighted that the global percentage of success 12 months after the treatment was 93% and it not vary according to the tipology of the approach used if a radical excision of the lesion is achieved. More in depth, among 35 cases, only 2 patients were found to have recurrences and were treated with coronal and endoscopic approach. Conclusion: It is fundamental to underline that surgery must be carried on in a radical manner to treat these tend to recur. A complete removal of the lesion and bone peripheral border filing are essential to perform a correct and definitive treatment. Also, endoscopic approach can be taken into account when tumors are localized median to a sagittal plan crossing the orbit median wall and when they did not massively compromised paranasal sinus walls

Ozone therapy in extractive surgery on patients treated with bisphosphonates

It is certain that oral extractive surgery is a remarkable trigger to avascular osteonecrosis of the jaw in patients treated with pyrophosphate analogous. This acquisition limits the use of endo-oral surgery in those patients, even when they have already developed the lesions. In this study, we present the results obtained in a group of 15 patients deriving from a 33-patient cluster with osteonecrosis of the jaw in treatment at our department with a new protocol based on ozone therapy. The object of this article is to demonstrate how dental extraction becomes possible in a patient with avascular bisphosphonate-related jaw osteonecrosis or in those who simply received pyrophosphate analogous when proper treatment with ozone therapy has been done

Facial Contour Recovery by Lipofilling: A Closed Loop System Protocol

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Management of sinonasal inverted papilloma: our experience

Aim. Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. This study describes the surgical experience of 32 patients with IP of paranasal sinuses treated at our institution , and it recurrence rate after (at least) a year of follow-up. Methods. A retrospective chart review was performed on patients presenting with IP of paranasal sinuses. Patient charts were reviewed for age, extent of tumor, location(s), follow-up, surgery technique and histopathologic diagnosis. 32 patients comprised the focus of this study. For all patients it was performed a pre-surgery TC, and for 5 more patients it was necessary to perform a Magnetic Resonance (MR) with gadolinium. Results. Twenty-one open surgeries, 9 endoscopic approach and 4 combined approach (open and endoscopic) were performed for IPs, with a minimum of 1 years’ follow-up. Our results highlighted that the global percentage of success 12 months after the treatment was 93% and it did not vary according to the tipology of approach used if a radical escission of the lesion is achieved. More in depth, among 32 cases, only 2 patients were found to have recurrences and were treated with coronal and endoscopic approach. Conclusion. It is fundamental to underline that surgery must be carried on in a radical manner to treat these neoplasms that tend to recur. The ideal approach is frequently determined intraoperatively, based on the IP attachment sites. A complete removal of the lesion and bone peripheral border filing are essential to perform a correct and definitive treatment. Also, endoscopic approach can be taken into account when tumors are localised median to a sagittal plan crossing the orbit median wall and when they did not massively compromised paranasal sinus walls

Orbital floor restoration

Orbital blow-out fractures reconstruction aims to restore the continuity of the orbital floor, to provide support of orbital contents and prevent soft tissues' fibrosis. Different materials have been tested over the years to reach this purpose. Traditionally, autogenous grafts have been used as the material of choice; in recent years alloplastic materials have gained popularity because of their availability and ease of use. The purpose of this study was to review materials used in orbital floor reconstructive surgery at the Department of Maxillo-Facial Surgery of University of Rome '' La Sapienza '', with emphasis on their biocompatibility, their shaping features, and mechanical properties. This report presents the results obtained by the application of these products on 379 patients who underwent surgical treatment for blow-out fractures from 1995 to 2003: the diagnosis of fracture of the orbital floor was based on clinical symptoms and CT axial scanning through coronal reconstruction. Followup period spanned from 1 to 8 years

Variations of the gonial angle in vertical surgical reduction of the maxillary-mandibular complex

From an esthetic point of view, the mandibular or gonial angle plays an important role in ensuring a harmonious facial profile. The purpose of this study was to analyze the values of the mandibular angle in relation to variations of the vertical and sagittal positions of the jaw. The study was carried out on a sample of 42 patients who underwent surgery for maxillary-mandibular repositioning, advancing or raising the jaw, after a Le Fort I osteotomy and bilateral sagittal osteotomy of the jaw according to the technique described by Obwegeser-Dal Pont. In all patients, the maxillary bone was raised with a discrepancy of at least 3 mm between the anterior and posterior portions (favoring the latter) as a result of (clockwise) rotation of the bispinal plane. The data, obtained by means of cephalometric analysis according to the method of Ricketts, showed how changes in the gonial angle differed between patients who require correction of an open-bite and those who do not. In particular, in patients without an open-bite, advancement of the maxilla limited the opening of the angle. Similarly, in patients with an open-bite, the tendency to form an open gonial angle can usually be corrected by the association of advancement of the maxilla whenever possible

Pigmented villonodular synovitis of the temporomandibular joint

Pigmented villonodular synovitis (PVNS) is a relatively rare disease, affecting the synovial-lined joints. PVNS was first fully described by Jaff in 1941, who considered it to be a benign inflammatory state of the synovium of an uncertain etiology Reports of this disease in the temporomanclibular joint (TMJ) are extremely rare. The authors report a case of a 38-year-old woman affected by pigmented villonodular synovitis of the TMJ. Clinical examination revealed the presence of a preauricular mass in the left side; a computed tomography scan showed a 3.0 x 2.0 cm preauricular mass in close continuity to the TMJ capsule. The purpose of this report is to describe the clinicopathological features of a case involving the TMJ. The previously reported cases in the literature are also reviewed

Dermoid Cyst: Unusual Localization

Dermoid cysts are embryonic lesions usually observed in the lateral eyebrow region and the midline nose and neck areas. Communication of these lesions with the central nervous system is rare and occurs in the nasal region. There are few clinical reports of temporal dermoid cysts presenting with intracranial extension, and we present a 15-year-old girl with a fronto-orbital dermoid cyst with intracranial extension and bone erosion. Her presenting symptom was a lacrimation reduction of the left eye. Excision of the cyst was done using a coronal approach because of its extension and localization