Bone graft sustained by implants

Aims: In this paper we show a case of a patient with a severe mandibular resorption treated with combined use of iliac crest graft fixed with endosteal implants. Methods: In 2014 an 82 y.o. man in good general health with a total mandibular edentulism and a severe mandibular resorptive process, was treated with bone graft sustained by implants. The gratest height of mandibular bone was 7mm. Results: No complications were observed at dismission. After a three months follow-up without complications, at third month, implants were loaded with prosthetic manufacts. After follow-up no problems occurred. Conclusions: Simultaneous use of iliac bone graft and implant positioning, as described in our work, represents the minimal invasive way for restoration of totally or partially edentulous jaws

Diagnosis of bell palsy with gadolinium magnetic resonance imaging

Bell palsy is a condition resulting from a peripheral edematous compression on the nervous fibers of the facial nerve. This pathological condition often has clinical characteristics of no importance and spontaneously disappears in a short time in a high percentage of cases. Facial palsy concerning cranial nerve VII can also be caused by other conditions such as mastoid fracture, acoustic neurinoma, tumor spread to the temporal lobe (e.g., cholesteatoma), neoformation of the parotid gland, Melkersson-Rosenthal syndrome, and Ramsay-Hunt syndrome. Therefore, it is important to adopt an accurate diagnostic technique allowing the rapid detection of Bell palsy and the exclusion of causes of facial paralysis requiring surgical treatment. Magnetic resonance imaging (MRI) with medium contrast of the skull shows a marked increase in revealing lesions, even of small dimensions, inside the temporal bone and at the cerebellopontine angle. The authors present a clinical case to show the important role played by gadolinium MRI in reaching a diagnosis of Bell palsy in the differential diagnosis of the various conditions that determine paralysis of the facial nerve and in selecting the most suitable treatment or surgery to be adopted

Endo-orbital osteoma: Two case reports

Osteoma is a benign, slow-growing tumor, which mainly occurs in the bones and cavities of the middle third of the face, representing the most frequent benign tumor of the paranasal sinuses. Osteoma of the paranasal sinuses is generally asymptomatic and it is discovered only as a coincidental radiological finding; when it becomes symptomatic, the most common presenting symptoms are headaches and facial pain. Rarely the sinusal osteoma may entail secondary orbital extension, with ocular signs and symptoms. Primary intraorbital involvement is extremely rare. The authors present a review of the literature and report two cases of primary orbital osteoma. In both cases surgical treatment led to the complete remission of symptoms. Diagnosis and surgical therapy are discussed

A rare Condition of Hand-Schuller-Christian Disease

The authors present the clinical case of a 61-year-old patient with Hand-Schüller-Christian disease associated with multisystemic involvement. The onset of such puzzling symptoms and the extremely rarity of this disease in a patient of such advanced age resulted in a delayed diagnosis and subsequently delayed treatment of the patient

Inferior alveolar nerve impairment after mandibular sagittal split osteotomy: an analysis of spontaneous recovery pattern observed in 60 patients

Sensory impairment after bilateral sagittal split osteotomy (BSSO) due to inferior alveolar nerve (IAN) lesions may be either temporary or permanent and either complete or partial. The aim of this prospective study is to evaluate, by means of objective sensory testing, IAN sensory disturbances development in patients who underwent BSSO.IAN sensory disturbances development at the first week, fourth week, sixth month, and twelfth month of follow-up review in a group of 60 patients who underwent BSSO from January 1, 1998, to July 31, 1999, at the Maxillofacial Surgery Department of the "La Sapienza" University of Rome. The 60 patients were examined in the presurgical period; the IAN functionality regarding thermal sensibility, nociception, and two-point discrimination, was assessed at follow-up in 120 sides. In our study the highest rate of spontaneous recovery of the entire IAN functionality was observed at the sixth month. This finding witnesses how neuropraxia and axonotmesis give a spontaneous recovery that most frequently occurs within 6 months from surgery, independently from age and sex of the patient. The persistence of anesthesia over 12 months could be a sign of neurotmesis

Soccer-related craniomaxillofacial injuries

The authors assessed the rate of craniomaxillofacial fractures in soccer and the areas where they occur, describing above all the injury pattern of this sport. Over a 5-year period (1995-2000) 46 cases of 329 with fractures associated with different sports activities have been surgically operated at the maxillofacial surgery department of the Policlinico "Umberto I" Hospital, University "La Sapienza" of Rome. All data collected have been selected on the basis of sex, age, anatomic site of the fracture, and the practiced sport. Information on injury patterns, severity, and play circumstances have been documented. The department examined 7 sports disciplines, but soccer was responsible for sports-related maxillofacial fractures in 34 of 46 cases (73.9%). All 34 fractures occurred to men. In soccer, the zygomatic and nasal regions are mainly involved. In fact the authors examined zygomatic fractures in 15 cases and nasal fractures in 10 cases. Direct contact between players generally causes soccer-related maxillofacial fractures: head-elbow impacts (21 cases) or head-head impacts (14 cases). The male:female ratio is 6.6:1, while the average age is 25 years for males and 23 years for females. In comparison with other sports (rugby, football, etc.) where physical contact occurs more frequently and the higher incidence of traumatic events justifies the use of protective measures, soccer is not a particularly violent sport. In soccer, maxillofacial traumas are caused by violent impacts between players that take place mainly when the ball is played with the forehead. In this moment there can be an elbow-head impact or a head-head impact. The authors believe that the low incidence of fractures, severity of the lesions, and discomfort caused by possible protective masks make their use unjustified. The data collected during this study witness that in soccer 21 of 34 cases of maxillofacial fractures are caused by elbow-head impacts. This fact suggests a preventive strategy against violent behavior in soccer play. Because the use of any sort of helmet proved impossible, the introduction of more severe penalties and a greater respect for the rules of the game by the players could reduce the percentage of impacts during matches. Impacts cause the most serious and frequent lesions in the maxillofacial region

Evaluation of the esthetic results of a 40-patient group treated surgically for dentoskeletal class III malocclusion

A dentoskeletal Class III malocclusion results in unesthetic alterations of the soft tissues, which may cause psychologic and interpersonal problems. Surgical treatment, if based on cephalometric evaluations alone, can result in inadequate correction of facial esthetics. The aim of this paper is to discuss the esthetic needs observed in surgical planning of a group of 40 Class III patients and to compare the presurgical esthetic parameters with those recorded in the sixth month of follow-up. To obtain the proper esthetic result and to restore proper stomatognathic functionality, surgical treatment planning required the integration and correction of skeletal cephalometric planning. In 24 of the 40 patients, the skeletal and esthetic planning were in agreement with each other. In the remaining 16 patients, the correction of skeletal planning with the esthetic planning was necessary to obtain the correct esthetic and functional restoration. In all patients, esthetic, radiographic, and functional analysis at the sixth month of follow-up revealed the restoration of correct facial esthetics in the vertical, transverse, and sagittal planes; no temporomandibular joint problems; and a high degree of personal satisfaction regarding the esthetic and functional result obtained, including improvements in social life and in masticatory function. Cephalometric indications should always be compared with esthetic clinical indications and, possibly, the skeletal planning must be corrected by the esthetic needs, so that esthetic and functional success can be reached at the same time

A case report of osteochondroma of the frontotemporosphenoidal suture.

Osteochondroma, also known as osteocartilaginous exostosis, is the most frequent benign bone tumour of the skeletal system. Despite its preference for long bones (tibia and femur), osteochondroma may occur in some short bones developing endochondral ossification. Seventy-five percent of the patients present only with a single lesion, whereas 25% have multiple lesions; this last clinical condition, defined as osteochondromatosis (disorder of autosomal dominant inheritance) shows a high risk of malignant transformation (about 11%). In the craniofacial area this tumour is very rare. The sites of predilection are the coronoid process and mandibular condyle, even though osteochondromas arising from the base of the skull, maxillary sinus and zygomatic arch have been previously described. However, an osteochondroma originating from the frontotemporosphenoidal suture has not been reported before in the literature. We present a unique case of osteochondroma of the frontotemporosphenoidal suture. Moreover, the relevant international literature has been reviewed and all diagnostic and surgical matters have been discussed

Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature

The aim of this study was to investigate the management and prognostic determinants of recurrent pleomorphic adenoma (RPA). A retrospective analysis was performed to examine the clinical features, the prevalence of surgical complications, and new recurrences of RPA. Tumor recurrence rate was estimated by the Kaplan–Meier method, and the prognostic value of some of the variables was tested by univariate analysis using the log rank test. The study focused on 33 patients, 18 female (54.5%) and 15 male (45.5%), aged 12–71 years (median 41). A total or extended total parotidectomy was performed in 16 cases (48.5%), a superficial parotidectomy in 10 cases (30.3%), and a local excision in 7 cases (21.2%). In ten patients (30.3%), a branch or the trunk of the facial nerve was deliberately sacrificed. Major complications included one unexpected definitive paralysis of the marginal mandibular branch of the facial nerve and 14 cases of Frey syndrome. Follow-up varied from 2 to 25 years (median 10.5 years), and there were 11 new recurrences (33.3%) within a period varying from 1 to 16 years (median 6 years). The estimated tumor recurrence rates were 14.1 ± 6.6% at 5 years, 31.4 ± 9.4% at 10 years, 43.0 ± 10.8% at 15 years, and 57.2 ± 14.8% at 20 years. Presence of a multinodular lesion and the type of intervention performed were significantly associated with a higher probability of recurrence. RPAs are prone to new recurrences, especially when multinodular and treated with a local excision. Surgical treatment should include facial nerve resection in selected cases. Follow-up for the patient’s lifetime is warranted

[The maxillofacial functional and esthetic surgical aspects in a case of osteopetrosis].

Osteopetrosis is an extremely rare condition characterized by an increase in osseous cell density. It shows three different hereditary patterns. Diagnosis is made by means of a 3D CT and an accurate study of hepatic and renal functions, as well as audiometric and labyrinth examination. In the frequent case of serious osseous alterations of the facial profile, surgical treatment is essential in order to obtain the best aesthetic and functional results