Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days–18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children

Functional disturbances of the inferior alveolar nerve following sagittal osteotomy of the ramus mandibulae: preventive surgical technic

Permanent functional disturbances of the inferior alveolar nerve after sagittal osteotomy of the ramus of the mandible form an increasingly common feature of the reported series. Reference is made to earlier experimental research in a description of a preliminary series in which this complication was avoided by cleaving the two cortical substances with a thin cement spatula used as a scalpel. The results were extremely encouraging. There were no reports of permanent functional disturbances of the alveolar nerve, while the incidence of temporary defects was also reduced

Reconstructive possibilities in oncological surgery of the lips

The authors face the problem of the treatment of tumours of the lip. First of all they express their own opinion about the choice between surgery and radiotherapy, specifying the reasons why they prefer in some cases one therapy and in others the other one. When they use surgical treatment, it is their duty to look not only at the oncological result, but to take care of the functional and aesthetic point of view. So, after the operation, it is very important to ensure complete lip closure without microstomia, with a good mobility and sensibility and an appearance as normal as possible. Beyond these aims we must comply with the aesthetic demands, as we work on the patient's face. So the reconstruction must be performed immediatly after the surgical removal and when it is possible, by means of local flaps. Actually the reparation performed with these kind of flaps simulates fairly well the original lip and often the scars are hidden in the natural lines of the face. In order to describe the different procedures used in the surgical treatment of these tumours, the authors classify these in: tumours of the lower lip; tumours of the vermillion; tumours of the labial commissure and tumours of the upper lip. Furthermore, for the neoplasms of upper and lower lip, they consider the extension of surgical removal (less than 1/3 of total lip length; from 1/3 to 2/3; more than 2/3). For everyone of these situations they choose and describe the surgical methods which, in their opinion, are most suitable to yield the best functional and aesthetic results

Regional odontodysplasia ("ghost teeth"). A case report[L'odontodisplasia regionale ("ghost teeth"). Descrizione di un caso.]

The authors present a rare case of developmental anomaly called regional odontodysplasia. It is also called odontogenic dysplasia, ghost teeth. It is a disorder that affects both the ectodermal and mesodermal dental components. The teeth usually fail to erupt and they have wide pulp chambers. Any teeth may be affected, but the disease is usually restricted to single quadrants. The cause is unknown