Covid-2019 pandemic: growing wave of cancelled meetings in oral and maxillofacial surgery and its impact on specialty

We are at war. All our energy should be on one aim: to slow the progress of the virus. 1 —Emmanuel Macron French President (March 16, 2020) The official cause of the coronavirus disease 2019 (Covid-19) 2 became a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 3 which was officially identified on January 9, 2020. 4 Generally described four transmission routes for the Covid-19: 1) aerosol transmission, 2) contact transmission, 3) droplets transmission, and even through 4) digestive system. 3 The most commonly reported symptoms in patients are cough, fever, myalgia/fatigue, pneumonia, and complicated dyspnea. 3,5 According to Li et al cases resulting in death were primarily in elderly and middle-aged patients with pre-existing co-morbidities. 6 The statistically proved number of death worldwide continues permanently to increase. On March 26 that number of death reached 21,297 people, 7 on April 1 – 42,341 people, 8 on April 7 – 74,820 people, 9 on May 29 – 362,091 10 , and on August 11 – 739,342 1

Neuronavigational approach for orbital neurofibroma excision: a case report

Orbital neurofibromas are uncommon in adults, accounting for approximately 1%-3% of all space occupying lesions of the orbit. The complex anatomy of the orbital region, with the pronounced vulnerability of its neurovascular structures, requires particular surgical precautions. Neuronavigation, as a high-tech device for intraoperative safety, represents a valuable option for the confined orbital space. However, the application of neuronavigation in orbital surgery has been rarely reported. The authors present a case report of a 32-year-old female with an isolated localized neurofibroma surgically approached by intraoperative navigation and a review of the literature

Reconstruction of the adult hemifacial microsomia patient with temporomandibular joint total joint prosthesis and orthognathic surgery

HFM patients' reconstruction has always been a challenge for maxillofacial surgeons, and numerous reconstructive techniques have been described. Surgical treatment depends on the patient's age and contemplates Temporomandibular Joint (TMJ) reconstruction in conjunction with orthognathic surgery, usually necessary following completion of growth to maximize the functional and esthetic results. Distraction osteogenesis had gained popularity as valid alternative in growing patients, but the two primary methods to reconstruct the TMJs involve the use of autogenous, using free or microvascular bone grafts, or alloplastic graft, but there is no widely accepted method

Facial impaled trauma involving anterior cranial fossa: case report

An extraordinary case of trans-orbital penetrating injury is presented. A 42-year-old male was surprised while he was stealing into an apartment. While he was trying to escape through the window, he fell on a rod of the fence with not severe ocular and cerebral complications. We describe a unique presentation of a trans-orbital penetration injury that had a good outcome and not severe ocular and cerebral complications. After being transported at the S.M. Goretti Hospital in Latina, the rod was removed outside the operating room and the CT scan was performed. Patient underwent urgent surgery after stabilization of vital parameters

Unilateral condylar hyperplasia recurrence after orthognathic surgery: a case report

Introduction: Unilateral Condylar Hyperplasia (UCH) is an uncommon condition resulting in facial asymmetry and malocclusion. At the time of diagnosis, an accurate evaluation of condylar activity through bone SPECT is necessary to determine the most appropriate surgical treatment. The Authors present a case of a UCH recurrence after orthognathic surgery in order to discuss about the clinical role of condylar SPECT in UCH therapeutic management. Case report: A 60-years old female patient was referred to the Department of Maxillo-Facial Surgery of Sapienza University of Rome for a relapse of mandibular laterodeviation. At the age of 24, she underwent orthognathic surgery after a diagnosis of UCH without condylar SPECT evaluation. As part of our clinical routine, condylar SPECT was performed and a significant difference in radiotracer uptake (20%) was found between the left condylar region and the contralateral one. She underwent high condilectomy and Bilateral Mandibular Sagittal Osteotomy. She had no evidence of recurrence till today. Discussion: Optimal surgical management of UCH is still controversial. In the diagnostic phase of UCH, a functional evaluation of condylar growth status by bone SPECT is an essential step to avoid long-term recurrence of mandibular asymmetry. On the basis of condylar metabolic activity, UCH can be classified in an active phase or a stationary phase. Clinical and functional evaluation of patients with mandibular asymmetry should be standardized in order to plan the most appropriate surgical and orthodontic treatment

Tinnitus in temporomandibular joint disorders: is it a specific somatosensory tinnitus subtype?

ABSTRACT: The most significant otologic symptoms, consisting of ear pain, tinnitus, dizziness, hearing loss and auricolar "fullness", generally arise within the auditory system, often are associated with extra auricolar disorders, particularly disorder of the temporo-mandibular joint. In our study we examined a sample of 200 consecutive patients who had experienced severe disabling symptom. The patiens came to maxillofacial specialist assessment for temporomandibular disorder. Each patient was assessed by a detailed anamnestic and clinical temporomandibular joint examination and they are divided into five main groups according classification criteria established by Wilkes; tinnitus and subjective indicators of pain are evaluated. The results of this study provide a close correlation between the joint pathology and otologic symptoms, particularly regarding tinnitus and balance disorders, and that this relationship is greater the more advanced is the stage of joint pathology. Moreover, this study shows that TMD-related tinnitus principally affects a younger population (average fifth decade of life) and mainly women (more than 2/3 of the cases). Such evidence suggests the existence of a specific tinnitus subtype that may be defined as "TMD-related somatosensory tinnitus"

Are YouTube Videos a Useful and Reliable Source of Information for Patients with Temporomandibular Joint Disorders?

peer reviewedCounseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information about TMJD that patients can obtain from YouTube. A YouTube.com search was conducted using the terms "temporomandibular joint disorder"; "limited movement of the mandible"; and "mandibular joint pain". The videos identified were assessed independently by two panels of three professional and lay reviewers with HONcode, modified DISCERN (MD) and the global quality scale (GQS). A total of 106 videos were included. The professional reviewers reported a mean HONcode score of 4.148 ± 1.314 and a mean MD score of 2.519 ± 1.267, testifying to a modest general quality of the videos. The mean GQS score was 2.987 ± 1.012 for the professional and 3.469 ± 0.891 for the lay reviewers (p < 0.001). The correlations between the ratings were significant between the reviewers within the same group but not between the two groups. The presence of animations significantly influenced the GQS score expressed by the lay reviewers (p = 0.011) but not that of the professionals (p = 0.640). The quality of the information on TMJD on YouTube is generally of poor quality. Healthcare systems and professionals should be prepared to correct misinformation and build trusting relationships with patients which are based on quality counseling. Similarly, academic institutions should produce quality content that leads patients with TMJD toward a correct diagnostic-therapeutic process

Accuracy of ChatGPT-Generated Information on Head and Neck and Oromaxillofacial Surgery: A Multicenter Collaborative Analysis

Objective: To investigate the accuracy of Chat-Based Generative Pre-trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery. Study design: Observational and valuative study. Setting: Eighteen surgeons from 14 Italian head and neck surgery units. Methods: A total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1-6), completeness (range 1-3), and references' quality Likert scales. Results: The overall median score of open-ended questions was 6 (interquartile range[IQR]: 5-6) for accuracy and 3 (IQR: 2-3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial intelligence (AI) model achieved a correct response in 84.7% of the closed-ended questions (11 wrong answers). As for the clinical scenarios, ChatGPT provided a fully or nearly fully correct diagnosis in 81.7% of cases. The proposed diagnostic or therapeutic procedure was judged to be complete in 56.7% of cases. The overall quality of the bibliographic references was poor, and sources were nonexistent in 46.4% of the cases. Conclusion: The results generally demonstrate a good level of accuracy in the AI's answers. The AI's ability to resolve complex clinical scenarios is promising, but it still falls short of being considered a reliable support for the decision-making process of specialists in head-neck surgery

Northern Mediterranean nose correction: Italian experience: preservation approach

Severe septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework it is mandatory its correction. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid. In certain cases, the association of a correct septoplasty and dorsal preservation allow the treatment of the crooked nose and at the same time gives natural results with rapid post-operative recovery. The aim of this chapter is to underline the versatility of the dorsal preservation technique for the correction of severe septal deviation

Diced cartilage and fluid cartilage in the nasal dorsum deficit

The saddle nose is a deformity of the nasal pyramid characterized by a reduction of the dorsal height due to an osteocartilaginous deficit. Most saddle noses are acquired, even though there are congenital causes, such as syphilis or intrauterine traumas. The acquired deformities are caused by previous traumas at the level of the septum or the nasal pyramid, from pathologies such as Wegener's granulomatosis and recurring polychondritis, cocaine abuse or the outcome of previous septorhinoplasties. An iatrogenic origin, due to the removal of an excessive quantity of osteocartilaginous hump during a previous operation, is the most frequent. The saddle nose is one of the morpho-functional alterations of the nose most difficult to correct. The correction does not aim only to camouflage the deformity with a graft but consists of an anatomical reconstruction plan of all the inadequate structures. After reconstructing a solid cartilaginous support framework of the nasal pyramid, a better definition and height of the dorsum can be obtained by making use of various types of graft for the purpose of obtaining functional and aesthetic results that are stable over time. Of the numerous autologous and heterologous materials described in the literature, each with advantages and disadvantages, autologous cartilage is currently the first choice. Heterologous materials, such as Medpor, are habitually used for refilling certain areas of the face, such as the zygoma or chin, but their application in the nose is often associated with serious complications of an infective nature, including long-term. Autologous cartilage “block” grafts, that is, used as a single segment, were used for many years, enabling creating even significant deformities to be corrected. However, over time the skin thins and adheres to them, making them visible in many cases, even when they were well modelled in order not to leave superficial irregularities. In the case of costal cartilage block grafts, moreover, there is also the problem of “warping”. The use of “crushed” (morselized) autologous or “diced” (cut into cubes) cartilage can prove invaluable for the purpose of preventing these complications, both to regularize and to raise the nasal dorsum. Diced cartilage (fig. 1) can be prepared by cutting it into larger cubes (1) or smaller ones (less than 0.2 mm) (2) wrapped or otherwise in the muscular fascia (DCF) (deep temporal, fascia lata or rectus abdominis) or otherwise in Surgicel (oxidized regenerated cellulose – polyanhydroglucuronic acid, commonly used as a hemostatic agent, reabsorbable in 48 hours) or in the acellular matrix (Allorderm, LifeCell Corp., Branchburg, N.J.). Sometimes, to aggregate the cartilage cubes, fibrin glue or the venous blood of the patient is used. It has been demonstrated in various studies that the vitality of the chondrocytes is greater than the "crushed” or “morsellised” cartilage. For many small defects, crushed cartilage still remains a valid alternative, if obtained with the right degree of morsellisation, known as "crocodile skin", that enables minimum reabsorption (fig. 2) (3). However, it must always be borne in mind that the degree of reabsorption of this cartilage is inversely proportional to the degree of morsellisation and the predictability of the long-term result is not so high as in diced cartilage (3)