Dermal regeneration template: reconstruction in oral cancer defects

BackgroundPost ablative oral mucosal defect resulting from the removal of tumors can be treated with various techniques.PurposeIn this paper, we are showing what, in our experience, are the advantages and disadvantages given using biosynthetic skin substitutes when dealing with this kind of lesions.Materials and methodsPatients included in the sample came to our attention with both neoplastic lesions (11 subjects) and important scar retraction after previous oncologic surgery (1 subject). All patients underwent trans-oral resection surgery following the same surgical protocol and post ablative oral mucosal defect were treated using the dermal regeneration template. The surgical defect location, size, and time of removal of the silicone layer varied from one subject to the other.ResultsMost patients showed good healing with reduced scarring and adequate remucosalisation of the defect. The main complications were shown in a palatal lesion treated with concomitant osteal resection, which developed an oroantral fistula at follow up, and tongue lesions which showed some scarring.ConclusionsGiven our experience, we would advise using dermal substitutes when reconstructing oral defects only after a cautious evaluation of the area of the lesion, the gap size, the possible adherence of the membrane to the gap, and the presence of tissue supporting the overlying membrane

Gingival reactive lesions in orally rehabilitated patients by free revascularized flap

The aim is to discuss four cases of gingival reactive hyperplastic lesions in patients with a history of excision of oral neoplastic lesions and rehabilitation by a free revascularized flap of the iliac crest. One female and 3 male patients were referred due to the presence of exophytic lesions at the rehabilitated sites. The clinical examination revealed that the poor oral hygiene was the common trigger factor in all the cases, in addition to trauma from the upper left second molar in the first case, pericoronitis related to a partially erupted lower right third molar in the third case, and poor stability of an upper removable partial denture in the fourth case. All the cases were subjected to elimination of these suspected triggering factors, exclusion of dysplasia, excisional biopsy by CO2 laser, and five follow-up visits. The histological examination of all the cases confirmed the diagnosis of pyogenic granuloma. These presented cases suggest that the limitations in oral functions and maintaining the oral hygiene measures following the free revascularized flap reconstruction surgery probably played a role in the development of gingival reactive hyperplastic lesions with presence of trigger factors such as local trauma, chronic infection, or inadequate prosthesis

Surgical management of the acromegalic face: Could the aesthetic improvement of the face influence the patient's QoL? Combined surgical approach

Acromegaly is a chronic and progressive disease related to a disorder of growth hormone production. It may present with a variety of clinical signs and a dento-facial deformity and this results in a loss of self-esteem and a reduction of Quality of Life. Presentation of case: A 38-years–old male patient, affected by acromegaly with class III malocclusion, noticeable nose deformity and macroglossia was treated. Bi-maxillary orthognathic surgery and partial glossectomy have been performed in one-step surgey. Open rhinoplasty was done in a second step. Both dento-skeletal class III and restoration of the facial appearance have been solved. Dento-skeletal class III was completly solved together with the restoration of the facial appearance and the patient satisfaction has been achieved. Conclusions: This case report describes the successful and stable treatment of an adult patient affected by acromegaly

Naso-Ethmoidal Phosphaturic Mesenchymal Tumor: A Rare Tumor Site for an Uncommon Paraneoplastic Syndrome

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Three-dimensional comparison of the maxillary surfaces through ICP-Type algorithm: accuracy evaluation of CAD/CAM technologies in orthognathic surgery

Purpose: This retrospective study aims to compare the accuracy of two different CAD/CAM systems in orthognathic surgery. The novelty of this work lies in the method of evaluating the accuracy, i.e., using an Iterative Closest Point (ICP) algorithm, which matches a pair of 2D or 3D point clouds with unknown dependencies of the transition from scan s(k) to scan s(k+1). Methods: The study population was composed of ten patients who presented to the Maxillofacial Surgery Department of the University “Sapienza” of Rome for the evaluation and management of skeletal malocclusions. The patients were divided into two groups, depending on the technique used: group 1: splintless group (custom-made cutting guide and plates); group 2: splint group (using a 3D-printed splint). STL files were imported into Geomagic® Control X™ software, which allows for comparison and analysis using an ICP algorithm. The RMSE parameter (3D error) was used to calculate the accuracy. In addition, data were compared in two different patient subgroups. The first subgroup only underwent a monobloc Le Fort I osteotomy (p-value = 0.02), and the second subgroup underwent a Le Fort I osteotomy associated with a segmental osteotomy of the maxilla (p-value = 0.23). Results: Group 1 showed a 3D error of 1.22 mm ± SD 0.456, while group 2 showed a 3D error of 1.63 mm ± SD 0.303. These results have allowed us to compare the accuracy of the two CAD/CAM systems (p-value = 0.09). Conclusions: The ICP algorithm provided a reproducible method of comparison. The splintless method would seem more accurate (p-value = 0.02) in transferring the surgical programming into the operating room when only a Le Fort I osteotomy is to be performed