La Prevenzione e il trattamento medico-chirurgico delle necrosi ossee dei mascellari

Aim: Osteoradionecrosis (ORN) of the jaws is a serious complication that can occur following radiotherapy in the head and neck. The treatment of ORN of jaws is currently accomplished by surgical bone resection and primary reconstruction with osteo-cutaneous free flap with good aesthetic and functional results. BP-ONJ is an emerging problem seen in patients receiving intravenous aminobisphosphonates (pamidronate disodium or zoledronic acid) therapy, for treatment of multiple myeloma and metastatic cancers affecting bone and also among individuals receiving oral bisphosphonates for osteoporosis. In BP-ONJ, the conventional treatments were associated with high failure rates, progression disease and decline in patient’s QoL and the role of surgical resection and microvascular reconstruction has not been clarified. The goal of this study is to make aware on potential risk of BP-ONJ, develop guidelines for prevention, early diagnosis and multidisciplinary treatment. Methods: A multidisciplinary panel of oral and maxillofacial surgeons, dental specialists, hematologists, oncologists, rheumatologists and radiologists was convened to review the literature and clinical evidence, identify risk factors for ORN and BP-ONJ. A retrospective cohort study was completed by reviewing health plan databases and medical charts of 18 patients with osteonecrosis of the jaws. Three patients with ORN and fifteen with BP-ONJ were evaluated and treated. Extensive surgery with primary microvascular reconstruction was performed in the three case of ORN, seven cases of BP-ONJ were treated conservatively and the others were surgically treated (debridement to mandibulectomy was performed). Results: The patients with ORN recovered successfully. The BP-ONJ was properly controlled in six of seven cases conservatively treated; no relapse was registered in seven of eight patients enrolled in the surgical arms of the study at eighteen months of follow-up. The only patient with relapse was submitted to the conservative protocol and actually is free from pain. Conclusion: Close coordination between treating physician, maxillofacial surgeon and dental specialist is strongly recommended in making therapeutic decisions and strict patient’s selection for primary successful surgery. An increased awareness of potential risk of ONJ in patients receiving biphosphonate therapy is needed

The mandibular condyle as uncommon metastatic site of neuroendocrine carcinoma: Case report and review of literature

Temporo-mandibular joint (TMJ) metastases are a very rare event and only 73 cases are reported in literature. In about 40% of cases condylar metastases represent the first clinical manifestation of a tumor of elsewhere and may then allow an early diagnosis. However, the identification of this tumoral process can be difficult as in over 50% of the cases it has a nuanced clinical presentation that is very similar to temporo-mandibular disorders. The first case of metastatic neuroendocrine carcinoma (NEC) of the temporo-mandibular joint (TMJ) mimicking a temporo-mandibular joint disorder is presented in this report. Furthermore, an extensive review of the literature has been performed in order to establish a correct diagnosticâ\u80\u93therapeutic protocol for these oncologic patients

Recommendations for a safe restart of elective aerosol-generating oral surgery procedures following the COVID-19 pandemic outbreak: An Italian multicenter study

Among healthcare workers, oral and maxillofacial surgeons are some of the most exposed to coronavirus disease (COVID-19). The aim of this retrospective study was to develop suggestions for continuing the work of oral and maxillofacial surgeons using a safe protocol for elective and urgent aerosol-generating procedures that could prevent the onset of new clusters. Based on the results obtained and a guidelines review of those Asian countries that had promptly managed the current pandemic, the following safety protocol was developed

Three-dimensional primary reconstruction of anterior mouth floor and ventral tongue using the 'trilobed' buccinator myomucosal island flap

Three-dimensional reconstruction of the anterior mouth floor and ventral tongue after ablative surgery can be achieved using several techniques. The ideal reconstruction should be accomplished with the same or similar type of tissue, and cheek axial myomucosal flaps based on the branches of facial or internal maxillary arteries seem ideal for this purpose. From March 2005 to May 2007, 23 patients underwent cheek axial myomucosal flap reconstruction after oral cancer surgical ablation. Thanks to their thinness and pliability, these flaps were frequently shaped to obtain an accurate reconstruction. According to Whetzel’s hypothesis, an intraoral flap designed to include the axial vessel of one area can safely carry the mucosa of a neighbouring vascular area. The authors describe a large buccinator myomucosal island flap based on the branches of the facial artery and formed in a trilobed shape in order to capture the adjacent buccal mucosal angiosome from the internal maxillary artery. The flap provided the correct anatomical oral reconstruction for the anterior mouth floor and ventral tongue. The function of the tongue, oral intake and mastication were not impaired. The trilobed buccinator myomucosal island flap is a suitable option for the three-dimensional reconstruction of the anterior mouth floor and ventral tongue

Management of midcheek masses and tumors of the accessory parotid gland

Tumors of the lateral wall of the mouth have different origins and behaviors. These lesions often arise from salivary tissues, such as the accessory parotid gland, but tumors can also originate from the muscles, buccal fat pad, or other structures. Surgical approaches are limited in this region by the presence of the facial nerve and the Stensen’s duct. In this article, we present 9 cases of midcheek masses that were operated on via extra- or intraoral approaches. We discuss the problems related to the diagnosis of such tumors, as well as the indications and rationales for different treatment approaches

Computed tomography-guided implant surgery for dental rehabilitation in mandible reconstructed with a fibular free flap: description of the technique

The fibular free flap, with or without a cutaneous component, is the gold standard for reconstructing mandibular defects. Dental prosthetic rehabilitation is possible this way, even if the prosthesis-based implant is still a challenge because of the many anatomical and prosthetic problems. We think that complications can be overcome or reduced by adopting the new methods of computed tomography (CT)-assisted implant surgery (NobelGuide®, Nobel Biocare AB, Goteborg, Sweden). Here we describe the possibility of using CT-guided implant surgery with a flapless approach and immediate loading in mandibles reconstructed with fibular free flaps

Compartment syndrome at the fibula flap’s donor site and salvage by anerolateral thigh chimeric flap

A very rare and dangerous fibula flap donor site complication is the compartment syndrome of the lower leg. This may be due to a variety of causes and may result in wide tissues defect leading to walking disturbances, if not immediately treated. We report a challenging case of chimeric anterolateral thigh flap reconstruction to cover peroneus longus and calcaneal tendons exposure as a consequence of a donor site compartment syndrome after fibula flap harvesting.</br

Rational and simplified nomenclature for buccinator myomucosal flaps

Background: Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide â\u80\u9cideal reconstructionâ\u80\u9d of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them. Methods: After a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer. Results: According to this nomenclature, six types of buccinator myomucosal flaps are described. Conclusions: This proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread