Infective complications after free flaps reconstruction in patients affected by head and neck cancer Our experience on 77 cases.

AIM: The success rates of free flaps in patients undergoing head and neck cancer (HNC) surgery are very high (95%- 97%) but the development of a surgical site infection (SSI) can put flap viability at risk. The aim of our study is to identify the risk factors for SSI in patients undergo free flaps reconstruction after head and neck cancer removal. MATERIAL OF STUDY: Seventyseven patients (44 male and 33 female) from April 2006 to April 2015 admitted at the Department of Maxillofacial Surgery of the University of Naples "Federico II" were included in this study. All the patients underwent free flap reconstruction for HNC. RESULTS: A microbiological analysis in 32 patients with signs of SSIs was performed, and 27 (35%) patients showed positive cul ture results, 5 patients were false positives. DISCUSSION: SSIs are one of the most common nosocomial infec tions that increase medical costs. HNC surgery frequently requires opening of the mouth floor, oropharynx, nasopharynx, or proximal esophagus, and these areas are likely to be contaminat ed by local microbiotics. Positive significant correlation between long operation timing and SSIs. CONCLUSION: Was observed the factors contributing to postoperative infections for patients affected by head and neck tumor. 35% of our study population devel oped an SSI (27/77). The most commonly discovered pathogen was MRSA (Methicillin-resistant Staphylococcus aureus). Were examinated sex, cardiovascular disease, blood loss more than 560 mL, and a long operation time ≥ 6 hours were significant risk factors for SSI. KEY WORDS: Free flaps, Head and neck cancer, Infective complications.

Complications after parotid gland surgery Our experience.

AIM: Complications after parotid surgery include deficit of the facial nerve, wound complications, as sialocele and salivary fistula, and Frey syndrome; the goal of this study was to evaluate the relationship between the type of parotid surgery performed and the incidence of each of these complications. MATERIAL OF STUDY: A total of 184 patients were evaluated and 158 were included in the study. Four different kinds of intervention were made: extracapsular dissection, partial superficial parotidectomy; superficial parotidectomy and total parotidectomy. The incidence of each complication was studied and correlated to the type of surgery performed. Statistical analysis was done using the chi-square test of independence. RESULTS: From all cases examined, 86 patients developed facial nerve complications with 59 minor asymmetry, 19 partial weakness and 8 complete weakness. Forty patients had wound complications, 28 sialocele and 12 salivary fistula. Sixteen patients developed Frey syndrome. DISCUSSION: Facial nerve complications and Frey syndrome were significantly related to superficial or total parotidectomy, differently extracapsular dissection and partial superficial parotidectomy had more cases of wound complications. CONCLUSION: The kind of complications that occur after parotid surgery depends on surgery performed. Chi-square test has a statistically significant result and confirms this kind of relationship (P <.0001). KEY WORDS: Facial nerve, Parotid glands, Parotidectomy.

Retained upper third molars during Le Fort I osteotomy with downfracture.

AIM: The aim of our study is to demonstrate that the presence of upper wisdom teeth must be evaluated before and during Le Fort I osteotomy because attention must be focused to the disadvantages or facilitations of surgery depending on molar presence. MATERIALS OF STUDY: Our study has analyzed two groups, each one including 20 patients, 10 males and 10 females, with an age between 16-30 years. The first group was treated with le Fort I osteotomy leaving in situ the wisdom upper third molars. The second group was treated with Le Fort I osteotomy after the extraction of the wisdom upper third molars. RESULTS: Group A: upper third molar avulsion, necessary in 5 cases, was the main reason for prolongation of surgical time. However, in group A, increased bleeding occurred in 3 cases, bone irregularities and bone interferences occurred in 2 cases, neurological injuries occurred in 2 cases, any complications occurred in 8 cases. Group B: the management of the hemorrhage resulting from the vascular injuries, occurred in 7 cases, was the main reason for prolongation of surgical time. However, in group B, bone irregularities and bone interferences occurred in 4 cases, neurological injuries occurred in 3 cases, any complication occurred in 6 cases. DISCUSSION: In literature is actually discussed the risks related to the presence of lower third molars during mandibular osteotomies. CONCLUSIONS: Our study is designed to be helpful to the beginner surgeons during them first time approach to this kind of surgery. KEY WORDS: Retained third molar, Le Fort I osteotomy, Wisdom teeth extraction.

Rare case of isolated osteochondroma of the zygomatic bone: an endoscopic-assisted approach.

AIM: Osteochondroma is a benign neoplasia that in the craniofacial district unfrequently can occur in the coronoid process and in the zygomatic arch. We describe a rare case of isolated osteochondroma of the zygomatic bone, undergoing surgical treatment by means of intraoral approach and endoscopic assistance. MATERIAL OF STUDY: A Caucasian woman aged fifty-two, has been observed in our Department on March 2012 because of pain in the right zygomatic area. Computed tomography (CT) scans of the right zygomatic bone showed an undefined, sessile lesion with lobar bounds (Fig. 2). Suspected diagnosis was osteochondroma. Surgery was planned via intraoral approach under general narcosis. The procedure was endoscope-assisted. The lesion was removed by using an endoscopic rotating cutter. RESULTS: No edema, pain or fever occurred during the immediate recovery period. The patient has been followed up for 16 months and she is still actually lesion and symptoms free. DISCUSSION: The use of endoscopy in the surgical treatment of this pathology has allowed to obtain a higher accuracy and a greater respect of the anatomic structures CONCLUSIONS: In literature are not reported other cases of isolated zygomatic osteochondroma treated with endoscopicassisted procedures. Intraoral approach grants no scarring; endoscopic aid gives a better view of all anatomical structures of this district, a good management of the pathology and minimize the risk of pathological fractures during intraoperative procedures. KEY WORDS: Endoscopic-assisted surgery,Isolated osteochondroma, Zygomatic bone osteochondroma.