How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience.

Fractures of the mandibular condyle are common and account for 25-35% of all mandibular fractures reported in the literature. Even with the development of a consensus on the preference for open reduction and internal fixation of these fractures, the clinician is still faced with a dilemma concerning the optimal approach to the ramus-condyle unit. Limited access and injury to the facial nerve are the most common problems. The most commonly used extraoral approaches are the submandibular, retromandibular and preauricular methods. In this study, we propose a modified cosmetic preauricular incision with a short end in the neck, to improve the transmasseteric anteroparotid (TMAP) approach previously described by Wilson et al. in 2005. We retrospectively analysed 13 patients treated in our department for mandibular condylar fractures. Post-operative complications, occlusal status, interincisal opening and joint tenderness were evaluated at 3 months after surgery. The wider skin incision described here provides a convenient approach for open reduction and rigid internal fixation, and good results were obtained. The follow-up ranged from 6 to 40 months.

Reconstruction of nasal skin cancer defects with local flaps.

Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma.

PURPOSE: The transconjunctival, subciliary, subtarsal, and subpalpebral approaches for accessing the infraorbital rim and orbital floor have both advantages and disadvantages. The most common complications include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, and frank ectropion. MATERIALS AND PATIENTS: From 2000 to 2007, we treated 29 patients with lower eyelid malposition after surgery to manage the floor and infraorbital trauma (22 subciliary approaches, five transconjunctival approaches and lateral canthotomies, and two transconjunctival approaches). To correct lower eyelid malposition, we applied the tarsal strip technique in all patients. RESULTS: Twenty-five patients had scleral show and four patients had ectropion: three were previous treated using transconjunctival access and one using subciliary access. Twenty-six patients obtained satisfactory correction of eyelid malposition in a single-step surgical procedure, while three patients required a second surgical step to correct the remaining scleral show. Good aesthetic and functional results were achieved in all cases. CONCLUSIONS: All approaches to the infraorbital rim or orbital floor have the potential for postoperative sequelae. The tarsal strip technique is a relatively simple technique that oral and maxillofacial surgeons can use to manage lower lid malposition, such as scleral show and ectropion.

Temporal myofascial flap in reconstructive surgery of the oral cavity.

AIM: The temporal myofascial flap is a simple, rapid and reliable surgical method for immediate reconstruction of facial defects: indications in the light of modern anatomical knowledge and personal experience, with the accent on achieving an appropriate access route without damaging the facial nerve. METHODS: Our series covers the period from January 1999 to December 2004, during which time myofascial flaps of temporal muscle were used for immediate reconstruction in 20 surgical oncological cases involving the face and neck. RESULTS: Postoperative progress was regular; no lesions of the facial nerve were observed, nor any cases of flap necrosis, including partial. Epithelialisation could already be observed as early as 15 days postsurgery without skin grafting being employed. CONCLUSIONS: Application of a Medpor prosthesis eliminates the only negative outcome from the aesthetic standpoint, related to harvesting the muscle from the fossa.

Treatment of lower lip cancer: an experience of 48 cases.

The article reports results obtained in 48 cases of lower lip cancer. Tumor classified as T1 or T2, requiring a resection up to 60% of the lower lip, were treated with the stair-case technique. Nine patients were treated with the bilateral symmetrical stair-case technique since their lesions were located medially, while 23 were treated with the bilateral method using two asymmetrical flaps because their lesions were in paramedian position but larger than 2 cm. Ten patients required a unilateral flap. The cases classified as T3, in which the lesion required resection of more than 60% of the lip, were treated with the Bernard-Freeman-Fries technique.

[Epithelial leiomyosarcoma of gingiva: a case report and review of literature]. / Leiomiosarcoma epitelioide gengivale: presentazione di un caso clinico e revisione della letteratura.

Epithelioid leiomyosarcoma (EL) is a rare malignant tumor of mesenchymal origin. The Authors review the literature and report a case of gingival epithelioid leiomyosarcoma in a 40-year-old patient. In this case the leiomyosarcoma was located in the lower front dental group and invaded the symphysis menti. A segmentary mandibolectomy was performed with reconstruction using a non-revascularized autologous iliac bone graft. The differential diagnosis of primary EL is quite complex and it is grouped with other sarcomas, sarcomatoid carcinoma, myoepithelioma, amelanotic melanoma and metastases from gastrointestinal EL. Anatomopathological examination and immunohistochemical study enabled a definitive diagnosis of primary EL of gingiva. The follow-up calls for clinical-radiological check-ups every three months for the first year and every six months thereafter. One year after surgery there were no signs of recurrence.

The staircase technique for treatment of cancer of the lower lip: a report of 36 cases.

PURPOSE: This article reports the authors' experience with treatment of lower lip cancer using the staircase technique. PATIENTS AND METHODS: Thirty-six patients with stage T1 or T2 cancers of the lower lip were treated. RESULTS: No recurrences were observed during a 6- to 32-month follow-up. All patients showed excellent aesthetic results and no microstomia. CONCLUSIONS: The staircase technique can be used to close defects of up to two thirds of the lower lip. Two bilateral symmetric flaps are used for median defects; 2 bilateral asymmetric flaps are used for paramedian defects greater than 20 mm; and only 1 contralateral flap is required for paramedian defects up to 20 mm.

[Synovial chondromatosis of the temporomandibular joint]. / Condromatosi sinoviale dell'articolazione temporo-mandibolare.

Synovial chondromatosis is an uncommon monoarticular proliferative disease of the synovium characterized by loose bodies developed in the synovial membrane. The literature is reviewed and two cases of synovial chondromatosis of the temporomandibular joint characterized by swelling, pain and limitation of mandibular movement are reported. Radiographic evidence of loose bodies may or may not be present. Computed tomography (CT) or magnetic resonance (MR) might be helpful in the diagnosis of synovial chondromatosis. The treatment of choice of synovial chondromatosis is surgical and the loose bodies should be removed by arthrotomy with examination of the joint cavity. In our patients, no recurrence had occurred according to other authors' experience.

[The coronal approach in maxillofacial surgery. Notes on the surgical anatomy]. / La via di approccio coronale in chirurgia maxillo-facciale. Note di anatomia chirurgica.

INTRODUCTION: In the light of personal experience and of the modern advances in surgical anatomy, the surgical approach and practice in coronal access is described. For a long time this approach has been considered unusual owing to the risk of damaging the frontal branch of the facial nerve. ANATOMY: The SMAS includes the galea capitis which in temporal region is named superficial temporal fascia; under the galea there are the subaponeurotic avascular plane by Merkel and the periosteum. In the temporal space the periosteum (named temporal fascia) is composed of the superficial fold and deep fold. The frontal branch of the facial nerve lies under the superficial temporal fascia, and where it crosses the zygomatic arch is separated only by the superficial fold of the temporal fascia and by areolar tissue. SURGICAL APPROACH: The incision is made deeply to the subaponeurotic areolar tissue following, about 4 cm posterior to the hairline. The periosteum is incised at 2 cm above the superior orbital margin. Four cm above the bony lateral canthus and at 7 cm on the tangential to the zygomatic arch, the incision is made deeply to the superficial fold of the temporal fascia and the interfascial vascular fat. CONCLUSIONS: If the approach is correct, the coronal access is considered an easy and very safe way. In personal experience important complications have not been observed, while the esthetic results have been remarkable and with no visible scars.

[Management of postoperative pain in stomatology with ibuprofen L-arginine and naproxen]. / Trattamento del dolore postoperatorio in odontostomatologia con ibuprofene L-arginina e naprossene.

BACKGROUND: The aim of this prospective, randomized study is to compare the efficacy and safety of ibuprofen L-arginine and naproxen in the treatment of postoperative dental pain. METHODS: Seventy patients undergoing removal of impacted third molars were randomly allocated to receive 4 hours after surgery a single oral dose of either ibuprofen L-arginine 400 mg or naproxen 550 mg. Ten patients dropped out from the study because they took the study drug before the allowed time. Using a self-rating record, patients rated their pain and its relief for 1 hour after the drug administration. Remedication, if needed, and mean time of remedication were also recorded. RESULTS: A statistically significant reduction in pain scores with respect to the baseline values was recorded 5 minutes and 15 minutes after the drug administration in the ibuprofen L-arginine and in the naproxen-treated group, respectively. The summed pain intensity difference (SPID) over 60 minutes resulted significantly higher in the ibuprofen L-arginine than in the naproxen-treated group. A complete abolition of pain 60 minutes after medication was obtained in 12/28 patients (42.9%) in the ibuprofen L-arginine and in 5/32 patients (15.6%) in the naproxen-treated group, respectively (p = 0.04). Number of patients requiring remedication, mean time of remedication and drug related adverse effects did not significantly differ in the two treatment group. CONCLUSIONS: Global evaluation of the drugs by the patients showed ibuprofen more effective drug than naproxen.

A combined technique for correction of the prominent ear.

PURPOSE: The literature illustrates a large number of different techniques for the correction of the prominent ear, and the great variety available is indicative of how difficult it is to achieve satisfactory results in all cases. This report describes a procedure for successfully treating such patients. PATIENTS AND METHODS: Forty patients were treated with a surgical procedure creating a new anthelical plica based on the Stenström and Mustardé method and producing an anatomic cavity in the mastoid region where the concha can be repositioned according to the Furnas method. The tension of the "cartilage spring," which is a likely cause of relapse, was relieved by dissecting a triangular portion of cartilage from the root of the inferior crus. RESULTS: No major complications were observed with this technique and a good esthetic result was achieved in all cases. CONCLUSIONS: This surgical technique is suitable for correction of all cases of prominent ear.

[Evolution of maxillo-malar osteotomy. Clinical experience]. / Evoluzione dell'osteotomia maxillo-malare. Esperienza clinica.

Zygomaticomaxillary osteotomy is indicated in patients who have midfacial deficiency, a class III skeletal malocclusion and normal nasal projection. Many surgical procedures using an intraoral and an extraoral approach of the intraoral approach alone have been described. We prefer the intraoral approach because of the good aesthetic and functional results and the very low incidence of operative and postsurgical complications. As an alternative to these methods some authors have proposed a Le Fort I osteotomy associated with bone or alloplastic grafts in the malar region and a "high" Le Fort I osteotomy called quadrangular Le Fort I osteotomy. These techniques envisage total mobilization of the maxilla including the infraorbital rim. In our experience patients who have a scleral-show can undergo an osteotomy with infraorbital rim mobilization; patients who don't need a protection of the inferior sclera, instead, are advantageously treated without mobilizing the intraorbital rim. We illustrate our experience by reporting two out of 48 patients operated on using the intraoral approach.

[Non-Hodgkin's lymphomas of the oromaxillofacial area. A clinical contribution]. / Linfomi non-Hodgkin della regione oro-maxillo-facciale. Contributo clinico.

The authors present a clinico-statistical review (January 1987-December 1994) of 19 patients with non-Hodgkin's lymphoma of the oro-maxillo-facial region, diagnosed in the Dentistry Department of the University of Verona in collaboration with the Haematology Department. Particular attention has been devoted to the localisation, symptomatology, diagnosis and histological typing of non-Hodgkin's lymphoma of the maxillofacial region, stressing the importance of diagnosis and staging, based on a multidisciplinary approach, in order to be able to plan the most appropriate therapeutic management of patients with the disease.

[Myositis ossificans of the pterygoid and temporal muscles with metachronous contralateral involvement]. / Miosite ossificante dei muscoli pterigoidei e temporale con interessamento metacrono controlaterale.

After reviewing the literature, the authors report a case of myositis ossificans of the right pterygoid and temporalis muscles in a patient undergoing surgery to remove the left medial pterygoid muscle owing to the same pathology. The metachronous localisation in contralateral masticatory muscles compared to the primary site leads the authors to emphasize the post-traumatic and iatrogenic etiology of this rare pathology. In the light of their experience, they underline the importance of a precise diagnosis and surgical exeresis, followed by cautious rehabilitation with the least trauma, if necessary backed by appropriate medical treatment.

[Brodie's syndrome. A report of 2 atypical cases]. / Sindrome di Brodie. Presentazione di due casi atipici.

The aim of the authors is to show the treatment of Brodie's syndrome even in atypical cases where this pathology can not offer typical signs but can be associated to other skeletal deformities of the face. There are two atypical cases of Brodie's syndrome both of them came to our out patient's department. They were grown-up (one 20 one 22 years old), one of them with an extreme vertical expansion of lower third of the face and with a big transverse expansion of the upper maxillary bone, all typical signs of Brodie's syndrome; the other patient was with an extreme transverse expansion of the upper maxilla associated to a II class and a defect of 11, 12, 21, 22. The first patient was treated with orthodontic Tweed technique continued with surgical operation setting out to the contraction of the transverse diameter of the upper maxilla, associated to a Le Fort I osteotomy and an Epker osteotomy of the jaw. This orthodontic-surgical correction, allowed us to achieve a good aesthetic and functional result. The second patient was treated with orthodontics followed by surgical correction of the excessive transverse expansion of the upper maxilla after a Le Fort I osteotomy; a sagittal split of the jaw on Gotte technique was performed to correct the III class. We gave the patient a good aesthetic result with the restoration of the lost teeth in the upper maxilla, reaching in this way a good aesthetic and a well functioning result. We think it's possible to treat patients with atypical Brodie's syndrome with orthodontics or surgery in the same way we treat Brodie's syndrome and other deformities of the face reaching good aesthetic-functional results.

[Surgical treatment of neoplasms of the lip]. / Il trattamento chirurgico del cancro del labbro.

The authors examine the surgical treatment of lip cancer and describe the reconstructive techniques used for various tumour localisation and extensions. In addition, they illustrate the current opinions regarding the treatment of satellite lymph node areas.

[Dens invaginatus. Review of the literature and presentation of two clinical cases]. / Dens invaginatus: revisione della letteratura e presentazione di due casi clinici.

Authors present two cases of dens invaginatus, radicular variety in lateral incisors teeth. They suggest a revision of literature, underlining epidemiological, classifying, clinical and terapeutical aspects of this pathology.