Impact of COVID-19 epidemic on maxillofacial surgery in Italy.

Maxillofacial departments in 23 surgical units in Italy have been increasingly involved in facing the COVID-19 emergency. Elective surgeries have been progressively postponed to free up beds and offer human and material resources to those infected. We compiled an inventory of 32 questions to evaluate the impact of the SARS-COV2 epidemic on maxillofacial surgery in 23 selected Italian maxillofacial departments. The questionnaire focused on three different aspects: the variation of the workload, showing both a reduction of the number of team members (-16% among specialists, -11% among residents) due to reallocation or contamination and a consistent reduction of elective activities (the number of outpatient visits cancelled during the first month of the COVID-19 epidemic was about 10 000 all over Italy), while only tumour surgery and trauma surgery has been widely guaranteed; the screening procedures on patients and physicians (22% of maxillofacial units found infected surgeons, which is 4% of all maxillofacial surgeons); and the availability of Personal Protective Equipment, is only considered to be partial in 48% of Maxillofacial departments. This emergency has forced those of us in the Italian health system to change the way we work, but only time will prove if these changes have been effective.

Analysis on photographs of the growth of the cleft lip following a rotation-advancement flap repair: preliminary report.

A preliminary report is submitted on the growth of the lip after repair of a unilateral complete cleft (with a modified rotation-advancement flap) in 20 patients. In half of these cases an additional small Z-plasty was performed. The patients were photographed by a standardized method immediately after surgery and again after 18 months. Lip length on the operated side was measured and compared with the opposite side; possible results were: equal, long and short. After 18 months, 65% of all cases remained unchanged, 25% had lengthened and 10% shortened. Among cases treated with an additional small Z-plasty, unchanged and lengthened cases had an almost equal distribution, while the majority (8 out of 10) of the cases treated without Z-plasty remained unchanged. Consequently, the authors emphasize the benefits of reconstructing the cleft lip as symmetrical to the opposite side as possible or, at the most, moderately shorter only in cases treated with an additional Z-plasty.

Repair of the cleft palate without lateral release incisions: results concerning 124 cases.

The authors report their experience in the treatment of cleft palate patients, with or without cleft lip, carried out without lateral release incisions. The surgical approach was as follows: the cleft palate only was closed in one step at the age of 10 to 12 months, while the cleft of lip and palate was closed in two steps: at 6 months of age the soft palate together with lip and nose repair and at 18 to 24 months the hard palate with gingivo-alveoloplasty. Out of the 147 patients treated from 1984 until 1992, 124 (73 cleft palate, 51 cleft lip and palate) were treated without lateral release incisions, allowing first intention healing in 122 cases. The failures observed involved 2 cases: in the first (a bilateral case with a wide cleft) an almost total dehiscence of the suture at the level of the hard palate occurred, while in the second (a cleft palate case) a small oronasal fistula developed (healed spontaneously in 2 weeks). Our results confirm that by performing the described surgical technique without lateral release incisions, a 98% success rate for closure of a cleft palate could be obtained. Of course, in very large clefts the lateral release incision should be considered however.

The early gingivoalveoloplasty. Preliminary results.

To try and achieve good alveolar structure without the need for later bone grafting, we have carried out secondary gingivoalveoloplasties in 19 consecutive patients with cleft lip and palate at a mean age of 36 months (range 19-68). The lip and soft palate had been repaired at a mean age of 6 months. Preliminary results suggest that simultaneous closure of the hard palate and reconstruction of the alveolomaxillary cleft results in good formation of new bone and good or reasonable alveolar structure, so obviating the necessity for bone grafting at the age of 9-10 years. Long term follow up is needed to confirm these results.

[The oral manifestations during Kaposi's disease]. / Manifestazioni orali in corso di malattia di Kaposi.

Kaposi's sarcoma is a rare neoplastic disease of the vascular system with multiple foci. Oral manifestations are uncommon. The authors report an oral localization of a Kaposi's disease; the etiopathogenesis, the clinical features and the treatment of such lesions are discussed.

[Osteomas of the paranasal sinuses: review of the literature and personal cases]. / Gli osteomi dei seni paranasali: revisione della letteratura e casistica personale.

The sinusal osteomas: a review of literature and personal cases. The osteoma is a osteogenetic benign tumour formed by a fully developed bone, characterized by a slow growth, which, as far as the maxillo-facial region is concerned, shows to be frequently located in the paranasal sinuses. The osteoma originates from one of the sinus walls and spreads into the sinus cavity itself producing symptoms related to a lesion space occupying. In the present report, taking into consideration 4 personal cases, some literature datas are examined concerning the epidemiology, clinical behaviour and especially the therapeutic implications to be adopted by the surgeon in the presence of sinusal osteoma.

Re-innervation pattern of heterotopically transposed lingual flaps.

Pedicled tongue flaps have proved to be an effective method of repairing defects due to tissue loss in the oral cavity. No histological investigations have been done in respect of the longterm fate of these flaps after section of their nutrient pedicle. The histological pattern of the re-innervation process of heterotopically transposed lingual flaps in the oral cavity is evaluated in this paper. Two cases are reported: in the first, the tongue flap was used to repair the vermilion of the lower lip and in the second, for the closure of a post-traumatic defect of the hard palate. The histological findings are similar in the two cases: myelinated and unmyelinated fibres, free nerve endings and encapsulated receptors are present.