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.

Patients' survival after free flap reconstructive surgery of head and neck squamous cell carcinoma: a retrospective multicentre study.

Head and neck squamous cell carcinoma of the (HNSCC) represents approximately 5% of malignant tumours in Italy. HNSCC are commonly treated with surgery or radiotherapy, or a combination of such therapies. The objectives of treatment are maximum cure rate balanced with organ preservation, restoration of form and function, reduction of morbidities and improvement or maintenance of the patient's quality of life. Immediate reconstructive surgery: local, regional or free flaps are now widely advised in the treatment of these patients. Microsurgical transfer requires expertise, is time and resource consuming, and as a whole requires substantial costs. These considerations introduce some concerns about the wide or indiscriminate use of free flap reconstructive surgery. When considering cost-benefit outcomes of such treatment, the main objective is undoubtedly, survival. This data is underreported in the current literature, whereas functional outcomes of free flaps have been largely diffused and accepted. This study collects data from 1178 patients treated with free flap reconstructive surgery following ablation of HNSCC in a group of Italian tertiary hospitals, all members of the Head & Neck Group affiliated with the Italian Society of Microsurgery. According to many authors, free flap surgery for HNSCC seems to be a beneficial option for treatment even in terms of survival.

Losses of heterozygosity in oral and oropharyngeal epithelial carcinomas.

We analyzed 25 oral and oropharyngeal epithelial carcinomas for loss of heterozygosity (LOH) and microsatellite instability by using 55 oligonucleotide repeat markers located in 45 chromosomal regions. The aim was to identify which chromosomal regions and tumor-suppressor genes (TSGs) are preferentially lost in these tumors and to relate LOH at specific loci to clinicopathologic data. The analysis was performed on tumor tissue and on a corresponding normal tissue (blood lymphocytes) with the use of the polymerase chain reaction technique followed by microsatellite allele separation with denaturing gel electrophoresis. Thirty-two of 45 chromosomal regions demonstrated a significant (>/=20%) incidence of LOH. An allelic loss of >/=50% was found in 9p21 (77.8%), 8p22-23 (70%), 3p12 (61.5%), 1p36.1 and 12q22 (60%), 3q28 (57.1%), 5q23.3 (54.5%), 3p25-26, 3p24, and 7q35 (50%). We did not find any microsatellite instability. Our results suggest that in addition to a group of TSGs, pleiotropic for several tumor types, other suppressor genes are specifically involved in oral and oropharyngeal carcinogenesis.

Technical refinements in surgical treatment of benign parotid tumours.

Over the last 15 years, a number of techniques have been developed that make it possible to treat benign parotid tumours surgically with virtually no morphofunctional sequelae. Given that the main objectives of the intervention are the complete removal of the lesion as well as isolation and preservation of the facial nerve and its branches, the authors recommend the following procedure: a face-lifting type of incision in order to disguise the cutaneous scar better; preservation of the posterior branch of the great auricular nerve, in order to maintain the sensitivity of the ear lobe; coverage of the residual defect by means of a flap composed of superficial and deep temporalis fascia in order to reduce the postoperative depression in the parotid region and the onset of Frey's syndrome.

Mandibular leiomyoma in an infant. Report of a case.

A case of mandibular leiomyoma in a 8-month-old baby is reported. This is the 5th case of intrabony leiomyoma of the jaws reported so far. The tumor presented as a symptomless swelling of the mandibular ramus and required a limited resection. The pertinent literature is reviewed and the histological features discussed.

The temporalis muscle flap in temporo-mandibular joint surgery.

In the treatment of the severely damaged TMJ structural components (ankylosis, arthrosis, tumour, perforation or degeneration of the disc), it is advisable to insert a biological interposition between bony articular surfaces. The temporal muscle, due to its anatomical, topographical, and functional properties, can be successfully employed for this purpose. Based on the experience of Tessier, Delaire and Rowe, a temporalis muscle flap, inferiorly based, is rotated downwards and medially to the zygomatic arch, interposed and then fixed to condyle and capsule. Using this surgical technique, 12 patients and 13 temporo-mandibular joints were treated with good functional results and without any complication.

Jaeger's jugal extended incision to approach the pterygomaxillary region.

In oncological surgery of the pterygomaxillary fossa it is essential to achieve a wide access. For this purpose we have employed the old Jaeger's incision extended posteriorly in association with access osteotomies (zygoma and coronoid). In our experience (9 cases) the jugal access has provided good results without noticeable cutaneous scars. The technique is described with the presentation of 2 cases.

Melanotic neuroectodermal tumour of infancy (MNTI). Immunohistochemical and ultrastructural study of a case.

A case of melanotic neuroectodermal tumour of infancy (MNTI) which occurred in the left lower jaw of a 15-months old child was studied by electron microscopy and immunohistochemical methods to verify the neural crest origin of this tumour. Two cell population were observed: pigment melanocyte-like cells and non-pigmented nerve-like cells. Immunohistochemical analysis with neuron-specific enolase (NSE) and S-100 protein visualized two cell subtypes in the non-pigmented cell population. The combined ultrastructural findings and immunohistochemical data confirm the neural crest origin of MNTI.

The pectoralis major myocutaneous flap. Experience in 100 consecutive cases.

The authors have made a study of 100 consecutive cases in whom a pectoralis major myocutaneous flap was employed for reconstruction after surgical ablation of advanced malignant tumours in the head and neck. The results obtained show that primary healing took place in 74% of cases with a relatively low incidence of complications. The authors therefore confirm the reliability of the pectoralis major myocutaneous flap, which, owing to its rich blood supply, offers the possibility of providing large cutaneous islands, and its proximity to the site of ablation provides a simple and reliable method which may be used in the majority of cases of immediate or delayed reconstruction of the cervico-maxillo-facial area.

Facial nerve and parotid surgery.

A series of 100 surgical procedures on the parotid gland affected by tumours is reported, with a detailed analysis of facial nerve function after parotid surgery. A low percentage of temporary lesions (28%) affecting only one branch of the facial nerve, all of which regressed in a short time, and only one case of a permanent lesion affecting the whole nerve, anatomically intact, however, was observed. The authors confirm the safety of parotidectomy, if correctly performed.

Total glossectomy without laryngectomy.

When cancer of the tongue reaches a large size (T3, T4) it is almost impossible to treat it successfully with radiotherapy. The only therapeutic possibility in such cases is, therefore, total glossectomy. This may be effected without laryngectomy and with immediate reconstruction using musculo-cutaneous flaps. Such an operation allows total removal of the tumour and is followed by an acceptable though impaired functional result. Eight cases subjected to total glossectomy without laryngectomy are presented and aspects of ablative and reconstructive surgery are discussed. A report is made of postoperative complications and of functional rehabilitation: mastication is certainly impaired. However, swallowing is regained rapidly and phonation, although altered, is still comprehensible. An acceptable quality of life and good possibilities for a return to a working life result.

Temporary intranasal prosthesis for a surgical defect of septum and columella.

A temporary intranasal prosthesis for the treatment of a surgical defect of the septum and columella after resection for a neoplasm has been described. The prosthesis is applied as soon as possible after surgery, which will limit complications during healing. Silicone elastomer is used because its softness does not produce decubitus ulcer, and it will accurately fit the surgical defect. The prosthesis can be relined easily during the postoperative period.

[Malignant centro-facial granuloma. Clinical contribution]. / Granuloma maligno centro-facciale. Contributo clinico.

The mid-face malignant granuloma represents an exceptionally rare disease. Its etiology is unknown and the prognosis is dismal. Characteristics pathological features are represented by granulomatous, ulcerative and lesions, with a destroying tendency. The AA., in reporting a recently observed case of the disease, stress the difficulties encountered in the diagnosis and analyze its clinical course typically showing relapsing episodes. Therapeutic strategies adopted in the various phases of the disease are discussed.

[Limitations in opening the mouth after temporal craniotomy. Observations on 3 clinical cases]. / Limitazioni dell'apertura della bocca dopo interventi di craniotomia temporale. Considerazioni su 3 casi clinici.

The authors describe 3 cases of mouth-opening limitations and dyskinesia of the remaining mandibular movements, of different degrees of severity, arisen following a cicatricial retraction of the temporal muscle, caused by neurosurgical accesses to the underlying encephalic regions. Having kept in mind the afflictions that could cause an analogous symptomatology, the authors stop to consider which is the most suitable kind of treatment (surgical or rehabilitative) in these specific cases. For both kinds of treatment, corresponding to the specific indications, they propose techniques confirmed by their personal experiences.

[Biologic bases of musculo-cutaneous flaps most frequently used in cervico-maxillo-facial surgery]. / Basi biologiche dei lembi muscolo-cutanei di più frequente impiego in chirurgia cervico-maxillo-facciale.

An anatomical investigation on the vascular supply to "Pectoralis major", "Trapezius lateralis" and "Latissimus dorsi" muscolo-cutaneous flaps is presented. The AA. call particular attention to the vascular supply of the cutis going beyond the muscular borders. In this way we can determine the maximal width of the flap it is possible to achieve, without previous autonomization and without trophic problems.