Surgical approach to oral lichen planus by submucosal autologous fat grafting.

Oral lichen planus is a chronic autoinflammatory mucositis. Oral lesions are predominantly white; they tend to be bilateral while involving the buccal mucosa especially cheek, tongue, gums, lips, and palate. Many topical and systemic agents are currently used with unpredictable results. Fat grafting is characterized by the placement of multiple parcels of purified fat with blunt cannulas; at the beginning, it was introduced to improve facial aesthetics. Recently, it has been translated to other surgical cases such as posttraumatic deformities and craniofacial anomalies and as ancillary reconstructive procedure after tumor resections. The successful results of this procedure encouraged us to use this approach to a clinical case of oral lichen planus refractory to conventional therapy.

Zygomatic metastasis from breast cancer.

Breast cancer continues to be the second most common cancer among women, after nonmelanoma skin cancer; in the United States, there is an average lifetime risk of 11% for developing a breast malignancy. Metastatic tumors from distant primary foci to the maxillofacial (MF) region are reported to account for only 1% of all MF malignancies, usually with grave prognosis. In the MF region, the bones more frequently involved in metastasis are the mandible, maxilla, temporal bone, frontal bone, and malar bone; the soft tissues more affected are gingiva, parotid gland, tongue, submandibular gland, and cheek. We describe a unique case of a solitary mass found in the body of the right zygoma, revealing a metastasis from breast cancer. According to the literature, the zygomatic complex is a very unusual site for metastasis; we found only 4 cases of metastatic localization from lung, rectum, liver, and uterine cancer. In MF region, oral and nasal cavity has been described as atypical sites of metastasis from breast cancer; this is to our knowledge the first recorded instance of malar metastasis from breast cancer.

Magnetic resonance imaging in the postsurgical evaluation of patients with mandibular condyle fractures treated using the transparotid approach: our experience.

PURPOSE: To evaluate the morphostructural and functional modifications of the temporomandibular joint and the onset of parotid complications in patients with extracapsular monocondylar fractures treated by reduction with the application of a titanium microplate via a transparotid approach. MATERIALS AND METHODS: The study was comprised of 20 patients (16 male patients and 4 female patients) with a mean age of 25 years (range, 15-44 years) who had undergone reduction of condyle fractures. Twelve months after surgery, all patients were examined by means of magnetic resonance imaging (MRI) of the temporomandibular joint and parotid gland on the treated side. MRI examination was performed by use of coronal T2-weighted turbo spin echo sequences, as well as parasagittal T1-weighted turbo spin echo and T2-weighted fast field echo sequences. Images were acquired from the resting position to the position of maximum oral opening. RESULTS: The 1-year clinical outcome in our patients was good. MRI showed, on the treated side, 5 cases of anterior dislocation of the disc (25%), 1 case of disc degeneration (5%), and 1 case of parotid fistula (5%). CONCLUSION: Both trauma and surgical intervention can damage the meniscal capsuloligamentous complex. MRI allowed the complications due to the trauma and/or treatment to be identified and made it possible to compare the condyles and joint function.

The role of fat grafting in the treatment of posttraumatic maxillofacial deformities.

Purpose The first autologous adipose tissue grafting was performed by Neuber in 1893 with an open approach. In the early 1980s, Illouz and Fournier introduced closed liposuction. In the 1990s, Coleman published a new method of atraumatic fat transplantation. Recently, immunohistochemical studies of the extracellular matrix of the lipoaspirate showed the presence of adipose-derived stem cells. The purpose of this study is to describe the role of fat grafting in the management of posttraumatic facial deformities. Methods The study population was composed of all patients who underwent facial fat grafting between March 2008 and November 2010 as a secondary reconstructive procedure after an initial unsatisfactory treatment of the skeletal fractures. We analyzed the postoperative morphological changes by comparing the grafted side of the face to the contralateral side with the aid of a software package. Results Nineteen patients were surgically treated with fat transplantation for facial asymmetry due to a pathological postoperative healing of the soft tissue. Clinical examination and software analysis showed adequate postoperative facial balance without major complications. Conclusion Fat grafting is a very powerful tool to correct posttraumatic maxillofacial deformities and to ensure a long-term follow-up. Although we have achieved excellent clinical results in our reconstructive clinical cases, we are convinced that more complex prospective studies, enriched by long-term radiological controls, are needed to fully understand the biological behavior of the transplanted fat in the posttraumatic face.