Do facial soft tissue thicknesses change after surgeries correcting dental malocclusions? An intra- and inter-patient statistical analysis on soft-tissue thicknesses in BSSO + LFI surgeries.

OBJECTIVES: The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed. MATERIALS AND METHODS: Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated. RESULTS: Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p > .05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region. CONCLUSIONS: The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects. CLINICAL RELEVANCE: This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.

Navigation-Assisted Resection and Fibula Free-Flap Reconstruction of an Extensive Maxillary Tumor.

OBJECTIVE: Tumor resection and reconstruction as a one-step procedure requires accurate definition of the intended safety margins, precise location of osteotomy lines and reliable individual rehabilitation.In recent years, the role of image-guided surgery in the maxillofacial region has increased significantly. As this technology allows the surgeon to track the actual position of each instrument during the operation in real-time, it makes it possible to perform extensive bone structure resections and reconstructions in anatomically distorted or complex areas, such as the head and neck region, without unnecessarily damaging vital structures.The authors described a case of a 26-year-old woman presented to our Clinic with an extensive maxillary squamous cell carcinoma involving the infratemporal fossa. The patient underwent single-step navigation-guided en bloc resection of the tumor and defect reconstruction.The aim of this study is describe and discuss the unusual surgical planning and the challenging operative technique adding a new case to the currently limited scientific literature on the computer-assisted head and neck oncologic surgery.

Implant Dental Rehabilitation of Fibula-Free Flap Reconstructed Jaws.

BACKGROUND: The possibility of placing dental fixtures in the reconstructed regions allows us to overcome the problems related to dental rehabilitation with removable prosthesis. The aim of this study was to assess the clinic-radiological outcome in a series of patients who underwent fibula flap jaws reconstruction and rehabilitation with implant-supported prosthesis with a minimum follow-up of 24 months. MATERIAL AND METHODS: The study included 10 patients who underwent reconstruction with fibula free flap between 2010 and 2018. Albrektsson criteria were used to define the implant survival. The follow-up evaluation was performed according to a standardized protocol including clinical examination, radiological evaluation (panoramic radiograph) and patient interview. RESULTS: A total of 45 implants were positioned.The time between mandibular reconstruction and implant placement ranged from 13 months to 39 months.The prosthesis used was fixed in 6 cases and supported overdenture in 4 cases.No implant failure was observed.Regarding implant survival no infections were observed in these series. Nine patients out of 10 had no pain and signs of mobility. Seven patients out of 10 had absence of peri-implant radiolucency at the panoramic radiograph.One patient presented with an overgrowth of granulomatous soft tissue around the implant abutments that caused pain. CONCLUSIONS: Implant placed in vascularized bone grafts are a safe and reliable opportunity to rehabilitate patients following mandibular resection. The results of this series demonstrate a high survival rate for implants placed in reconstructed mandibles with an improvement of the quality of life.

Evaluation of the Accuracy of Virtual Planning in Orthognathic Surgery: A Morphometric Study.

BACKGROUND: The purpose of this study was to prospectively test the accuracy of computer-aided orthognathic surgery comparing the virtual surgical planning with the three-dimensional (3D) outcome. METHODS: Patients that underwent computer-assisted orthognathic surgery were retrospectively evaluated. The postoperative results were compared with the surgical plan, superimposing the postoperative computed tomography (CT) scan onto the virtual plan. Surface-based superimpositioning of the postoperative CT scan onto the 3D preoperative plan was carried out to visualize the discrepancy between preoperative virtual plan and postoperative 3D CT result. RESULTS: A total of 17 consecutive patients that underwent two-jaw computer-assisted orthognathic surgery were enrolled in the study.The average linear differences for selected points were <1 mm in 12 patients out of 17. In 5 patients out of 17, the average differences for selected points were <2 mm. CONCLUSIONS: An overall high degree of accuracy between the virtual plan and the postoperative result was found.

Surgical Management of Myofibroma of the Gengiva.

The purpose of this paper is to report a rare patient of oral myofibroma in a 12-year old patient and to describe its clinical, histopathologic, and immunohistochemical features to establish the correct diagnosis and surgical management.Pathological and immunohistochemical examination is a mandatory method for establishing a definitive diagnosis of this lesion avoiding unnecessary treatment. Surgical excision and careful postoperative observation should be a treatment option.

To computer-aided design and manufacturing or not to computer-aided design and manufacturing? Free fibula flap with computer-aided technique for mandibular reconstruction.

AIM: The purpose of this study was to analyze the accuracy of computer-assisted free fibula flap for reconstruction of large mandibular defects for benign tumors. MATERIALS AND METHODS: Between December 2012 and January 2014, a total of 4 free osteocutaneous computer-assisted fibula flaps have been used in an equal number of patients for reconstruction of the mandible at the Division of Maxillofacial Surgery, Città della Scienza e della Salute Hospital, University of Turin. Inclusion criteria were large mandibular defects due to benign tumors. The computer-assisted fibula flap was chosen when 2 or more osteotomies were requested. Intraoperative complication, mean ischemia time, operative time, and morphologic outcomes were analyzed in all cases. After surgery, a postoperative computed tomography compared the virtual plan with the surgical results. RESULTS: All 3 flaps were harvested and transplanted successfully. For the free flaps examined in this work, no intraoperative complications were noted. Postoperative computed tomography showed high correspondence in terms of bone contour according to the virtual plan. The immediate and long-term morphologic results were satisfactory. CONCLUSIONS: Microsurgical mandible reconstruction using a computer-assisted fibula flap technique is the best available method to manage complex defects.

The Le Fort I osteotomy as surgical approach of an extensive pleomorphic adenoma of the palate.

Pleomorphic adenoma (PA) is the most common benign mixed salivary gland tumor. We describe here a peculiar case of a 72-year-old woman with a PA of the palate resected with palatal approach combined with Le Fort I osteotomy, adding to the currently limited scientific literature on intraoral approach for removal of extensive tumors of the midface. The Le Fort I osteotomy approach allows direct visualization of the tumor and ensures a wide excision, increasing safety and minimizing the possibility of recurrence.

Evaluation of plate-related complications and efficacy in fibula free flap mandibular reconstruction.

AIM: The objective of this study was to evaluate the incidence of plate-related complications after vascularized bony reconstruction of the mandible, comparing the plate type used. PATIENTS AND METHODS: Between 2004 and December 2012, a total of 41 free osteocutaneous fibula flaps have been used in an equal number of patients for reconstruction of the mandible, at the Division of Maxillofacial surgery, San Giovanni Battista Hospital, University of Turin. Malignant pathology was the most common indication for segmental mandibulectomy.Patient outcomes were retrospectively evaluated with special attention to plate complications such as plate fracture, exposure, infection, and bony nonunion.The types of reconstruction plates used were mandible plates 2.0, locking plates 2.0, miniplates (<2.0), and locking 2.4 plates. RESULTS: Mandible plates 2.0 were used in 14 patients, locking plates 2.0 in 12 patients, and locking 2.4 plates in 4 patients. The most commonly used plates were miniplates, which were used in 86 patients.A total of 5 plate complications occurred after 41 procedures in an equal number of patients.Two complications occurred in patients receiving 2.0 mandible plates (2/14). One complication occurred in patients receiving 2.0 locking plates (1/12). Two complications occurred in patients receiving miniplates (2/86). CONCLUSIONS: In our experience, miniplates are not associated to a high rate of complications comparing to other plates. The advantage of these plates and the low rate of complications make them our first choice for mandibular reconstructions.

Oral mucosa harvest for urologic reconstruction: role of maxillofacial surgeon and donor-site morbidity evaluation.

PURPOSE: The aim of this study was to present retrospective analysis of our experience regarding complications associated with the donor site after oral mucosa harvest for urethral reconstruction. MATERIALS AND METHODS: Between May 2010 and January 2013, a total of 18 patients with recurrent urethral strictures received a buccal mucosal graft for urethral reconstruction at the San Giovanni Battista Hospital, University of Turin, Turin. All operations were performed in a 2-team approach. All patients were retrospectively evaluated by clinical examination and using a questionnaire. RESULTS: Urethroplasty with oral mucosa graft was performed successfully in a 1-step procedure in 17 of 18 patients. No intraoperative complications were observed.The most common complication occurring at the buccal donor site was scarring and contracture (n = 3). CONCLUSIONS: Oral mucosa graft for urethroplasty is a simple and safe method in the interdisciplinary treatment of urethral strictures. Donor-site morbidity measured by clinical assessment and questionnaire is tolerable.

Management of needle breakage using intraoperative navigation following inferior alveolar nerve block.

This report describes a peculiar case of needle breakage during inferior alveolar nerve block to perform third molar extraction that was removed with the aid of a BrainLAB VectorVision neuronavigation system. This report adds to the currently limited scientific literature on the image-guided removal of foreign bodies from the oral cavity.

Single-step resection and reconstruction using patient-specific implants in the treatment of benign cranio-orbital tumors.

PURPOSE: The aim of this study was to evaluate surgical outcomes using patient-specific prostheses produced by computer-aided design and manufacturing for primary reconstruction in patients with benign cranio-orbital tumors. Polyetheretherketone was used to manufacture the implants. MATERIALS AND METHODS: The present study included 3 patients who underwent fronto-orbito-pterional craniotomy using individual custom-made surgical guides. Patient-specific polyetheretherketone prostheses were used for reconstruction during the same surgery. All patients underwent esthetic examination (facial and orbital symmetry, globe projection and position), ophthalmologic examination (diplopia with the Hess-Lancaster test, visual field and acuity), and radiologic evaluations (computed tomography and magnetic resonance imaging) during the preoperative and follow-up periods. Operating time and short- and long-term complications were recorded. RESULTS: The immediate and long-term morphologic results were satisfactory; in particular, ocular globe position and projection were correct. After 25 to 31 months, none of the patients developed implant-related complications, such as infection, extrusion, or malposition. Two-year postoperative computed tomograms and magnetic resonance images showed no recurrences. CONCLUSION: Single-step resection and reconstruction with computer-aided designed and manufactured implants is a challenging new technique that decreases operative time and morbidity. The implants adequately restore an anatomically complex area with satisfactory cosmetic results.

Ossifying fibroma affecting the mandibular condyle: report of an uncommon case.

We describe the surgical management of an uncommon case of ossifying fibroma affecting the mandibular condyle. A condylectomy was performed with an immediate temporomandibular joint reconstruction by a total temporomandibular joint prosthesis.

Surgical management of synchronous central giant cell granuloma and ossifying fibroma of the mandible.

We describe the surgical management of an uncommon case of synchronous presentation of central giant cell granuloma and ossifying fibroma in the mandible. A mandibular resection was performed and a fibula-free flap was harvested to reconstruct the defect.

Accuracy of intraoperative navigation for orbital fracture repair: A retrospective morphometric analysis.

In this retrospective case series, patients undergoing surgery to treat isolated orbital floor fractures were morphometrically analyzed. Cloud Compare was used to compare mesh positioning with a virtual plan, using the distance-to-nearest-neighbor method. To assess the accuracy of mesh positioning, a mesh area percentage (MAP) parameter was introduced and three distance ranges were defined as the outcome measures: the 'high-accuracy range' included MAPs at a distance of 0-1 mm from the preoperative plan; the 'intermediate-accuracy range' included MAPs at a distance of 1.1-2 mm from the preoperative plan; the 'low-accuracy range' included MAPs at a distance of >2 mm from the preoperative plan. To complete the study, morphometric analysis of the results was combined with clinical judgment ('excellent', 'good', or 'poor') of mesh positioning by two independent blind observers. In total, 73 of 137 orbital fractures met the inclusion criteria. In the 'high-accuracy range' the mean, minimum, and maximum MAP values were 64%, 22%, and 90%, respectively. In the 'intermediate-accuracy range', the mean, minimum, and maximum values were 24%, 10%, and 42%, respectively. In the 'low-accuracy range', the values were 12%, 1%, and 48%, respectively. Both observers classified 24 cases of mesh positioning as 'excellent', 34 as 'good', and 12 as 'poor'. Within the limitations of the study, it seems that virtual surgical planning and intraoperative navigation has the potential to add quality to the repair of the orbital floor and, therefore, should be taken into consideration whenever appropriate.

Complex and compound odontomas.

PURPOSE: This study aimed to analyze and discuss the demographic, clinical, and surgical aspects of 53 surgically treated odontomas and to review the literature. PATIENTS AND METHODS: A retrospective review was performed on all cases of treated odontomas in our center. A review of the recent literature about demographic aspects of odontomas was performed. RESULTS: A total of 53 odontomas with a mean age of 35 years were surgically treated during the study period: 32 complex odontomas, 20 compound odontomas, and 1 immature odontoma. Compound odontomas occurred more often at the mandible with a predilection for the anterior region, whereas complex odontomas showed up more often in the posterior regions of the mandible. Odontomas most commonly occurred in patients in the second decade of life. The main presenting sign was the eruption failure of permanent teeth (44 cases), whereas 1 patient referred pain as the presenting symptom. CONCLUSIONS: Odontomas are hamartomas not rarely encountered by oral and maxillofacial surgeons. Odontomas usually determine delayed eruption; thus, in case of any dentition anomaly or jaw deformation in children and adolescents, it is very important to investigate the presence of possible odontomas with radiographs.

Etiology and patterns of facial lacerations and their possible association with underlying maxillofacial fractures.

BACKGROUND: This study was designed to analyze the etiology and patterns of soft-tissue facial lacerations associated with maxillofacial fractures and to identify associations between facial lacerations and underlying fractures. METHODS: Of 1960 patients who had been admitted for maxillofacial fractures between 2001 and 2010, only patients with complete clinical records presenting with facial lacerations were considered for this study. Facial lacerations were classified according to the MCFONTZL system. RESULTS: Of the 1960 patients admitted with maxillofacial fractures, 637 had 836 associated facial lacerations. Motor vehicle accidents and falls were responsible for most injuries to patients with facial lacerations. According to etiology, fractures resulting from work-related accidents more frequently produced associated lacerations.For all causes of injury, more facial lacerations were observed over the "T" area formed by the upper orbit and forehead, nose, upper and lower lips, and chin. Lacerations and maxillofacial fractures were more frequently localized to the middle third of the face, followed by the inferior third.There was a strong association between lacerations and fractures in the chin region, considering both symphyseal and parasymphyseal fractures (direct trauma) and condylar fractures (indirect trauma). CONCLUSIONS: An association between facial lacerations and underlying maxillofacial fractures was observed, particularly in the inferior orbital area and over the zygoma, mandible, and chin.

Malar augmentation with zygomatic osteotomy in orthognatic surgery: Bone and soft tissue changes threedimensional evaluation.

BACKGROUND: The aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery. MATERIALS AND METHODS: From January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score. For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes. RESULTS: Considering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr - Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03. Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR). CONCLUSION: The malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures.

Accuracy of Fibula Reconstruction Using Patient-Specific Cad/Cam Plates: A Multicenter Study on 47 Patients.

OBJECTIVES: This prospective study evaluated the accuracy of mandibular reconstruction using free fibular flaps (by comparing virtual plans to the three-dimensional postoperative results), and the extent of bone-to-bone contact after computer-assisted surgery. METHODS: We included 65 patients who underwent partial-continuity mandibular resections from February 2013 to January 2017, and evaluated virtual planning, surgical techniques, and accuracy. RESULTS: Forty-seven patients were analysed. A total of 112 fibular segments received 54 implants. We measured 227 distances between landmarks to assess the accuracy of reconstruction. Postoperative reconstruction accuracy ranged from 0.5 to 3 mm. CONCLUSION: Virtual surgical planning very accurately translated simulation into reality, particularly in patients requiring large, complex mandibular reconstructions using multiple fibular segments. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2169-E2175, 2021.