Epidemiological analysis of the facial fractures pattern in relation to motorcycle helmet type: A retrospective study on 282 patients.

Most maxillofacial traumas are caused by road traffic collisions and, in particular, by motorcycle accidents. Helmets represent an efficient protective tool in these traumas but they do not provide complete protection. The aim of this study was to perform an epidemiological analysis of facial fractures pattern in relation to the helmet type worn during the accident. The study was a retrospective analysis of 282 patients with a diagnosis of maxillofacial fracture caused by a motorcycle accident. The patients were divided in three groups based on helmet type (Group A: full-face helmet; Group B: modular [half-face] helmet; Group C: open-face helmet). For each group, fractures type and trauma severity, using the Comprehensive Facial Injury (CFI) scale, were recorded. Results showed that isolated midface fractures were strongly related to full-face helmet wearing (p < 0.001), while mandibular fractures and panfacial trauma/combined fractures were negatively correlated (p < 0.001). Mandibular fractures (p < 0.001) and panfacial trauma/combined fractures (p < 0.001) were strongly related to open helmet. Moreover, severe trauma (CFI 8.16) was recorded for open-face helmet wearing. In conclusion, full-face helmet wearing reduced the risk of facial fracture, in particular panfacial trauma/combined fractures, while open-face helmet wearing increased the risk of these fractures.

The "canine first technique" in maxillary impacted canines: analysis of the treatment duration and success of therapy.

Objectives: The goal of the study was to analyze the eruption time of the maxillary impacted canines treated with the "canine first technique" and evaluate the success rate. Materials and methods: A total of 103 patients with 131 impacted canines were treated. Alpha angle, Erickson-Kurol sectors, and age were studied to assess the difficulty of canine eruption. All the canines were treated with the "canine first" approach. The median follow-up time was evaluated using the Kaplan-Meier inverse procedure. The primary outcome (canine eruption time) was analyzed using Kaplan-Meier curves. The curve comparison between the different known risk factors was made using the log-rank test. The median eruption time (95% confidence interval) was calculated for each result. Results: The majority of the canines (66.4%) were placed palatally and positioned in sector 3 (30.16%). The median alpha angle was 38.7°. In 88.9% of cases, canines erupted and the median time of eruption was 4.2 months. A statistically significant difference in alpha angle >/<22° able to influence the eruption time was assessed. The variation of the alpha angle (>/<22°) has found to be statistically significative when compared to the eruption time variation. Conclusion: The canine first technique is effective for the eruption of impacted canines, and an alpha angle <22° can be considered a favorable prognostic factor.

In house 3-D printed surgical guide for frontal sinus osteotomy in traumatology: A technical note.

Frontal sinus surgery and particularly frontal sinus osteotomy represent historically a procedure demanding precision and careful planning. Achieving optimal results while minimizing complications requires meticulous preoperative planning and execution. Cutting guides are crucial tools in surgical procedures, particularly in complex osteotomies like could be those involving the frontal sinus. The aim of the study is to show the worflow for the in-house custom made cutting guide for secure and accurated frontal sinus approach. Given the simplicity, efficacy, rapidity, and safety of the procedure, the workflow for programming the cutting guide can be considered valid for all surgical procedures that contemplate performing an osteotomy on the anterior wall of the frontal sinus, such as trauma pathology, inflammatory naso-sinus pathology, benign or malignant neoplastic pathology, and craniofacial malformation pathology.

Mandibular reconstruction after post-traumatic complex fracture: Comparison analysis between traditional and virtually planned surgery.

BACKGROUND: Jaw reconstruction after complex post-traumatic fracture is still a challenge for surgeons using traditional surgery. Virtual surgical planning has proven to be a valid tool for managing these fractures. The aim of this study is to quantitatively evaluate the VSP effectiveness compared to traditional surgery in the management of complex mandibular fractures. METHODS: 30 patients with diagnosis of complex mandibular fracture were enrolled and divided in two groups: Group A (virtually planned surgery), The plate was pre-modeled and employed during the surgery; Group B (traditional surgery), the plate was shaped directly during the surgery. Virtually planned and post-operative Computer Tomography were after compared for both the groups to highlight discrepancies in mm. RESULTS: Fracture surgical reduction was successful without intraoperative complications. In Group A, all the mean discrepancies' values were <1 mm while in Group B the values were included between 1.36 and 1.94 mm. The mean operative time was 69 min for Group A, while 106 min for Group B. CONCLUSIONS: Fracture virtual reduction and realization of pre-modeled plate are able to guarantee a more anatomically correct reduction and a decrease in operating times. These outcomes translate into a decrease in both short and long-term complications.

Correction: Ionna et al. Sentinel Lymph Node Biopsy (SLNB) for Early-Stage Head and Neck Squamous-Cell Carcinoma of the Tongue: Twenty Years of Experience at I.N.T. "G.Pascale". Cancers 2024, 16, 1153.

In the published publication [...].

Sentinel Lymph Node Biopsy (SLNB) for Early-Stage Head and Neck Squamous-Cell Carcinoma of the Tongue: Twenty Years of Experience at I.N.T. "G.Pascale".

Oral tongue squamous-cell carcinoma (OTSCC) is the most prevalent malignancy in the head and neck region. Lymphatic spread, particularly to cervical lymph nodes, significantly impacts 5-year survival rates, emphasizing the criticality of precise staging. Metastatic cervical lymph nodes can decrease survival rates by 50%. Yet, elective neck dissection (END) in T1-2 cN0 patients proves to be an overtreatment in around 80% of cases. To address this, sentinel lymph node biopsy (SLNB) was introduced, aiming to minimize postoperative morbidity. This study, conducted at the ENT and Maxillofacial Surgery department of the Istituto Nazionale Tumori in Naples, explores SLNB's efficacy in early-stage oral tongue squamous-cell carcinoma (OTSCC). From January 2020 to January 2022, 122 T1/T2 cN0 HNSCC patients were enrolled. Radioactive tracers and lymphoscintigraphy identified sentinel lymph nodes, aided by a gamma probe during surgery. Results revealed 24.6% SLN biopsy positivity, with 169 SLNs resected and a 21.9% positivity ratio. The study suggests SLNB's reliability for T1-2 cN0 OTSCC patient staging and early micrometastasis detection.

Minimally Invasive Harvesting Technique for Costal Cartilage Graft: Donor Site, Morbidity and Aesthetic Outcomes.

Cartilage grafts are well-known as being reliable in reconstructive surgery for craniofacial pathologies. The aim of this study is to describe a new technique which requires an incision smaller than 1.5 cm but is still effective for harvesting cartilage graft. Thirty-six patients who underwent costal cartilage harvesting for septorhinoplasty have been included in this study, admitted from January 2018 to December 2021. Out of 36 patients, 34 have not reported any major complications, and two cases were followed up for pneumothorax. There were no infections and no chest wall deformities. All patients reported minimal pain at the donor site. The Vancouver Scar Scale was used to evaluate the entity of the postoperative scarring phenomena. This scale total ranges from 0 (representing normal skin) to a maximum score of 13 (representing worst scar imaginable). The results were 1.53 SD ± 0.64 (on average) 1 week after the surgical procedure and 1.28 SD ± 0.45 (on average) at the 6 months follow-up. This minimally invasive method provided a valid and effective surgical technique for cartilage graft. Despite the limitations of the case series, it seems that this procedure might be comparable to other and well-established traditional procedures and could be even preferred when the minimal invasiveness is mandatory.

Facial soft tissue thickness measurement method and relationship with BMI, age and sex.

INTRODUCTION: Facial aesthetics results from the harmony of various components of the craniofacial region, a structure whose physiognomy and topography are determined by a set of hard and soft tissues. Few works in the literature have investigated the relationship between the variables of sex, age, BMI and soft tissue thickness and have considered how these variables may influence operative outcomes. The purpose of this study is to increase the pre-operative knowledge of the thickness of the soft tissues of the face through an analysis of their measurement conducted on cone beam computed tomography (CBCT) and to investigate the impact that the variables of gender, age and BMI have on their determination. MATERIALS AND METHODS: For this study 82 patients were recruited between January 2020 and January 2021 in the Department of Maxillofacial Surgery of the University of Naples "Federico II". A descriptive analysis of the sample was carried out on the selected sample, calculating averages and standard deviations for the individual variables analyzed. RESULTS: BMI has a predominant role on some craniometric points while age and sex have a more marginal role. Our analysis shows that some points are affected by only one variable, BMI (G' N' PR' ID' SM' GN' PG' MIO' ACP' GO' ZY' SC' IC' ECMS' and MMB'); some points are affected by both BMI and gender (MP' and MR'); while only two (RHI' and MSO') are influenced by all the three variables. CONCLUSION: A priori knowledge through CBCT of the thickness of the soft tissues of the face and a comparison with the data we propose could provide the surgeon with advance notice of the characteristics of the tissues which she/he will encounter.

Are YouTube Videos a Useful and Reliable Source of Information for Patients with Temporomandibular Joint Disorders?

Counseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information about TMJD that patients can obtain from YouTube. A YouTube.com search was conducted using the terms "temporomandibular joint disorder"; "limited movement of the mandible"; and "mandibular joint pain". The videos identified were assessed independently by two panels of three professional and lay reviewers with HONcode, modified DISCERN (MD) and the global quality scale (GQS). A total of 106 videos were included. The professional reviewers reported a mean HONcode score of 4.148 ± 1.314 and a mean MD score of 2.519 ± 1.267, testifying to a modest general quality of the videos. The mean GQS score was 2.987 ± 1.012 for the professional and 3.469 ± 0.891 for the lay reviewers (p < 0.001). The correlations between the ratings were significant between the reviewers within the same group but not between the two groups. The presence of animations significantly influenced the GQS score expressed by the lay reviewers (p = 0.011) but not that of the professionals (p = 0.640). The quality of the information on TMJD on YouTube is generally of poor quality. Healthcare systems and professionals should be prepared to correct misinformation and build trusting relationships with patients which are based on quality counseling. Similarly, academic institutions should produce quality content that leads patients with TMJD toward a correct diagnostic-therapeutic process.

Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature.

Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 15 June 2021 to 15 June 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect.

Titanium Internal Fixator Removal in Maxillofacial Surgery: Is It Necessary? A Systematic Review and Meta-Analysis.

Titanium plates and screws are essential devices in maxillofacial surgery since late 1980s, but despite their wide use there is no consensus in titanium internal fixators removal after bone healing. A systematic literature review and meta-analysis were conducted on seventeen retrospective studies. Effect size and 95% confidence intervals were calculated for plate removal (per plate and per patient) and for removal causes (infection, pain, screws complications, exposition, palpability). Odds ratio, 95% confidence intervals, and χ 2 test were measured for sex, smoking, and implant site. Heterogeneity was evaluated with Cochran and Inconstancy test. Obtained data were used to design Forest and Funnel plots. The aim of the study is to identify and clarify reasons and risk factors for plates and screws removal. Infection is the most frequent reason; the habit of tobacco usage and implant site (mandibula) are the main risk factors. The administration of antibiotic prophylaxis is essential, and patients must quit smoking before and after surgery. In conclusion there is no scientific evidence supporting the removal of internal devices as mandatory step of the postoperative procedure.

Guidelines and Recommendations for Patient Management, Surgical Activities, and Safety in the Maxillofacial Unit and Head and Neck Department During COVID-19 Pandemic.

The recent pandemic has led to an unprecedented overload of sanitary systems around the world. Despite that a maxillofacial department is not a frontline specialty in the treatment of coronavirus disease 2019 infections, our department has found itself faced with numerous problems in keeping the care system active and efficient while ensuring safety for patients and healthcare professionals. Massive redistribution of health personnel was needed to improve prevention and personal safety measures. The education and training system has been kept active, giving residents a decisive role in managing the state of emergency response. This article outlines new guidelines for infection prevention: from clinical control, treatment processes, clinical management, protection, and disinfection of healthcare professionals.