Benign Paroxysmal Positional Vertigo After Oral and Maxillofacial Surgery: Our Experience and Review of Literature.

OBJECTIVES: The aim of our study is to evaluate the influence of patient risk factors and the length of surgical time on the onset of BPPV (benign paroxysmal positional vertigo) and suggest surgical and clinical strategies to prevent this rare complication. METHOD: Our retrospective study analyzes that, in 2 years, 281 patients, divided into three groups, underwent wisdom teeth extraction, sinus lift elevation and orthognathic surgery, at the Oral and Maxillofacial Department of the University of Naples "Federico II." RESULTS: Twenty-one patients presented postoperative BPPV. Some comorbidities, like dyslipidemia, high cholesterol levels, vascular problems, endocrinological disorders, perimenopausal age, female gender, cranial trauma, neurologic disorders, migraine, hypovitaminosis D, autoimmune disease, flogosis of inner ear, can be risk factors to the occurrence of postoperative vertigo. CONCLUSION: Our statistical analysis revealed a relationship between surgical time and comorbidity and onset of vertigo for each group of patients.

The Influence of Socioeconomic Factors on the Epidemiology of Maxillofacial Fractures in Southern Italy.

Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable and its analysis is crucial to establish effective treatment and prevention of these injuries. The aim of this multicentric retrospective study was to analyze causes, demographics, incidence, characteristics of 987 patients diagnosed with maxillofacial trauma between 2011 and 2015 at Complex Operative Unit of Maxillofacial Surgery of Federico II University of Naples and Magna Graecia University of Catanzaro, Italy; 657 male and 310 female patients were admitted in the study. The most frequently observed fracture involved the mandible (399 patients, 35.4%), followed by zygomatic complex (337 patients, 29.9%), orbital walls (160 patients, 14.2%), and nasal bones (129 patients, 11.4%). The most frequent cause of fracture was assaults (30.4%), followed by road traffic injuries (27.2%), falls (23.2%), sport accidents (15.4%), and others causes (2.6%). Significant variations of etiology have been detected between the 2 hospitals in relationship with different migration flow trends and cultural and socioeconomic features. Epidemiological analysis of maxillofacial fractures is crucial to identify the trauma burden and to help in developing a more efficient system to plan resource allocation and to deliver care and preventive measures establishing clinical and research priorities for effective treatment and prevention of these injuries.

Incidental finding of upper lip Warthin tumor.

AIM: This report shows an incidental finding of Warthin tumor in upper lip mucosa during hospitalization for a biting lesion of cheek mucosa MATERIALS AND METHODS: A 32-year-old male affected by a biting lesion of cheek mucosa was presented at Maxillo- Facial Unit of Federico II University. Clinical examination showed as an incidental finding a solid mass in the superficial layer of upper lip mucosa. We performed mini-invasive surgical treatment to obtain a radical excision of the cheek lesion at the same time as excision of Warthin tumor. RESULTS: a follow up of 12 months was performed. The complete healing of the two wounds was achieved, with no recurrence of any of the pathologies. DISCUSSION: The location of this Warthin tumor of minor salivary glands is very unusual. The role of imaging in diagnosis of Warthin tumor of minor salivary glands is to define localization, shape and dimension, contour, malignant features, nodal involvement. The role of fine needle aspiration cytology (FNAC) is critical in the diagnosis and therapy of minor salivary gland tumors. The surgical treatment in patients affected by Warthin tumour of minor salivary glands is local excision with a wide tumor free margin to prevent potential recurrence. CONCLUSIONS: Warthin tumor of minor salivary glands is a rare disease. We report a singular case of Warthin tumor localized in the upper lip mucosa, found as an incidental finding during a recovery for a biting lesion of cheek mucosa. KEY WORDS: Incidental finding, Minor salivary glands, Warthin tumor.

Retained upper third molars during Le Fort I osteotomy with downfracture.

AIM: The aim of our study is to demonstrate that the presence of upper wisdom teeth must be evaluated before and during Le Fort I osteotomy because attention must be focused to the disadvantages or facilitations of surgery depending on molar presence. MATERIALS OF STUDY: Our study has analyzed two groups, each one including 20 patients, 10 males and 10 females, with an age between 16-30 years. The first group was treated with le Fort I osteotomy leaving in situ the wisdom upper third molars. The second group was treated with Le Fort I osteotomy after the extraction of the wisdom upper third molars. RESULTS: Group A: upper third molar avulsion, necessary in 5 cases, was the main reason for prolongation of surgical time. However, in group A, increased bleeding occurred in 3 cases, bone irregularities and bone interferences occurred in 2 cases, neurological injuries occurred in 2 cases, any complications occurred in 8 cases. Group B: the management of the hemorrhage resulting from the vascular injuries, occurred in 7 cases, was the main reason for prolongation of surgical time. However, in group B, bone irregularities and bone interferences occurred in 4 cases, neurological injuries occurred in 3 cases, any complication occurred in 6 cases. DISCUSSION: In literature is actually discussed the risks related to the presence of lower third molars during mandibular osteotomies. CONCLUSIONS: Our study is designed to be helpful to the beginner surgeons during them first time approach to this kind of surgery. KEY WORDS: Retained third molar, Le Fort I osteotomy, Wisdom teeth extraction.

Complications after orthognathic surgery: our experience on 423 cases.

INTRODUCTION: Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples. MATERIALS AND METHODS: Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate. RESULTS: One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%). CONCLUSIONS: Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

Functional Endoscopic Surgery After Facial Trauma.

The present study describes 3 patients of previous facial trauma who have subsequently been treated with functional endoscopic sinus surgery. The authors want pay attention on the possible correlation between facial trauma and sinusitis. Such fractures can be the cause of onset of paranasal sinusitis or of worsening of a previous sinusitis. The correlation between these 2 pathologies could be due to the fact that facial fractures concern the anatomic structures of paranasal sinuses. The damage to these structures during the facial trauma and tissue regeneration after injury or surgical treatment subverts the anatomy and function of the sinuses in a basically compromised situation.