New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction.

In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.

Palatal reconstruction with tunnellized Bichat fat pad flap after tumor resection.

BACKGROUND: Reconstruction of palate defects following tumor ablative surgery can be a challenging problem. Different methods have been suggested over the time for the reconstruction of postoperative palatal defects. Since the first report of the Bichat fat pad flap in1977, it has become one of the most used flaps for the reconstruction of palate after tumor excision. We report our results using the tunnellized Bichat fat pad (BFP) flap for 23 cases of palate reconstruction after minor salivary glands tumor excision. METHODS: The authors performed a tunnellized Bichat fat pad flap for primary reconstruction of small- medium-sized surgical defects of the palate in 23 patients suffering from minor salivary glands palatal tumors in the period between 2016 and 2019. Each case was reviewed for primary pathologic findings, wound healing, postoperative complications. RESULTS: All 23 tunnellized BFP procedures showed excellent recovery and uneventful follow-up. With this technique after 12 months follow-up complete wound healing after only 4 weeks without complication was observed. CONCLUSIONS: The tunnellized BFP flap is useful, easy, and uncomplicated new alternative method for primary reconstruction of small to medium-sized palatal surgical defects, that can be performed with a very low morbidity. Submucosal tunnel for the pedicle passage introduced by the Authors adds some advantages in final outcomes with less discomfort for the patients, proving to be a technique able to adds itself to surgical reconstructive technique available today.

A new operative open-wings technique to correct the frontoforehead unit in metopic synostosis.

The technology adoption and creation of a multidisciplinary team have helped to overcome the complexity associated. Craniofacial surgery has thus emerged from the valuable contributions of neurosurgery, maxillofacial surgery, plastic surgery, eyes, nose, and throat as well as head and neck surgery. A patient with trigonocephaly may present a prominent "keel" forehead, accompanied by recession of the lateral orbit rims, hypotelorism, and constriction of the anterior frontal fossa when the metopic suture fuses before 6 months of age. In a period between 2007 and 2011, in the Salesi Children's Hospital, were treated for nonsyndromic variety of metopic synostosis 11 infants; their ages ranged from 6 months to 9 months, and 7 were males and 4 females. The most important aims of our new surgical technique are the achievement of symmetry as well as normal proportion and reconstruction of the frontoforehead unit but remaining in a very conservative treatment. The morphology and position of the supraorbital ridge-lateral orbital rim region are key elements of upper facial esthetics. This new "open-wings" technique for the reconfiguration of the bilateral emisupraorbital bar requires a midline incomplete osteotomy that involves only the internal cortex of the frontonasal region. Hence, both lateral orbital walls are bent inwardly and tilting forward, as in computed tomographic scan planning, with a greenstick fracture pivoting on the preserved medial frontonasal region. This open-wings conservative technique allows the avoidance of the most important complication that may result in the traditional way such as dead space in the anterior cranial fossa, infections, and blood loss but with an achievement of satisfactory craniofacial form and aesthetic result.

Contemporary management of vascular malformations.

PURPOSE: To review the literature on vascular malformations and to clarify their diagnosis, clinical presentation, and treatment options. MATERIAL AND METHODS: The authors reviewed the current literature on vascular malformations looking for more innovative and credited diagnostic criteria and treatment protocols. RESULTS: The review is divided in 4 sections (capillary, venous, arteriovenous, and lymphatic malformations). In each section, the clinical presentation, radiologic features, and treatment options for each kind of vascular malformation are described. The experience and results of the authors also are presented. CONCLUSIONS: Vascular malformations are a heterogeneous group of diseases. Each type of malformation has unique features that make it largely different from the others. Only a clear and correct diagnosis can lead to optimal results.

Repair of cocaine-related oronasal fistula with forearm radial free flap.

BACKGROUND: Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions. MATERIALS AND METHODS: From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication. RESULTS: In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved. DISCUSSION: Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness.

Partial and total lower lid reconstruction: our experience with 41 cases.

PURPOSE: To report our experience on lid reconstruction in patients with epitheliomas. METHODS: A total of 41 consecutive patients affected by basal cell (n=32) or squamous cell carcinoma (n=9) underwent partial (n=35) or total (n=6) surgical demolition of the lower lid. Surgical defects<25% (n=10) received direct closure. If the defect involved 30-60% of the eyelid (n=21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n=10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. RESULTS: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. CONCLUSIONS: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results.

Maxillary reconstruction and placement of dental implants after treatment of a maxillary sinus fungus ball.

A fungus ball is one of the fungal diseases that can affect the paranasal sinuses. It requires surgical treatment. Because there is only one previously reported case of dental implant placement after treatment of a maxillary sinus fungus ball, the authors here report on a case of a maxillary sinus fungus ball with bone erosion that was treated surgically with a combined endoscopic endonasal and endoral (Caldwell-Luc) approach. One year later, a graft from the ilium was obtained and a sinus elevation was performed to allow the placement of dental implants. Three months later, the dental implants were placed, and they were all osseointegrated at the 9-month follow-up.