Bone Regeneration of the Maxillofacial Region Through the Use of Mesenchymal Cells Obtained by a Filtration Process of the Adipose Tissue.

In this work, the authors will discuss about a new protocol and rapid alternative to isolate the mesenchymal stromal cells from the stromal vascular fraction, without the use of collagenase, to regenerate the bone tissue in the maxillo-facial region. This method employs a device that allows the isolation and concentration of stromal vascular fraction by means of lipoaspirates, which separate the lipid component and fragments of the extracellular matrix. The innovative element consists in using a filtration device instead of a centrifuging device to separate the different components. The purpose of this work was to illustrate the results obtained with the above-mentioned method in a series of 8 patients suffering from cystic neoformations maxillary or mandibular.

Schwannoma of the parotid gland. Case report.

Schwannoma is encapsulated benign tumors arising from nerve cell. Of which ancient schwannoma is one of five variants. Intraparotid facial nerve schwannoma is been documented sporadical throught the medical literature, althought a few ancient schwannomas have been reported in different locations in the head and neck region. In this report, a 31 year old man patient with an misunderstanding tumor of the parotid gland is described and the histopathologic exam was performed to diagnosed the schwannoma.

Fronto-orbito-zygomatic trauma with eyelid involvement.

As part of the trauma of the upper third of the massive face, the fronto-orbito-zygomatic arch is the most frequent and is often associated with eyelid involvement. From 2001 to 2008, 135 patients with fronto-orbital eyelid complex alterations occurred at our center; the patients were included in clinical follow-ups until 2010. Most patients (80%) came to our observation in a state of emergency due to automobile accidents, sports injuries, or assaults, whereas a smaller proportion (20%) was because of previous trauma or surgery. Among the urgent patients, 28 patients present bone lesions without soft-tissue involvement, 62 present bone lesions with soft-tissue involvement, and 16 present only soft-tissue lesions. Among the patients who came as outcomes, in 16 patients, a bone review was necessary; in 15 patients, only soft-tissue review was necessary; and 8 patients needed only scar outcome review. Soft-tissue treatment was more difficult, especially the eyelid. The eyelid must be treated as soon as possible to avoid corneal lesions and major complications like total vision lost. The surgical design must satisfy even the aesthetic profile to guarantee functional success and aesthetic too.

Biomaterial implantation in facial esthetic diseases: ultrasonography monitor follow-up.

Facial deficit diseases are corrected by biomaterial implantation. The ideal biomaterial should be easy to implant and remove and simple to be identified by a low-dose radiation and low-cost radiologic technique. The purpose of this work was to evaluate ultrasonography (US) as a technique in monitoring biomaterial status after operation. In the last 3 years, for this study we used polyethylene porosus and polyacrylamide. Our study included 300 patients grouped accordingly as follows: malformative syndromes, degenerative syndromes, and esthetic problems, results of skull-facial traumas, and whether they are treated in the early phase and or the late phase. In this paper, we describe the better 15 clinical cases for their excellent result and for their variety of US images. Ultrasonography has been shown as an excellent way to visualize clinical features and a possible pathologic process of an implanted biomaterial; it is a noninvasive, low-radiation and low-cost dose radiologic technique. Reconstruction in facial deficit diseases needs adequate biomaterial to implant and a careful patients observation, that is, both clinical and radiologic. Ultrasonography is a fundamental component of the follow up of implanted biomaterial patients.

Maxillofacial prosthetic rehabilitation using extraoral implants.

The prosthetic rehabilitation is a surgical alternative in functional-aesthetic facial reconstruction when the conventional reconstructive surgery cannot be applied either because of the psychophysical conditions of the patient or because of an excessive substance loss. From May 2002, 35 facial prosthesis (111 implants) have been positioned. Defects were congenital (N = 12), consequent to trauma (N = 8) and to demolitive surgery for malignant tumors (N= 8), and infection (N = 7). In 4 patients, implants were placed in previously irradiated areas. A total of 111 titanium implants were placed to support 21 auricular prostheses (bilateral in 2 cases), 4 orbital prostheses, 8 nasal prostheses, and 2 complex midfacial prostheses. Implant failure was observed for 2 of the 3 implants placed to support a nasal epithesis in a patient with hepatitis C virus, with an important parodontal disease, who experienced a postinfective necrosis of the nose after a liver transplantation; it was necessary to place an adhesive prosthesis. An implant failure was also observed in a diabetic patient with an extensive midfacial defects due to a mycotic infection, but it did not compromise the retention of the prosthesis. According to our experience, the indication to epithesis is when the conventional reconstructive interventions is inapplicable.

Unusual foreign body in the nasal cavity.

Foreign objects frequently have been reported in the nasal structures, often these foreign bodies are occasionally inhaled by children or they are often inserted in nasal cavities after various accidents. Frequently, the presence of foreign bodies in the nose represents an emergency, particularly for pediatric patients where the incidence is high. The report in this article described an unusual nasal foreign body in an adult discovered incidentally during a cranial radiography. This report is an unusual case of facial asymmetry caused by a foreign nasal body in adult, which is destitute of complications, connected to long-term presence of the intranasal button. The finding was accidental; moreover the patient was an adult and did not present a clear symptomatology. Through careful clinical and fibroscopy exam, valuating also the site of the foreign body, it is necessary an intranasal surgery treatment. The results of the treatment is connected to a combined use of different branches of learning with the aim of obtaining positive results from both a clinical and legal point of view.

Nevus sebaceus of Jadassohn.

The nevus sebaceus of Jadassohn (SNJ) is a hamartomatous disorder of the skin and its adnexa pertaining to the group of "organoid nevi,'' most frequently involving the face and scalp. During adulthood, patients with SNJ have a 10% to 20% risk of the development of cutaneous or adnexal neoplasia, so that prophylactic excision before puberty is recommended by most authors, and tissue expansion is considered to be the best method of reconstruction. It has been largely demonstrated in literature that most of the lesions that have been interpreted as basal cell carcinoma (BCC) are actually examples of primitive follicular induction or trichoblastomas, not authentic BCCs. A literature review on histopathologic findings associated with SNJ and a retrospective chart review of two cases occurring in young females are presented. In one case, the lesion was treated by intraoperative expander-assisted reduction and scalp graft (Case 1); in the other one, a primary closure with adjacent tissue was performed (Case 2). No signs of malignant degeneration or residual pathology have been found. For treatment of the biggest lesions, when preoperative tissue expansion cannot be performed, intraoperative one, transfer of a scalp graft has been shown to be a good reconstructive method. For the smallest lesions, a primary closure with adjacent tissue is sufficient.

Brain abscess by mycotic and bacterial infection in a diabetic patient: clinical report and review of literature.

This report presents a case of lethal invasive mucormycosis, a rare fungal infection, which predominantly affects immunocompromised patients, and is reported in a 57-year-old female who presented with cerebral abscess. The patient, who had undiagnosed diabetes mellitus, presented with extensive right hemifacial deficiency of the bones and soft tissues consequent to surgical resection of the ethmoid-spheno-maxillo-orbital district after mucormycosis. A reconstruction with a pectoral pedunculated flap was performed. The maxillary swelling extended to the contiguous area, involving the palate and homolateral orbital floor. Mucous and cutaneous samples showed the presence of Aspergillus fumigatus, and diagnosis of rhinocerebral mucormycosis was made. The patients also presented with a right hemiplegia consequent to a cerebral abscess by Eikenella corrodens. The authors decided to position an intraoral prosthesis to restore palatal integrity and masticatory function and inserted four titanium fixtures for the retention of the bone-anchored facial prosthesis.