A. Baj

Oral lichen planus and malignant transformation: a longitudinal cohort study.

OBJECTIVE Oral lichen planus (OLP) is associated with risk for developing oral squamous cell carcinoma (OSCC). We performed a 7-year prospective study to assess the incidence of malignant transformation of OLP among adults. STUDY DESIGN Three hundred twenty-seven OLP patients, 229 women (70.0%) and 98 men (30.0%), were observed during the follow-up period. RESULTS During a mean follow-up of 81.7 months, 8 of 327 patients developed an OSCC in OLP areas (0.36%/y), yielding the high overall standardized incidence ratio of 17.7 (95% confidence interval [CI] 8.8-35.3). The standardized incidence ratio for OSCC was significantly higher in women [27.0 (95% CI 11.2-64.8)] than in men [11.2 (95% CI 3.6-34.9)]. Six OSCCs were well differentiated (75%) and 2 moderately differentiated (25%). Three subjects (37.5%) developed recurrences within 2 years (mean 16.1 ± 3.5 months). Disease-free survival rate after 69.8 months was 97.3%. CONCLUSIONS OLP was associated with a significant increase in the risk for OSCC. Close surveillance may help to reduce the morbidity of OSCC arising from OLP at 24 months.

Subciliary versus swinging eyelid approach to the orbital floor

In this retrospective study, the authors compare the outcomes of two different approaches to the orbital floor: the classic subciliary versus the transconjunctival plus lateral canthotomy (swinging eyelid). Forty-five patients who underwent orbital surgery (47 approaches) for different indications (orbital fractures, correction of Graves exophthalmos, tumours of the internal orbit and correction of enophthalmos in secondary trauma) were placed in two groups, depending on the approach. The long-term effects of the incisions, the outcome of the approach and the complications were recorded and compared. The minimum follow-up for inclusion in the study was 1 year. Twenty-three orbits underwent subciliary incision, and 24 underwent swinging eyelid. No ectropion or entropion was seen in any patient. For the swinging eyelid approach, complications included three cases (12.5%) of canthal malposition; for the subciliary approach, five cases (21.14%) of lagophthalmos and 10 visible scars were observed. Our findings show the advantages of the swinging eyelid: better aesthetic results, the same or greater exposure of the orbital floor and the caudal part of the lateral and medial walls, shorter surgical time (sutureless) and a less extended scar. Although in our experience this approach is preferable in orbital surgery, some indications for the subciliary still remain.

Cheek mucosa: A versatile donor site of myomucosal flaps. Technical and functional considerations

Reconstruction of moderate‐sized mucosal defects of the oral cavity/oropharynx represents a surgical challenge. The most widely used reconstructive techniques are skin grafts, local or regional pedicled flaps, and free flaps, but they do not provide mucosal sensitivity, mobility, volume, or texture similar to that of native tissue. The cheek myomucosal flaps seem to provide “ideal reconstruction” because they carry a thin, mobile, well‐vascularized, and sensitive tissue, like those excised or lost. The purpose of this retrospective analysis was to evaluate the indications for the advantages and disadvantages of 6 types of buccinator myomucosal flaps which are possible to raise from the cheek mucosa.

Is neck dissection needed in squamous-cell carcinoma of the maxillary gingiva, alveolus, and hard palate? A multicentre Italian study of 65 cases and literature review

The occurrence of occult cervical metastases due to squamous-cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed that many patients return with a delayed cervical metastasis following resection of a primary cancer at these sites. Some of these patients have died as a result of a regional or distant metastasis, despite control of the primary cancer. The literature contains few recommendations to guide the treatment of maxillary squamous-cell carcinoma; prospective studies are difficult due to the rarity of such tumours. The aim of this study is to define the incidence of cervical metastasis and to investigate whether elective neck dissection is justified. We present a retrospective multicentre study of 65 patients with squamous-cell carcinomas of the maxillary alveolar ridge and hard palate and review of the existing literature. The overall incidence of cervical metastases was 21%. We evaluated the significance of primary-site tumours as indicator of regional disease. The maxillary squamous-cell carcinoma cases in our multicentre study and in the literature review exhibited aggressive regional metastatic behaviour, comparable with that of carcinomas of the tongue, mouth floor, and mandibular gingiva. Based on our findings, we recommend selective neck dissection in clinically negative necks as a primary management strategy for patients with maxillary squamous-cell carcinomas involving the palate, maxillary gingiva, or maxillary alveolus.

FAMM flap reconstruction of the inferior lip vermilion: Surgery during early infancy

The lips are complex, laminated structures consisting of skin, subcutaneous tissue, muscle, submucosa and mucosa. Clearly when the lip is lost through injury or disease, it presents a complex reconstructive challenge. The facial artery muscular mucosal flap (FAMM), harvested from lateral cheek, is a composite flap with many features which make it an excellent option for lip and vermilion reconstruction. The authors present a review of literature and a case of a 2-year-old girl with medial lower-lip vermilion avulsion, reconstructed with a FAMM flap.

Computer-assisted orthognathic surgery for correction of facial asymmetry: results of a randomised controlled clinical trial.

In this randomised controlled clinical trial, 2 homogeneous groups of patients with facial asymmetry (n=10 in each) were treated by either classic or computer-assisted orthognathic corrective surgery. Differences between the 2 groups in the alignment of the lower interincisal point (p=0.03), mandibular sagittal plane (p=0.01), and centering of the dental midlines (p=0.03) were significant, with the digital planning group being more accurate.

Mandibular coronoid process grafting for alveolar ridge defects

OBJECTIVE We describe the clinical results of mandibular augmentation with coronoid process bone grafts for dental implant insertion. STUDY DESIGN Fifteen patients with vertical and transverse defects of the posterior alveolar process of the mandible were treated. All patients underwent mandibular rehabilitation with autogenous coronoid process bone grafts via minimal-access surgery. After 6 months, 40 dental implants were inserted. RESULTS At the time of implant insertion, the grafted alveolar ridges showed mean transverse and vertical augmentations of 3.07 and 2.80 mm, respectively. At 24 months after implant surgery, the cumulative implant survival rate was 95% and mean marginal bone loss was 1.6 ± 0.18 mm. No complete bone graft loss or infection occurred. CONCLUSIONS Coronoid process bone grafts can be used to reconstruct moderate defects in edentulous alveolar processes. The insertion of the graft with minimal access in a tunneled fashion minimizes the risk of infection.

Stair Ascent and Descent in Assessing Donor-Site Morbidity Following Osteocutaneous Free Fibula Transfer: A Preliminary Study

PURPOSE The aim of this study was to investigate gait kinematic parameters during stair ascent and descent after fibula free flap removal for facial reconstruction. MATERIALS AND METHODS Eight patients who underwent facial reconstruction with fibula free flap removal ascended and descended 3 standard steps. Their movements were recorded by a motion analyzer; gait kinematic parameters were obtained and compared with those calculated in 8 control subjects. RESULTS Stride time, percentage of swing, and support phases did not differ among healthy and operated limbs and control subjects (Kruskal-Wallis, P > .05). No significant differences were found for hip and knee movements, pelvis rotation and tilt, and body center of mass displacements. During stair descent, the patients had significantly larger pelvis inclinations than the control subjects (P < .05). CONCLUSIONS No functional limitations during stair performance were found. The only significant difference could indicate a minor control of the pelvis and should be used to define specific rehabilitative interventions.

Microsurgical Upper Lip Replantation: A Case Report

Lip amputation is rare, and systematic microsurgical replantation is necessary to achieve morphofunctional restoration of the traumatized structure in a single surgical operation. We describe a case of right hemilip and labial filter avulsion, resulting from a dog bite. The amputated section was revascularized by arterial micro-anastomosis, whereas no venous anastomosis was performed, because no venous blood vessel was identified. Venous drainage was obtained through the postoperative application of leeches together with anticoagulant and antibiotic therapy. The esthetic and functional results were good in terms of form, color, scarring, and the restoration of lip function and sensitivity. Traumatic lip amputation is rare, with only a few dozen reported cases. It often has devastating effects from esthetic, functional, and psychological perspectives. The most common causes of lip amputation are dog bites and human aggression. The upper lip is affected twice as frequently as the lower lip. Considering the available reconstruction methods, standard nonmicrovascular lip replantation procedures often do not ensure sufficient functional and esthetic restoration and local tissue is frequently sacrificed. 1,2 Advances in microsurgical techniques allowed James 3 to perform the first successful lip replantation, in 1976, in a child with nasolabial amputation caused by a dog bite. We describe upper lip replantation in a patient after traumatic avulsion caused by a dog bite carried out at the Department of Maxillo-Facial Surgery of the Galeazzi Orthopedic Institute in Milan, Italy.

Minimally invasive harvest of free fibula flap.

rately detect a present but unsuitable perforator and thus redesign of the skin island may be needed. Finally, even though high accuracy has been obtained so far, in our opinion, the sensitivity and specificity of this test remain to be investigated in larger series. A case study is presented to illustrate the high correlation between the preoperative examination and the intraoperative findings. DOI: 10.1097/PRS.0b013e31827c738b