Alessandra Leonardi

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.

PET and PVC Separation with Hyperspectral Imagery

Traditional plants for plastic separation in homogeneous products employ material physical properties (for instance density). Due to the small intervals of variability of different polymer properties, the output quality may not be adequate. Sensing technologies based on hyperspectral imaging have been introduced in order to classify materials and to increase the quality of recycled products, which have to comply with specific standards determined by industrial applications. This paper presents the results of the characterization of two different plastic polymers—polyethylene terephthalate (PET) and polyvinyl chloride (PVC)—in different phases of their life cycle (primary raw materials, urban and urban-assimilated waste and secondary raw materials) to show the contribution of hyperspectral sensors in the field of material recycling. This is accomplished via near-infrared (900–1700 nm) reflectance spectra extracted from hyperspectral images acquired with a two-linear-spectrometer apparatus. Results have shown that a rapid and reliable identification of PET and PVC can be achieved by using a simple two near-infrared wavelength operator coupled to an analysis of reflectance spectra. This resulted in 100% classification accuracy. A sensor based on this identification method appears suitable and inexpensive to build and provides the necessary speed and performance required by the recycling industry.

Parry-Romberg syndrome.

The authors report an unusual case of Parry-Romberg syndrome (PRS). Magnetic resonance imaging and computed tomography scan of the craniofacial region and surgical correction of enophthalmos were performed. Results after the operative intervention included persistent palpebral edema and ecchymosis and transient choroid vasculitis of the right eye, highlighted with echography and fluorescein angiography. The fundus oculi examination showed retinal choroid folds. Immunological test results were weakly positive. The authors conclude enophthalmos, associated with right side hemi atrophy, and the transient choroids vasculitis support the diagnosis of PRS. Furthermore, it is suggested the case had an autoimmune etiology, rather than a hemi facial asymmetry caused by a facial trauma that occurred in puberty.

Tinnitus in patients with temporo-mandibular joint disorder: Proposal for a new treatment protocol

The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old. The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution.

Management of Facial Trauma in Patients Older Than 75 Years

Abstract According to the literature and World Health Organization, elderly people are specified as persons older than 65 years of age. The authors believe that the indication for surgery patients over 65 is based on the restoration of functionality and the aesthetics. The behavior of the surgeon has to change with patients aged older than 75 years where the restoration of function and, therefore, a good quality of life is far more important than the aesthetic restoration. In a retrospective study of 1022 patients consecutively hospitalized at Maxillofacial department in Roma, Università “Sapienza,” the patients older than 75 years were analyzed. During this period, the data of all patients undergoing treatment because of trauma-related injuries were collected. Data were registered regarding etiology, localization of the injury, surgical treatment ratio, medium average stay, age, and sex distribution. Surgical treatment in these patients should be driven by the general condition of health whenever possible; reduction of facial fractures should be guided by the need to return a good quality of life for the patients. The goal of this study was to analyze a new group of population, people older than 75 years, that is, a real new and growing group of population.

Unknown Posttraumatic Foreign Body in Facial Region

Abstract:This study emphasizes the importance of scrupulous diagnostic first aid procedures to avoid the consequences of trauma due to a foreign body. Two patients were examined, both with facial trauma showing nonspecific symptoms. Through objective internal and external oral examination complete with clinical and radiographic examinations Three dimensional computed tomography (TC3D), foreign bodies unknown at the time of the trauma were identified. When the foreign bodies had been removed, the ache symptoms disappeared, restoring functionality and the patients facial appearance. This study shows the need for detailed early diagnosis to achieve correct monitoring and therefore proper treatment for these patients.

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.

Role of a new orthognathic surgery in maxillomandibular reconstruction by free flaps.

Purpose: The objective of this study was to describe the orthognathic surgery techniques for the treatment of occlusal anomalies in those patients who underwent complex maxillomandibular reconstruction with bony free flap. Materials and Methods: The authors describe their personal technique developed over years of experience with reconstruction of mandibular defects with bony free flaps. Results: The outcomes in these patients who were treated according to our surgical planning were completely satisfying, with a 100% stability of the treated bones. Conclusions: Orthognathic procedure on bony free flaps for the reconstruction of mandibular defects is nowadays accepted. Patients who underwent major mandibular destruction due to oncologic disease or trauma outcomes can now benefit from this technique.

DELFI: a new orbital conformer in the management of enucleated patients.

AbstractAnophthalmia and micro-orbitism due to infections, traumatic events, and oncologic disease can occur both in adulthood and in childhood. After restoring the volume of the socket surgically or using an expander, concurrent forniceal expansion with expanding conformer should be maintained. We created a new type of conformer that is possible to fit even in very reduced or very irregularly shaped socket. It is formed by 3 acrylic portions connected by metallic clumps that represent an intrinsic mechanism of expansion. The 3 acrylic portions could be modeled on the shape of the individual patient socket while the metal elements allow a thrust in 3 directions. The positioning of this conformer does not need any surgical treatment and it is possible to fit it in an ambulatory manner; it is shaped on the individual patient and is then available in most cases that occur.