Giada Anna Beltramini

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.

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

Aesthetic Analysis of the Face: The Maxillofacial Deformity

Facial analysis involves evaluation of functional and aesthetic disharmonies. It is important to appreciate what constitutes ones own perceptions of beauty and how the clinician can translate this into successful clinical results.

Anophthalmic Orbit Syndrome: A new free tissue transfer

3. Hamano H, Kawa S, Ochi Y, et al: Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet 359:1403, 2002 4. Kamisawa T, Nakajima H, Hishima T: Close correlation between chronic sclerosing sialadenitis and immunoglobulin G4. Intern Med J 36:527, 2006 5. Grossman A, Gibson J, Stansfeld AG, et al: Pituitary and testicular fibrosis in association with retroperitoneal fibrosis. Clin Endocrinol 12:371, 2008 6. Petersdorf RG, Beeson PB: Fever of unexplained origin: Report on 100 cases. Med Baltimore 40:1, 1961

SOFT-TISSUE FACIAL ASYMMETRY BEFORE AND AFTER ORTHOGNATHIC SURGERY: APPLICATION OF A NEW 3D PROTOCOL

Introduction: Skeletal Class III patients often present a major facial asymmetry. In the current investigation, a quantitative method to assess 3D facial asymmetry was applied to an orthognathic surgery patient to quantify possible postsurgical modifications. Methodology: Soft-tissue facial scans of a 20-year-old man with skeletal Class III, candidate to orthognathic surgery, were collected in the pre-surgery stage and 6, 12, 24 months post-surgery with a stereophotogrammetric system. Soft tissue asymmetry was calculated in the facial thirds according to a published protocol (J Craniomaxillofac Surg 2017;45(1):76-81), and the relevant time-related modifications described. The results were also compared to normal values from a group of 23 control subjects (10 men, 13 women, mean age 26) by using z-scores. Results: The longitudinal analysis of the soft-tissue facial asymmetry showed a marked difference in the analysed time points: orthognathic surgery did reduce facial symmetry in the present patient. The comparison between the patient and the control subjects by using z-scores highlighted a clear difference in all-time points: the patient with facial dysmorphia had a higher degree of asymmetry than healthy subjects. Conclusion: The measurements of soft-tissue facial asymmetry using 3D optical digitisers can provide clinically useful information. The graphical representation of results can help in the patient’s understanding of the treatment phases, thus increasing compliance.

Fibula free flap pedicle ossification: Experience of two centres and a review of the literature

PURPOSE The osteogenic potential of vascularized periosteum has been described in a few cases in the literature, and many different factors have been pointed out as plausible. Our aim was to review the literature in order to give a complete overview of this topic and to report on our clinical experience. PATIENTS & METHODS Our experience includes three patients who underwent maxillectomy and FFF reconstruction. A progressive reduction in mouth opening was noticed in the months after surgery, and CT scans showed calcified tissue around the pedicle. Surgical revisions were performed. No recurrences were noticed. A full systematic literature review was conducted, including studies published on or before September 2016. RESULTS Clinically, free flap pedicle ossification is presented as trismus, hard swelling, and severe pain during movements, although the diagnosis is scarce and often fortuitous. From January 2010 to January 2016 we performed 68 FFF reconstructions, and the incidence of FFF pedicle ossification in our experience was 4.4%. CONCLUSION Ossification of FFF pedicle is uncommon, but when it occurs, it has dramatic clinical consequences. Follow-up CT scan can be useful in diagnosis. In our experience, surgery should be performed only when the patient is symptomatic.

Resorbable Materials for Reconstruction of the Orbital Floor in Children.

AbstractThe best treatment of pediatric orbital fractures is debated and different strategies are proposed in the literature. Resorbable materials, due to their features and the specific requirements of the pediatric population, seem a very suitable choice. The authors present their experience by describing 3 cases and explaining their mesh modeling technique. Two fractures were caused by accidental falls, whereas the other resulted from aggression. Clinical and radiological evaluation (computed tomography scanning) was performed before surgery. No complications occurred either immediately after surgery or in the long term (maximum follow-up of 3 y). As there has been little experience of the use of resorbable mesh in maxillofacial pediatric traumatology, the authors describe their technique, which may facilitate the use of this material in orbital fractures.

Maxillary sinusitis after sinus lift due to Gemella morbillorum: antibiotic and surgical treatment.

AbstractSinus lift is a predictable procedure for increasing alveolar bone height in the posterosuperior alveolar regions to allow oral prosthetic rehabilitation. Several complications have been documented in the literature and vary from sinus membrane perforation to maxillary rhinosinusitis. The authors present a case of Gemella morbillorum acute sinusitis after sinus lift surgery. The purpose of this report is to describe the surgical and pharmacological management of a patient allergic to penicillin.