Giulio Gasparini

Abrikossoff's Tumor

Abrikossoffs tumor is a disease that more commonly affects the oral cavity but can also occur at other sites. It develops between the second and sixth decades of life, more frequently among women and blacks. The neoplasm can affect all parts of the body. The head and neck areas are affected in 45% to 65% of cases and of these, 70% are located interorally (tongue, oral mucosa, hard palate). The benign form shows polygonal cells with granular, eosinophilic cytoplasm and small nuclei. The malignant form, however, is associated with a high mitotic index and pleomorphic cellular tissue. The clinical aspect of the neoformation is a swelling covered by mucus of normal appearance. Studies of the neoformation show that in addition to the objective examination, further instrumental research is necessary, i.e., with nuclear magnetic resonance or computed tomography with contrast CT scan. However, the only examination that can confirm the clinical diagnosis is the histological examination. The only treatment for Abrikossoff tumor is surgery. The surgical treatment provides for an extirpation of the neoformation with the overhanging mucus and the underlying periosteum. In this work, the authors discuss a case of Abrikossoff tumor affecting the mucus of the right side of the hemipalate in a 53-year-old patient and present a review of the literature.

Inferior alveolar nerve impairment after mandibular sagittal split osteotomy: an analysis of spontaneous recovery patterns observed in 60 patients.

Sensory impairment after bilateral sagittal split osteotomy (BSSO) due to inferior alveolar nerve (IAN) lesions may be either temporary or permanent and either complete or partial. The aim of this prospective study is to evaluate, by means of objective sensory testing, IAN sensory disturbances development in patients who underwent BSSO.IAN sensory disturbances development at the first week, fourth week, sixth month, and twelfth month of follow-up review in a group of 60 patients who underwent BSSO from January 1, 1998, to July 31, 1999, at the Maxillofacial Surgery Department of the “La Sapienza” University of Rome. The 60 patients were examined in the presurgical period; the IAN functionality regarding thermal sensibility, nociception, and two-point discrimination, was assessed at follow-up in 120 sides. In our study the highest rate of spontaneous recovery of the entire IAN functionality was observed at the sixth month. This finding witnesses how neuropraxia and axonotmesis give a spontaneous recovery that most frequently occurs within 6 months from surgery, independently from age and sex of the patient. The persistence of anesthesia over 12 months could be a sign of neurotmesis.

Fanconi anemia manifesting as a squamous cell carcinoma of the hard palate: a case report

Fanconi Anemia is a rare autosomal recessive disorder characterized by various congenital malformations, progressive bone marrow failure at a very young age and of solid tumors development. The authors present a rare case of a squamous cell carcinoma of the hard palate in a Fanconi Anaemia patient. The atypical clinical manifestation rendered the diagnosis more difficult. This case, for age of appearance, sex and localization, is unique in international literature. We recommend a quarterly follow up of the oral-rhino-pharynx complex in FA patients and to consider as carcinomas, all oral lesions that last more than two weeks.

Activities of masticatory muscles in patients after orthognathic surgery

AIM To evaluate left and right masseter and anterior temporalis muscle activity in patients before and after orthognathic surgery. PATIENTS Nineteen patients were enrolled, 9 males and 10 females, aged 17-34 years. Four patients were suffering from a prognathic syndrome (skeletal class II with mandibular retrusion) and were candidates for surgical correction involving a mandibular Bilateral Sagittal Split Osteotomy (BSSO), whereas the other 15 patients showed a progenic syndrome (skeletal class III with mandibular protrusion) and were selected for bimaxillary surgery with maxillary advancement and mandibular retrusion. METHODS Electromyographic examinations were carried out on all subjects presurgically and 6-8 months postoperatively. To verify the neuromuscular equilibrium, the electromyographic activities of both the right and left masseter and anterior temporalis muscles were registered and analysed calculating: percentage overlapping coefficient (POC, index of the symmetric distribution of the muscular activity determined by the occlusion) and torque coefficient (TC, index of presence of mandibular torque). RESULTS After surgery, a trend in the improvement of POC and TC indices was found, with a reduced intragroup variability. CONCLUSION The electromyographic evaluation allowed the impact of occlusion on neuromuscular equilibrium to be quantified, and showed that improvements gained by surgical intervention are primarily due to better occlusal stability and not to biomechanical advantages.

Distraction osteogenesis in the surgical treatment of craniostenosis: a comparison of internal and external craniofacial distractor devices

PurposeTo compare the practical difficulties of external and internal craniofacial distraction devices used in craniofacial advancement in terms of technical surgical limitations and patients’ discomfort.Materials and methodsThis study involved analysis of the pertinent literature and personal experience on the treatment of patients affected with syndromic craniosynostoses treated with craniofacial distraction advancement.ResultsOne hundred patients who underwent internal craniofacial distraction were analyzed. This kind of distraction device was found to be adequately tolerated by the patients with regards to physical and psychological aspects. They had relatively little impact on day-life activities. However, a significant drawback of this type of device is represented by the difficulty in controlling the vectors of distraction. Thirty-eight patients were analyzed after having received the implantation of an external craniofacial distraction device. This type of instrumentation was found to have a significant psychological impact and important limitation on recreational activities. External devices, however, offered important advantages in the control of the vectors of distraction, which could be modified according to the patient’s needs during the perioperative and early postoperative clinical course. There were no significant differences among the two types of devices with regard to osteogenesis and degree of facial advancement.ConclusionBoth internal and external devices are effective in distraction craniofacial advancement. However, significant differences do exist concerning the surgical aspects and the practical difficulties experienced by the patients.

Techniques on modeling the vascularized free fibula flap in mandibular reconstruction

In mandibular reconstruction with bone grafts, the functional and aesthetic outcomes are clearly influenced by reconstructive techniques. Vascularized free fibular flaps are considered the most suitable choice for mandible reconstruction because of their good aesthetic and functional outcomes. Several techniques have been described in literature. According to various authors, shaping of the fibular graft can be performed by means of computer-aided design/computer-aided modeling procedures for the evaluation of the presurgery anatomy and three-dimensional models of fibula graft. However, these models are expensive, require a strict realization of the programmed intervention, and are not easily adaptable to a surgical treatment different from the planned one. We report our experience on a technique for mandibular reconstruction using a free fibular flap, obtained by modeling a template on the resected mandible. Our operative technique consists of 5 steps: preplating, resection, template modeling, contouring of the fibula, and fixing the flap on the mandible.Template modeling is performed to record the length of the resected bone, the mandibular curvature on the 3 space planes, and the width of the basal bone. On the basis of the template, the fibula flap was modeled while still attached to the pedicle. The plates, positioned at the level of the fibular osteotomies, were preformed to make the fibula precisely fit in the template. Once the fibula was shaped, mandibular reconstruction was completed by positioning the fibula graft on the mandibular stumps. Bone graft modeling by means of template is a rapid, safe, and flexible method to reconstruct the mandible.

Intraosseous hemangioma of the maxillofacial district: clinical analysis and surgical treatment in 10 consecutive patients.

The aims of this study are to illustrate functional and esthetic results obtained with different surgical strategies and to report a review of the relevant literature. There were 6 female patients and 4 male patients included in this study, with an average age of 35.7 years. Zygomatic bone was affected in six cases, the mandible in two cases, the medial orbital wall in one case, and the upper jaw in one case. In all 10 patients, surgery consisted of a wide excision of the intraosseous hemangioma with margins of 3 mm at least to ensure complete removal. Immediate reconstruction was carried out in 5 of the 10 patients. An analysis indicates that intraosseous hemangiomas of the maxillofacial area are rare; diagnosis can be difficult and is mainly based on computed tomography scans. Surgical excision, with previous angiography and embolization in cases of intraosseous hemangioma with a larger dimension or abnormal blood supply, is the treatment of choice.

Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy—review of literature and meta-analysis

OBJECTIVE This study compared extracapsular dissection (ED) vs superficial parotidectomy (SP) in the treatment of pleomorphic adenoma and benign parotid tumors. STUDY DESIGN The research covered the years 1950-2011 in PubMed, Ovid MEDLINE, the Cochrane Database of Systematic Reviews, and Scopus. Of 1152 articles screened, 123 studies met the inclusion criteria. A review of the nomenclature of the different parotid surgery techniques was done. Recurrence rate, permanent facial nerve paralysis, and Frey syndrome of patients who underwent ED vs those who underwent SP were compared by meta-analysis. RESULTS Our meta-analysis data comparing ED and SP found that: (1) the recurrence rate is higher in patients treated with SP; (2) SP has a higher incidence of cranial nerve VII paralysis; and (3) Frey syndrome is more common after SP. CONCLUSIONS ED may be a viable option in the treatment of unilateral benign parotid tumors of the superficial lobe, sized less than 4 cm, without involvement of the facial nerve.

Three-dimensional analysis in facial asymmetry: comparison with model analysis and conventional two-dimensional analysis

The purpose of this study was to compare a computed tomographic (CT) three-dimensional analysis with a model analysis to use it as diagnostic aid for the evaluation of occlusal plane tilting in facial asymmetry. Ten patients with facial asymmetry underwent CT three-dimensional examination, plaster cast analysis, and two-dimensional cephalometric analysis. The distance between a reference plane to the upper first molar and upper canine was measured on three-dimensional CT, on models, and on cephalograms to assess occlusal plane tilting. Measurements taken on three-dimensional CT were compared with those taken on articulator and cephalograms, and the level of discordance between the different analyses was evaluated. Quantitative data on the occlusal tilting are similar, but three-dimensional CT gives a better representation of anatomy, thus reducing interpretative problems about altered individual anatomy. Three-dimensional CT seems to be so helpful in detecting individual anatomical variations that it can be adopted in the diagnosis for severe craniofacial asymmetry.

Aneurysmal Bone Cyst located in the Mandibular Condyle

A rare case of aneurysmal bone cyst (ABC) located in the mandibular condyle in a 10-year-old boy is presented. The patient came to our attention for a sudden swelling in the right temporomandibular region, the mouth opening was not reduced.A rapid growing mass, depicting soft tissue invasion, in the right condyle of the mandible was found. Clinically and radiographically it resembled to a malignant lesion. The surgical excision of the mandibular condyle allowed a complete removal of the lesion. The histological examination revealed a pseudocystic expanding osteolytic lesion containing blood-filled space separated by connective tissue and many osteoclastic giant cells, which was a conventional vascular ABC.The ABC is an infrequent bone lesion which can only be found very rarely at the craniofacial skeleton. There have been described about 160 cases of ABC originated in the molar region or in upper maxilla and even more rare is the location of this cyst in the mandibular condyle. Only 6 cases were reported in the literature to date.A complete surgical resection of this osteolytic lesion is the treatment of choice considering its high recurrence rate. The condyle was not replaced with any graft. Therefore a functional device was used after surgery to overcome the lack of the condyle and to stimulate the growth of the ramus.