Giuseppina Fini

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.

Complications of bicortical screw fixation observed in 482 mandibular sagittal osteotomies.

Bicortical screw fixation after bilateral sagittal split osteotomy (BSSO) of the mandible is commonly used in orthognathic surgery and allows many advantages compared with osteosynthesis wires and maxillomandibular fixation. Complications include early loosening, hardware exposition, skeletal instability or early relapses, persistent nerve impairments, infection, and scar formation. This article is based on a retrospective analysis of complications of bicortical screw fixation observed in 241 consecutive patients with dento-skeletal Class III, corresponding to 482 sides, during the immediate postoperative period and at 1, 3, 6, and 12 months’ follow-up. In the immediate postoperative period, poor stability of fixation caused by screw loosening was observed in 3 of 482 (0.62%) sides; at the 1-month follow-up, infections were encountered in 12 (2.48%) sides at mandibular angles. Additional complications were not seen in the series. Stability of fixation was found in the 482 sides at 12 months. However, complications directly related to bicortical screws were observed in 15 sides or 3.11%. Age and gender of patients were not correlated with the incidence of complications. Assiduous follow-up during the early postoperative period and 1 and 2 months after surgery is recommended in patients with bicortical screw fixation after BSSO to verify adequate oral hygiene and provide early observation of the onset of any infections, skeletal instabilities, or relapses.

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

Abstract: 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.

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.

Angiodysplasia with osteohypertrophy affecting the oromaxillofacial area: clinical findings.

The authors report a case of oro-facial port-wine stain angiomatosis with cutaneous and mucosal lesions localized in the first and the second branch surface distribution areas of the right trigeminal nerve in association with right upper and lower lip, cheek, and hemimaxillary true hypertrophy leading to a severe dento-skeletal malocclusion with open-bite and facial asymmetry. The authors through a revision of the Bibliography locate nosologically this case among the rare congenital angiodysplastic syndromes affecting the maxillo-facial district as the Sturge-Weber and the Klippel-Trenaunay syndromes. They debate also about etiopathogenetic, clinical, differential diagnosis, and therapeutic aspects concerning the treatment of patients affected by this kind of malformation.

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.

The rare condition of maxillary osteomyelitis.

Osteomyelitis is an acute or chronic inflammatory process that can involve cortical and trabecular aspects of bone or bone marrow. Cranial bones are infrequently involved, but spreading of inflammation with involvement of surrounding structures represent important risk, as are cerebral abscess, encephalitis, or meningitis. We present a case of osteomyelitis of right maxillary sinus in an adult caused by a spreading of contiguous inflammation sustained by a chronic intrasinusal polyp; the complete resolution of infection was gained with a combination of surgical treatment and antibiotic therapy. The aims of this article are to illustrate diagnostic patterns and surgical treatment experienced in a case of maxillary osteomyelitis and to report radiographic and histopathologic findings.

Orbital Metastases in a Female Patient with Breast Cancer

Breast cancer is the most common malignant disease among women, with a lifetime risk of approximately 10%. Frequent and well-known locations of metastases are bone, liver, lung, skin and brain, but tumour repetition has been seen in almost any anatomic site. Orbital involvement is quite rare, or perhaps underestimated. Orbit metastases (OMs) represent 1–13% of all orbital cancers, and are difficult to discriminate with other differential diagnoses, such as a simple blepharitis, or orbital pseudotumor, up to more complex forms of cancer such as lymphoma. The prevalence of OMs is calculated to occur in 2–4.7% of primitive cancer patients. Typical manifestations of orbital metastases include overall regional inflammation, mass effect causing displacement or ocular globe proptosis, pain, bone infiltration, chemosis and eyelid swelling. Infiltration of soft tissue leads to ptosis, diplopia or enophthalmos. We report the case of a 70-year-old female patient who developed chronic inflammatory process of both orbital regions due to orbital metastases, without evidence of other systemic disease after 8 years from primary breast cancer diagnosis. The diagnostic pathway as well as the differential diagnosis are discussed.

Biophysics-induced tissue regeneration. A pilot study using “Delta-S” entropy variation system on burns sequelae and keloids

Abstract Poorly consolidated scar tissue resulting from injury, surgical incisions and burns is hard to sort out and represents a cause of both functional and psychological problems for the patient. A new possibility of treatment has been sought by subjecting to clinical trial an innovative method based on Bioengineering. This method uses as its active principle a ‘reduction in entropy’ artificially obtained by using electromagnetic induction to convey ‘energy packets’ that can be used by the body to support or reactivate its own regenerative processes. Twelve patients presenting scar tissue due to traumas or burns were treated (40 sessions using a series ETV “Delta-S” Entropy Variation System). The lesions initially displayed keloid features, with traction on the underlying tissues and consequent retraction and loss of elasticity of the cutaneous layers, lymphoedema of the surrounding tissue associated with alteration of normal skin pigmentation to a reddish-violet colour. At the end of treatment, the scar tissue displayed greater elasticity, reduced cutaneous retraction and a consequent enhanced mobility of the underlying cutaneous layers, normalization of lymphatic circulation and lastly an improved pigmentation of the lesion. No side effects were observed either during treatment or in the subsequent monitoring period.