Luigi Angelo Vaira

Evaluation of discriminative sensibility recovery in patients with buccinator myomucosal flap oral cavity reconstructions

BackgroundSensitive restoration is the primary aim of oral reconstructive surgery. Discriminative sensibility is an important index of innervation density of a tissue. Instruments normally used to assess this type of skin sensibility are bulky and difficult to introduce in the oral cavity, even in healthy patients with a normal mouth opening. This study was intended to evaluate the recovery of static and dynamic two-point discrimination sensitivity of the reconstructed areas of the oral cavity.MethodsSurgical staples, calibrated in predetermined width (from 1 to 30 mm) and introduced in the oral cavity with a Mayo needle holder, were used to evaluate two-point discrimination recovery in 57 patients who underwent reconstructive surgery with buccinator myomucosal flaps. Tests were conducted both on the reconstructive flap and on the non-operated contralateral side. The latter also included the non-operated cheek.ResultsAll of the considered flaps showed a recovery of tactile sensitivity. The overall average discriminative threshold value assessed on this sample was 9.11 ± 2.46 mm for the static and 6.56 ± 2.46 mm for the dynamic.ConclusionsThe use of surgical staples allows easy assessment of tactile sensitivity in all oral cavity areas, even in operated patients who often present lockjaw or microstomia. In our series, buccinator myomucosal flaps demonstrate a much greater recovery of the sensation compared to results found in the literature on fasciocutaneous free flaps, even those reinnervated.Level of Evidence: Level III, prognostic study

Rational and simplified nomenclature for buccinator myomucosal flaps

BackgroundReconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide “ideal reconstruction” of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them.MethodsAfter a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer.ResultsAccording to this nomenclature, six types of buccinator myomucosal flaps are described.ConclusionsThis proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread.

Reconstruction of full-thickness cheek defect with chimeric facial artery free flap: A case report

Full‐thickness cheek defects represent a difficult challenge for reconstructive surgeons. Multiple techniques have been described, including local, regional, and free flaps. In this report, the reconstruction of a through and through left cheek defect, resulting from a self‐inflicted gunshot injury, with a chimeric facial artery free flap is presented. The patient underwent reconstruction with a chimeric full‐thickness facial artery free flap, with 9 × 3 cm diameter skin paddle and a 6 × 5 cm myomucosal paddle, was harvested on the contralateral cheek with a 7‐cm length of facial pedicle. The flap was transferred via a microsurgical technique and an end‐to‐end microsurgical anastomosis was performed between the donor and the contralateral facial vessels. The flap was transplanted successfully and there were no donor or recipient site complications with a satisfactory esthetic result 5 years after surgery. This technique may be a good reconstructive option for medium size, full‐thickness, cheek defects allowing a “like with like” reconstruction with minimal donor‐site morbidity.

Vertiginous crisis following temporomandibular joint athrocentesis: a case report

Temporomandibular joint arthrocentesis and arthroscopy have recently exceeded open surgeries for disorders that failed to respond to conservative treatment. The efficacy of arthrocentesis in reestablishing normal mouth opening and reducing pain and dysfunctions is now commonly accepted, but in contrast to arthroscopy, there are no large series studies on arthrocentesis complications. We report the major complication occurred in our experience: a case of a patient that complained of a violent vertigo, without hearing disorders, following the procedure.

Complications after orthognathic surgery: our experience on 423 cases

IntroductionOrthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples.Materials and methodsMedical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate.ResultsOne hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%).ConclusionsSerious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

The epidemiological analysis of maxillofacial fractures in Italy: The experience of a single tertiary center with 1720 patients

PURPOSE Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable, and its analysis is crucial to establish effective treatment and prevention of these injuries. However only two works have been published about maxillofacial fracture epidemiology in Italy. MATERIALS AND METHODS The records of 1720 patients diagnosed with maxillofacial fractures in a 15-years period (2001-2015) in our department were retrospectively reviewed. RESULTS A total of 1108 male and 612 female patients were included in the study. The most frequent aetiology of fracture was road traffic injuries (57.1%), followed by assault (21.7%), falls (14.2%), work accidents (3.5%), sport accidents (3.3%) and other causes (0.2%). Significant variations of aetiology were detected between males and females and between Italians and individuals from other countries. The most frequently observed fracture involved the mandible (861 cases, 36%), followed by zygoma (489 cases, 20.4%), orbital walls (386 cases, 16.1%) and maxilla (282 cases, 11.8%). CONCLUSION Road traffic legislation enforcement and continuous public education regarding the use of security devices remain an ongoing problem in our region and should be encouraged. In the same way, as migration flows influence and change the epidemiology of facial traumas, it is crucial to establish social support programs that avoid these disadvantaged categories of victims of violence and crime.

Aesthetic and Functional Evaluation of Total Nasal Reconstructions

The loss of a portion or the totality of the nose has great relevance on the perception of the beauty of a face and can result in a catastrophic quality of life impairment. Several surgical techniques are currently available for the reconstruction of the nasal pyramid. However, there are very few nasal reconstruction quality evaluation protocols that allow the surgeon to choose objectively the best technique for each kind of defects. Six total nasal reconstruction performed in University of Sassari Maxillofacial Unit were evaluated with a protocol that investigate objectively and subjectively the surgical aesthetic and functional outcome. Sensitivity recovery on the reconstructive flaps was also assessed. Patients reported a satisfactory nasal reconstruction both functionally and aesthetically. Sensitivity recovery on the forehead flap was always present even after pedicle resection or in case of traumatic section of the infraorbital nerve. The use of a three layer reconstruction has proved a viable technique both aesthetically and functionally. In particular the use of the forehead flap to reconstruct the outer layer of the nose allows to carry a tissue with very similar characteristics to the original with a recovery of the sensitivity almost complete.

Complications and post-operative sequelae of temporomandibular joint arthrocentesis

Abstract Objective: To evaluate intraoperative complications and postsurgical sequelae associated with arthrocentesis of the TMJ, including injection of Sodium Hyaluronate. Methods: This retrospective study evaluated 433 arthrocentesis procedures performed in 315 patients between January 2009 and August 2016. The authors reviewed the complications identified during the procedure and the follow-up period. Results: Temporary swelling of the periarticular tissues (95.1%) or the external auditory canal (23.5%), ipsilateral temporary open bite (68.8%), frontalis and orbicularis oculis paresis (65.1%), preauricular hematoma (0.4%), and a case of vertigo (0.2%) were the complications detected. Conclusions: TMJ arthrocentesis remains a procedure with a minimum number of important complications. If present, complications are generally temporary, caused by the anesthetic effect or by the soft tissue edema created by the fluid extravasation created by the irrigation procedure, and can be managed on an outpatient basis.