Luigi Califano

Midline (dermoid) cysts of the floor of the mouth: report of 16 cases and review of surgical techniques.

A retrospective review of 16 cases of midline (dermoid) cysts of the floor of the mouth is presented, evaluating the different surgical approaches. Sixteen cases of patients with a diagnosis of midline cyst of the floor of the mouth, treated at the Maxillofacial Surgery Department of the School of Medicine and Surgery of the “Federico II” University of Naples (Naples, Italy), were observed over a 10-year period, between 1988 and 1998; age, sex, localization, diagnostic technique, and type of treatment were evaluated. Male patients were more frequently affected, with a male-to-female ratio of 3:1 (12:4 cases). Patients ranged in age from 5 to 51 years (average age, 27.8 years). The preoperative assessment was made using ultrasonography in all cases but one, computed tomography in eight cases, and magnetic resonance imaging in three cases. Regarding surgical techniques used, a transcutaneous approach was adopted for median geniohyoid cysts, an extended median glossotomy technique was used for very large median genioglossal cysts, a median glossotomy technique was used for median genioglossal cysts, and a midline incision of the oral mucosa along the lingual frenulum was used for sublingual cysts. During the postoperative course, there were no complications except for modest edema in three cases. Follow-up ranged between 24 months and 12 years; no relapses or malignant changes were observed. In the authors’ experience, the intraoral approach was also effective for the treatment of large lesions and led to very good cosmetic and functional results, whereas the extraoral incision was necessary only when the cysts were under the geniohyoid muscle.

Mandibular lengthening by external distraction: an experimental study in the rabbit.

OBJECTIVE To observe the development of bone at different times during the period of mandibular lengthening by external distraction using Ilizarovs transosseous osteosynthesis technique. MATERIALS AND METHODS Fifteen rabbits, 2 to 3 kg in weight, were used for this experiment. The left side of the mandible was exposed and a corticotomy was performed with a water-cooled drill. After 12 hours, distraction was started and continued 1 mm per day for 2 weeks. Plain radiography and three-phase bone scan scintigraphy were performed on the 1st, 7th, and 14th postoperative days. The mandibles were then either removed for immediate histologic evaluation or after 2, 5, or 8 weeks of postdistraction fixation. RESULTS Elongation of up to 11 mm was achieved. Radiographic and scintigraphic evaluation suggested a residual inflammation on the 7th day and definite ossification on the 14th day. Histologic observations of the distraction site showed a gradual change from an amorphous matrix to a fibrous matrix and, finally, an osseous-like tissue. CONCLUSION Bone lengthening by gradual distraction is commonly used in tubular bones. To achieve mandibular lengthening it is necessary to resolve many problems. Morphologic, radiographic, scintigraphic, and histologic observations confirm that mandibular lengthening by external distraction is possible, with the formation of new bone tissue.

Accuracy of fine needle aspiration biopsy in head and neck tumors

PURPOSE Fine-needle aspiration biopsy (FNAB) is frequently used in the diagnosis of lesions occurring in the head and neck region. This study evaluated the correlation between the findings on FNAB and the histological findings observed after surgery. MATERIALS AND METHODS A review of 218 patients who underwent FNAB of a head or neck tumor was performed. Cytological reports were classified into the following diagnostic categories: negative or positive for malignant cells and unsatisfactory. False-positive, false-negative, true-positive (sensitivity), and true-negative (specificity) rates were calculated. RESULTS Twelve specimens did not allow an adequate diagnosis (5.5%). Among benign tumors, 96.2% of the cases were correctly diagnosed, and 3.8% were nondiagnostic specimens. Among malignant tumors, 86.4% of cases were correctly identified. There were two (3.4%) false-negatives and six (10.2%) nondiagnostic specimens, with a total false-negative rate of 13.6%. CONCLUSIONS Sampling errors present a minor problem with FNAB. Most nondiagnostic or incorrect specimens were caused by nonhomogenous lesions, with poor placement of the needle and an insufficient amount of aspirated material. FNAB is a useful modality for the diagnosis of head and neck masses.

Volume changes of autogenous bone after sinus lifting and grafting procedures: A 6-year computerized tomographic follow-up

OBJECTIVES To evaluate long-term bone remodelling of autografts over time (annually, for 6 years), comparing the block and particulate bone procedures for sinus floor elevation, as well as to evaluate the survival of positioned dental implants. PATIENTS AND METHODS Twenty-three sinus lift procedures with autogenous bone were performed: seven sinus lift procedures using particulate graft and 10 with block autogenous bone were performed in 17 patients. Employing a software program, pre- and post-surgical computerized tomography (CT) scans were used to compare the volume (V) and density (D) of inlay grafts over time (up to 6 years), and to determine the percentage of remaining bone (%R). All variable (V, D and %R) measurements were then compared statistically. RESULTS At the 6-year survey for block form, a resorption of 21.5% was seen, whereas for particulate grafts there was a resorption of 39.2%. Both groups exhibited bone remodelling between the first and second follow-up which was significant regarding volume for the block form and regarding density for the particulate group. CONCLUSIONS During the initial period of healing, the cortico-cancellous block bone grafted into the maxillary sinus underwent a negative remodelling of the volume, which is most probably due to graft cortex resorption, coupled with, primarily, an increase in density in the spongious area; for the particulate grafts, significant augmentations in density were obtained. The lack of significant differences among volumes was due to the wide degree of dispersion of the data. The rough data presented in this paper seem to support the use of a bone-block grafting procedure in maxillary sinus augmentation.

Volume Changes of Iliac Crest Autogenous Bone Grafts After Vertical and Horizontal Alveolar Ridge Augmentation of Atrophic Maxillas and Mandibles: A 6-Year Computerized Tomographic Follow-Up

PURPOSE To evaluate by computerized tomography the long-term volume resorption of autogenous corticocancellous grafted bone harvested from the ilium and used in an alveolar augmentation procedure followed by endosseous dental implant placement. PATIENTS AND METHODS Eleven maxillary grafts (8 positioned horizontally) and 13 mandibular grafts (10 positioned vertically) were placed in 16 patients. Using software programs, pre- and postsurgical computerized tomographic scans were used to compare volumes of grafts over time (up to 6 yr) to determine the annual percentage of remaining bone and the overall percentage of bone resorption that could be expected. Yearly measurements of volumes and percentages of remaining bone were then compared statistically. RESULTS At the 6-year survey for blocks grafted in the mandible, an average resorption rate of 87% was obtained; for maxillary grafts at the same survey, complete resorption of the grafts (mean, 105.5%) was recorded. In general, bone resorption appeared slow, except for that recorded in the first 2 years of healing, the only period in which statistical comparisons among all time points showed significant differences for all variables. CONCLUSIONS Volumetric measurements of the grafts and their related percentages of remaining bone attested to a progressive and unavoidable bone resorption of almost all the grafted bone in the maxilla and mandible. Although the present data were from a heterogeneous group of defects treated with horizontal and vertical procedures, clinicians, when performing alveolar bone augmentation with an autogenous hip bone, should aim at titanium dental implant osseointegration, not only in the augmented bone but also in the native bone below the graft.

Surgical Management of Benign Tumors of the Parotid Gland: Extracapsular Dissection Versus Superficial Parotidectomy—Our Experience in 232 Cases

PURPOSE The purpose of this study was to retrospectively analyze all cases of benign parotid tumors treated at our institution from 2002 to 2009. MATERIALS AND METHODS We carried out a retrospective review of 232 patients with benign primary parotid tumors. Extracapsular dissection or superficial parotidectomy was performed. Clinical and histopathologic data were analyzed, and management was described. The statistical difference between the 2 techniques as concerns evaluated recurrence rate and complications was measured with the log-rank (Cox-Mantel) test. The chosen level of statistical significance was P < .05. RESULTS A total of 232 patients were enrolled, 107 women and 125 men, whose mean age was 53.2 ± 11.3 years. Extracapsular dissection was performed in 176 cases (76%) (mean age, 52.82 ± 11.55 years), and superficial parotidectomy was performed in 56 cases (24%) (mean age, 54.59 ± 10.56 years). The mean lesion size was 1.89 ± 0.52 cm for extracapsular dissection and 3.49 ± 0.43 cm for superficial parotidectomy (P < .001). Mean follow-up was 52.6 ± 4.5 months for the group of patients treated with superficial parotidectomy and 46 ± 5.2 months for the group treated with extracapsular dissection. No significant differences as concerns capsular rupture and recurrence were observed after extracapsular dissection and superficial parotidectomy (3.4% vs 1.8% [P = .1] and 4.5% vs 3.6% [P = .1], respectively). Transient facial nerve injury, facial paralysis, and Frey syndrome were significantly more frequent after superficial parotidectomy than after extracapsular dissection (26.8% vs 3.9% [P = .001], 8.9% vs 0% [P < .001], and 5.3% vs 0% [P < .001], respectively). CONCLUSIONS Extracapsular dissection showed similar effectiveness and fewer side effects than superficial parotidectomy and could be considered as the treatment of choice for tumors located in the superficial portion of the parotid gland.

Two load sharing plates fixation in mandibular condylar fractures: biomechanical basis.

Mandibular condylar fractures have a high incidence but there is no consensus regarding the best choice of osteosynthesis. From a review of the literature, it is evident that the technique used most frequently for fixation is the positioning of a single plate despite complications concerning plate fracture or screw loosening have been reported by various authors. Different studies have highlighted that the stability of osteosynthesis is correlated with the mechanical strains occurring in the condylar region, generated by the muscles of mastication. The aim of our study was, through a mandibular finite element model (FEM), to confirm this correlation and to analyse the behaviour of single and double elements of union in the fixation of mandibular subcondylar fractures. We concluded that the use of two plates provides greater stability compared with the single plate, reducing the possibility of displacement of the condylar fragment. Therefore we recommend that this technique should be adopted whenever possible.

Accuracy in the diagnosis of mandibular involvement by oral cancer

Cancer of the mandibular region usually has a poor prognosis; this is particularly correlated to invasion of the mandible. To reduce the consequences of poor therapeutic planning, careful preoperative assessment of bone infiltration is necessary. We have examined the records of 50 patients evaluated by clinical examination, conventional radiography, computed tomography (CT), bone scintigraphy with 99mTc and magnetic resonance imaging (MRI). The highest sensitivity (100%) was attained by scintigraphy; the highest values of specificity (96.3%) were reached by CT scan and MRI. A CT scan showed the highest predictive positive value (95.4%) and efficiency (94%), this plus MRI have good values and the associated sensitivity and efficiency are higher than when these techniques are used alone.

Volume Changes of Grafted Autogenous Bone in Sinus Augmentation Procedure

PURPOSE To evaluate associations between the osseous remodeling and the 3-dimensional features of both the grafted bone and the recipient site, as well as the density of the grafted bone, and to assess the relation between the degree of bone resorption and the type of autogenous bone-grafting procedure or the source (block or particulate bone from iliac crest or block bone from chin). PATIENTS AND METHODS A retrospective chart review of patients receiving sinus lifting and grafting procedures for implant positioning was conducted: radiographic analysis of the volume and area of both sinuses and autogenous bone grafts was performed, as per Smolka et al and Krennmair et al. The volumetric remodeling--measured at 1 year after implant positioning as the percentage of residual bone (%R)--was correlated, with Spearman analysis, to 3-dimensional features of both graft and recipient sites. All quantities correlated with %R at a statistically significant level were used for 2-dimensional and multidimensional visualizations with scattergrams. RESULTS Twenty-five iliac crest or chin grafts were inlay positioned in the maxillary sinuses of patients. Computed tomography scans, taken before implant positioning and after 1 year, showed a 1-year negligible volume remodeling for block graft from chin (97.9%) but slightly greater resorption values (%R) for particulate and block grafts from iliac crest (93.8% and 83.3%, respectively). Three- and four-dimensional scattergrams of significant data resulting from Spearman correlation tests (particulate and block grafts both from iliac crest) showed a variation of the remodeling pattern dependent on 3-dimensional features, namely inlay graft thickness, surface area of the graft in contact with basal bone, volume of the recipient site, and surface area of the graft projecting into the sinus cavity. CONCLUSIONS Retrospective data analysis shows that iliac crest grafts positioned on a small basal bone volume (≤ 2.5 mL) may point to a very favorable remodeling of the volume when the particulate graft is molded to a thickness of less than 4 mm, with a reduced surface area protruding into the sinus (≤ 5 cm(2)). Bone blocks with a reduced contact surface and with basal bone (≤ 4 cm(2)) also display minimal resorption.

Lymph-node metastasis in squamous cell carcinoma of the lip A retrospective analysis of 105 cases

During 1975-87, 105 patients with squamous cell carcinoma (SCC) of the lip were surgically treated. All patients underwent radical resection of the tumor. Only the patients with palpable lymph nodes had a simultaneous neck dissection. All patients were followed up for at least 5 years. Of the 80 patients without palpable lymph nodes, only three developed lymph-node metastasis. Of the 25 patients with palpable lymph nodes who underwent modified neck dissection, four had recurrence of lymph-node metastasis at a different level. The over-all 5-year survival rate was 97%. The survival rate for patients with lymph-node metastasis was 88%.