Paolo Boffano

European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.

Keratocystic odontogenic tumor (odontogenic keratocyst): preliminary retrospective review of epidemiologic, clinical, and radiologic features of 261 lesions from University of Turin.

PURPOSE To analyze and discuss the demographic, clinical, and surgical aspects of 261 surgically treated keratocystic odontogenic tumors. PATIENTS AND METHODS A retrospective review was performed of all cases of treated keratocystic odontogenic tumors. Statistical analysis was used to search for associations among age, presenting symptoms, location, dimension, and locularity. RESULTS Keratocystic odontogenic tumors most commonly occurred in patients in the third and fourth decades of life. The ratio of males to females was 2:1. The mandibular angle region was the most frequently involved site. Significant associations were found between multilocular lesions and lesions larger than 31 mm (P < .00000005), a mandibular site and larger lesions (P < .05), patients younger than 41 years old and multilocular lesions (P < .05), and younger patients and larger lesions (P < .00005). CONCLUSION It is likely that most multilocular, larger (and probably aggressive) lesions are found in patients younger than 41 years of age.

Surgical treatment of odontogenic myxoma.

Background: There is no consensus about the surgical treatment of odontogenic myxoma. The aim of the current study was to present our experience and discuss the surgical management and outcome in 10 patients diagnosed with odontogenic myxoma. Methods: A retrospective review of charts of patients who were surgically treated for odontogenic myxoma was performed. Patients were recalled, and eventual recurrences were investigated. Results: Eight lesions were mandibular, whereas 2 were maxillary. In 3 patients, enucleation and curettage was performed. Instead, in the remaining 7 patients, segmental resection and immediate reconstruction were decided. At follow-up, no patient showed recurrence of the lesion. Conclusions: Our protocol is to perform conservative surgery by enucleation and curettage when lesions were smaller than 3 cm, whereas a segmental resection with immediate reconstruction is preferred in patients affected by bigger tumors. Long-term follow-up is required, in particular when conservative surgery is preferred.

Long-term clinical and radiological outcomes for the surgical treatment of mandibular condylar fractures.

PURPOSE This retrospective study evaluated the long-term results and complications of open reduction and internal fixation of displaced and dislocated fractures of the condylar process. PATIENTS AND METHODS Two hundred four patients were treated via various surgical approaches between 1991 and 2005. Fifty patients with a total of 57 treated condylar fractures who underwent complete clinical and radiological documentation were included in this study. Follow-up clinical and radiological evaluations were carried out after an average period of 88 months. RESULTS We found that 12% of our patients reported temporary weakness of the facial nerve and 4% had mild permanent facial nerve palsy. Clinical and radiological assessment showed satisfactory recovery of facial symmetry. Excellent recovery of function was observed, and very few patients complained of temporomandibular joint-related symptoms. Severe condylar remodeling was observed in 8% of the patients, 47% showed slight or moderate remodeling, and 45% showed no remodeling. A statistically significant association was observed between the presence of condylar remodeling and poor mouth opening at the follow-up examination. CONCLUSIONS Surgical treatment of condylar fractures, in association with postoperative functional therapy, promotes the recovery of function, occlusion, and facial symmetry with few complications. However, some difficulties remain related to the surgeon, the patient, and the objective complexity of this pathology.

Aetiology of maxillofacial fractures: a review of published studies during the last 30 years

The epidemiology of facial trauma may vary widely across countries (and even within the same country), and is dependent on several cultural and socioeconomic factors. We know of few reviews of published reports that have considered the sex distribution and aetiology of maxillofacial trauma throughout the world. The aim of this review was to discuss these aspects as they have been presented in papers published during the last 30 years. We made a systematic review of papers about the epidemiology of maxillofacial trauma that were published between January 1980 and December 2013 and identified 69 studies from Africa (n=9), North America and Brazil (n=6), Asia (n=36), Europe (n=16), and Oceania (n=2). In all the studies men outnumbered women, the ratio usually being more than 2:1. In American, African, and Asian studies road traffic crashes were the predominant cause. In European studies the aetiology varied, with assaults and road traffic crashes being the most important factors. In Oceania assaults were the most important. A comparison of the incidence of maxillofacial trauma of different countries together with a knowledge of different laws (seat belts for drivers, helmets for motocyclists, speed limits, and protection worn during sports and at work) is crucial to allow for improvement in several countries. To our knowledge this paper is the first attempt to study and compare the aetiologies of maxillofacial trauma.

Morbidity associated with anterior iliac crest bone graft

OBJECTIVE The aim of this retrospective study was to assess the morbidity of the harvest of the anterior iliac bone graft and the overall satisfaction rates in a group of patients who underwent harvesting of iliac crest bone graft. PATIENTS AND METHODS Patients who underwent iliac crest bone graft procedures from January 2002 to August 2009 were recalled and invited to answer a questionnaire about postoperative pain, sensory disturbance, functional limitations, and cosmetic appearance. RESULTS A total of 61 patients were included in this retrospective study. Seventeen patients (28%) reported postoperative pain. A patient reported an intraoperative hip fracture. Sensory disturbances were reported by 3 patients. CONCLUSIONS Anterior iliac crest can still be considered a favorable donor site for preprosthetic and cleft surgery. Given its relatively low morbidity rate, early ambulation, and hospital discharge, anterior iliac crest still remains the donor site of choice according to the authors.

The surgical management of oral and maxillofacial manifestations of Gardner syndrome.

Gardner syndrome (GS) is a rare autosomal-dominant genetic disorder characterized by multiple colorectal adenomatous polyps and extraintestinal lesions, such as multiple osteomas, dental abnormalities, polyps of the stomach and small bowel, and mesenchymal tumors of the skin and soft tissues. Although most cases show familial clustering, about 30% of cases occur because of a new dominant mutation. 1-4

Lingual nerve deficit following mandibular third molar removal: review of the literature and medicolegal considerations

The removal of mandibular third molars is probably the most frequently performed procedure in oral and maxillofacial surgery, and it is the most common surgical procedure associated with lingual nerve deficit. Lingual sensory impairment remains a clinical problem in oral and maxillofacial surgery and has serious medical and legal implications. In fact, damage to the lingual nerve is a common cause of litigation in dentistry. The purpose of this article was to review the literature about lingual nerve deficit following mandibular third molar removal and discuss the associated medicolegal aspects.

Platelet-rich fibrin and piezoelectric surgery: a safe technique for the prevention of periodontal complications in third molar surgery.

Purpose: The surgical removal of impacted mesioangular mandibular third molars (3Ms) may produce trauma to the soft tissues and bony structures. In particular, healing of postextractive socket may cause periodontal defects at the distal root of the second molar. The aim of the present prospective study was to assess the outcomes of a surgical protocol to remove 3Ms including the use of ultrasound bone surgery devices and platelet-rich fibrin (PRF) as a grafting material. Patients and Methods: Twenty-eight impacted mandibular 3Ms were removed. Fourteen 3Ms were removed by piezoelectric osteotomy and PRF application. Instead, the 14 3Ms of the control group were removed by piezoelectric osteotomy but without PRF application. Probing depth in the distal position for all the mandibular second molars was registered before and 6 months after surgery. Results: No complications were encountered. In the study group, alveolar socket fulfillment was rated as sufficient in 4 cases and adequate in the remaining 10 cases, whereas in the control group, it was rated as insufficient in 3 cases, sufficient in 4 cases, and adequate in 7 cases. Mean preoperative periodontal probing in the control group was 3.78 mm, whereas in the study group, it was 3.93 mm. Six months after surgery, mean periodontal probing was 3.28 mm in the control group and 3.07 mm in the study group. Conclusions: Combined action of PRF and piezoelectric surgery can be considered a safe and fine technique for third molar surgery and alveolar socket healing.

Bicycle-related maxillofacial injuries: a double-center study

OBJECTIVE Bicycle-related injuries account for an important proportion of road injuries all over the world. As only few reports have focused on the characteristics of maxillofacial fractures sustained in bicycle accidents, the purpose of this study was to present and compare epidemiological data about bicycle-related maxillofacial injuries in two European centers between 2001 and 2010. METHODS Bicycle-related facial fractures occurred in 105 patients (79 males, 26 females) in Turin, with a percentage of 5.77 among all facial fractures, and in 103 patients (55 males, 50 females) in Amsterdam, with a percentage of 19.69. RESULTS The major risk groups include young people between their first to third decades. The mandible is the most frequently involved facial bone. Among mandibular injuries the most commonly involved site was the condyle. CONCLUSIONS Bicycle-related injuries must be considered an important etiological factor in maxillofacial fractures with typical patterns, such as a peculiar seasonal incidence.