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Owing to the rarity of publications describing ameloblastic carcinoma, little is known about this entity in pediatric patients. To our knowledge, malignant transformation from an odontogenic cyst into an ameloblastic carcinoma in a pediatric patient has not been documented to date. We present the case of a 14-year-old boy in whom a large osteolytic lesion associated with an impacted right maxillary third molar germ was fortuitously detected by orthopanoramic radiography. With a preoperative clinical-radiographic diagnosis of odontogenic cyst, the patient underwent surgical enucleation of the lesion. Histologic evaluation rendered a diagnosis of follicular cyst with a focal area of ameloblastic carcinoma. The literature addressing ameloblastic carcinoma is reviewed.

Objective. To describe the histological features of bone tissue harvested from patients affected by jaw osteonecrosis associated with bisphoshponates (BONJ) or with radiotherapy (ORN), in undecalcified ground sections. Materials and methods. Sixteen bone tissue samples from 14 patients with BONJ and two patients with ORN were processed in order to obtain both ground, undecalcified sections and decalcified sections. The sections underwent histometric and morphometric analysis. Results. Bone tissue samples obtained from patients with BONJ or ORN of the jaws shared some histological characteristics. Common histological features included the loss of bone architecture, the absence of a proper Haversian system and proper marrow spaces, the presence of necrotic spots of non-mineralized tissue, areas of empty osteocytic lacunae next to areas of hypercellularity, the presence of resorption pits with rare osteoclast-like cells and the presence of bacteria and of an inflammatory infiltrate. A violet rib of tissue characterized by large resorption pits facing was frequently observed between the mineralized bone and the inflammatory infiltrate. Conclusions. The histological features of BONJ and ORN are similar and resemble those of osteomyelitis. Even though it is not clear whether infection is the cause or consequence of bone exposure, inflammatory cells, bacteria or their products may have a massive, direct lytic effect on bone tissue challenged by bisphosphonates.

An essential step in the navigation procedure is the recording of markers required for the triangulation of the intraoperative navigation system. The aim of this study was to describe the procedure and preliminary results of a simple methodology for the application of dental markers to achieve good triangulation of the navigation system in maxillofacial surgery, highlighting the indications, contraindications, and possible limitations. We analyzed results from a sample of 7 patients with orbital or orbitozygomatic fractures, who were subjected to surgical intervention for the reduction and synthesis of the zygomatic fracture and from 1 case of untreated orbital fracture with enophthalmos and diplopia. We used 2 different types of dental markers: in 3 patients, we used 4 or 5 ordinary orthodontic brackets, which we placed on their upper maxillary teeth, and in 1 patient, the hexagonal-headed screws used in osteosynthesis. The accuracy of the recording was assessed during surgery by checking healthy anatomic structures against computed tomographic images. By analyzing our clinical results in light of the most recent literature, we highlighted that the application of dental markers is comparable with the best recording systems requiring a discrepancy of less than 1 mm. From the preliminary clinical analysis of the results, we confirm that the introduction of this new and simple procedure enables the successful triangulation of the navigation system, which can be used whenever the use of a navigator is required.

The Authors present how the use of the navigator can achivea good function a good aesthetic in orbital reconstruction.

Objective: To detect the changes in 3D mandibular motion after two types of condylar fracture therapies. Materials and methods: Using a 3D motion analyzer, free mandibular border movements were recorded in 21 patients successfully treated for unilateral fractures of the mandibular condylar process (nine patients: open reduction, rigid internal fixation, and functional treatment; 12 patients: closed reduction and functional treatment; follow-up: 6-66 months), and in 25 control subjects. Results: No differences were found among the groups at maximum mouth opening (MO), protrusion and in lateral excursions. During opening, the patients had a larger maximal deviation to the fractured side than the controls (controls 2.3 mm, open treatment 3.9 mm, closed treatment 4.2 mm; Kruskal-Wallis test, p = 0.014; closed treatment vs. controls, p = 0.004), with a larger coronal plane angle (controls 2.4°, open treatment 3.6°, closed treatment 4.4°; p = 0.016; closed treatment vs. controls, p = 0.013). In the closed treatment patients, a longer follow-up was related to increased maximum MO (p = 0.04), sagittal plane angle (p = 0.03), and reduced lateral mandibular deviation during MO (p = 0.03). Conclusion: Mandibular condylar fractures can recover good function; some kinematic variables of mandibular motion were more similar to the norm in the open treatment patients than in closed treatment patients

AIM: The aim of this study is to analyze the transconjunctival approach in the treatment of orbital fractures and to evaluate the indications, the advantages of the surgical approach, and the occurrence of possible complications. MATERIALS AND METHODS: From 2005 to September 2009 we used a transconjunctival approach on 53 patients for a total of 56 cases of orbital fractures (three cases with bilateral floor fractures), 54 cases of acute trauma, and two outcomes of previous fractures. We evaluated the incidence of intra or postoperative complications and in the postoperative follow-up we investigated the presence of: entropion, ectropion, scleral show, trichiasis, conjunctival granuloma, mobilization or exposure of orbital reconstruction material. RESULTS: In 56 cases we had four temporary postoperative complications and no long-term complications; two cases of trichiasis and two cases of partial entropion were treated only with medical therapy. All complications, as described in the literature, were transitory and did not require corrective surgery. CONCLUSION: The transconjunctival approach is the most effective surgical access, not only to the medial orbital wall, but also to the orbital floor, as it does not interfere with the lachrymal drainage system and gives as wide a visualization of the orbital floor as does the palpebral approach. This surgical approach is simple to perform and gives good functional and aesthetic results

AIMS: Epithelial-myoepithelial carcinoma (EMC) is a rare malignant salivary gland neoplasm that most commonly occurs in the parotid gland, but can also arise in the minor salivary glands. Three cases are reported of epithelial-myoepithelial carcinoma of the minor salivary glands, with the goal of better defining this entity. PATIENTS AND METHODS: All three cases showed a characteristic nodular/multinodular growth pattern and classic biphasic tubular histology. All parts of each tumor were surrounded by a myoepithelial cell rim and there was evidence of invasion. RESULTS: Immunohistochemical analysis showed the tumor cells to be weakly positive for S100, cytokeratin (CK) CK5/6, CK7, CKAE-1/AE-3 and strongly positive for epithelial membrane antigen (EMA) and p63; they were focally positive for calponin and acute lymphoblastic leukemia antigen (CD10). The tumor cells were negative for vimentin, alpha-smooth muscle actin (SMA) (except one case), glial fibrillar acid protein (GFAP) and MIB1. The tumors were resected completely with wide margins and no recurrence or metastasis had occurred from 6 to 15 months after surgery. CONCLUSION: Three cases of minor salivary gland tumors are described and the differential diagnosis underlined in relation to benign myoepithelioma. The characteristic morphological and immunohistochemical features aided diagnosis of these biphasic tumors.

Objectives: Cervico-facial haemorrhages are an indication for surgeon and operative neuroradiologist cooperation. Patient with traumatic vascular lesions, stabilised according to Advanced Trauma Life Support procedures, is entrust to the Maxillo-Facial surgeon to manage the bleeding. Lesions of inaccessible vessels, dangerous for haemorrhagic shock and airways obstruction, are treated according to Damage Control principles to ensure to realize neuroradiologic diagnostic and operative procedures. Methods: Angiography is performed by femoral microcatheterism; if vascular lesion is identified (10% of cases) embolization is performer by use of Enducrilate + Lipiodol 1:3. In case of widespread bleeding with poorly defined origin (90% of cases) the material of choice is Polyvinyl Alcohol particles (150–300 mm). Results: All cases treated to Niguarda Trauma Center Hospital in Milan had a good management of haemorrhages with neuroradiologic diagnostic and operative procedures. The minority of them needed a secondary embolization to treat anastomotic bleeding paths. No ischaemical damage occurred. Conclusion: Evolution of neuroradiologic endovascular procedures offers to Maxillo-Facial Surgeons a mini-invasive alternative to manage life-threatening bleeding refractory to any local haemostatic measures. This kind of treatment is simple, repeatable, counter-indicated only in patients with hypersensivity to iodine. Surgical ligature of neck blood vessel must be avoided because of frequent onset of collateralisation of blood supply. This procedure may exclude neuroradiologic diagnostic and operative procedure

Objectives: The aim of this study was to analyse the stability of midfacial advancement and the pattern of growth after Le Fort III osteotomy and distraction osteogenesis (D.O.). Methods: We performed D.O. after a Le Fort III osteotomy in 6 cases (3 patients with Crouzon S., 2 patients with Apert S. and 1 patient with Pfeiffer S.). The latency period was 5 days, the distraction rate 1 mm/die for first 12 days, than 0.5 mm/die. The consolidation period was about 60 days every 10 mm. We analyzed and superimposed Lateral Cephalometric X-Rays pre DO, immediately post DO and at the longest follow up. Results: The mean sagittal midfacial advancement was 14.5mm at the level of posterior orbitale point and 18.16mm at A point level. After 1 year follow up a mild relapse was noted (an average of 1mm at posterior orbitale and of 2.5mm at A point). Regarding post surgical growth no subsequent maxillary horizontal growth was observed (no sutural growth) and in some patients resorbitive remodelling was seen. On the other hand vertical maxillary growth was present (posterior more than anterior). Conclusions: D.O. of the midface allows for accurate planned correction of the midface deformity. The correction is acceptably stable as showed by post op X-Ray Tracing Superimposition. The original pattern of growth does not change, therefore, overcorrection is highly advised, especially in growing patients.

Objective: Modern bone surgery aim at a rapid and complete restoration of form and function. The conventional system of internal fixation with miniplates, especially in the unfavourable physiopathologic cases, could have potential complications like plates failure or plates loosening. A disadvantage of conventional bone plates system is that the plate must be perfectly adapted to the underlying bone to prevent alterations in the alignment of the segments. Some Authors maintain that the most important reasons of early mobilization are the compression of the plates on cortical bone and the traction of the screws on plate. The use of 2.0 Lock system plates could avoid these complications. Methods: We treated 34 cases with 2.0 Lock plates (Compact Lock 2.0, Synthes). The cases were selected according to fractures type: site, type of fracture, number of fragments, fracture line with or without dislocation, bone quality, malocclusion, patients characteristic and requirements. Results: All patients have a good fracture healing. In any case we use the inter maxillary block in the postoperative period. In the 10 cases with condylar fractures we performed an early physiotherapy. Conclusions: This system gives optimal results avoiding delayed fracture healing or non-union and allows a complete and early recovery of skeletal function. The 2.0 Lock plates are a valid alternative to the conventional mini plates, but they don’t substitute 2.4 lock plates that takes indication in treatment of comminuted fractures, in atrophic mandible and in oncologic reconstruction

Le cisti del collo sono un gruppo di patologie benigne a media incidenza che interessano soprattutto la popolazione pediatrica e dei giovani adulti. Queste derivano perlopiù da residui embrionari a livello degli archi branchiali, tasche o fessure. La mancata risoluzione dell’epitelio giunzionale e la sua inclusione comporta la formazione di neoformazioni cistiche.Il capitolo tratta in modo analitico e completo tutte le neoformazioni cistiche con localizzazione cervicale. Specificamente sono trattate le cisti degli archi branchiali, la cisti broncogena sottocutanea, la cisti de dotto tireoglosso, la cisti dermoide, la cisti parotidea, la cisti timica e la ranula cervicale. Di queste vengono trattati numerosi aspetti: l’epidemiologia, la patogenesi, l’anatomia patologica, il trattamento e la prognosi. Tutte queste patologie richiedono un trattamento chirurgico che se ben programmato ed eseguito comporta la risoluzione della patologia. Le recidive sono rare e legate soprattutto ad una mancata radicalizzazione. Si rimanda al testo la consultazione di ogni singola sede

Congenital anophthalmia is a rare malformation where the optic vesicle fails to develop. Therefore there is a micro-orbitism, microblepharism and hemifacial hypoplasia. The Authors report early treatment of one patient affected by congenital unilateral anophthalmia who was treated by the equip of the O.U. of Maxillofacial Surgery, S.Gerardo University Hospital of Monza, by self-inflating hydrogel orbital expanders implant. The procedure consisted in implanting, to a 7-months old baby, a lens-shaped auto-expander with 9 ml of final volume for the expansion of the lids and to deepen the fornix. After 3 months, the first device has been substituted with a spherical expander with 2 ml of final volume and after 12 months with a 3 ml device for the orbital skeleton expansion, still in place, in association with an eye prosthesis already at 11 month of age. Today’s follow-up is 30 months, it was studied with clinical ad ultrasound investigations. Surgical procedure was very easy and quick. At the end of lids expansion period, conjunctival sac and fornix were adequate to maintain both the spherical expander and the eye prosthesis. Palpebral rims are symmetrical. The use of spherical expanders together with eye prosthesis permitted to obtain a good facial skeleton symmetry with an excellent aesthetic result. In contrast with the orbital expansive techniques that require the use of silicon balls expanders or conformers, self-inflating hydrogel expanders, are more comfortable for patients and require a less number of interventions

OBJECTIVE: To supply quantitative information about the facial soft tissues of adult operated patients with cleft lip and palate (CLP). DESIGN, SETTING, AND PATIENTS: The three-dimensional coordinates of soft tissue facial landmarks were obtained using an electromagnetic digitizer in 18 Caucasian patients with CLP (11 males and 7 females aged 19 to 27 years) and 162 healthy controls (73 females and 89 males aged 18 to 30 years). From the landmarks, 15 facial dimensions and two angles were calculated. Data were compared with those collected in healthy individuals by computing z-scores. Two summary anthropometric measurements for quantifying craniofacial variations were assessed in both the patients and reference subjects: the mean z-score (an index of overall facial size), and its SD, called the craniofacial variability index (an index of facial harmony). RESULTS: In treated patients with CLP, facial size was somewhat smaller than in normal individuals, but in all occasions the mean z-score fell inside the normal interval (mean +/- 2 SD). Almost all patients had a craniofacial variability index larger than the normal interval, indicating a global disharmonious appearance. Overall, in patients pronasale, subnasale, and pogonion were more posterior, the nose was shorter and larger, the face was narrower, and the soft tissue profile and upper lip were flatter than in the reference population. CONCLUSIONS: The facial soft tissue structures of adult operated patients with CLP differed from those of normal controls of the same age, sex, and ethnic group. In this patient group, surgical corrections of CLP failed to provide a completely harmonious appearance, even if the deviations from the reference were limited. Further analyses of larger groups of patients are needed.

Measurements were taken from 18 patients operated on for cleft lip and palate, aged 19 to 27 years, and 162 control subjects matched for sex, age, and ethnic group. Nine soft-tissue landmarks on the lips were digitized by a three-dimensional electromagnetic instrument. From the landmarks, several linear distances (mouth width, philtrum width, vermilion height of upper and lower lip, total vermilion height, total lip height), the interlabial angle, and some areas (vermilion of upper lip, vermilion of lower lip, total vermilion) and volumes (upper lip volume, lower lip volume, total lip volume) were calculated. Patient and reference data were compared by t tests and Watson-Williams tests. In the men, significant differences (p < 0.05) were found in width of the philtrum, height and area of the vermilion part of the upper lip, and total vermilion height and area (all larger in male patients than in controls). In the women, significant differences were found in the height and area of the vermilion part of the upper lip (larger in female patients than in controls), and in the height and area of the vermilion part of the lower lip (smaller in patients than in controls). In both sexes, the interlabial angle was smaller than in the reference population. In conclusion, the upper lip of adult patients operated on for cleft lip and palate differed from that of healthy controls of the same age, sex, and ethnic group. Surgical correction of cleft lip and palate failed to provide a completely normal appearance. The analysis pointed out those parts of the lips and mouth (in particular, the vermilion part of the upper lip) that differed the most from the norm. The method may be used to indicate to the surgeon and patient where additional procedures might be performed to approximate the morphologic characteristics of a reference population.

BACKGROUND: A new "light" maxillo-mandibular fixation system for treatment of mandibular fractures, based on use of special pins, is proposed. METHODS: Fifteen patients with non-displaced mandibular fractures (angle, body and symphysis), have been treated at the Department of Maxillofacial Surgery, S. Paolo University Hospital, Milan. The system is based on pins formed by a no. 1 metal wire and a bead. The free end of the pin is threaded around a tooth and then wound three or four times around the bead to fix it in place and, at the same time, separate it from the gingiva. One pin is usually positioned on each quadrant. Once the pins are in place they are tied to each other using a loop no. 0 to complete the maxillo-mandibular fixation. Particular attention was paid to maintain a correct individual occlusion. The time of maxillo-mandibular block was 10-15 days. RESULTS: Results were good with complete healing of all fractures, restoration of individual occlusion, minimal periodontal lesions and a good compliance for the treatment by the patients. CONCLUSIONS: It is suggested to use this system routinely because quick, economic, easy on periodontium and relatively comfortable for the patients. The contraindication include an unstable occlusion, the absence of a suitable pair of teeth on both sides of the jaws, avulsion or trauma or periodontopathy of one of the teeth needed for the fixation system.

The authors propose a new experimental model in the rat designed to planimetrically, microangiographically, histologically and histochemically assess the hemodynamic effects of gradual cutaneous expansion on vitality in the random zone of the abdominal axial flap, in order to establish if and how it influenced survival. 30 outbred male Wistar rats were divided into three groups: - Group 1 (control A, n = 10): a monopedicled abdominal flap was raised (7 cm long by 6 cm wide) of which half was axial and half randomly vascularized. - Group 2 (control B, n = 10): a monopedicled abdominal island flap was raised (7 cm x 6 cm) 14 days after insertion of a hollow silicons expander (6 cm long by 4 cm wide, nominal volume 60 cc), with a view to 'autonomizing' the flap. - Group 3 (study group, n = 10): a monopedicled abdominal island flap was raised (7 cm x 6 cm) after being expanded for 14 days (60 cc) with an expander identical to the one used in group 2. Planimetric assessment showed the following survival rates in the random zone: group 1: 61.8%, (SD 2.4); group 2: 74.2% (SD 3.6); group 3: 89.7% (SD 2.8). Microangiographic testing revealed the total absence of tracer in the random zone in group 1; the opening of arteriovascular connections in group 2 with tracer spreading to much of this zone; hypertrophy and vessel dilatation in group 3 with tracer spreading to entire flap. Histological sectioning of the random zone showed the presence in group 1 of areas of necrosis with vasal thrombosis extending to almost the entire surface. In group 2 these areas were only present in the more peripheral part, while in group 3 they were limited to the suture. In group 3 histochemical analysis indicated vasal ectasia with neoangiogenesis throughout the random zone. These results show that gradual expansion may amplify extension of the random zone of an axial cutaneous flap, thereby permitting exceptionally large flaps to be raised.

To expect a predictable long-term prognosis and good esthetic results for dental implants a sufficient volume of healthy jaw bone should be present at potential implant recipient sites. The aim of this work is to evaluate the volume maintenance in post-extraction sockets where alloplastic material is used . Computer image analysis on radiographies was performed to measure the horizontal distance between the pre-implantation bone-alloplastic profile and the pre-extraction bone profile. Biopsies made 3 months before implant placement were evaluated. The histologic and clinical results confirm that this procedure can be used for volume post extraction maintenance prior to implant placement

In arterialized venous flpas (AVF), arterial blood reaches the flap through a vein which is anastomosed with an arterial vessel. Venous drainage comes about through one or more afferent veins. An essential requirement for this type of flap is that the arterial blood, which passes through the venous tree by inverted flow, is able to reach the capillary bed and hence the tissues, in order to ensure oxygenation and nutriment. Despite the theoretical assumptions, however, the survival of these flaps (with the exception of those described to repair minor tissue loss in the hand) is not in practice comparable to that of standard axial flaps. Their use in clinical practice has therefore been highly conditioned by the risk of failure. In particular, it has been observed that, in experimental AVF models, after termino-lateral arteriovenous anastomosis, without any other technical adjustments, the flow of arterial blood through the vein, normally able to stand low pressure levels, gave rise to excessive dilatation and consequently a hyperflow of blood. Since this was not sufficiently drained by the actual venous system, stasis ensued, to the detriment of flap survival. We have therefore designed an experimental model composed of a rectangular abdominal flap based solely on superficial epigastric veins, one of which has been anastomosed with the femoral artery, that has in turn been joined upstream of the anastomosis. This technique produces reverse arterial flow, at lower pressure through the arterialized venous tree. Flaps raised in this way have shown good survival and vitality, which has been compared with that of classis, nonreverse AVF and standard axial flaps. Another control group was composed of AVF in which arteriovenous anastomosis was performed 72 hours prior to the flap being raised (AVF with delay). The good survival of reverse AVF suggests that modulating arterial flow may reduce the problems related to stasis and ensure greater reliability of AVF raised in a si

Authors report their experience according to the mental nerve rigeneration in the rat in terms of loss of substance. Different primary microsurgical repair tecniques have been compared among which the substitution of the loss segment through sensitive and mixed autogenous graft have been displayed. Gross sensory return was estabilished with neurophysiology, histochesmistry, and histology. Results have shown a quicker return of recovery of gross sensation in the group treated with sensitive auto graft, which has but presented a greater number of subjects whith long-term hypersthesia than the group treated whith mixed nerve graft.

Anterior plagiocefhaly in characterized by flattening of fronto-orbital region. Two are the types of plagiocephaly: the deformational one and the synostotic one. The former is extremely frequent (5-8% of newborn)and clears up spontaneously or simply by changing sleeping position in most patients. the letter-synostotic plagiocephaly - is quite rare (1 oer 10.000 newborns) and woesen as time pass with negative influence on facial growth. Consequentely synostotic plagiocephaly must undergo early surgery, before one of year of life, in order to estabilish good cranial symmetry and correct facial growth.