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In 2006 following the development of dedicated osteosynthesis plates, Meyer and colleagues reported a successful clinical study of condylar fractures treated by a modified submandibular approach; it was called high submandibular approach or "Strasbourg approach." The aim of this study is to describe the high submandibular approach step by step.Between January 2010 and December 2015 at the Maxillofacial Unit of the Hospital "Policlinico San Martino" 13 patients affected by subcondylar fracture underwent open reduction and internal with high submandibular approach. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 89 minutes, ranging from 66 to 125 minutes. The mean hospital stay was 2.9 days, ranging from 2 to 6 days. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible.The morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and aesthetic deformity. The authors think that further prospective clinical trials are necessary to assess and eventually develop this approach.

The most effective treatment for orbital fractures is still under debate and different strategies are proposed in the literature. All such strategies focus on reconstruction of the orbital structure, neglecting the main function of the medial and inferior walls, these latter being constructed so as to break during high energy trauma. The aim of the authors is to highlight the difference between different reconstructive techniques in an orbital fracture restoration, being inclined to favor repair over reconstruction of the orbital floor, assuming that a second trauma could happen and reconstructive material left in the orbit may damage the visual apparatus in such a scenario. Following this theme, the authors propose a reconstruction strategy using a custom made stereolithographic model and resorbable plate made of polylactic acid mesh molded onto it. The mesh is used alone or in combination with bone graft, to obtain a better reparative result. At present, this approach is best suited to sports people and the young. Even if a deeper evaluation of the method would be useful, the series of case studies presented could be of stimulus for future discussion.

The maxillo-mandibular osteotomy with advancement treatments (telegnathic maxillo-mandibular advancement - Princell et all) have proven over the years extremely effectiveness in the OSA treatment, highlighting the primary role of extrapharyngeal surgery than intrapharyngeal. We present our experience, based on 40 patients among in which we highlight a series of 10 patients, illustrating a therapeutic process that has led us to define the gnato- oral- pharyngeal normalization concept, meaning in the need of balance between different elements that define the volume of the upper airway: individual dental occlusion, soft tissue and maxillo-mandibular skeletal. A cases serie of 40 patients were treated with telegnathic maxillo-mandibular advancement. For 10 of these patients has been planned and executed a treatment according to the gnato-oral-pharyngeal normalization concept which provides in a presurgical orthodontic preparation followed by the osteotomy surgery. The results are encouraging: average of AHI 6,3±3,6 and average of Epworth sleepiness scale 1,8±1,8 confirm the healing (AHI The osteotomy surgery success shows how the lack of dynamic equilibrium between the soft tissue and the air duct limited by the maxillo-mandibular skeletal structure, which offers a rigid support to the upper airways, represent the main etiologic factor in OSAS . Patients undergoing gnato-oral-pharyngeal normalization in addition to achieving a clinical healing (AHI

A lot of authors stated that surgical treatments in OSAS remain controversial, mainly because controlled studies and standardized criteria to define surgical efficacy are lacking. These considerations are debatable regarding the maxillo-mandibular advancement (MMA) procedure, that nowadays is the most powerful therapeutic option to treat patients with OSAS, with a strong rationale that supports indications and results. The surgical indications for MMA in the OSAS in adults are linked to an accurate diagnosis based on international guidelines. We claim that MMA is at least as effective as CPAP in the reduction of the apnoic obstructive events in OSAS. MMA has an immediate therapeutic effect, obtained in one surgical operation and stable with time. Fourty patients was treated with MMA a few minor complications (transitory trigeminal impairment, plates exposure and surgical access dehiscence) were not considered serious with severe or moderately severe OSAS who in terms of quality of life and cost-effectiveness by patients managed able to stop CPAP. The therapeutic solution of MMA proposed by the maxillofacial surgeon aims to re-establish a better anatomy with no damage for the organs involved in OSAS. If planned and carried out adequately, MMA can lead to a nearly 100% cure of OSAS. Accordingly, the use of MMA is the surgical treatment of choice in OSAS, instead of using it only for severe cases or after the failure of additional surgical procedures, among patients with or without important maxillomandibular dismorphosis.

Background: During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods: We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results: Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion: The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures.

Orbital floor fractures are the most common facial fractures. The goals of orbital floor fracture repair are to free incarcerated or prolapsed orbital tissue from the fracture defect and to span the defect with an implant to restore the correct anatomy of the orbital floor and the pretrauma orbital volume. No consensus exists on the choice of implants to be used for orbital floor reconstruction, and several implant materials are available.Our study intended to evaluate, for the first time, the effectiveness and complications related to the use of a resorbable collagen membrane in the reconstruction of small pure blow-out fractures. From October 2008 to November 2010, 23 patients who underwent reconstruction of the orbital floor using a resorbable collagen membrane following fracture were included in this study. At the 6-month follow-up, only 2 patients (9%) reported postoperative complications secondary to the operative procedure (surgical approach, orbital floor dissection), but these were not directly related to the use of the membrane. In 12 cases, a computed tomography scan revealed new bone formation beneath the membrane.On the basis of this data, we believe that the use of a resorbable collagen membrane is a safe and effective alternative for reconstruction of small (

Osteochondroma or osteocartilaginous exostosis is one of the most common benign bone tumours. It usually develops in the metaphyses of long flat bones, but rarely occurs in the oral and maxillofacial area, where it is generally associated with the coronoid process or the condyle. Loose osteochondromas inside the joint are generally a rare pathology usually described in large joints. The authors present a case of an intra-articular loose osteochondroma of the temporomandibular joint (TMJ), which represents the first case of such a pathological entity in the literature. The authors suggest that it should be considered in any differential diagnosis of loose bodies described in the TMJ.

We report our experience with the repair of the orbital floor fractures and present new technical findings. We evaluated 30 subjects with pure blowout fractures treated at the Department of Maxillofacial Surgery of the Federico II University of Naples, Italy, between 2005 and 2007. A preoperative examination by computed tomography scans provided classification of the orbital floor fractures into small and large fractures by measurement of the bone defect to choose the appropriate reconstructive implant materials, resorbable or nonresorbable. The clinical follow-up has been performed at 1 week, 1 month, 3 months, and 6 months. We observed a resolution of preoperative symptoms. The scar was not evident, and there was an absence of postoperative complications. We concluded that the use of resorbable materials for small orbital floor fractures and nonresorbable materials for large orbital floor fractures offers satisfactory results in both functional and aesthetic considerations. Furthermore, the new technical findings allow standardization of the surgical technique to be more accurate, also reducing the economic costs.

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.

Introduction. Myositis ossificans traumatica is a pathological condition characterized by the extraskeletal formation of bony tissue, induced by violent or repeated trauma. Case presentation. A 30-year-old Italian man, after surgical treatment for multiple facial fractures, presented with a progressive limitation of mouth opening. A computed tomography scan showed a significant calcification of the fibers of the left lateral pterygoid muscle. The working diagnosis was myositis ossificans traumatica of the left lateral pterygoid muscle. Surgical excision was suggested but not performed. Our patient underwent physiotherapy treatment resulting not in a complete restoration of mandibular movements but in an acceptable recovery of mouth opening. Conclusions: Myositis ossificans is a rare complication that can be caused by muscle trauma. Therefore, special attention should be paid to surgical trauma. In the present case, surgical excision was considered, in accordance with the literature, and suggested to our patient, but he declined due to the absence of any pain or any significant limitation to his daily life activities. He therefore underwent physiotherapy treatment, in line with our unit's guidelines, resulting not in a complete restoration of mandibular movements but in an acceptable recovery of mouth opening. © 2014 Spinzia et al.; licensee BioMed Central Ltd.