Search

Background: Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. Methods: An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I “Sapienza” with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. Results: Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, “Sapienza” University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. Conclusions: Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.

Purpose: This retrospective study aims to compare the accuracy of two different CAD/CAM systems in orthognathic surgery. The novelty of this work lies in the method of evaluating the accuracy, i.e., using an Iterative Closest Point (ICP) algorithm, which matches a pair of 2D or 3D point clouds with unknown dependencies of the transition from scan s(k) to scan s(k+1). Methods: The study population was composed of ten patients who presented to the Maxillofacial Surgery Department of the University “Sapienza” of Rome for the evaluation and management of skeletal malocclusions. The patients were divided into two groups, depending on the technique used: group 1: splintless group (custom-made cutting guide and plates); group 2: splint group (using a 3D-printed splint). STL files were imported into Geomagic® Control X™ software, which allows for comparison and analysis using an ICP algorithm. The RMSE parameter (3D error) was used to calculate the accuracy. In addition, data were compared in two different patient subgroups. The first subgroup only underwent a monobloc Le Fort I osteotomy (p-value = 0.02), and the second subgroup underwent a Le Fort I osteotomy associated with a segmental osteotomy of the maxilla (p-value = 0.23). Results: Group 1 showed a 3D error of 1.22 mm ± SD 0.456, while group 2 showed a 3D error of 1.63 mm ± SD 0.303. These results have allowed us to compare the accuracy of the two CAD/CAM systems (p-value = 0.09). Conclusions: The ICP algorithm provided a reproducible method of comparison. The splintless method would seem more accurate (p-value = 0.02) in transferring the surgical programming into the operating room when only a Le Fort I osteotomy is to be performed.

BACKGROUND Restoration of mandibular continuity, functionality and attempting to return patients to their premorbid state is the ultimate goal of reconstruction. Some studies compare different flaps but the reconstructed portions vary and there is little consensus on the best option for a particular defect. METHODS This pilot study compares three different reconstructive options with free flap. We will analyze the accuracy of the reconstruction, the post-operative complications related to the reconstruction, the morbidity of the donor site. This pilot study compares three different reconstructive options with free flap in the reconstruction of the mandibular symphysis: iliac crest, scapula and fibula. RESULTS In our sample the morbidity of the donor site was overlapping, as for all three choices free from complications. In post resection edentulous patients, the fibula seems to guarantee better positioning, while in patients with residual occlusion the iliac crest (figure n.4 and n.5) seems to allow a more congruous repositioning. The fibula seems to have a superiority over the other flaps in terms of accuracy in all types of patient. CONCLUSIONS Contrary to the most recent work on the accuracy of CAD / CAM, we have analyzed the error in the reconstruction of a specific segment and in the repositioning of the residual mandibular component without the use of guided computer programming.

Italy has been the first affected country in the western hemisphere by SARS-CoV-2 with over 200,000 cases during the first months of the pandemics. To control the spread of the virus, the whole country was placed under lockdown with limitations in the circulation of people and vehicles from March 2020 to the first half of the month of May.We aimed to analyze the incidence and type of facial traumas referred to our tertiary care hospital during the months of Italy lockdown due to SARS-CoV-2 spread compared with those during the same months of 2019 to determine eventual variations in the incidence, type and causes of trauma.During the 2 months of COVID-19-related lockdown, a dramatic decrease in facial trauma patients was observed at our tertiary care hospital with a shift toward older age ranges. Regarding the causes of trauma, the largest percentage reduction was found in road, sports and work accidents; this percentage reduction was not found in aggressions.A small increase in the percentage was also found regarding surgical indications, likely because more severe cases were more prone to be referred to the hospital despite the fear of being infected.

INTRODUCTION The success of surgery first approach has been defined by the number of advantages offered and is definitively determined by the satisfaction of the patients themselves. The strength of this protocol resides in its philosophy that puts the patient at the center of the whole diagnostic-therapeutic process. The compliance of the patient, its happiness and comfort are the best guarantee of a good final results. While pursuing this philosophy we have wondered whether there was way to increase the comfort of surgery first approach even more and to make it even more appealing for the patients. For these reasons, we have decided to work on a preliminary protocol in order to reduce or even eliminate the use of orthodontic braces and wires during perioperative stages. Materials and Methods: No orthodontic braces or wires are bonded on the teeth before surgery. Intraoperatory intermaxillary fixation (IMF) is carried out with the use of IMF screws which are positioned at the beginning of the operation on the edge between keratinized and nonkeratinized gingiva. Once the osteotomies are performed IMF with IMF screws is carried out on the planned occlusion with the use of surgical splints.Discussion and Conclusions: In selected cases the postsurgical orthodontic treatment can be carried out with the use of clear aligners, completely eliminating the need of braces and wires with an additional level of comfort.

Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients, in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.

Objectives Italy has been the first affected country in the western haemisphere by SARS-COV 2 with over 200.000 cases during the first months o the pandemica. To control the spread of the virus, the whole country was placed under lockdown with limitations in the circulation of people and vehicles from March 2020 to the first half of the month of May. Materials and methods We aimed to analyze the incidence and type of facial traumas referred to our tertiary care hospital during the months of Italy lockdown due to SARS - COVID 2 spread compared with those during the same months of 2019 to determine eventual variations in the incidence, type and causes of trauma. Results and conclusions During the 2 months of COVID-19-related lockdown, a dramatic decrease in facial trauma patients was observed at our tertiary care hospital with a shift toward older age ranges. Regarding the causes of trauma, the largest percentage reduction was found in road, sports and work accidents; this percentage reduction was not found in aggressions. A small increase in the percentage was also found regarding surgical indications, likely because more severe cases were more prone to be referred to the hospital despite the fear of being infected.

Binder Syndrome occurs in less than 1 per 10,000 live births. Mean features of the syndrome include arhinoid face, abnormal position of the nasal bones, intermaxillary hypoplasia with associated malocclusion, reduced or absent anterior nasal spine, atrophy of the nasal mucosa and absence of the frontal sinus. Treatment of these facial deformities is obviously surgical. In the present work, the authors describe, step by step, their technique in secondary rhinoplasty in a 36-years-old patient affected by Binder Syndrome. In this case, the authors used autologous cartilage graft and heterologous bone graft.Satisfying results are achieved in 12 months of follow-up: graft resorption is acceptable, position of the graft is stable, the authors have no signs of infection and the patient is satisfied with the aesthetical and functional results. The authors believe that the first option, in complex nose's reconstruction, is the use of autologous grafts but, the use of cartilage heterologous bone graft should be taken in account, in the future, as a secondary option in Binder Syndrome and in malformed patients.

Nei Dipartimenti di Salute mentale abbiamo bisogno di una mappa che riorganizzi il nostro lavoro, rendendo leggibile il centro del nostro intervento, che dovrebbe essere quello dell’intervento precoce in psichiatria, dell’individuazione degli stati mentali a rischio, della ricostruzione e della comprensione dei percorsi della patologia e di individuazione di interventi possibili ed efficaci. Parliamo di "clinica del vuoto", che comprende tutte quelle manifestazioni sintomatiche che caratterizzano la nostra epoca: anoressie, bulimie, obesita, tossicodipendenze, attacchi di panico, depressioni. Piu in generale, in tutte le nuove configurazioni del sintomo, non prevale il binomio rimozione/ritorno del rimosso, come avviene nella clinica della nevrosi classica, ma il binomio angoscia/difesa. Il tema del narcisismo interviene a definire uno dei contenuti principali della clinica del vuoto. Abbiamo a che fare con soggetti che hanno una costituzione narcisistica debole, che vivono la loro vita come superflua, insensata, vulnerabile, sradicata, senza desideri e senza senso. Ebbene, rispetto a questa fragilita narcisistica, il sintomo (anoressia, tossicomania, bulimia, ecc.) funziona come una sorta di iniezione, di cemento narcisistico dell’identita. Le nuove forme sintomatologiche e comportamentali sembrano cosi riconducibili al conflitto in cui gioca un ruolo centrale un’istanza che non puo piu essere identificata con il Super-Io, ma piuttosto con l’ideale dell’Io, ed anche al ruolo che il corpo gioca in questa vicenda. Gli ideali dell’Io appaiono come ideali molto crudeli che costringono a disprezzare il corpo, a punirlo, ucciderlo, o comunque farlo scomparire allo sguardo degli altri (abbiamo cosi il suicidio, l’autolesionismo, il ritiro sociale, i disturbi della condotta alimentare). Il gruppo multifamiliare diventa il luogo dove poter mettere in gioco tutti questi aspetti; lo possiamo pensare come una "rete sociale primaria artificiale" che fornisce sostegno e disponibilita di nuovi apprendimenti quando si e prodotta una sorta di "rottura" nella rete sociale naturale.

Objectives The purpose of this article is to evaluate endoscopic-assisted technique by lateral approach for sinus floor augmentation, to reduce the incidence of Schneiderian membrane perforation, and to guarantee a sufficient apposition of new bone even in the posterior maxillary sinus. Methods From January 2017 to December 2017, 10 patients affected by severe maxillary atrophy underwent endoscopic-assisted sinus augmentation using a lateral approach. Results In only 1 patient, a little perforation of sinus membrane was observed intraoperatively and it was repaired. No abnormal postoperative bleeding was observed. None of the patients experienced oro-antral fistula, infection, or V2 dysesthesia. The authors did not find radiologic evidences of biomaterial displaced on the maxillary sinus or postoperative sinusitis. Conclusions The authors evaluated endoscopic-assisted maxillary sinus augmentation technique using a lateral approach that allows a direct and clear view of the surgical field. This technique, as the preliminary results demonstrate, is safe and helpful, especially in avoiding membrane perforation and in xenograft optimal distribution. It could be very useful in retreatment patients.

Objective Fascia lata (FL) is a worldwide adopted source of autologous grafts. In our Department, the endoscopic endonasal transphenoidal surgery (EETS) has been performed regularly for anterior and middle cranial fossa lesions, and FL graft has commonly been a practical resource in repairing tissue defects after EETS.Enough, we used routinely harvesting FL to restore symmetry in facial palsy. To our known, this is the biggest case series about FL harvesting to repare tissue defects after EET. The purpose of our study was to evaluate our experience with the harvesting of FL, in particularly the donor site morbidity. Study design This is a prospective study case series, which evaluated by questionnaire the morbidity of FL donr site. Methods The details of 44 patients were analyzed from 2011 to 2016. Thirty-eight patients needed cranial base reconstruction and 6 patients needed facial reanimation. Results Adequate length of FL was harvested in all our patients. There were no intraoperative complications. We did not use drain in any case. We analyzed 18 women (40%) and 26 men (59.9%). The estimated median age at presentation was 51.53. Conclusion For little FL's gap, diameter until 3 × 6 cm, it's possible to suture FL's margin with Nylon, but for bigger gap it's necessary to reconstruct with allograft to avoid muscle bulge or compartmental syndrome.

The aim of this work is to illustrate a transoral mini-invasive approach to safely remove elongated styloid process in Eagle syndrome. A 34-year-old Asian male came to our center referring pharyngeal and cervical pain on the right side on swallowing and opening the mouth. Computed tomography showed elongation of the right styloid process. Surgical removal was performed through endoscopy-assisted intraoral approach using a pituitary curette to perform dissection and piezosurgery for the osteotomy. Surgical intervention was completed in 25 minutes. Postoperative period was uneventful except for transient (12 hours) right facial palsy that resolved spontaneously. Two months after surgery, patient referred resolution of symptoms. This technique is easy to perform and permits to obtain good result with reduction of surgical time and with low risk of complication.

We propose our experience in soft tissue reconstruction in Hemifacial microsomia using a free fascioadiposal flap.Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. A 18-year-old female presented with hemifacial microsomia involving the left side. A free SCIA/SIEA fascioadiposal flap was transferred to the left face for soft tissue augmentation.The immediate postoperative course of the patient was uneventful, with no complication and adequate augmentation in contour deformity was achieved. One year after the procedure, the patient presented a good resolution of the deformity with improved facial symmetry DISCUSSION: Reconstruction for facial contour deformities is still a challenging process and treatment for most cases is achieved only by soft tissue augmentation. Several microsurgical flaps have been proposed for restoration of facial asymmetry and improvement of facial volume and contour in these patients: deltopectoral, parascapular, anterolateral thigh, groin and deep inferior epigastric. This article reports our experience in facial soft tissue reconstruction with microsurgical superficial circumflex iliac artery/superficial inferior epigastric artery (SCIA/SIEA) fascioadiposal flap transfer in patient with HFM. This flap, which has a dual blood vascularization and pliant soft tissue, can provide an ideal treatment for soft tissue augmentation in hemifacial microsomia with optimal aesthetic results both in the face and at the donor site.The free SCIA/SIEA fascioadiposal flap is a optimal choise option for soft tissue reconstruction with good esthetical outcome both in the face and at the donor site.Facial augmentation, Free flaps, Free SCIA/SIEA flap, Hemifacial microsomia.Il trattamento chirurgico delle gravi atrofie dei tessuti molli caratterizzanti la microsomia emifacciale rappresenta attualmente una ardua impresa. In questo articolo riportiamo la nostra esperienza mediante ricostruzione con lembo libero fascio-adiposo basato su doppio peduncolo vascolare (SCIA/SIEA) in una paziente affetta da microsomia emifacciale sinistra. Molteplici opzioni terapeutiche sono disponibili al fine di correggere il deficit dei tessuti molli in tale patologia: biomateriali, lipostruttura, trapianto di tessuto adiposo autologo, lembi peduncolati e lembi liberi. In letteratura sono descritti diversi lembi microchirurgici impiegati per la ricostruzione dei tessuti molli caratterizzati spesso da risultati insoddisfacenti e gravati da complicanze locoregionali. Il lembo microchirurgico fascio-adiposo basato su SCIA e SIEA presenta svariati vantaggi tra cui la doppia vascolarizzazione e la possibilità di rimodellamento differito del suddetto. A nostro giudizio dunque il lembo fascio-adiposo SCIA/SIEA rappresenta una valida opzione chirurgica nella ricostruzione dei deficit moderati e severi dei tessuti molli nei pazienti affetti da microsomia emifacciale con ridotta morbilità a livello del sito donatore e ricevente, unitamente ad un buon risultato estetico.

Aim Removal of impacted third maxillary molar is frequently carried out without difficulties and low rate of intraoperative complications. The rare and particularly challenger to manage it is the third molar dislocation into the infratemporal fossa (IF). In this clinical report, the authors present their solution to manage and resolve this particular complication. Methods A 28-year-old woman was referred to the emergency rescue unit of the authors' hospital by her dentistry, after the attempt to extract the left impacted maxillary third molar. During the procedure the tooth accidentally dislodged and was lost sight of it. The patient had significant mouth-opening limitation, omolateral mid face swelling and pain. Computer tomography was immediately performed to determine the exact position of the tooth, showing the dental element dislocated into the IF. Results Considering all of possible complications the best surgical option must guarantee a direct approach and a constant eye contact of the tooth, even in case of further displacement during the procedure, and allow early surgery. The authors used an endoscopic transoral approach through the preexisted access and solved all the issues reducing morbidity. Conclusion Removing tooth from the IF could be burdened by serious risk of bleeding and/or nerve injury. The endoscopic approach provides direct view of the IF reducing morbidity.