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L’oggetto della presente invenzione è un dispositivo per il fissaggio e la tenuta in sede di un sondino nasogastrico, comprendente un elemento aghiforme atto ad essere inserito passante attraverso la columella o il setto nasale del paziente; un 5 anello collegato o collegabile a detto elemento aghiforme; ed un elemento di fissaggio collegato o collegabile a detto anello e a detto sondino, in maniera tale da trattenere il sondino in prossimità di detto anello. La presente invenzione permette di migliorare la stabilità del sondino, di ammortizzarne i piccoli movimenti, ed evitare irritazioni da sfregamento o contatto, riducendo lo spostamento del 10 sondino stesso anche in pazienti poco collaborativi che necessitano di periodi protratti di nutrizione enterale.

The aim of this study is to present an oral device that improves splanchnocranium stability after osteodistraction in children treated for correction of craniofacial malformations. When removal of the distraction device before the end of the treatment is necessary, the reposition of a new fixation system might not be possible. In these cases, regrown bone is immature, and relapse of malformation occurs frequently. We have been treating these cases by the application of an oral device named Maxillary Advancement Contention (MAC). MAC is used in every patient when any complication interrupts the protocol of osteodistraction before the end of the stabilization time. The device is placed immediately after the removal of the distraction device and left in place for at least three months. We used MAC in six children surgically treated for correction of craniosynostosis with facial or craniofacial advancement. To establish the relapse of malformation we analyzed relations Sella-Nasion-Orbitale (SNOr) and Sella-Nasion-A point (SNA) angles before application of the MAC and after one year. The analysis of stability was excellent in every patient. This device might help, with a minimally invasive procedure, to maintain the obtained advancement allowing stabilization of the regrown bone.

BACKGROUND: Piezosurgery (PS) has gained increasing dispersion in neurosurgery. In pediatric neurosurgery, the experience is limited to craniosynostosis surgery. The present study assesses PS in the pediatric population, also considering outcomes and complications in cranial and spinal procedures. METHODS: All consecutive craniotomies and laminotomies, performed with PS (group A) or conventional osteotomes (group B) in the 2014-2017 period were reviewed. The following variables were analyzed: dural tears, estimated blood loss and need of transfusion, cosmetic outcome (Sloan score), and operative times. A review of the pertinent literature is included. RESULTS: 172 children were enrolled, 90 in group A and 82 in group B. The mean follow-up time was 2.1 years. A statistically significant difference in favor of group A was found about EBL (105 vs. 113 ml) and late outcome (Sloan class A 98.5% vs. 91.5%). PS also reduced the risk of dural tears (1 vs. 7 cases in groups A and B, respectively) and blood transfusion (52% vs. 55.5%) but without statistical significance. The operative times were significantly shorter in group B (13 vs. 23 minutes), although the newer PS plus (PSP) was demonstrated to significantly shorten these times compared with the traditional PS (3.5 vs. 6.5 minutes for orbitotomy and 7.5 vs. 9.5 minutes for hemicraniotomy). CONCLUSIONS: PS is a safe and effective tool that can be specifically recommended for bone splitting and graft, laminotomy, and craniotomy in cosmetically eloquent areas. The limit of operation times can be overcome by a learning curve in neurosurgery and PSP.

The use of navigated surgery in the treatment of craniofacial malformations can help obtain optimal results. In this article, the authors will discuss a case of anterior plagiocephaly, corrected with frontorbital bandeau remodeling. Navigation was used during the osteotomy and the reposition phase to ensure the correct positioning of the osteotomy instruments. It was also used to ensure that the bandeau was correctly repositioned in accordance with the surgical plan determined during the virtual simulation phase of the surgery.

What is considered attractive may not fall into the "norm," and it can vary from culture to culture and depending on the historical time, for this reason the standard cephalometric and antropometric references may not be sufficient in these cases.Lately some techniques have arose to popularity that are aimed to changing the frontal and lateral aspect of the facial lower third, such as V-line or the Chin-Wing Osteotomy technique, but no reference system exists at the moment to define to which extent a modification of the lower third falls within what is considered beautiful, and everything is left to the patient's will or to the surgeon's sensitivity.The aim of this article is to study which antropometric value is considered attractive by the most for what concerns the frontal shape of the lower third of the face.Twenty-four female models were enrolled in this study and the angle taken into consideration was the one at the intersection between the 2 lines connecting the cutaneous gonial angle of each side of the face and the most external part of the chin on the same side. Measures were made on pictures in frontal view.Two hundred two random examiners were asked to see the pictures and rate them as attractive or nonattractive.Results were then paired with the angles values.Among the models the higher angle measured was 107.5° (found in 1 individual) while the lower angle was 76° (found in 1 individual), the average measure calculated was 88.3° while the median angle was 89.5°.According to the result the subjects considered more attractive were those with an angle between 84.5 and 91.5 (92 for male examiners).This could be an important starting point for studies who can evaluate attractiveness from a numerical point of view.

Purpose: Desmoid-type fibromatosis is a benign fibrous neoplasia originating from connective tissue, fascial planes, and musculoaponeurotic structures of the muscles. Currently, there is no evidence-based treatment approach available for desmoid fibromatosis. In this article, a case of a patient in the pediatric age affected by desmoid fibromatosis localized in the orbit is presented. The aim of the article is to describe this unusual and rare location for the desmoid fibromatosis and outline the principle phases in the decision-making process and the therapeutic alternatives for a patient affected by desmoid fibromatosis. Methods: The protocol of this review included study objectives, search strategy, and selection criteria. The primary end point of this study was to analyze the head and neck desmoid fibromatosis. The secondary end point was to identify the available therapies and assess their specific indications. Results: The mean age of patients was 18.9 years ranging from 0 to 66, and 52% were female. A bimodal age distribution was observed, and two age peaks were identified: 0-14 years (57%) and 28-42 years (18%). The most common involved areas were the mandible (25%) followed by the neck (21%). In 86% of the cases, the treatment was the surgical resection of the disease, and only in 5% of the cases, the surgical resection was followed by adjuvant radiotherapy. Conclusion: The orbital location is extremely rare, especially in the pediatric population. The management of desmoid fibromatosis is based on the function preservation and the maintenance of a good quality of life, but in case of symptomatic patients or aggressive course of the disease or risk of functional damages, the surgical approach may be considered. Therapeutic alternatives to surgical resection are radiotherapy and systemic therapy.

BACKGROUND: In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection. METHOD: From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection. RESULTS: Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications. CONCLUSION: The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.

The purpose of this study was to evaluate the clinical and radiological outcomes of 2 piezosurgical split techniques performed in conjunction with the sinus lift.The present retrospective study included 20 patients with edentulism of the posterior maxilla who had undergone the sinus lift and alveolar ridge split treatment separately or the sinus lift combined with the monoblock alveolar ridge split. Differences between these 2 techniques were analyzed.All the surrounding areas successfully produced an adequate bone volume for the insertion of implants. A clinical evaluation showed a mean vertical augmentation of 3.6 ± 0.4 mm in Group A and 3.2 ± 0.7 mm in Group B. With regards to the lateral augmentation, the clinical evaluation gives a mean gain of 5.2 ± 0.3 mm in Group A and 4.9 ± 0.5 mm in Group B. The mean vertical and horizontal bone augmentation recorded for both types of surgical procedures were comparable.The proposed surgical procedures enabled the tridimensional volume of the alveolar ridge to be recreated. This resulted in the creation of a natural contour of hard and soft tissues which enabled a functional and aesthetic rehabilitation of the edentulous posterior maxilla to be obtained.

Pseudoaneurysms are an uncommon complication of mandibular condylar-subcondylar fractures; however, if present, their recognition and management is mandatory to avoid life-threatening situations. The authors report a case of internal maxillary artery pseudoaneurysm rupture that occurred after an open reduction and internal fixation of a mandibular subcondylar fracture, along with a review of the literature.

INTRODUCTION: Correction of severe malocclusions with skeletal discrepancies requires orthodontic treatment in combination with orthognathic surgery. Even though conventional orthognathic surgery (COS) is a common and well-accepted approach its influence on the signs and symptoms of temporomandibular disorders (TMDs) is still debated. Recently with the introduction of surgery first approach, a different timing for the management of dentoskeletal imbalances has been proposed. The present study is aimed at assessing the relationship between surgery first approach and temporomandibular joint (TMJ) disorders. METHODS: The study sample consisted of 24 patients who were selected to be treated with surgery first approach. Clinical follow-ups after surgery were performed every week for the first month, at 3 months, 6 months, and at 1 year. A radiological follow-up was performed at 1 week and at 1 year after the operation with a panorex and a latero-lateral teleradiograph. To assess the effect of surgery first approach on the TMDs signs and symptoms, a clinical assessment was performed 4 days before surgery (T1), 6 months after surgery (T2), and 1 year postoperatively (T3). RESULTS: The results of the authors' study show that pain assessment revealed a general improvement of this symptom in correspondence to TMJ and masticatory muscles except in the masseter and neck region. Also joint noises, TMJ functioning, migraine, and headache underwent a considerable improvement. CONCLUSION: Surgery first approach is an innovative orthognathic procedure and, by undergoing surgery first approach, patients with pre-existing TMJ dysfunction may experience a significant improvement or even resolution of the TMDs signs and symptoms.

Authors' response

Introduction The purposes of the study were to investigate and evaluate the differences detected by the patients between the traditional orthognathic approach and the surgery-first one in terms of level of satisfaction and quality of life. Methods A total of 30 patients who underwent orthognathic surgery for correction of malocclusions were selected and included in this study. Fifteen patients were treated with the conventional orthognathic surgery approach, and 15 patients with the surgery-first approach. Variables were assessed through the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile questionnaire and analyzed with 2-way repeated-measures analysis of variance. Results The results showed significant differences in terms of the Orthognathic Quality of Life Questionnaire (P <0.001) and the Oral Health Impact Profile (P <0.001) scores within groups between the first and last administrations of both questionnaires. Differences in the control group between first and second administrations were also significant. Questionnaire scores showed an immediate increase of quality of life after surgery in the surgery-first group and an initial worsening during orthodontic treatment in the traditional approach group followed by postoperative improvement. Conclusions This study showed that the worsening of the facial profile during the traditional orthognathic surgery approach decompensation phase has a negative impact on the perception of patients’ quality of life. Surgeons should consider the possibility of a surgery-first approach to prevent this occurrence.

The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

Myotonic dystrophy, or Steinert’s disease, is themost common formofmuscular dystrophy that occurs in adults.Thismultisystemic form involves the skeletalmuscles but affects also the eye, the endocrine system, the central nervous system, and the cardiac system. Theweakness of the facialmuscles causes a characteristic facial appearance frequently associated with malocclusions. Young people withmyotonic dystrophy, who also have severemalocclusions, have bad oral functions such as chewing, breathing, and phonation. We present a case report of a 15-year-old boy with anterior open bite, upper and lower dental crowding, bilateral crossbite, and constriction of the upper jaw with a high and narrow palate. The patient’s need was to improve his quality of life. Because of the severity of skeletal malocclusion, it was necessary to schedule a combined orthodontic and surgical therapy in order to achieve the highest aesthetic and functional result. Although therapy caused an improvement in patient’s quality of life, the clinical management of the case was hard. The article shows a balance between costs and benefits of a therapy that challenges the nature of the main problem of the patient, and it is useful to identify the most appropriate course of treatment for similar cases.

OBJECTIVE: To date, no systematic review has been undertaken to identify the complications of segmental osteotomies. The aim of the present systematic review was to analyze the type and incidence of complications of segmental osteotomies, as well as the time of subjective and/or clinical onset of the intra- and post-operative problems. MATERIALS AND METHODS: A search was conducted in two electronic databases (MEDLINE - Pubmed database and Scopus) for articles published in English between 1 January 2000 and 30 August 2015; only human studies were selected. Case report studies were excluded. Two independent researchers selected the studies and extracted the data. Two studies were selected, four additional publications were recovered from the bibliography search of the selected articles, and one additional article was added through a manual search. RESULTS: The results of this systematic review demonstrate a relatively low rate of complications in segmental osteotomies, suggesting this surgical approach is safe and reliable in routine orthognathic surgery. CONCLUSIONS: Due to the small number of studies included in this systematic review, the rate of complication related to surgery first approach may be slightly higher than those associated with traditional orthognathic surgery, since the rate of complications of segmental osteotomies must be added to the complication rate of basal osteotomies. A surgery-first approach could be considered riskier than a traditional one, but further studies that include a greater number of subjects should be conducted to confirm these findings.

In some patients, the resolution of severe maxillary atrophies can be hardly achieved without the use of zygomatic implants. Although many scientific studies have already demonstrated the excellent immediate stability in long term, the use of zygomatic implants is not yet widespread. Among the complications of this technique, the most threatening is the risk of damaging the eyeball or the maxillary nerve.The use of the navigator system as a surgical aid for implant placement allows to control, at any time, the position of the drill in the bone, avoiding any injury to ocular and nervous structures. The authors present a clinical report which shows a patient affected by a very severe form of post-traumatic maxillary atrophy that has been solved through the of zygomatic implants placement using the “Implant Bone Navigation” system. This procedure allows both to cut down the risks on ocular and nervous structures of the maxilla and also to reach excellent rehabilitation results in such severely compromised patients.

Authors' response

The treatment of cystic lesions and the extraction of impacted third molars are 2 of the most common procedures in oral and maxillofacial surgery. The surgical treatment of cysts of the jaws can consist of a cystectomy, a cystotomy, or a staged combination of the 2 procedures. The surgical techniques developed for the extraction of impacted third molars are: coronectomy, orthodontic extraction, and surgery using intraoral or extraoral methods. There are various complications related to both surgical treatments. With regards to these complications, authors' department has developed a new surgical technique based on a previously described technique, which provides better support to the mucoperiosteal flap and improves bone regeneration after healing. Additionally, authors' goal was to reduce the risk of nerve injury, which has been achieved thanks to a direct visualization of the inferior alveolar nerve as well as cystic lesion or the dental element. The surgical procedure described produces major advantages over the traditional alternatives, despite needing a longer operation. This technique is particularly useful in the treatment of cystic lesions that have caused considerable bone loss. It can also be utilized for cysts or impacted dental elements strictly linked to the inferior alveolar nerve.

BACKGROUND: Adipose tissue (AT) harvested through lipoaspiration is widely exploited in plastic and cosmetic surgery, due to its remarkable trophic properties, especially relying on the presence of adipose stem cells (ASCs). The common procedures for ASC isolation are mainly based on tissue fractionation and enzymatic digestion, which require multiple hours of uninterrupted work, unsuitable for direct surgical applications. Recent studies demonstrated the feasibility of isolating adipose stromal cells without the need for enzymatic digestion. These studies reported the processing of the fluid portion of liposucted AT (lipoaspirate fluid, LAF), which contains a significant amount of progenitor cells endowed with plastic and trophic features. Here we introduce a brand new closed device, namely MyStem Evo® kit, which allows non-enzymatic tissue separation and enables the rapid isolation of LAF from human liposucted AT METHODS:: AT was liposucted from 14 donors, split into aliquots, and alternatively processed using either centrifugation or the MyStem EVO® kit, to separate fatty and LAF portions. The samples were comparatively analyzed by flow cytometry, histology, and differentiation assays. Osteo- and angio-inductive features were analyzed through in vitro co-culture assays. RESULTS: The alternative procedures enabled comparable yields; the kit rapidly isolated LAF comprising a homogenous cell population with ASC immunophenotype, bi-lineage potential, and efficient osteo- and angio-inductive features. CONCLUSIONS: MyStem EVO® allows the rapid isolation of LAF with trophic properties within a closed system, potentially useful for regenerative medicine applications.

BACKGROUND: The management of unilateral complete cleft lip and palate patients (UCCLP) requires a combination of orthopedics and surgery. Depending to the forces involved, pre-surgical orthopedic appliances are classified into active or passive. An active approach employs controlled forces to move maxillary segments in the direction of where alveolar bone apposition is desired, while passive devices act as an obturator that covers the palate and maintains the distance between the two maxillary segments. Nowadays, increasing number of cleft centres uses 3D model imaging and landmark digitization in order both to obtain repeated measurements of all casts (minimizing interoperator and intraoperator error) and improve accuracy of data analysis, sharing and storage for documentation and research purposes. Aim of the cast study is a three dimensional analysis of subsequent changes to maxillary arches following different orthopedic procedures in the treatment of patients with UCCLP. METHODS:Two male patients with congenital non-syndromic unilateral complete cleft lip and palate (III Veau class) on the left side are considered to enter the study. The inclusion criteria are the absence of syndromic or medically compromised conditions. The exclusion criteria is the presence of prior surgical or orthopedic treatments. The study reports the results achieved at the last month of the therapy. A putty-wash procedure was adopted: patients underwent an initial impression taken by a silicone putty-dough of heavy consistency with a light-cured acrylic custom-made impression tray and then a light-consistency polyvinyl elastomeric fast-setting material was placed exclusively in the tray above the heavy stage for the final impression. After an ADA Type III plaster cast was poured, an hard self-cured acrylic resin plate was realized. All the orthopedic devices were fabricated by the same laboratory technician. In patient A, the stone cast was duplicated and then discarded 1 mm in the mid

BACKGROUND: Presurgical infant orthopedic therapy was introduced by McNeil in 1956 in order to facilitate patients’ feeding ando to provide stimulation and guidance of maxillary segments’ growth as well as to facilitate surgical management of cleft lip and palate patients. To quantify soft-tissue labial changes in patients treated different orthopedic appliances for the correction of unilateral complete cleft lip and palate (UCCLP) a new three-dimensional (3D) software (3dMD, Atlanta,Ge) was employed. Previous studies have used this new technology to investigate the growth rate and the effectiveness of orthopedic equipment in patients affected by UCCLP. The aim of the study is to evaluate three dimensional subsequent changes to nasolabial area following different orthopedic procedures in the treatment of patients with UCCLP. METHODS: Three male patients with congenital non-syndromic unilateral complete cleft lip and palate (III Veau class) on the left side are presented in this report. The study reports the results achieved at the last month of the therapy. As described in the putty-wash technique, maxillary impressions covering the critical areas of the alveolar ridge and palate cleft were taken in two stages using putty-dough and light-bodied fast setting polyvinyl siloxane (PVs) impression materials with a light-cured resin custom-made impression tray. ADA Type III plaster casts were poured. All the orthopedic devices were fabricated by the same laboratory technician. In patient A, the stone cast was duplicated and then discarded 1 mm in the midsagittal plane before plate realization in order to reduce the transversal discrepancy between maxillary segments prior to surgery. The cast replica was used to realize a custom tray. In patient B, after alveolar segments had achieved a proper alignment, clinicians decided to realize a final passive plate in order to avoid recurrence. According with the Cutting-Grayson technique, in patient C a nasal stent was applied with

The aim of this study was to validate a new aesthetic analysis and establish the sagittal position of the maxilla on an ideal group of reference.We want to demonstrate the usefulness of these findings in the treatment planning of patients undergoing orthognathic surgery. We took a reference group of 81 Italian women participating in a national beauty contest in 2011 on which we performed Arnett’s soft tissues cephalometric analysis and our new “Vertical Planning Line” analysis.We used the ideal values to elaborate the surgical treatment planning of a second group of 60 consecutive female patients affected by skeletal class III malocclusion. Finally we compared both pre- and postoperative pictures with the reference values of the ideal group. The ideal group of reference does not perfectly fit in Arnett’s proposed norms. From the descriptive statistical comparison of the patients’ values before and after orthognathic surgery with the reference values we observed how all parameters considered got closer to the ideal population. We consider our “Vertical Planning Line” a useful help for orthodontist and surgeon in the treatment planning of patients with skeletal malocclusions, in combination with the clinical facial examination and the classical cephalometric analysis of bone structures.

BACKGROUND: Adipose tissue (AT) harvested through lipoaspiration is widely exploited in plastic and cosmetic surgery, due to its remarkable trophic properties, especially relying on the presence of adipose stem cells (ASCs). The common procedures for ASC isolation are mainly based on tissue fractionation and enzymatic digestion, which require multiple hours of uninterrupted work, unsuitable for direct surgical applications. Recent studies demonstrated the feasibility of isolating adipose stromal cells without the need for enzymatic digestion. These studies reported the processing of the fluid portion of liposucted AT (lipoaspirate fluid, LAF), which contains a significant amount of progenitor cells endowed with plastic and trophic features. Here we introduce a brand new closed device, namely MyStem Evo® kit, which allows non-enzymatic tissue separation and enables the rapid isolation of LAF from human liposucted AT METHODS:: AT was liposucted from 14 donors, split into aliquots, and alternatively processed using either centrifugation or the MyStem EVO® kit, to separate fatty and LAF portions. The samples were comparatively analyzed by flow cytometry, histology, and differentiation assays. Osteo- and angio-inductive features were analyzed through in vitro co-culture assays. RESULTS: The alternative procedures enabled comparable yields; the kit rapidly isolated LAF comprising a homogenous cell population with ASC immunophenotype, bi-lineage potential, and efficient osteo- and angio-inductive features. CONCLUSIONS: MyStem EVO® allows the rapid isolation of LAF with trophic properties within a closed system, potentially useful for regenerative medicine applications.

BACKGROUND: Adipose tissue (AT) harvested through lipoaspiration is widely exploited in plastic and cosmetic surgery, due to its remarkable trophic properties, especially relying on the presence of adipose stem cells (ASCs). The common procedures for ASC isolation are mainly based on tissue fractionation and enzymatic digestion, which require multiple hours of uninterrupted work, unsuitable for direct surgical applications. Recent studies demonstrated the feasibility of isolating adipose stromal cells without the need for enzymatic digestion. These studies reported the processing of the fluid portion of liposucted AT (lipoaspirate fluid, LAF), which contains a significant amount of progenitor cells endowed with plastic and trophic features. Here we introduce a brand new closed device, namely MyStem Evo® kit, which allows non-enzymatic tissue separation and enables the rapid isolation of LAF from human liposucted AT METHODS:: AT was liposucted from 14 donors, split into aliquots, and alternatively processed using either centrifugation or the MyStem EVO® kit, to separate fatty and LAF portions. The samples were comparatively analyzed by flow cytometry, histology, and differentiation assays. Osteo- and angio-inductive features were analyzed through in vitro co-culture assays. RESULTS: The alternative procedures enabled comparable yields; the kit rapidly isolated LAF comprising a homogenous cell population with ASC immunophenotype, bi-lineage potential, and efficient osteo- and angio-inductive features. CONCLUSIONS: MyStem EVO® allows the rapid isolation of LAF with trophic properties within a closed system, potentially useful for regenerative medicine applications.

Zygomatic arch fractures are caused by a vector force orthogonal to the bone segment that causes the collapse of the arch through depression of the bone fragments. Reduction of isolated zygomatic arch fractures are usually only of esthetic interest, with the exception of those cases where the fracture causes an impingement with the underlying mandibular coronoid process, causing limitation of mandibular movements. Reduction is usually performed with an extraoral approach, more rarely through a transoral approach. In this article, authors compare the traditional transcutaneous technique with the intraoral approach in 2 groups for a total number of 42 patients. For what concerns the correct alignment of the fragments, the 2 techniques have shown being equivalent. Although the intraoral approach has shown being a faster surgical procedure leaving no visible incision, allowing faster recovering and reduced postoperative pain.

The treatment of cystic lesions and the extraction of impacted third molars are 2 of the most common procedures in oral and maxillofacial surgery. The surgical treatment of cysts of the jaws can consist of a cystectomy, a cystotomy, or a staged combination of the 2 procedures. The surgical techniques developed for the extraction of impacted third molars are: coronectomy, orthodontic extraction, and surgery using intraoral or extraoral methods. There are various complications related to both surgical treatments. With regards to these complications, authors' department has developed a new surgical technique based on a previously described technique, which provides better support to the mucoperiosteal flap and improves bone regeneration after healing. Additionally, authors' goal was to reduce the risk of nerve injury, which has been achieved thanks to a direct visualization of the inferior alveolar nerve as well as cystic lesion or the dental element. The surgical procedure described produces major advantages over the traditional alternatives, despite needing a longer operation. This technique is particularly useful in the treatment of cystic lesions that have caused considerable bone loss. It can also be utilized for cysts or impacted dental elements strictly linked to the inferior alveolar nerve.

BACKGROUND: Adipose tissue harvested through lipoaspiration is widely exploited in plastic and cosmetic surgery, because of its remarkable trophic properties, especially relying on the presence of adipose-derived stem cells. The common procedures for adipose-derived stem cell isolation are mainly based on tissue fractionation and enzymatic digestion, requiring multiple hours of uninterrupted work, unsuitable for direct surgical applications. Recent studies demonstrated the feasibility of isolating adipose stromal cells without the need for enzymatic digestion. These studies reported the processing of the fluid portion of liposuctioned adipose tissue (lipoaspirate fluid), which contains a significant amount of progenitor cells endowed with plastic and trophic features. In this article, the authors introduce a brand new closed device--the MyStem EVO kit--which allows nonenzymatic tissue separation and rapid isolation of lipoaspirate fluid from human liposuctioned adipose tissue. METHODS: Adipose tissue was liposuctioned from 14 donors, split into aliquots, and alternatively processed using either centrifugation or the MyStem EVO kit, to separate fatty and lipoaspirate fluid portions. The samples were analyzed comparatively by flow cytometry, histology, and differentiation assays. Osteoinductive and angioinductive features were analyzed through in vitro co-culture assays. RESULTS: The alternative procedures enabled comparable yields; the kit rapidly isolated lipoaspirate fluid comprising a homogenous cell population with adipose stem cell immunophenotype, bilineage potential, and efficient osteoinductive and angioinductive features. CONCLUSION: MyStem EVO allows the rapid isolation of lipoaspirate fluid with trophic properties within a closed system, and is potentially useful for regenerative medicine applications.

3D analysis allows for simulation of orthognathic surgery and prediction of aesthetic and functional outcomes. Our study aims to find common and repeatable parameters on the behaviour of soft tissues following bone movement by pre- and post-treatment by photogrammetric analysis. Three representative patients who underwent bimaxillary surgery of advancement/retrusion of the jaws for correction of class III dento-skeletal malformation were presented. By overlapping pre-operative and post-operative 3D photos we obtained colour and millimetric maps that allowed the objective appreciation of facial soft tissues modification in all planes of the space after orthognathic surgery

PURPOSE: The study aimed to identify premature synostosis of "major" and "minor" sutures of the coronal sutural arch and splanchnocranium sutures to evaluate the relationship between craniofacial dysmorphology and the sutural pattern in children with anterior plagiocephaly. METHODS: A quantitative analysis of the skull base and facial changes was performed on preoperative high-resolution CT images in 18 children with anterior synostotic plagiocephaly and compared with imaging findings in 18 age-matched healthy subjects. RESULTS: All patients had patent splanchnocranium sutures. Fifteen out of 18 children showed early and isolated synostosis of the unicoronal suture (the major suture of the coronal ring) and were classified in groups II and III according to the classification scheme of anterior synostotic plagiocephaly based on the severity of craniofacial dysmorphology. Premature fusion of the unilateral coronal suture in groups II and III caused a marked asymmetry and reduced growth of the anterior and middle fossae on the synostotic side and a secondary varying severity in terms of asymmetric growth of the facial complex. Although both groups showed anterior displacement of the mandibular articulation on the synostotic side, group II showed only maxillary asymmetry, while group III showed maxillary and mandibular asymmetry. CONCLUSIONS: In anterior synostotic plagiocephaly, the severity of skull base changes and asymmetric growth of the facial complex is not caused by skull base sutural synostotic involvement but is probably related to the different timing of unilateral coronal suture closure.

Ameloblastic carcinoma (AC) is an uncommon malignant odontogenic tumor that can be difficult to differentiate from ameloblastoma and can arise directly as an undifferentiated lesion or from a pre-existing benign lesion. The current study presents a novel case of primary maxillary AC and review the literature on AC of the maxilla. The review of the literature indicates that secondary tumors and posterior localization are associated with a higher tendency for recurrence and, often, multiple recurrences. Surgical therapy, eventually followed by radiotherapy, is the treatment modality most frequently applied, while the role of chemotherapy remains unclear. Several new cases of maxillary AC have been recently described in literature, making this pathology more frequent than previously considered; this is perhaps an indication of an increased diagnostic sensibility, rather than a real increase in the incidence of the disease itself.

Introduction: This prospective study aims to evaluate the reliability of a reconstructive technique, which uses autologous J-shaped graft (Jgraft) harvested from the mandibular ramus. Materials and Methods: Thirtysix maxillary defects among 32 patients (20 women and 12 men) were treated. All patients presented enough bone volume at the donor site to perform the harvesting procedures needed for the autologous reconstruction. All patients underwent clinical and radiographical evaluations through standardized radiographs taken before the intervention, immediately after the bone grafting, 6 to 7 months, and 1 year later. The loss of tooth vitality, the alterations of skin and mucosa sensibility, and the patients' subjective perception of discomfort related to the surgical procedure were investigated. Results: We found an overall success rate of 91.66% with a mean bone gain of 4.8 mm vertically and 5.6 mm horizontally, assessed through computed tomography. According to clinical examinations, 35 sites completely recovered with proper incorporation of the graft, whereas 33 sites reached enough bone volume to allow the implant placement. Conclusion: The described technique explains how to harvest and shape a J-graft. It achieves the simultaneous restoration of the horizontal and vertical bone loss with a single bone block.

The introduction of "surgery first" has resulted in a new requirement to compare and resolve medical legal problems which previously did not exist in traditional orthognathic surgery. The first issue relates to the relationship between the doctor and the patient and, in particular, the need to create a new informed consent form for surgery first. The second problem that has arisen with the arrival of surgery first concerns the relationship between health workers, namely the surgeon, and the orthodontist. The authors of this article propose a new template for informed consent specifically created for surgery first and also a model for the new working relationship between surgeons and orthodontists which will facilitate and improve co-operation between them. This will improve results, and guarantee a greater level of protection for the surgeon. It will also enable the identification the individual responsibilities of each person.

Maxillo-mandibular asymmetry has numerous aetiologies: congenital, traumatic, iatrogenic and post-oncologic. Patients with congenital dentofacial malformations are generally submitted to orthognathic surgery and/or additional procedures (genioplasty, alloplastic implants) with satisfactory results. However, despite achieving skeletal symmetry, noticeable facial asymmetry may persist.This study was performed in 45 patients (29 women and 16 men) operated between December 2012 and June 2014. All patients were affected by maxilla-mandibular asymmetry and underwent orthognatic surgery for hard tissue correction of the deformity. Residual facial alterations were then treated with lipofilling refinement proceure. In all cases good integration of the grafted fat was observed in the recipient sites. Retrospective analysis of photographic documentation showed progressive volumetric decrease for up to approximately 6 months after surgery; after that graft volume remained relatively stable. There were no significant surgical complications, either from the fat harvest site or the reconstructed site. Mild oedema and bruising were frequent during the first post-operative week. No haematomas, infections, vascular or nervous injuries were recorded. Twenty-four patients felt the need to have a second procedure. A second fat transfer was performed in 22 cases, and a third in 2 (total of 69 procedures). Based on the observations of our study, fat grafting is a simple, effective and reproducible technique, with a high satisfaction rate and few disadvantages or complications. We demonstrated that the success of lipofilling is dependent on the treated aesthetic subunits of the face. The malar and lateral cheek regions seem to be highly favourable for fat grafting, unlike the upper and lower lips subunits. Composite procedures using orthognathic surgery and autologous fat provide the surgeon with an additional, more customisable option for patients with maxillo-mandibular malformations.

In some patients, the resolution of severe maxillary atrophies can be hardly achieved without the use of zygomatic implants. Although many scientific studies have already demonstrated the excellent immediate stability in long term, the use of zygomatic implants is not yet widespread. Among the complications of this technique, the most threatening is the risk of damaging the eyeball or the maxillary nerve.The use of the navigator system as a surgical aid for implant placement allows to control, at any time, the position of the drill in the bone, avoiding any injury to ocular and nervous structures. The authors present a clinical report which shows a patient affected by a very severe form of post-traumatic maxillary atrophy that has been solved through the of zygomatic implants placement using the "Implant Bone Navigation" system. This procedure allows both to cut down the risks on ocular and nervous structures of the maxilla and also to reach excellent rehabilitation results in such severely compromised patients.

Rationale. The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. Objectives. To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. Methods. Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. Measurements and Main Results. The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81-1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82-0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76-0.92) for severe OSA (AHI ≥ 30). Conclusions. The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.

The gold standard in modern surgical treatment of patients with severe maxillo-mandibular atrophy must include the aim to achieve restoration of function and aesthetics with immediate reconstruction of the oro-mandibular defects. The medical records of 14 patients who were treated in a 5-year period (2010-2014) at our department with severe maxillary and mandibular atrophy, and reconstructed by vascularised free fibula flap were reviewed. Among the former, a total of 14 patients underwent maxillary and mandibular reconstruction using the osteoperiosteal fibula free flap. No major complications were reported. The main advantage of this technique is that it allows the formation of keratinised gengiva, which provides the best implantological options. The only disadvantage of the technique is that the wounds have to heal for second intention, and for this reason patients have to undergo strict follow-up for the first months after the operation. The aim of this article is to evaluate the efficiency of the technique in bone reconstruction after jaw resection or severe atrophy. © 2015, Pacini Editore S.p.A. All rights reserved.

Midface is a critical area for the aesthetics of the face. Despite malar hypoplasia is often combined with a class III malocclusion, there are few studies focusing on the results of a combined approach of malar implants and Le Fort I. We describe a new aesthetic analysis, named "beauty arch" analysis, for the assessment of sagittal projection of the malar region. We took a reference group of 74 Italian women participating in a national beauty contest in 2011 on which we performed our analysis. We used the ideal values to elaborate the surgical treatment planning of a second group of 45 consecutive female patients affected by skeletal class III malocclusion.Twenty-three patients undergo simultaneous Le Fort I osteotomy and malar implants. From the descriptive statistical comparison of the patients' values before and after orthognathic surgery and malar implants with the reference values, we observed how all parameters considered got closer to the ideal population. We consider our beauty arch a useful help for surgeon in the treatment planning of patients with skeletal malocclusions and malar implants.

The purpose of this study is to demonstrate that the GOCCLES® medical device allows proper autofluorescence examination of the oral mucosa in a dental care setting. This is a non-randomised multicentre clinical trial on consecutive patients at risk for oral cancer. Patients underwent a classical naked eye inspection of the oral cavity followed by autofluorescence examination wearing the GOCCLES® spectacles while the light from a dental curing light irradiated the oral mucosa. Lesions were defined as visible potentially malignant lesions and/or fluorescence loss areas. All persisting lesions underwent excisional or incisional biopsy. Sixty-one patients were enrolled. Data from 64 biopsies were analysed. Of the 62 lesions identified by the device, 31 were true positives. The device identified 31 of 32 true positive lesions. One lesion (an invasive carcinoma) was not visible to the naked eye. The device identified all lesions classified as moderate dysplasia to invasive cancer. In 56.7% of cases, true positive lesions showed greater extension when observed through the device. The GOCCLES® medical device allowed the direct visualisation of fluorescence loss in patients suffering from mild to severe dysplasia and in situ to invasive oral cancer. It allowed autofluorescence examination with each source of light used during the study. These results suggest that the role of the autofluorescence visualisation is that of a complementary inspection following naked eye examination when dealing with patients at risk for oral cancer. The device allows detection of otherwise invisible lesions and otherwise impossible complete resections. © 2015, Pacini Editore S.p.A. All rights reserved.

Traumas, malformative or dysplastic pathologies, atrophy, osteoradionecrosis, and benign or malignant neoplasm can cause bone deficits in the mandible. Consequent mandibular defects can determine aesthetic and functional problems; therefore, being able to perform a good reconstruction is of critical importance.Several techniques have been proposed for mandibular reconstruction over the years. In this article, we present and discuss the evolution during the time of the methods of mandible reconstruction as well as pros and cons of each procedure on the basis of experience of 10 years in the maxillofacial department of the Catholic University of Sacred Heart of Rome.Free flaps represent the gold standard method of reconstruction of large mandibular defects: the fibula bone flap represents the best choice for large defects involving the arch and the mandibular ramus, whereas the deep circumflex iliac artery represents a valid alternative for mandibular defects involving the posterior region.In cases where free flap reconstructions are contraindicated, the use of regional pedicle flap combined with autologous bone grafts still represents a valid choice. Patients who are not deemed suitable for long and demanding surgery can still be treated using alloplastic materials in association with regional pedicle flap or, when adjuvant radiation therapy is needed, by simple locoregional pedicle flap. Finally, in selected cases, the bone transporting technique should be considered as a valid alternative to the more "traditional" reconstructive methods because of the extraordinary potential and its favorable cost-benefit ratio.

The purpose of this study is to demonstrate that the goCClES® medical device allows proper autofluorescence examination of the oral mucosa in a dental care setting. This is a non-randomised multicentre clinical trial on consecutive patients at risk for oral cancer. Patients underwent a classical naked eye inspection of the oral cavity followed by autofluorescence examination wearing the goCClES® spectacles while the light from a dental curing light irradiated the oral mucosa. lesions were defined as visible potentially malignant lesions and/or fluorescence loss areas. All persisting lesions underwent excisional or incisional biopsy. Sixty-one patients were enrolled. data from 64 biopsies were analysed. of the 62 lesions identified by the device, 31 were true positives. The device identified 31 of 32 true positive lesions. one lesion (an invasive carcinoma) was not visible to the naked eye. The device identified all lesions classified as moderate dysplasia to invasive cancer. in 56.7% of cases, true positive lesions showed greater extension when observed through the device. The goCClES® medical device allowed the direct visualisation of fluorescence loss in patients suffering from mild to severe dysplasia and in situ to invasive oral cancer. it allowed autofluorescence examination with each source of light used during the study. These results suggest that the role of the autofluorescence visualisation is that of a complementary inspection following naked eye examination when dealing with patients at risk for oral cancer. The device allows detection of otherwise invisible lesions and otherwise impossible complete resections

Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: "surgery patients" who accepted surgical treatments of their condition and "no surgery patients" who refused surgical procedures. The "surgery patients" group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and "no surgery" group to indicate the main reason that influenced their decision to avoid II phase procedures.We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results.Themain reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation. Copyright © 2015 Giulio Gasparini et al.

Background: Among the reconstructive options after orbital exenteration, the temporalis myofascial flap (TMF) has been widely recognized as the one of the best available solutions. We think that the hemicoronal approach to harvest the TMF represents a disadvantage so we adopted a modified approach that we named the anterior retrograde approach to the TMF. Methods: Nine patients with malignant orbital tumors underwent orbital exenteration and primary reconstruction with TMF harvested with the anterior retrograde approach. The temporalis muscle was widely exposed through the anterior incision used to perform the orbital exenteration. The harvested flap was then rotated and insetted to fill the orbital cavity. Results: Neither cases of total/partial flap failure nor local/regional recurrence of tumor were recorded. The technique showed a significant reduction of morbidity, surgical time, and blood loss compared with the traditional technique. Conclusions: We think that the anterior retrograde approach should be considered as a valid alternative to the traditional hemicoronal approach. Copyright © 2013 by Lippincott Williams & Wilkins.

RiassuntoObiettivi La sindrome di Binder è un raro disordine di eziologa sconosciuta, caratterizzato da ipoplasia del naso e del mascellare superiore e dall'alterazione della morfologia dei tessuti molli associati. Gli autori riportano il caso di una paziente di 10 anni affetta da sindrome di Binder, con naso corto e ipoplasia della spina nasale anteriore. Materiali e Metodi La paziente è stata trattata prima con TSME (Transverse Sagittal Maxillary Expander) per correggere l'ipoplasia del mascellare e successivamente con terapia fissa per ottenere i risultati estetici. Alla fine del trattamento ortodontico è stata effettuata la chirurgia maxillofacciale per correggere l'ipoplasia nasale. Conclusioni Un approccio multidisciplinare, che comprenda anche la terapia ortodontica, è necessario per risolvere le alterazioni presenti nella sindrome di Binder. © 2014 EDRA LSWR SpA.

Introduction: Fractures of the orbital-maxillo-zygomatic complex are among the most common fractures affecting the facial skeleton. Goal of surgical treatment is the realignment of fracture lines for a complete functional and aesthetic rehabilitation. Materials and Methods: From January 2008 to January 2011 in the Department of Maxillofacial Surgery of Complesso Integrato Columbus of the Universita Cattolica del Sacro Cuore in Rome, 25 patients, affected by comminute fractures of the anterior wall of the maxillary sinus associated with fractures of the orbital-maxillary complex were selected. The synthesis of the larger fracture fragments was performed by plates and screws (1.5 mm) while a biocompatible glue (N-Butyl-2-Cyanoacrylate-Glubran2 ®) was applied to treat the comminute fractures of the anterior wall of the maxillary sinus. Results and Conclusion: The aim of our article is to report our experience and a review of the literature on application of-Butyl-2-Cyanoacrylate for treatment of comminute fractures of the anterior wall of the maxillary sinus. According to the results achieved in our study the N-Butyl-2- Cyanoacrylate can be indicated to treat comminuted fractures of the anterior wall of the maxillary sinus which could not easily be treated with internal rigid fixation. © The Association of Oral and Maxillofacial Surgeons of India 2015.

This study compared extracapsular dissection (ED) vs superficial parotidectomy (SP) in the treatment of pleomorphic adenoma and benign parotid tumors.

Even after a well-executed rhinoplasty, small dorsal irregularities are not uncommon. Many materials have been used for camouflage, including autologous, homologous, and alloplastic materials. We used an equine pericardium membrane in 33 postrhinoplasty patients to prevent or correct nasal dorsal irregularities. The membrane promotes a local fibrous reaction, which leaves a uniform connective layer. In our hands, equine pericardium membrane seems to be a useful material for rhinoplasty refinements.

Temporal depression after temporalis muscle flap transposition is characterized by a concavity of the soft tissue and associated with the relief of the orbital rim and zygomatic arch. The purpose of this study was to describe the use of autologous fat grafting for the treatment of postsurgical temporal contour deformities.

Trismus-Pseudocamptodactyly Syndrome (TPS) is a rare autosomal syndrome characterised by the inability to open the mouth fully, pseudocamptodactyly, short stature and foot deformities. The maxillofacial feature entails hyperplasia of the coronoid processes which mechanically interfere with the zygomatic processes during mouth opening.

The inclusion of maxillary canines is a very common condition. The intraoral approach to the canine extraction can be buccal or palatal depending on the position of the tooth. However, in some cases, the proximity to the nasal floor or the side wall of the nose makes the transoral approach rather invasive. The aim of this article was to describe a novel transnasal endoscopically assisted approach for the extraction of high palatal/paranasal impacted canines. Thirty-seven maxillary canines have been extracted in 29 patients. The surgical approaches were buccal in 5 cases, palatal in 24 cases, and transnasal endoscopically assisted in 8 cases. Patients treated with the transnasal approach required the least amount of pain killers in the postoperative period, and the average of the operative time was shorter than that of the transoral extraction. In our opinion, the transnasal endoscopically assisted approach is a safe and effective procedure for the extraction of highly impacted maxillary canines located within 2 cm from the piriform aperture.