Abstract Introduction Temporomandibular joint ankylosis is a joint disorder due to bone or fibrous adhesion of the joint components that cause loss of function. There are many causes, such as trauma, ...infections and systemic diseases. To date, no uniform treatment protocol has been established. Materials and methods We enrolled in the study patients that underwent single stage alloplastic total joint replacement for complete bony ankylosis. The subjective and objective variables were as follow: TMJ pain, diet, jaw function, quality of life, maximum interincisal opening (MIO) and occlusion. The minimum follow-up was 12 months. Results 12 patients met the inclusion criteria. Six patients underwent bilateral or monolateral total joint reconstruction with stock prosthesis, six patients underwent bilateral total joint reconstruction with custom made prosthesis. The mean preoperative MIO was 7.9 mm. The mean MIO reordered at 12-month follow-up was 26.5 mm (P < 0,0001). The occlusion was unchanged in 9 patients out of 12. In two patients the occlusion was changed by means of custom prosthesis design. In one patient occlusion worsened with less stable functional contact. Quality of life and diet relevantly improved in all cases. Conclusions Single stage resection and reconstruction with total alloplastic TMJ reconstruction is an effective and reliable method to reestablish stable long-term mandibular function in ankylotic patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The possibility of placing dental fixtures in the reconstructed regions allows us to overcome the problems related to dental rehabilitation with removable prosthesis. The aim of this study was to ...assess the clinic-radiological outcome in a series of patients who underwent fibula flap jaws reconstruction and rehabilitation with implant-supported prosthesis with a minimum follow-up of 24 months.
The study included 10 patients who underwent reconstruction with fibula free flap between 2010 and 2018. Albrektsson criteria were used to define the implant survival. The follow-up evaluation was performed according to a standardized protocol including clinical examination, radiological evaluation (panoramic radiograph) and patient interview.
A total of 45 implants were positioned.The time between mandibular reconstruction and implant placement ranged from 13 months to 39 months.The prosthesis used was fixed in 6 cases and supported overdenture in 4 cases.No implant failure was observed.Regarding implant survival no infections were observed in these series. Nine patients out of 10 had no pain and signs of mobility. Seven patients out of 10 had absence of peri-implant radiolucency at the panoramic radiograph.One patient presented with an overgrowth of granulomatous soft tissue around the implant abutments that caused pain.
Implant placed in vascularized bone grafts are a safe and reliable opportunity to rehabilitate patients following mandibular resection. The results of this series demonstrate a high survival rate for implants placed in reconstructed mandibles with an improvement of the quality of life.
Purpose Orbital trapdoor fractures are pure orbital floor fractures with herniation and entrapment of the orbital contents, leading to restricted eye movement and diplopia. Trapdoor fractures in ...children have been discussed widely in published reports; however, the treatment policy and outcome remain controversial, although early treatment has been advocated. Our retrospective study analyzed the long-term results of pediatric patients undergoing surgery for trapdoor fractures to determine the outcome in relation to the type of fracture and the timing and technique of intervention. Patients and Methods The present study included 24 patients (age range 6 to 16 years) who underwent surgery for trapdoor fractures from 1998 to 2007. The demographic, etiologic, radiologic, and surgical findings, interval between trauma and surgery, surgical techniques, and complications were recorded. Diplopia, ocular motility, dysesthesia, and scar quality were recorded at follow-up. Results The follow-up duration averaged 36 months. At follow-up, 1 (8.3%) of 12 patients who underwent surgery within 24 hours (urgent treatment) had residual diplopia. In contrast, 3 (37.5%) of 8 patients who underwent surgery 24 to 96 hours (early treatment) and 4 (100%) of 4 who underwent surgery after 96 hours (late treatment) had diplopia. No sensory deficit of the skin or unesthetic eyelid scar was noted. Conclusions We found a correlation between the outcome and the timing of surgery for trapdoor fractures in the pediatric population. The success rate was significantly better when the fractures were treated within 24 hours of the injury. The results of the present study have strengthened the assertion that trapdoor orbital fractures pose a true surgical emergency.
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GEOZS, NUK, OILJ, SBCE, UL
Abstract Purpose The aim of this study was to evaluate the surgical outcomes using polyetheretherketone (PEEK) patient-specific prostheses produced by computer-aided design and manufacturing for ...primary and secondary reconstruction in patients with craniofacial defects. Material and methods The study included 13 patients who underwent reconstruction for craniofacial defects using PEEK patient-specific implants (PSI). Eight patients underwent single-step primary reconstruction using individual custom-made surgical guides and custom-made prostheses during the same surgery; five patients underwent delayed reconstruction. The material used to manufacture the implants was PEEK in 13 cases. All patients underwent esthetic examination, ophthalmological examination, and radiological evaluation during the preoperative and follow-up periods. The operation duration and short- and long-term complications were recorded. Results The shape and global position of the implants were satisfactory in each case. Fitting of the implant during surgery required extensive adaptation in 1 case and minor in 11 cases. Of 13 implants, 11 adequately restored a morphological complex area with satisfactory cosmetic results. No complications related to the implants were reported. Conclusion Reconstruction for cranio-facial defects using PEEK computer-aided designed and manufactured implants is a promising new technique that allows for accurate restoration of the complex 3D anatomy of the craniofacial region.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
5.
Lingual Squamous-Cell Carcinoma Zavattero, Emanuele; Fasolis, Massimo
The New England journal of medicine,
12/2013, Volume:
369, Issue:
25
Journal Article
Peer reviewed
An otherwise healthy 58-year-old man was referred for the management of painful swelling on the left side of his tongue. A lesion had been growing insidiously for the preceding 8 months, with no sign ...of bleeding.
An otherwise healthy 58-year-old man was referred for the management of painful swelling on the left side of his tongue. A lesion had been growing insidiously for the preceding 8 months, with no sign of bleeding. The patient had been smoking more than 20 cigarettes a day for 26 years. Examination of the oral cavity revealed a vegetative circular mass on the left side of the tongue (measuring 2 cm in diameter) and associated leukoplakia. A biopsy was performed, and histopathological examination revealed squamous-cell carcinoma. The tumor was surgically removed, and the tongue was reconstructed with the use of a . . .
Today, surgical operations are less invasive than they were a few decades ago and, in medicine, there is a growing trend towards precision surgery. Among many technological advancements, augmented ...reality (AR) can be a powerful tool for improving the surgery practice through its ability to superimpose the 3D geometrical information of the pre-planned operation over the surgical field as well as medical and instrumental information gathered from operating room equipment. AR is fundamental to reach new standards in maxillofacial surgery. The surgeons will be able to not shift their focus from the patients while looking to the monitors. Osteotomies will not require physical tools to be fixed on patient bones as guides to make resections. Handling grafts and 3D models directly in the operating room will permit a fine tuning of the procedure before harvesting the implant. This article aims to study the application of AR head-mounted displays (HMD) in three operative scenarios (oncological and reconstructive surgery, orthognathic surgery, and maxillofacial trauma surgery) by the means of quantitative logic using the Quality Function Deployment (QFD) tool to determine their requirements. The article provides an evaluation of the readiness degree of HMD currently on market and highlights the lacking features.
Three-dimensional technologies have had a wide diffusion in several fields of application throughout the last decades; medicine is no exception and the interest in their introduction in clinical ...applications has grown with the refinement of such technologies. We focus on the application of 3D methodologies in maxillofacial surgery, where they can give concrete support in surgical planning and in the prediction of involuntary facial soft-tissue changes after planned bony repositioning. The purpose of this literature review is to offer a panorama of the existing prediction methods and software with a comparison of their reliability and to propose a series of still pending issues. Various software are available for surgical planning and for the prediction of tissue displacements, but their reliability is still an unknown variable in respect of the accuracy needed by surgeons. Maxilim, Dolphin and other common planning software provide a realistic result, but with some inaccuracies in specific areas of the face; it also is not totally clear how the prediction is obtained by the software and what is the theoretical model they are based on.
This report describes a peculiar case of needle breakage during inferior alveolar nerve block to perform third molar extraction that was removed with the aid of a BrainLAB VectorVision ...neuronavigation system. This report adds to the currently limited scientific literature on the image-guided removal of foreign bodies from the oral cavity.
Purpose The aim of this study was to evaluate surgical outcomes using patient-specific prostheses produced by computer-aided design and manufacturing for primary reconstruction in patients with ...benign cranio-orbital tumors. Polyetheretherketone was used to manufacture the implants. Materials and Methods The present study included 3 patients who underwent fronto-orbito-pterional craniotomy using individual custom-made surgical guides. Patient-specific polyetheretherketone prostheses were used for reconstruction during the same surgery. All patients underwent esthetic examination (facial and orbital symmetry, globe projection and position), ophthalmologic examination (diplopia with the Hess-Lancaster test, visual field and acuity), and radiologic evaluations (computed tomography and magnetic resonance imaging) during the preoperative and follow-up periods. Operating time and short- and long-term complications were recorded. Results The immediate and long-term morphologic results were satisfactory; in particular, ocular globe position and projection were correct. After 25 to 31 months, none of the patients developed implant-related complications, such as infection, extrusion, or malposition. Two-year postoperative computed tomograms and magnetic resonance images showed no recurrences. Conclusion Single-step resection and reconstruction with computer-aided designed and manufactured implants is a challenging new technique that decreases operative time and morbidity. The implants adequately restore an anatomically complex area with satisfactory cosmetic results.
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