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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.

Le asimmetrie maxillo-mandibolari riconoscono numerose eziologie: congenita, traumatica, iatrogena e post resezione oncologica. I pazienti affetti da malformazioni congenite vengono generalmente sottoposti a chirurgia ortognatica con o senza procedure aggiuntive (genioplastica, impianti alloplastici) con risultati soddisfacenti. Tuttavia, nonostante il raggiungimento della simmetria scheletrica può esitare una asimmetria residua più o meno evidente. Lo studio presentato è stato effettuato su 45 pazienti (29 femmine e 16 maschi), trattati chirurgicamente tra Dicembre 2012 e Giugno 2014. Tutti i pazienti erano affetti da asimmetria maxillo-mandibolare e sono stati sottoposti a chirurgia ortognatica per la correzione ossea della deformità. Le alterazioni residue sono state trattate con lipofilling. In tutti i casi si è osservato un buon attecchimento del grasso a livello del sito ricevente. L’analisi retrospettiva della documentazione fotografica ha dimostrato un progressivo decremento dei volumi raggiunti in seguito al trattamento con lipofilling fino a sei mesi dalla procedura, dopodiché i volumi sono rimasti invariati. Non sono state riportate complicanze significative sia a livello del sito donatore sia del ricevente. Un lieve edema ecchimotico è stato osservato frequentemente nella prima settimana post-operatoria, non sono stati riportati casi di ematoma, infezioni, danni nervosi o vascolari. 24 pazienti hanno avuto necessità di ulteriori applicazioni, una seconda applicazione si è resa necessaria in 22 pazienti ed una terza in 2 pazienti. (totale di 69 procedure). Sulla base dei risultati di questo studio la metodica del lipofilling si è dimostrata semplice, efficace e facilmente riproducibile, mostrando un alto indice di soddisfazione da parte dei pazienti e una scarsa incidenza di svantaggi e complicanze. Abbiamo inoltre dimostrato come il successo del riempimento con grasso autologo sia dipendente dalla subunità del viso che viene trattata. Le regioni malare e della guancia hanno mostrato i migliori risultati mentre le subunità corrispondenti al labbro inferiore e superiore hanno mostrato uno scarso attecchimento del grasso innestato, con una conseguente maggiore perdita di volume. In conclusione si può dire che le procedure composite, che prevedono l’utilizzo congiunto della correzione chirurgica delle basi scheletriche e un successivo ritocco per mezzo di innesto di grasso autologo, costituiscono una opzione addizionale e personalizzabile per i pazienti affetti da malformazioni maxillo-mandibolari.

Background A cooling system based on polyurethane preshaped masks for postoperative cryotherapy, named Hilotherm, has been recently introduced. The purpose of this study was to evaluate the effectiveness of this equipment in controlling postoperative edema and compare the results with those obtained with a group treated with conventional cryotherapy and a group not treated with cryotherapy. Methods Ninety patients were included in this randomized controlled trial. The 90 patients were divided into 3 groups. Group A was treated with Hilotherm. Group B was treated with conventional cryotherapy. Group C was not treated with cryotherapy. Using a tape measure, we measured for both sides of the face the distances in centimeters between point 0 and external canthus ([alpha]), most lateral point on the ala of the nose ([beta]), commissura labialis ([gamma]), and Pos ([delta]). We performed a Kruskal-Wallis test comparing the average variation of edema on the right and left sides of the face for each facial segment of patients of the 3 groups from time 0 to time 24 hours. Results No cryotherapy is the worst treatment for every segment studied. In anatomic regions defined [beta], [gamma], and [delta], Hilotherm was more effective in containing edema than the ice pack 24 hours after the first measurement. Opposite results were seen on district [alpha], the site not completely enclosed in the mask. Conclusions The substantial difference between different treatments probably consisted in the greater reliability of the Hilotherm system, which is characterized by easy handling, constant temperature control, comfort, and practicality of the masks.

Loss of autofluorescence as an early phenomenon as- sociated with tissue degeneration seems to be promising for the diagnosis of oral cancer. The method seems to make visible early structural and biochemical alterations of the oral mucosa not always evident under direct inspection of the oral cavity. For this reason, the margins of the mucosal lesions usually appear wider compared with direct visualization. Actual extension of the potentially malignant lesions must be precisely perceived to avoid any underestimation of the tumor. In this study, 32 patients at risk for oral cancer underwent autofluorescence test. Of these patients, 12 (group A) experienced potentially malignant diseases. The other 20 patients (group B) were previously operated on for oral cancer. In addition, 13 patients showed loss of autofluorescence (8 patients from group A and 5 patients from group B). Among these 13 patients, 12 were affected with lesions of relevance (in group A, 6 had squamocellular carcinoma and 2 had low-grade dysplasia; in group B, 2 patients had high-grade dysplasia, 2 had low-grade dysplasia, and 1 had an epithelial hypertrophy with inflammatory cells). Preliminary results seem to indicate that autofluorescence is a high-performing test for the individuation of oral cancer in populations at risk (sensibility up to 100% and specificity up to 93% in this study).

A reliable method for precise identification of the dominant perforator would be extremely valuable in perforator flap surgery. During the past 5 years, multidetector-row computed tomography has demonstrated excellent results in preoperative planning of abdominal free flap breast reconstruction, significantly reducing operative time and complications. The main drawbacks of computed tomography are unnecessary radiation to the patient and possible allergic reactions to intravenous contrast material. To circumvent these limitations, we performed noncontrast magnetic resonance imaging for abdominal perforator mapping. The aim of our study was to assess the accuracy and reliability of this technique in preoperative planning of breast reconstruction with deep inferior epigastric artery perforator flaps. From October 2007 to February 2009, noncontrast magnetic resonance preoperative mapping was performed in 56 female patients who underwent breast reconstruction after mastectomy with deep inferior epigastric artery perforator flaps. Imaging results were compared with the intraoperative clinical findings in all patients. Preoperative magnetic resonance imaging without the contrast showed no false-positive or false-negative results. In all cases, the perforator chosen as dominant according to magnetic resonance images corresponded with the perforator chosen intraoperatively (100% predictive value). Preoperative imaging techniques make perforator flap surgery safer for the patient. Noncontrast magnetic resonance imaging provides reliable information on the vascular anatomy of the abdominal wall, facilitating selection of the most appropriate deep inferior epigastric artery dominant perforator. It avoids radiation to the patient and also the need for intravenous contrast medium as required for the multidetector-row computed tomography. In our opinion, noncontrast magnetic resonance imaging is an ideal method for preoperative planning of breast reconstruction with deep inferior epigastric artery perforator flaps.

The objective of this study was to assess the reconstructive options after radical, extensive vulvectomy; relate them to tumor characteristics; and select a choice of flaps able to correct every remaining defect. This study is a retrospective review of a 4-year experience with 31 flaps in 20 consecutive vulvar reconstructions. Three of the 31 flaps presented nonsignificant delayed healing at their tips and 3 other flaps developed a major breakdown related to an infection or an error in flap planning. According to the authors, the size of the defect is the main issue that must be taken into consideration during the establishment of reconstructive needs. Closure of vulvar defects is preferably performed using fasciocutaneous flaps, which are very reliable flaps and can be raised with different techniques to meet different needs. A flap is then chosen with the fewest potential complications. An algorithm has been thus established: Small to medium-size defects are closed with island V-Y flaps, island gluteal fold flaps, or pedicled pudendal thigh flaps. Among them, the island V-Y flap is the workhorse flap for vulvar reconstruction because of its versatility, reliability, and technical simplicity compared with its very low complication rate. If the vulvar defect is large and/or reaches the vulva-crural fold, V-Y flaps are also preferred to close these large and posteriorly extended excisions. If the vulvar defect is very large, extending both anteriorly and posteriorly, the use of a distally based, vertically oriented rectus abdominis muscle flap is recommended. Using this algorithm, immediate vulvar reconstruction with pedicled local or regional flaps can be performed easily and reliably.

We suggest a new solution for the problem of wearing eyeglasses after rhinoplasty. We present an original eyeglasses model that enables to avoid pressure on the nasal bridge. In contrast to other tools suggested in previous reports, our device is small, very light, comfortable and pleasant for the patient, allowing at the same time a clear vision. We strongly recommended the use of our device to solve the problem of wearing eyeglasses during the post-operative period of nose surgeries.

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.From January 2008 to January 2011 in the Department of Maxillofacial Surgery of Complesso Integrato Columbus of the Università 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.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.

Background 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. Methods Between March 2008 and April 2011, 45 patients were treated with lipofilling. A virtual 3-dimensional preoperative assessment was used to objectively quantify the loss of volume of the affected side. Two different methods were used to evaluate the surgical outcomes. Results A noticeable soft tissue augmentation of the temporal region was noted in all cases. In 35 patients, a second procedure was required and in 1 patient, a third procedure was required. The final result was assessed as fully satisfactory by 39 patients (86.6%), as satisfactory by 5 patients (11.1%), and as unsatisfactory by 1 patient (2.2%). Conclusion We believe that structural fat grafting at the temporalis muscle flap donor site is an effective technique that provides a high satisfaction rate and only a few complications. © 2013 Wiley Periodicals, Inc. Head Neck 36: 1296–1304, 2014

The aim of the current study was to appraise the effectiveness of distraction osteogenesis combined with bilateral 2-step osteotomy for the vertical augmentation of atrophic edentulous mandibles. To verify the predictability of this technique, we evaluated bone density and vertical bone gain of a cohort of 27 patients. The intraoral alveolar distractor was placed in the symphyseal area; then, it was left in situ for 2 months after surgery to consolidate the newly formed bone. A total of 189 implants were inserted. The main complications' issue was tied up to the neurosensory disturbances of the inferior alveolar nerve, which disappeared few months after the surgery.At the end of the distraction osteogenesis, a mean vertical bone gain of 10.5 mm evaluated by comparing preoperative and postoperative computed tomography was reached. Three months after the surgery, the radiologic data indicated that the difference in the mean bone density, recorded in Hounsfield units (HU), between the distracted bone and the preexisting mandibular bone was not statistically significant (P > 0.05). The last measurements done showed that the osseous density in the distraction chamber was higher than the original medullary bone density: the regenerated bones were more dense (876.8 [205.9] HU) than the preexisting medullary bone (312.1 [142.3] HU) and less dense than the preexisting cortical bone (1721.1 [170.4] HU) at the ninth month.In conclusion, this approach appeared to be a viable solution for the improvement of vertical volume in atrophic mandibles.

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.

Nasal deviation plays an important role in plagiocephaly nosography, and it is frequent in plagiocephaly and objectivable both in early treated patients and in those patients who did not undergo any surgical correction.The group analyzed consisted of 12 patients affected by anterior synostotic plagiocephaly. All of them had reached the end of growth. A morphological analysis was made by using anthropometry. All patients were asked to undergo computed tomography, and all the scans were then reconstructed into three-dimensional models using a dedicated software. We made two-dimensional assessments on coronal and axial slices, and three-dimensional reconstruction was used to evaluate the volumetry of ethmoidal cells.From anthropometry, we realized that, in all patients, not only that the tip of the nose is deviated to the not affected side but also that the root itself does not lie on the midline and it is tilted to the synostotic side. Analysis of the computed tomographic scan results shows that the ethmoid bone, as much as the vomer and the upper maxilla, is deeply involved in these nasal abnormalities, presenting a deviated position and an altered development.We concluded that nasal morphology in plagiocephaly is strictly related to basicranium dysmorphism.

The correction of many craniofacial malformations requires the improvement and stabilization of the midface area. In this article, we present a simple surgical technique for improving and correcting the orbitozygomatic area. This technique is called zygomatic sagittal split osteotomy (ZSSO).Between September 2003 and June 2008, we performed ZSSO on 12 patients. The technique is described in the article. We performed a clinical evaluation of the technique using the following criteria: postsurgical complications, loss of stability, and sagittal prominence. In addition, a radiologic evaluation was performed on axial computed tomographic images. We considered a 1-year follow-up.We performed 15 ZSSO procedures. No evidence of postsurgical complications, loss of stability, or sagittal prominence was reported during the 1-year follow-up.Zygomatic sagittal split osteotomy is a simple surgical technique to be used in the correction and stabilization of the midface area. It can be performed without using graft or osteodistraction device.

The antiphospholipid syndrome is a pathological condition characterized by recurrent thrombotic manifestations in venous and/or arterial vascular systems and by peculiar laboratory findings as anticardiolipin antibodies and/or positive lupus anticoagulant. We present a case of massive pedicle thrombosis of a free anterolateral thigh perforator flap used for tongue reconstruction following hemiglossectomy in a patient with antiphospholipid syndrome, which compelled us to an immediate second reconstruction choice with a radial forearm free flap. This case is an example of how this syndrome, especially if unknown before surgery, can influence the outcome of microsurgical transfer of flaps.