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The palatovaginal or pharyngeal artery is a small branch of the internal maxillary artery supplying the nasopharynx. Bleeding from this artery is exceptional and only one case of traumatic epistaxis from this artery has been reported previously. We report a case of a 66-year-old male presenting with right recurrent posterior epistaxis. Endoscopic dissection of the pterygopalatine fossa and direct visualization of the palatosphenoidal canal permitted to identify the origin of bleeding, and coagulation of the pharyngeal artery solved the epistaxis. Although rare, intractable posterior epistaxis may arise from the pharyngeal artery. The anatomical knowledge of this artery and of the palatosphenoidal canal is of outmost importance in endoscopic transpterygoid and nasopharyngeal procedures, to identify the vidian canal, evaluate nasopharyngeal cancer spread in the pterygopalatine fossa, reduce bleeding during surgery of the nasopharynx, and harvest adequately the pedicle of the nasoseptal flap.

PurposeHead and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.Design/methodology/approachThe Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).FindingsThe results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.Research limitations/implicationsWhile the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.Practical implicationsEmploying the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.Originality/valueThere is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.

Background: The first applications of computer-aided design/computer-aided manufacturing (CAD/CAM) in maxillofacial surgery date back to the 1980s. Since then, virtual surgical planning (VSP) has undergone significant development and is now routinely used in daily practice. Indeed, in an extraordinary period, such as that of the current COVID-19 pandemic, it offers a valuable tool in relation to the protection of healthcare workers. In this paper we provide a comprehensive summary of the clinical applications reported in the literature and review our experience using an in-house rapid prototyping technique in the field of maxillofacial surgery. methods: Our research was focused on reconstructive surgery, traumatology (especially in relation to orbital floor and zygomatic arch fractures), and COVID-19 masks. The first step was a radiographic study. Next, computed tomography (CT) scans were segmented in order to obtain a three-dimensional (3D) model. Finally, in the editing phase, through the use of specific software, a customized device for each patient was designed and printed. results: Four reconstructive procedures were performed with a perfect fitting of the surgical device produced by means of VSP. In nine orbital floor fracture cases a good overlapping of the mesh on the orbital floor was obtained. In sixteen zygomatic arch cases the post-operative CT scan showed an excellent fitting of the device and a correct fracture reduction. Regarding the COVID-19 period, six masks and shields produced proved to provide effective protection. conclusions: The timescale and costs required for the production of our &ldquo, home-made&rdquo, virtual design are low, which makes this method applicable to a large number of cases, for both ordinary and extraordinary activities.

Tongue cancers are among the most frequent malignancies in the population and their influence can be affected by many risk factors. Patients undergoing tongue surgery face different complications and can experience a long length of hospital stay (LOS). The aim of this paper is to compare two pharmacological therapies in order to understand which one decreases the LOS. At the University hospital of Naples “Federico II” two antibiotics were employed: Cefazolin plus Clindamycin and Ceftriaxone. Six Sigma methodology was employed to analyse two group of patients treated with these two different antibiotics: 55 patients treated with the antibiotic Cefazolin plus Clindamycin and 66 patients with the antibiotic Ceftriaxone. This is the first time that this methodology is used in order to compare two antibiotics in the oncology field. The results obtained show clearly and with a statistical evidence that patients treated with Ceftriaxone experienced a lower LOS (−28.6% in terms of percentage between medians). Reducing the LOS for patients means limiting the number of complications and, therefore, reducing the hospitalization costs. It would be valuable for both hospital and patients: the former would save money that they could invest in other important care activities; the latter would experience a higher quality of care with fewer complications.

Major salivary gland malignancies are rare, constituting 1%-3% of head-neck tumours. The surgical management of the clinically negative neck (cN0) does not have a univocal consensus yet. We have carried out a retrospective study on 119 cases of malignant parotid tumours that were surgically treated between January 1999 and January 2014. Our aim was to analyse preoperative findings (cytotype, cTNM) and to correlate these with postoperative results (grading, histotype, occult neck metastasis) in patients with parotid tumours to obtain an appropriate indication for neck management. In cN0 patients with a T1, T2 low-grade cancer a wait-and-see approach is preferred. Instead, in cNO patients with high-grade or low-grade T3, T4 tumours an elective neck dissection (END) is always planned. Levels II, III and IV, at least, must be dissected. The decision to dissect level V or I depends on the location of the primary tumour. In the cN0 group 19 of 58 (32.7%) patients who underwent an END had occult metastases. In clinically positive neck (cN+) patients a Modified Radical Neck Dissection (MRND), at least, must be performed. The criteria to add adjuvant radiotherapy (PORT) include deep lobe parotid tumours, advanced lesions (T3-T4), microscopic (R2) or macroscopic (R1) residual disease after surgery, high grade tumours, perineural diffusion, lymph node metastasis, capsular rupture, and local recurrence after previous surgery. Kaplan-Meier analyses have shown a reduction in the overall survival (OS) from 100% to 91% and in disease-free survival (DFS) from 100% to 95.5% for the NO-PORT and PORT group, respectively. In our study, the cN0 pN+ patients had a higher degree of DFS compared to the cN+.

Dysthyroid orbitopathy or Graves’ ophthalmopathy (GO) is an autoimmune disease with a complex pathogenesis that usually occur in patients with hyperthyroidism. Surgical decompression of the orbit is an accepted and validated treatment of thyroid eye disease (TED). This is a case of a patient with left exophthalmos and ipsilateral maxillary sinusitis after 10 years from the surgical bone decompression of the orbital floor for TED.

Orbital cellulitis can be caused by distant infective foci, local spread and surgical procedures. Typical symptoms and signs are conjunctival chemosis, pain, extraocular muscles dysfunction, proptosis and visual impairment; systemic symptoms are fever and general discomfort. Nowadays death is uncommon, due to prompt antimicrobial and surgical management, but loss of vision remains an important cause of morbidity. This article shows the case of a 50-years-old woman referred to the Department of Orbital Pathology of the hospital Polyclinic Federico ii (Naples) with a severe case of odontogenic orbital cellulitis. The orbital infection caused bulbar perforation and endophthalmitis. an evisceration surgery was indicated to avoid a risky sympathetic endophthalmitis. Surgical and medical prompt therapy lead to clinical improvement. Odontogenic orbital cellulitis is a rare, serious infection which can lead to endophthalmitis and visual loss. unfortunately, the dental origin of infection can be missed during the examination. For these reasons, it’s important for the practitioner to consider this source or infection. The management consists of prompt medical therapy, intensive monitoring, cultural exams, serial imaging and proper surgical intervention, if needed. Therefore, early hospitalization and multidisciplinary approach are mandatory.

Hyaluronic Acid (HA) plays many roles in wound healing in general, through different mechanisms. Several authors reported the effectiveness of hyaluronic acid in promoting mucosal healing and reducing discomfort for patients after endoscopic sinus surgery (ESS). Different methods for HA nasal administration have been reported. The aim of our study has been to evaluate the efficacy of the administration of nebulized HA through a nasal douche compared with its administration through a nasal spray with patients undergoing ESS for chronic rhinosinusitis. From January 2013 to January 2019 a prospective clinical trial was carried out in our hospital with 163 patients who had undergone ESS for chronic rhinosinusitis. The sample was divided into three groups according to the method of administration of HA. Our study confirm the efficacy of the administration of nebulized HA through nasal douche in post-operative care (6.5% vs 4.5%). The most relevant data regards the nasal dryness sign: the data revealed an unexpected percentage of worsening of that sign at time T3 (p = 0.049) particularly evident in the patients treated with HA through nasal douche compared to whom the nasal spray device was prescribed (4% vs 1%). Further studies are needed to identify the best means of administration of HA, which would satisfy the requirements for efficacy in terms of the results and, at the same time, patient compliance.

Reconstruction of scalp defects can be performed with local flaps for medium to large defects (2–25 cm2) and microvascular free flaps for extensive full-thickness scalp reconstruction greater than 25 cm2. Doppler flowmetry with its ability to exactly mark the course of arteries on the overlying skin, is a useful tool for the surgical planning of large local flaps. In our retrospective study conducted on 38 patients (all patients had malignancies or post-traumatic scalp defects), consisting of 39 total surgical procedures, we studied the impact of doppler ultrasonic flowmetry in the surgical planning for pedicled flaps in extensive full-thickness scalp reconstruction (>25 cm2) by evaluating overall flap survival rate. Nine different types of local flaps were employed in the scalp reconstruction: Superficial temporal artery (STA) pedicled rotation flap, STA pedicled transposition flap, STA islanded flap, bipedicled STA flap, bipedicled fronto-occipital flap, Supraorbital/Supratrochlear artery rotation flap, Supraorbital/Supratrochlear artery transposition flap, Occipital artery (OA) pedicled rotation flap, OA pedicled transposition flap. Before each surgical procedure a hand held doppler Huntleigh Diagnostic flowmeter with a 8 MHz probe was used to identify and follow the course of the arteries. Flap survival rate was 100%. No postoperative complications related to the flap were reported, while in two patients a partial skin graft failure occurred.

Background In 1908 Sluder described a clinical picture of unilateral facial pain, lachrymation, rhinorrhea and mucosal congestion deriving from the Sphenopalatine Ganglion (SPG) irritation. We described a case of monolateral xerophthalmia, dry palate and mouth, deriving from SPG lesion after septoplasty that we called “SPG Deficit Syndrome”. Methods In our study a woman complaining functional nasal disorders and Computer Tomography (CT) images of a huge condro-vomerian septal spur in right nasal cavity, was underwent to septoplasty. After surgery she complained monolateral xerophthalmia, xerostomia and migraine. Results We formulated hypothesis of parasympathetic postgangliar nerve transmission interruption due to a lesion of effector fibers, supported by post-operative CT images of posterior wall of maxillary sinus lesion and by endoscopic evaluation of dryness of palatal mucosa and right nasal cavity. Conclusion To the best of our knowledge this is the first case of this kind of symptomatology reported as complication after septoplasty.

Osteomas are common benign bone tumors of the skull and facial structures involving primarily the cranial vault, mandible, external auditory canal, paranasal sinuses, nasal cavity, and orbit.1,2 These neoplasms are usually asymptomatic and account for 0.43% of tumor in population with an incidental finding on 1% of radiographs and on 3% of computed tomography (CT) scans. [1] These solid nodular sclerotic lesions usually arise from the outer table and are usually

Pleomorphic adenomas are rounded, lumpy, capsulated lesions that are more common in women. They are typically benign, but can be associated with malignancy in a minority of cases (such as carcinoma ex pleomorphic adenoma), between 3% - 12% of the time, according to available data. The purpose of our study was to evaluate clinical outcomes in patients with benign parotid gland tumours after extracapsular dissection (ECD) or superficial parotidectomy (SP). We made a retrospective study of 297 patients who had had benign tumours of the parotid gland, and had been referred to our department from 2002 - 2016 to have either procedure. We measured the statistical differences between the two techniques (evaluated recurrence rate and complications) with the chi squared test. The chosen level of statistical significance was p