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Purpose: the purpose of this study was to retrospectively analyze the clinical records of patients admitted for maxillo-facial fracture to 18 Italian center, evaluating the epidemiological differences between the different phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery deparments in Italy, from February 23, 2020 to February 23, 2022. According to the date of admission, all the data were stratified in four chronological periods encompassing the four different moments in terms of restriction in Italy: pre-pandemic, first wave, partial restrictions and post-pandemic groups. Differences in epidemiological data between the groups were analysed. Results: 2,938 patients were included. There was a statistically significant difference in the cause of hospitalization between pre-pandemic and first wave groups (p=0.005) and between pre-pandemic and partial restriction groups (p=0.002). The differences between the pre- and post-pandemic groups where instead not significant (p=0.106). Compared to the pre-pandemic period, the number of Black patients was significantly higher during the first wave and the post-pandemic period. Differences between the periods in terms of gender, age, type of fracture, treatment modality, and length of hospital stay were not found to be statistically significant. Conclusions: during the COVID-19 pandemic there have been profound changes in the epidemiology of fractures influenced by the restrictive measures implemented by the government. At the end of the pandemic, the epidemiology of fractures returned to being the same as in the pre-pandemic period.Purpose: the purpose of this study was to retrospectively analyze the clinical records of patients admitted for maxillo-facial fracture to 18 Italian center, evaluating the epidemiological differences between the different phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery deparments in Italy, from February 23, 2020 to February 23, 2022. According to the date of admission, all the data were stratified in four chronological periods encompassing the four different moments in terms of restriction in Italy: pre-pandemic, first wave, partial restrictions and post-pandemic groups. Differences in epidemiological data between the groups were analysed. Results: 2,938 patients were included. There was a statistically significant difference in the cause of hospitalization between pre-pandemic and first wave groups (p=0.005) and between pre-pandemic and partial restriction groups (p=0.002). The differences between the pre- and post-pandemic groups where instead not significant (p=0.106). Compared to the pre-pandemic period, the number of Black patients was significantly higher during the first wave and the post-pandemic period. Differences between the periods in terms of gender, age, type of fracture, treatment modality, and length of hospital stay were not found to be statistically significant. Conclusions: during the COVID-19 pandemic there have been profound changes in the epidemiology of fractures influenced by the restrictive measures implemented by the government. At the end of the pandemic, the epidemiology of fractures returned to being the same as in the pre-pandemic period.

The frontal sinus is one the most complex of the paranasal sinuses, its proximity to the cranial vault and the orbit cause that frontal sinus pathologies can progress to involve these structures and lead to significant morbidity, or even death. Surgical management of the frontal sinus is technically challenging, the most commonly used surgical approaches are coronal, butterfly, gullwing and suprabrow. The purpose of this article is to propose the C-S approach, an interesting alternative to the gullwing approach for the managing of median and paramedian frontal sinus lesions or isolated displaced fractures of the anterior wall. The main advantage of this technique is represented by the fact that it follows the new tension lines described in the literature, a curved vertical line that follows the glabellar frown.

Osteonecrosis of the jaw (ONJ) is an adverse effect of bisphosphonate treatment that has become the subject of increasing investigations, in particular due to its poorly understood pathogenesis. Several experimental studies on animal models have been conducted; however, the majority of these replicate human ONJ following tooth extraction, and describe alterations in the bone and gingival epithelium when necrosis is manifested. The aim of the present study was to analyze the rat mandibular bone and gingival epithelium during 45 days of zoledronate treatment (which is a bisphosphonate agent), without tooth extraction. Intraperitoneal injections of zoledronate acid (0.1 mg/kg) were performed three times a week in normal male Wistar rats (n=20), while a control group of rats (n=20) was treated with saline solution for 45 days. After 7, 15, 30 and 45 days of drug treatment, all rats were sacrificed and hematoxilin and eosin staining, immunofluorescence and scanning electron microscopy analyses were performed. The results of the analyses after 7 and 15 days of treatment were similar in the treatment and control group. After 30 and 45 days of treatment, structural alterations were observed in the bone. No structural alterations to the gingival epithelium were observed. Based on these results, it was hypothesized that low doses of zoledronate act directly on the bone tissues to induce morphological alterations from bone to necrotic tissue following surgical procedures, although no cytotoxic effects were detected in the gingival epithelium.

We evaluated, by means of a non-invasive procedure based on MRI, the masticatory muscular microstructure in a 55-year-old-female patient affected by bruxism. The patient underwent MR examination before and after 1 month of splint therapy, when she mentioned the complete disappearance of all symptoms. By means of diffusion tensor imaging we observed changes at microstructural level of masticatory muscular complex. We conclude that diffusion tensor imaging may be a useful instrument both to perform panoramic reconstruction of the masticatory muscle complex and to investigate microstructural modifications related to the pain relief in bruxism.

To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and masseter muscle by using diffusion tensor Imaging on two patients affected by mandibular asymmetry.Two female patients with mandibular excess and asymmetry who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were recruited for this study. Morphological (TDiffusion tensor imaging was able to identify the muscle geometrical morphology and diffusion microstructural changes. Both at T0 and T1, mean FA values had no significant differences between the right and left side of masseter (at T0: p = 0.91; at T1: p = 0.54) and LPM (at T0: p = 0.92; at T1: p = 0.43), respectively. Both patients reported a significant improvement in FA mean values of the left LPM (p = 0.03) between T0 and T1, whereas no diffusion parameters' changes were observed for the bilateral masseter muscles and right LPM.We found that after the surgery the LPM ipsilateral to the deviation side showed a significant increase of FA compared to the baseline. Although preliminary, our findings suggest that diffusion tensor imaging may represent a promising tool to investigate non-invasively the masticatory muscles in temporomandibular joint disorders.

Bone graft are used in dentistry for the reconstruction of severely atrophic jaws. Fresh frozen bone has no osteogenic property but it has osteoconductive and osteoinductive properties because its matrix contains growth factors such as vascular endothelial growth factor. The purpose of the present study was to evaluate morphological and protein expression characteristics of fresh frozen bone before graft and after six months of graft in patients who needed maxillary reconstruction. After 6 month of graft we observed the presence of viable bone as evidenced by full osteocyte lacunae and by the presence of RANKR, osteocalcin positive cells and vascular endothelial growth factor. In conclusion, our findings show that the fresh frozen bone after six month of graft is for the most part viable bone, encouraging its use as an alternative to autogenous bone for reconstructing maxillary bone defects prior to implant.

Pseudoaneurysm of the internal maxillary artery due to a traumatic event is a rare condition. Pseudoaneurysms are usually directly produced by arteries break with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Then, this sac gradually expands and can be damaged. It is rare to see pseudoaneurysms of IMA. They are usually associated with fracture of the neck of the mandible. To the best of our knowledge the pseudoaneurysm of the internal maxillary artery related to maxillofacial trauma is an event extremely rare in the literature and if not quickly managed can lead to the patient’s death. This case underlines how the close cooperation between surgeons and radiologists results in a quick diagnosis and management of such pathological events.

Rhabdomyomas are rare benign mesenchymal tumors distinguished in cardiac and extracardiac forms. Extracardiac rhabdomyomas are classified as adult type, fetal type, and the genital type. Adult extracardiac rhabdomyomas are mostly found in the head and neck and usually present a slow growth. We report a case of a patient with a manifestation in the submandibular and sublingual glands.

In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation.From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture.Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope.The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application.

Primary paranasal sinus lymphoma is a rare presentation of extranodal non-Hodgkin lymphoma. It is less aggressive and carries a relatively better prognosis. We describe a patient with diffuse large B-cell lymphoma of the left ethmoido-orbital region.

L Catalfamo,1 E Belli,2 C Nava,1 E Mici,1 A Calvo,1 B D'Alessandro,1 FS De Ponte1 1Unit of Maxillofacial Surgery, University of Messina, Azienda Ospedaliera Universitaria, Policlinico G Martino, Messina, Italy; 2Unit of Maxillofacial Surgery, University Rome Sapienza, Azienda Ospedaliera Sant Andrea, Rome, Italy Background: To date, there are no studies reported in the literature on the possible use of bovine collagen, oxidized regenerated cellulose, or synthetic hyaluronic acid medications in the oral cavity. The aim of this paper is to report the use of bovine collagen, oxidized regenerated cellulose, and synthetic hyaluronic acid medications to improve wound healing in the oral cavity by stimulating granulomatous tissue. Methods: From 2007 to 2011, 80 patients (median age 67 years) suffering from oral mucosal lesions participated in this double-blind study. The patients were divided into two groups, each consisting of 40 patients. One group received conventional medications, while the other group of patients were treated with the advanced medications. Results: Advanced medications allowed re-epithelialization of the wound margin in 2–20 days, whereas patients receiving conventional medication showed a median healing duration of 45 days. Conclusion: The results of this study demonstrate that treating oral mucosal wounds with advanced medication has an advantage with regard to wound healing time, allowing patients to have a rapid, functional, and esthetic recovery. Keywords: bioengineering, oral cavity, mucosal recovery

Osteonecrosis of the jaw is an adverse outcome associated with bisphosphonate treatment. Bisphosphonates are used in conjunction with antineoplastic chemotherapy for the treatment of hypercalcaemia associated with malignancy, lytic bone metastasis and multiple myeloma. However, it is not known if the osteonecrosis of the jaw lesion originates in the bone or whether it initiates in the gingival epithelium. Two bisphosphonates are commonly used in cancer treatment. One of these is pamidronate disodium, a second-generation bisphosphonate that differs from the first-generation drug because it inhibits bone resorption at a dose that does not affect bone mineralization. The other widely used BP, zoledronate, is a third-generation drug that is the most potent bisphosphonate in clinical use, showing strong anti-osteoclastic activity, similar to pamidronate. The aim of the present study was to evaluate the modifications of human oral mucosa and underlying bone in patients after treatment with these nitrogen-containing bisphosphonates for 24 and 36 months. We analyzed the structural damage of the oral mucosa and damage of the perilesional mandibular bone observing possible correlations from them. Our results allow to express two hypotheses about the mechanism responsible for these results relating to mandible matrix necrosis; first, an increased skeletal microdamage associated with turnover suppression occurred early in treatment and progress with longer treatment duration, second, opening damage in osteonecrosis of the jaw modifies structural morphology of gingival epithelium.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but potentially severe condition, and the etiopathology and risk factors are poorly defined. The American Association of Oral and Maxillofacial Surgeons position paper on BRONJ update 2009 remarks all the risk factors of developing BRONJ. Local anatomy such as lingual tori, mylohyoid ridge or palatal tori, and areas with thin mucosa overlying bony prominences represent some of these local factors. We have recently treated a patient presenting a mandibular osteonecrosis involving a rigid miniplate which had been placed 18 years ago during a surgical excision of a radicular cyst. The patient, a 70-year-old female, did not show any other risk factors which could expose her to BRONJ, such as cortisone therapy, head and neck radiotherapy, chemotherapy, periodontal disease, or other.

Lymphangioma is a benign, hamartomatous tumor of the lymphatic channels. It is usually found in the head and neck region. Most lymphangiomas are present at birth and are usually diagnosed in infancy or early childhood. When lymphangioma occurs in the mouth, the anterior two thirds of the tongue is the most commonly affected region. A risk of secondary growth is classically described after surgical reduction. In this paper, we present 9 cases of tongue lymphangioma. We provide a literature review of tongue lymphangioma.

Major surgery in BIONJ should be considered only for patients with stage III disease and large lesions. In this chapter, the characteristics of patients who are candidates for major surgery are described. We also discuss the methods used in jawbone resection, reconstruction of secondary defects, and the resolution of complications in advanced-stage disease.

Schwannomas are peripheral nerve sheath tumors. Approximately 25% of extracranial schwannomas are located in the head and neck district, but only 1% shows an intraoral origin. We report a case of a 28-year-old patient with a tongue schwannoma. Morphologic analysis and immunohistochemical findings strongly support the diagnosis. Surgical treatment is discussed.

Osteonecrosis of the jaw (ONJ) is an adverse outcome associated to bisphosphonate treatment. However, it is not known whether the ONJ lesion originates in the bone, or whether it may initiate in the oral mucosa. The aim of our study was to evaluate the pattern of basal lamina of oral mucosa after bisphosphonate administration and to analyze the structural damage of the mucosa in ONJ patients, and in subjects treated with bisphosphonates without osteonecrosis. By immunohistochemistry, we evaluated changes in basement membrane by expression of signalling proteins, laminin, and type IV collagen. All tested proteins were almost absent in basal lamina and mucosa of subjects treated with bisphosphonates without osteonecrosis, whereas in mucosa of patients with ONJ, they showed a clearly detectable pattern of the same proteins, specifically in basal lamina, but less in comparison to control samples. Moreover, in pathological mucosa, the clearly detectable staining pattern for VEGF indicated a massive neoangiogenesis. Bisphosphonates induce changes in expression of proteins also in oral mucosa. The increase of these proteins in basal lamina, and the neo-angiogenesis, concomitant with formation of the lesion, could indicate a compensative behaviour in the remodelling of the gingival mucosa in order to restore the epithelial architecture.

Intraosseous mandibular artero-venous malformations (AVMs) are rare (5% of all vascular malformations) but of great clinical importance. They can lead to dental emergencies and may cause disfigurement, morbidity, and even death. We describe the radiological appearance and the endovascular treatment of a rare high-flow vascular malformation of the mandibular body resembling a dental cyst, embolized by Guglielmi's detachable coils (GDC).

The authors report the case of a patient who sustained a complex craniofacial trauma secondary to a recreational fireworks blast. Initial assessment and management were performed with a multidisciplinary approach to achieve control of cerebral hemorrhage, debridement of wounds and brain, isolation of the brain from the external environment, reconstruction of the cranial base floor, and orbital and facial reconstruction. Modification of multiple conventional approaches, along with a multispecialty surgical team, were used to deal effectively with this unusual patient who was treated by single-stage immediate management. Reconstruction of both the intracranial and extracranial compartments was considered successful with a satisfactory cosmetic result. Language: en

Excision of neoplasm and trauma involving the anterior cranial base may often result in communication between the intracranial and extracranial compartments. Many techniques have been proposed to obtain a watertight separation. We report our 5 years of experience in the management of anterior skull base defects using a galeal-pericranial flap. Between January 2001 and April 2006, 22 patients were treated for a cranial base reconstruction at the University of Messina. Five of them presented with persistent cerebrospinal fluid (CSF) leak after previous craniofacial trauma. Ten underwent a combined maxillofacial-neurosurgical approach for the removal of a benign tumor involving the anterior skull base. Seven had severe craniofacial trauma, which required an intervention of reconstruction of the anterior skull base. In the whole series, a galeal-pericranial flap was used to separate intra- and extracranial compartments. No patients developed postoperative brain contusions or subdural-epidural blood collections. Throughout the follow-up period, there was no evidence of flap failure. In all but one patient, no postoperative CSF leak was evident. In one patient, a mild transient postoperative CSF leakage was present. There has been no recurrent CSF leak or meningitis. The follow up average of 23 months shows no incidence of infection. Even if our series does not comprise malignancies and previously irradiated patients, our data confirm the validity of the galeal- pericranial flap for the surgical management of minimal and moderately sized defects of anterior cranial base.