In most cases of monostotic or monofocal fibrous dysplasia of the craniofacial region, modern surgical techniques allow an aggressive but definitive treatment with good functional and aesthetic results. The authors perform radical treatment even in cases involving the maxilla and mandible, and prefer a conservative approach only in polyostotic cases and McCune-Albright syndrome.

The aim of our study was to demonstrate the role of certain risk factors in reconstructive head and neck surgery with free flaps. The data taken from the charts of all patients who received free flap for head and neck reconstruction in our department between January 2001 and December 2004 were analyzed. We evaluated the association of preexisting risk factors with the onset of surgical complications such as orocutaneous fistulae, flap infections, hematomas, thrombosis, and necrosis. One hundred and twenty-two free flaps have been used for the reconstruction of head and neck area in 118 patients. Preoperative risk factors included smoking habit (77 patients), alcohol use (6 patients), hypertension (9 patients), diabetes mellitus (8 patients), family history positive for vascular disorders (27 patients), and hypercholesterolemia/hypertriglyceridemia (5 patients). The percentage of full flap survival was 95.08%. Statistical analysis showed that diabetes mellitus (P < 0.01) is significantly associated with a negative prognosis for free flap reconstructive operation, whereas a smoking habit seemed to be at the verge of statistical significance. Therefore, our current practice is to prefer as much as possible the use of local flaps as opposed to free flaps in the reconstruction of head and neck defects in diabetic patients.

Abrikossoff's tumor is a disease that more commonly affects the oral cavity but can also occur at other sites. It develops between the second and sixth decades of life, more frequently among women and blacks. The neoplasm can affect all parts of the body. The head and neck areas are affected in 45% to 65% of cases and of these, 70% are located interorally (tongue, oral mucosa, hard palate). The benign form shows polygonal cells with granular, eosinophilic cytoplasm and small nuclei. The malignant form, however, is associated with a high mitotic index and pleomorphic cellular tissue. The clinical aspect of the neoformation is a swelling covered by mucus of normal appearance. Studies of the neoformation show that in addition to the objective examination, further instrumental research is necessary, i.e., with nuclear magnetic resonance or computed tomography with contrast CT scan. However, the only examination that can confirm the clinical diagnosis is the histological examination. The only treatment for Abrikossoff tumor is surgery. The surgical treatment provides for an extirpation of the neoformation with the overhanging mucus and the underlying periosteum. In this work, the authors discuss a case of Abrikossoff tumor affecting the mucus of the right side of the hemipalate in a 53-year-old patient and present a review of the literature.

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Orbital blow-out fractures reconstruction aims to restore the continuity of the orbital floor, to provide support of orbital contents and prevent soft tissues' fibrosis. Different materials have been tested over the years to reach this purpose. Traditionally, autogenous grafts have been used as the material of choice; in recent years alloplastic materials have gained popularity because of their availability and ease of use. The purpose of this study was to review materials used in orbital floor reconstructive surgery at the Department of Maxillo-Facial Surgery of University of Rome "La Sapienza", with emphasis on their biocompatibility, their shaping features, and mechanical properties. This report presents the results obtained by the application of these products on 379 patients who underwent surgical treatment for blow-out fractures from 1995 to 2003: the diagnosis of fracture of the orbital floor was based on clinical symptoms and CT axial scanning through coronal reconstruction. Follow-up period spanned from 1 to 8 years.

Although the fibula flap and the deep circumflex iliac artery flap remain the first choice for bone reconstructions of the mandible and maxilla, the scapula flap has some features that make its use extremely advantageous in some circumstances. In particular, we advocate the use of the osteomuscular latissimus dorsi-scapula flap for reconstruction of large-volume defects involving the bone and soft tissues, whereas fasciocutaneous parascapular flaps represent a valid alternative to forearm flap and anterolateral thigh flap in the reconstruction of soft tissue defects.

Objective. The acronym MRONJ has been created in order to identify “Medication-Related Osteonecrosis of the Jaw,” observed after the use of Bisphosphonates, RANK ligand inhibitor, and antiangiogenic medications. Only a case of osteonecrosis of the jaw in a Chron's disease patient following a course of Bisphosphonate and Adalimumab therapy has been recently described, so that it has been supposed that also this medication could promote manifestation of osteonecrosis. Clinical Case. On August, 2014, a 63-year-old female with a history of idiopathic arthritis treated with medical treatment with Adalimumab from 2010 to 2013 presented referring pain in the right mandible. Results. This patient presented with nonexposed osteonecrosis of the jaw after placement, on September, 2010, of four titanium fixtures in the mandible. Conclusions. The authors suggest that the biologic therapy with an anti-TNF-α antibody might promote the manifestation of osteonecrosis and compromise oral healing capacity of the bone.