Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.
Orbital fractures can lead to esthetic deformities and functional impairments, and adequate surgical timing is considered important in obtaining good results from surgery. By means of chart review, a retrospective analysis was carried out in 108 consecutive cases of pure orbital fractures to investigate the differences in surgical timing and the correlations with patient age and clinical and radiographic findings. In this analysis, surgical timing of pure orbital fractures was strongly related to the combination of parameters such as anatomical location of the fracture, eventual exposure of the fracture, cerebrospinal fluid (CSF) leakage or penetrating wounds, age of patients, eventual functional impairments or muscle entrapment, and serious conditions of compression or ischemia. As the data confirmed, an urgent approach was considered indispensable in severe orbital apex fractures and in orbital fractures with CSF leakage, penetrating objects, or exposure. Early surgery was necessary within 3 days in children with diplopia (type IIIb) and mainly within 7 days in adults with double vision (type IIIa). Delayed surgery, within 12 days in all cases, was performed orbital wall fractures with no impairments (type II) or in orbital rim fractures (type I). Data from this retrospective analysis confirm the need for an aggressive approach to all orbital fractures. In our experience, surgery was performed within 12 days and most orbital fractures were treated during the first week after trauma, which is earlier than previously reported.
BackgroundDuring the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures.MethodsWe used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded.ResultsOf the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures.ConclusionThe topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures.
In the last 5 years, many studies about autogenous platelet-rich plasma have been undertaken pointing out its regenerative and reparative properties on tissues. The features of this product are an attribute of platelet cells, which, after cellular interactions, release growth factors. These molecules promote tissue healing and also induce cellular regeneration. Bone is a dynamic tissue subject to balanced processes of bony formation and reabsorption; autologous platelet gel or concentrate (PRP) can be used alone or in association with bony graft for the treatment of bony defect, cystic lesions, alveolar bone defects, and periodontal pockets. Its application fields are oral and maxillofacial surgery, plastic surgery, and general surgery, and it can be applied particularly in patients with coagulation diseases. In our experience, a giant cystic lesion of the jaw was treated with PRP and granules of bovine-derived hydroxyapatite xenograft to enhance bony regeneration and promote tissue healing.
The improvement in the knowledge of the main anatomical landmarks permits an evolution in the safety of the surgical treatment and a conceptual development of the geometrical anatomico-surgical characteristics of the infratemporal fossa. This conceptual evolution determines surgical and oncological advantages: firstly, improved comprehension of the anatomico-surgical limits of the resection and secondly the safeguarding of the oncological "en-bloc" dissection. The lateral approach of the infratemporal fossa gives a wider exposure of the surgical field, a shorter depth of work, a good control over the vessels and the possibility of carry out a microsurgical transfer. The surgical approaches correspond to the topographical location and the biology of the neoplasm in cases with infratemporal fossa and inferior compartment location the lateral transfacial approach is indicated. In cases with involvement of the superior compartment a lateral transcraniofacial subtemporal approach is necessary in order to remove the skull base. In cases with a neoplastic invasion of the skull base where the dura mater is the anatomical plane free from disease it is necessary to utilize an intradural approach. In patients with a secondary spread into the inferior compartment from the maxilla a combined antero-lateral transfacial approach is indicated. Finally, an orbitomaxillary involvement with secondary spread in the upper compartment of the infratemporal fossa necessitates an antero-lateral transcraniofacial subtemporal subfrontal approach.
Teamwork between neurosurgeons and head and neck surgeons has increased the possibility of managing tumours involving the skull base. The authors distinguish the anterior half of the skull base into a median and two lateral portions and describe the surgical approaches utilized to expose it. The authors present their clinical experience in 27 patients with extensive lesions of the anterior half of the skull base and their results.
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