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.

BackgroundThere have been no quantitative standards for volumetric and surface measurements of the mandibular condyle in Caucasian population. However, the recently developed cone-beam computed tomography (CBCT) system allows measurement of these parameters with high accuracy.MethodsCBCT was used to measure the condylar volume, surface and the volume to surface ratio, called the Morphometric Index (MI), of 300 temporo-mandibular joints (TMJ) in 150 Caucasian young adult subjects, with varied malocclusions, without pain or dysfunction of TMJs.ResultsThe condylar volume was 691.26 ± 54.52 mm3 in males and 669.65 ± 58.80 mm3 in, and was significantly higher (p< 0.001) in the males. The same was observed for the condylar surface, although without statistical significance (406.02 ± 55.22 mm2 in males and 394.77 ± 60.73 mm2 in females).Furthermore, the condylar volume (693.61 ± 62.82 mm3 ) in the right TMJ was significantly higher than in the left (666.99 ± 48.67 mm3, p < 0.001) as was the condylar surface (411.24 ± 57.99 mm2 in the right TMJ and 389.41 ± 56.63 mm2 in the left TMJ; t = 3.29; p < 0.01). The MI is 1.72 ± 0.17 for the whole sample, with no significant difference between males and females or the right and left sides.ConclusionThese data from temporomandibular joints of patients without pain or clinical dysfunction might serve as examples of normal TMJ's in the general population not seeking orthodontic care.

Ameloblastoma, a benign tumor of odontogenic type, represents 10% of all tumors of the jawbone. It is localized in the mandible in 80% of cases and in the upper jaw in the remaining 20%. In every case, the selection of the surgical treatment to be applied must consider some fundamental elements, including the age and general state of health of the patient, the clinicopathological variant, and the localization and extent of the tumor. In addition, it is necessary to evaluate whether the neoplasm to be treated is a primitive lesion or a recurrence. Although ameloblastoma has relative histological characteristics of benignity, this neoplasm has a high percentage of local recurrence and possible malignant development when treated inadequately. The aim of this study was to carry out a follow-up of 60 patients treated for ameloblastoma of the mandible between 1977 and 1998, analyzing the problems faced in removing this benign neoplasm and those concerning reconstruction of the surgical defect.

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.

Twenty-eight patients received surgical treatment for a paranasal sinus mucocele with intracranial and/or intraorbital extension. The lesions were classified by site and extension: anterior without intracranial extension (Type 1), 7 patients; anterior with intracranial extension (Type 2), 11 patients; posterior midline without intracranial extension (Type 3), 5 patients; and posterior with intracranial extension (Type 4), 5 patients. The surgical approaches were: transnaso-orbital, transfrontonaso-orbital, transsphenoidal, transmaxillosphenoidal, and subfrontal transbasal; the choice depended on the site and extension of the lesion, with the aim of securing maximum exposure to ensure total removal of the lesion with its capsule. A transcranial approach was reserved for mucoceles possessing an intracranial extension or causing distension of the bone structures with optic pathway neurological symptoms. With a coronal or transfacial skin incision along the lines of the forehead, nose, and orbital muscles of expression and careful reconstruction, the patients' natural cast of features was spared or restored in a single operation.

Avascular osteonecrosis of the jaw (ONJ) may occur as a consequence of several conditions, even including chemotherapy treatment in patients affected by tumors or osteoporosis. We report our clinical experience in treating bisphosphonate-induced ONJ with a therapeutic methodology that includes ozone therapy as a new and original approach for the clinical management of maxillary necrotic lesions. Of 58 patients with ONJ observed at our department, 33 gave their informed consent to be part of the research and were treated according to a therapeutic approach, which included noninvasive surgery associated with pre- and postsurgical cycles of ozone therapy consisting of eight sessions lasting 3 minutes each besides antibiotic and antifungal therapies. Outcomes showed how ozone therapy increases the benefits of surgical and pharmacologic treatments, increasing the complete healing of the lesions with the disappearance of symptoms and brings cases of lesion progression down to zero. In conclusion, ozone therapy is a reliable presidium in treatment of ONJ; its benefits are remarkable and improve significantly the outcomes of the surgical approach.

Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint as sequela to trauma, infection, autoimmune disease, or failed surgery. Various procedures have been reported for treatment of temporomandibular joint (TMJ) ankylosis; this article aims to describe the diagnostic protocol and the surgical procedures adopted at the department of Maxillo-Facial Surgery of Rome University "La Sapienza". Between 1980 and 2000, 123 patients affected by TMJ ankylosis came under our observation; 60 of them (25 females and 35 males of 30 years average age) underwent surgery; bilateral TMJ ankylosis was observed in 21 cases, right-sided in 20 cases, left-sided in 19 cases. In 12 cases coronoid processes were involved. Etiopathogenesis was traumatic in 48 cases, septic in 5 cases, auto-immune (RA and seronegative spondyloarthropathies) in 5 cases; after block removing, arthroplasty was performed with pedunculated flap of temporal muscle (10 cases), Silastic material (11 cases), or lyophilized dura mater (2 cases). Simple condylar shaving was used in the remaining 36 cases. All patients under treatment showed a distinctive improvement both in articular functionality and symptoms; secondary surgery was necessary in seven cases due to the onset of articular complications from previous surgery. Silastic removal was necessary in five cases due to its inducement of foreign body granuloma. Follow-up was performed at 12, 24, and 48 months and 5 years postoperatively. In our opinion the gold standard surgery of TMJ ankylosis today is represented by shaving of articular surfaces and subsequent arthroplasty with or without temporal muscle myofascial flap interposition, whereas the use of Silastic as alloplastic material could be associated to an increased persistence of the local symptoms and a higher risk of foreign body granuloma and it may favor ankylosis relapse and hinder rehabilitation.

Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.