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Papers by Luca Autelitano

Surgical Atlas of Cleft Palate and Palatal Fistulae

xxi Congress of the European Association for Cranio–Maxillo–Facial Surgery, 2012

Objective. The harvesting of local flaps is the gold stan- dard to reconstruct craniofacial or cr... more Objective. The harvesting of local flaps is the gold stan- dard to reconstruct craniofacial or cranial base defects after ablative cancer surgery. A second effective recon- structive method, when defects are larger or local tissue conditions prevent to use local flaps is represented by free flaps, such as latissimus dorsi, forearm, anterolateral thigh ones. Traditional pedicled flaps (as latissimus dorsi, pec- toralis major, deltopectoral, superior trapezius, lower island trapezius myocutaneous flaps) are commonly the last reconstructive choice because their distal tissues (gen- erally located into the third angiosome) may by lost be- cause of poor vascularization. That may lead to fistulae, infections and life threatening complications. However, in some selected cases, pedicled flaps become an important surgical option. That is the case of patients previously treated with radiotherapy or with poor general health conditions (diabetes mellitus, hypertension, severe vascu- lophaty). Methods. Between 2007 and 2012, 7 head and neck pedi- cle flap reconstruction procedures were carried out among our Maxillo-facial and Neurosurgical teams. The patients (4 females, 3 males) were affected by cranial or cranial base tumours. The histology was infiltrating basal cell carcinoma of the temporal region and scalp in 2 cases, squamous cell carcinoma of the occipital and parietal regions in 2 case, bone and soft tissue defects after abla- tive neurosurgery in 3 cases. The defect size ranged from 15 to 25 cm of major diameter. Three patients were recon- structed with pedicled latissimus dorsi muscolocutaneous flap, two with pectoralis major flap, two with lower island myocutaneous trapezius flap. All patients included in the study have previously under- gone radiotherapy or were affected by systemic diseases which could impair the success of a local or microvascular flap. Results. No patients had significant post-operative compli- cations. No total nor partial flaps failure occurred. The morbidity related to this technique was acceptable, with poor functional sequelae and great acceptance by all pa- tients. Four patients have shown reduced motor function of the upper limbs, so they underwent physiotherapy with great functional improvements. Conclusions. The use of pedicled flaps may offer a safe option in selected cases, offering some advantages such as a shorter duration of the procedure, a shorter hospitaliza- tion and reduction of post-operative complication

Obiettivo. Indagare la possibile influenza di un pregresso trattamento radiante e di pregressi in... more Obiettivo. Indagare la possibile influenza di un pregresso trattamento radiante e di pregressi interventi chirurgici sullo sviluppo di complicanze post-operatorie nelle ricostruzioni con lembi liberi del distretto cefalico. Metodi. \ue8 stato studiato un campione di 205 lembi liberi eseguiti presso la Cattedra e Divisione di Chirurgia Maxillo-Facciale dell\u2019Ospedale San Paolo di Milano nel periodo aprile 1995-maggio 2004. I 205 casi sono stati suddivisi in 4 gruppi sulla base di due parametri: pregresso trattamento radiante e pregressi interventi chirurgici sulla regione da ricostruire. Gruppo A: 140 casi mai sottoposti a precedenti trattamenti; Gruppo B: 27 casi sottoposti in precedenza a radioterapia; Gruppo C: 14 casi sottoposti a precedente intervento chirurgico demolitivi sul distretto cervico-facciale; Gruppo D: 24 casi sottoposti in precedenza ad entrambi i trattamenti radioterapico e chirurgico. Con uno studio retrospettivo sono state osservate e confrontate tra i quattro gruppi l\u2019incidenza di complicanze postoperatorie a carico dei lembi liberi. Risultati. Non sono state evidenziate differenze significative tra i 4 gruppi presi in esame. Conclusioni. Gli interventi microchirurgici su un campo operatorio precedentemente irradiato sono tecnicamente pi\uf9 difficili rispetto ad interventi eseguiti su un campo non irradiato. Tali difficolt\ue0 sono ancora maggiori se il paziente \ue8 stato in precedenza sottoposto a trattamento chirurgico demolitivi. Ciononostante, sulla base dei risultati, si pu\uf2 affermare che, con gli opportuni accorgimenti tecnici, n\ue9 un pregresso trattamento radiante n\ue8 una pregressa chirurgia demolitiva predispongono in modo significativo ad un maggior rischio di complicanze post-operatorie a carico dei lembi liberi.To research the possible influence of prior radiation treatment and prior surgery on the development of post-surgery complications in the reconstruction of the cephalic region with free flaps. Methods. A study was made on a sample of 205 free flap cases performed to reconstruct post-oncological defects at the Maxillo-facial Surgery Department of the San Paolo Hospital in Milan, during the period April 1995-May 2004. The 205 cases were sub-divided into 4 groups according to two parameters: prior radiation treatment and prior surgical operations in the area to undergo reconstruction. Group A: 140 cases that never underwent prior treatment; Group B: 27 cases previously treated with radiotherapy; Group C: 14 cases that underwent prior ablative oncology cervicofacial surgery; GROUP D: 24 cases that previously underwent both radiotherapy and surgery. By means of a retrospective study, the four postoperative groups were observed and comparisons made regarding incidence of postoperative complications relating to free flaps. Results. no significant differences among the 4 groups under examination were highlighted. Conclusions. the micro-surgical operations on a previously irradiated surgical area are technically more difficult compared with surgery carried out on a non-irradiated area. These difficulties are even greater if the patient underwent prior ablative surgery. Nevertheless, on the score of results obtained, it can be stated that, with suitable technical expedients, neither a prior radiation treatment nor prior ablative surgery will significantly lead to a greater risk of postoperative complications on the free flaps

The Cleft Palate-Craniofacial Journal, 2021

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the... more Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in pa...

Cases presentation: Implant placement requires an adequate quantity and quality of alveolar bone.... more Cases presentation: Implant placement requires an adequate quantity and quality of alveolar bone. In case of severe maxillary or mandibular atrophy, several options are available to fill the alveolar defect: autologous, homologous or heterologous grafts or synthetic products. Each of these materials has advantages and disadvantages; currently homologous bone, provided by bone banks, is often used because of its immunological and viral safety. A total of 25 patients had been treated with fresh-frozen bone (FFB): 15 patients underwent reconstruction through tricortical iliac crest, while 10 through femoral bone. After a mean post-grafting period of 6 months for the ilaiac bone and 9 months for the femur, 20 patients underwent implant surgery. After an additional month, 16 of these have also delivered the final prosthetic restoration. Patients, who completed the implant loading time, were followed in a standardized clinical method for up to 9,25 months (range, 2-18 months). Results: All surgical phases were carried out following the standard protocols used for bone augmentation. Endosseous implants were placed adequately and bone biopsies were performed. In our sample we reported 1 post-operative tissue necrosis, 1 graft resorption, because of the delayed implant insertion time, and 23 positive results. Conclusion: Our experience, although limited in term of number of patients and follow up period, is certainly positive. This surgical procedure has been shown to be a predictable and reliable method for rehabilitation of patients with extreme resorption of the alveolar ridge. The use of homologous bone presents several potential advantages: cheap, available in unlimited amount, reduced surgical procedures and safe

Introduction: One of the most common causes of incomplete facial palsy is Bell\u2019s palsy. Alth... more Introduction: One of the most common causes of incomplete facial palsy is Bell\u2019s palsy. Although in most cases this idiopathic condition evolves towards complete restoration, almost 30% of these patients report some degree of functional and morphological sequelae, including, but not limited to, facial synkinesis and paresis. Different surgical techniques have been proposed to reanimate complete facial palsy this kind of facial weakness: neural neurorrhaphy between the hypoglossus nerve and the injured facial nerve, cross face nerve grafting, mini -temporalis flap rotation and free muscle transfer to restore facial symmetry and mimic movements. Others prefer to symmetries the face by injecting botulin toxin on the healthy side. Materials and Methods: Between 2011 and 2016, twenty -four patients (17 females; 7 males) affected by an incomplete unilateral facial palsy underwent surgical treatment in the Maxillofacial Surgery Department of the San Paolo Hospital of Milan (Italy) to restore the symmetry of the face at rest and during smiling. 20 patients were affected by an incom plete facial palsy of the middle third of the face. In these patients, a neural anastomosis between the masseteric nerve and a branch of the injured facial nerve directed to the zygomatic muscle was created to give new contractile strength to the midface mimic muscles. 4 patients were affected by an incomplete facial palsy of the lower third of the face. In these patients, a neural neurorrhaphy between the masseteric nerve and the marginalis mandibulae nerve was created. Furthermore, all patients received a cross face sural nerve graft to restore the spontaneity of smile: nerve graft was directed to the middle third of the face in 20 patients, while in 4 patients to the lower third, according to the paresis localization. Results: Surgery was uneventful in all cases. Follow up time ranged from 3 months to 5 years (only 4 patients, operated during the current year, have a follow up time lower than 18 months). A significant improvement of facial movement was achieved in all evaluated patients. Facial recovery began within 2 and 12 months after surgery with the restoration of facial symmetry at rest. All patients had to clench their teeth while smiling in the beginning. After 2 to 4 months of exercising with a physiotherapist, the patients had to think about smiling if they wanted to do it, but clenching was no longer necessary. From 6 to 12 months after the onset of paralysis, smiling became automatic. Spontaneous smile was restored through the use of the contralateral facial nerve. Conclusions: The nervous anastomosis between the masseteric nerve and a branch of the facial nerve represents a valid choice for the reanimation of the incomplete facial palsy; in addition, its association with a cross face nerve grafting allows not only to achieve an excellent symmetry during the voluntary movement but also to restore the emotional smile

La necrosi dei mascellari in seguito a trattamento con difosfonati \ue8 oramai divenuta una situa... more La necrosi dei mascellari in seguito a trattamento con difosfonati \ue8 oramai divenuta una situazione clinica di frequente riscontro. Spesso i pazienti affetti presentano scadenti condizioni generali e pertanto il loro trattamento \ue8 di tipo conservativo, che nelle prime fasi \ue8 limitato alla rimozione del sequestro osseo. Negli stadi avanzati della malattia la necrosi pu\uf2 portare alla formazione di fistole cutanee ed alla frattura mandibolare, con conseguente deterioramento delle condizioni di vita dei pazienti. Presentiamo un\u2019utile soluzione tecnica per la stabilizzazione delle fratture mandibolari causate dalla necrosi ossea nei pazienti che assumono difosfonati ,al fine di ridurre il dolore e consentire la ripresa dell\u2019alimentazione. Previa cervicotomia, su un piano superficiale al muscolo platisma, una placca mandibolare ricostruttiva autobloccante dello spessore di 2,4 mm viene modellata e successivamente posizionata, con l\u2019impiego di viti corticali posizionate lontano dalla frattura. Il sito di frattura \ue8 invece approcciato per via endorale, e la chirurgia \ue8 limitata al courettage, con la rimozione di un eventuale sequestro osseo presente ed al lavaggio abbondante con soluzione fisiologica. I vantaggi di lavorare su un piano extraplatismatico sono molteplici. Si tratta di un piano sicuro nei confronti del n. marginalis mandibulae che si trova profondamente. Non essendoci interruzione del periostio, l\u2019apporto ematico ai monconi residui della mandibola non viene compromesso. Inoltre questa tecnica consente di evitare il contatto diretto tra il sito di frattura spesso infetto e la placca ricostruttiva. Sebbene la guarigione della frattura non venga ottenuta , la fissazione della placca con questa tecnica \ue8 stabile nel tempo, i pazienti non hanno pi\uf9 dolore e possono riprendere ad alimentarsi, con un conseguente grande miglioramento della loro qualit\ue0 di vita. Riteniamo che questa tecnica sia veloce, semplice ed efficace, in grado di offrire ai pazienti un lungo periodo libero da malattia

Journal of Stomatology, Oral and Maxillofacial Surgery, 2019

The Journal of craniofacial surgery, Jan 9, 2017

The myomucosal buccinator flap, first described by Bozola in 1989, has become an important tool f... more The myomucosal buccinator flap, first described by Bozola in 1989, has become an important tool for intraoral defects reconstruction. In the literature, there is a variety of proposed myomucosal cheek flaps, both pedicled and island, based on the buccal or the facial arteries. From January 2007 to December 2011, the authors used a pedicled buccinator flap based posteriorly on the buccal artery to reconstruct partial lingual defects following tumor resection in 27 patients. The buccal fat pad was translated to cover the donor site defect. After 3 to 4 weeks from the original surgery, a second procedure under local anesthesia was performed to detach the pedicle and remodel the flap. The morphological and functional outcomes of the procedures were evaluated by the surgeons and a speech and language therapist. All patients presented satisfactory results. The authors consider the use of the described technique as the gold standard in the reconstruction of partial tongue defects after tum...

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2013

Resection and simultaneous reconstruction with free flaps of wide tumours of the scalp and poster... more Resection and simultaneous reconstruction with free flaps of wide tumours of the scalp and posterior neck region are difficult to perform through a single surgical approach. In such cases, the park-bench position - a lateral oblique position - could allow simultaneous resection and reconstruction of tumours of the scalp and occipital region without changing the patient's position. In the case described here, this position was used to treat microcystic adnexal carcinoma in a patient who presented with three scalp lesions and a lesion of the right scapular region. This arrangement allowed both resection and reconstruction with a microvascular flap without changing the patient's position, as a result of being able to find neck vessels suitable for microanastomosis. Reconstruction was carried out using a right latissimus dorsi myogenous and subcutaneous flap, and anastomoses were created between the thoracodorsal artery and vein, and the transverse cervical artery and vein. In t...

Minerva stomatologica

The aim of this paper was to compare histologically and histomorphometrically the osseointegratio... more The aim of this paper was to compare histologically and histomorphometrically the osseointegration of iliac crest fresh-frozen allografts and autografts in human pre-prosthetic maxillary and mandibular onlay bone blocks reconstruction. Twelve patients with edentulous atrophic ridges, scheduled for implant-supported prosthetic restorations, underwent reconstruction using iliac crest fresh-frozen allografts (group A, six patients) or autografts (group B, six patients). Four-to-nine months later implants were placed in the augmented areas and bone specimens were simultaneously obtained using trephine burs. The specimens were processed for ground sections and evaluated histologically and histomorphometrically. The postoperative course was uneventful in all patients in group B and in all except one in group A. Late complications occurred in 5 patients of group A. Dental implants could be inserted in all cases. Specimens from group A showed a vascularized bone with osteoprogenitor stem ce...

Minerva stomatologica, 2010

Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial su... more Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial surgery and in oral surgery. LN runs superficially into the lateral mouth floor just beneath the mucous layer and this position enhances damage frequency. This article lists the different aetiologies of iatrogenic LN injuries and it almost focuses on lesions due to surgical treatment of ranulas. In the case report a LN lesion due to oral ranula excision is discussed; the patient experienced anaesthesia and hyperpatia in the corrisponded tongue side. It was treated with a microneurosugical anastomosis of LN, after amputation neuroma excision. The partial and definitive recovery of perception happened in six months and was deemed satisfying with 70% of functionality restored (results compared with the functionality of the contralateral side). An algorithm for diagnosis and therapy indication for iatrogenic injuries to nerves is also proposed. In case of surgical treatment, funcitonal recover...

Minerva stomatologica

This article describes the successful surgical treatment of a case of damage to the inferior alve... more This article describes the successful surgical treatment of a case of damage to the inferior alveolar nerve, due to inadvertent extrusion of endodontic material into the mandibular canal. The accident was favoured by an anatomical variant of the nerve canal ending with a double mental foramen, already described in the literature. The complex surgical operation of uncertain outcome was dictated by neuralgia refractory to medical treatment, rather than hypoesthesia associated with compression of the nerve trunk. Problems related to loss of sensitivity and possible causes of nerve damage (traumatic, pathological and iatrogenic) are discussed.

Minerva stomatologica, 2008

In preprosthetic surgery the autologous bone is universally considered the gold standard. Calvari... more In preprosthetic surgery the autologous bone is universally considered the gold standard. Calvaria is, among many options, one of the preferred for its unique characteristics of hardness, easy of harvest and very low morbidity at donor site. Moreover, it gives the possibility of harvesting the pericranium. This technique, recently introduced in common practice in Milan, allows to harvest a large quantity of periosteum to cover bone grafts perioperativly. Periosteal tissue is used to cover bone grafts for two reasons. First, it would provide a layer of tissue that, thanks to its osteogenic potential, would prevent bone resorption. Second, this would interpose a layer of soft tissue to act as a cushion between the bone and mucosal flap to minimize the risk of wound dehiscence, that would bring to bone exposure and consequent failure of reconstruction. Five jaw reconstructions were performed with autologous bone and pericranium. In all cases the outcome was good, the grafts took with c...

International journal of oral and maxillofacial surgery, 2008

Ribs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral g... more Ribs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral graft is easy and safe. The main complications are related to pneumothorax and chest-wall deformity in children. A complication is described in a patient who underwent an orbito-zygomatic reconstruction with two contiguous ribs and a latissimus dorsi free flap, and who subsequently developed a transthoracic hernia that required reconstruction with polypropylene mesh.

Minerva stomatologica, 2007

A variety of benign lesions that are typically treated conservatively can affect the mandible. Th... more A variety of benign lesions that are typically treated conservatively can affect the mandible. The treatment must be radical when these lesions are locally aggressive and involve the perimandibular soft tissues or involve most of the thickness of the mandible. The main treatment is mandibular resection and reconstruction with bone grafts, mainly iliac crest bone grafts for segmental mandibulectomy or a calvaria bone graft for resection without interruption of the mandible body. These grafts are limited due to the possibility of infection and the unpredictable long-term resorption. Free flap surgery, particularly with fibula free flaps, represents a new era in mandibular reconstruction. This technique has similar donor site morbidity, while the transferred bone resists infection and bone resorption. These advantages are achieved at the cost of a procedure that is about 1 h longer when performed by an experienced microsurgical team. We report our experience with mandibular reconstruct...

The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requir... more The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requires removal of bone excess in the proximal segment by a subperiosteal dissection, preserving vascular connections between the pedicle and the bone and leaving well vascularized periosteum attached to the vascular pedicle. Among about 100 reconstructions with fibular flaps, 4 cases were observed of abnormal ossification along the vascular pedicle. Periosteum preserves its osteogenic capability after transposition, especially in a revascularized flap; this characteristic, together with the direct contact with the bone, allows the possibility of new bone formation along the pedicle. It would appear necessary to change the technique of reducing fibular excess, with removal of periosteum together with the bone, in order to avoid the complication described.

International Journal of Oral and Maxillofacial Surgery, 2010

NA. Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of th... more NA. Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of the literature. Surv Ophthalmol 2003: 48: 544-554. 5. Piperi E, Rohrer MD, Pambuccian SE, Koutlas IG. Vascular solitary fibrous tumor with ''floret'' cells or giant cell angiofibroma? A lingual example highlighting the overlapping characteristics of these entities and positive immunoreaction for estrogen and progesterone receptors.

Surgical Atlas of Cleft Palate and Palatal Fistulae

xxi Congress of the European Association for Cranio–Maxillo–Facial Surgery, 2012

Objective. The harvesting of local flaps is the gold stan- dard to reconstruct craniofacial or cr... more Objective. The harvesting of local flaps is the gold stan- dard to reconstruct craniofacial or cranial base defects after ablative cancer surgery. A second effective recon- structive method, when defects are larger or local tissue conditions prevent to use local flaps is represented by free flaps, such as latissimus dorsi, forearm, anterolateral thigh ones. Traditional pedicled flaps (as latissimus dorsi, pec- toralis major, deltopectoral, superior trapezius, lower island trapezius myocutaneous flaps) are commonly the last reconstructive choice because their distal tissues (gen- erally located into the third angiosome) may by lost be- cause of poor vascularization. That may lead to fistulae, infections and life threatening complications. However, in some selected cases, pedicled flaps become an important surgical option. That is the case of patients previously treated with radiotherapy or with poor general health conditions (diabetes mellitus, hypertension, severe vascu- lophaty). Methods. Between 2007 and 2012, 7 head and neck pedi- cle flap reconstruction procedures were carried out among our Maxillo-facial and Neurosurgical teams. The patients (4 females, 3 males) were affected by cranial or cranial base tumours. The histology was infiltrating basal cell carcinoma of the temporal region and scalp in 2 cases, squamous cell carcinoma of the occipital and parietal regions in 2 case, bone and soft tissue defects after abla- tive neurosurgery in 3 cases. The defect size ranged from 15 to 25 cm of major diameter. Three patients were recon- structed with pedicled latissimus dorsi muscolocutaneous flap, two with pectoralis major flap, two with lower island myocutaneous trapezius flap. All patients included in the study have previously under- gone radiotherapy or were affected by systemic diseases which could impair the success of a local or microvascular flap. Results. No patients had significant post-operative compli- cations. No total nor partial flaps failure occurred. The morbidity related to this technique was acceptable, with poor functional sequelae and great acceptance by all pa- tients. Four patients have shown reduced motor function of the upper limbs, so they underwent physiotherapy with great functional improvements. Conclusions. The use of pedicled flaps may offer a safe option in selected cases, offering some advantages such as a shorter duration of the procedure, a shorter hospitaliza- tion and reduction of post-operative complication

Obiettivo. Indagare la possibile influenza di un pregresso trattamento radiante e di pregressi in... more Obiettivo. Indagare la possibile influenza di un pregresso trattamento radiante e di pregressi interventi chirurgici sullo sviluppo di complicanze post-operatorie nelle ricostruzioni con lembi liberi del distretto cefalico. Metodi. \ue8 stato studiato un campione di 205 lembi liberi eseguiti presso la Cattedra e Divisione di Chirurgia Maxillo-Facciale dell\u2019Ospedale San Paolo di Milano nel periodo aprile 1995-maggio 2004. I 205 casi sono stati suddivisi in 4 gruppi sulla base di due parametri: pregresso trattamento radiante e pregressi interventi chirurgici sulla regione da ricostruire. Gruppo A: 140 casi mai sottoposti a precedenti trattamenti; Gruppo B: 27 casi sottoposti in precedenza a radioterapia; Gruppo C: 14 casi sottoposti a precedente intervento chirurgico demolitivi sul distretto cervico-facciale; Gruppo D: 24 casi sottoposti in precedenza ad entrambi i trattamenti radioterapico e chirurgico. Con uno studio retrospettivo sono state osservate e confrontate tra i quattro gruppi l\u2019incidenza di complicanze postoperatorie a carico dei lembi liberi. Risultati. Non sono state evidenziate differenze significative tra i 4 gruppi presi in esame. Conclusioni. Gli interventi microchirurgici su un campo operatorio precedentemente irradiato sono tecnicamente pi\uf9 difficili rispetto ad interventi eseguiti su un campo non irradiato. Tali difficolt\ue0 sono ancora maggiori se il paziente \ue8 stato in precedenza sottoposto a trattamento chirurgico demolitivi. Ciononostante, sulla base dei risultati, si pu\uf2 affermare che, con gli opportuni accorgimenti tecnici, n\ue9 un pregresso trattamento radiante n\ue8 una pregressa chirurgia demolitiva predispongono in modo significativo ad un maggior rischio di complicanze post-operatorie a carico dei lembi liberi.To research the possible influence of prior radiation treatment and prior surgery on the development of post-surgery complications in the reconstruction of the cephalic region with free flaps. Methods. A study was made on a sample of 205 free flap cases performed to reconstruct post-oncological defects at the Maxillo-facial Surgery Department of the San Paolo Hospital in Milan, during the period April 1995-May 2004. The 205 cases were sub-divided into 4 groups according to two parameters: prior radiation treatment and prior surgical operations in the area to undergo reconstruction. Group A: 140 cases that never underwent prior treatment; Group B: 27 cases previously treated with radiotherapy; Group C: 14 cases that underwent prior ablative oncology cervicofacial surgery; GROUP D: 24 cases that previously underwent both radiotherapy and surgery. By means of a retrospective study, the four postoperative groups were observed and comparisons made regarding incidence of postoperative complications relating to free flaps. Results. no significant differences among the 4 groups under examination were highlighted. Conclusions. the micro-surgical operations on a previously irradiated surgical area are technically more difficult compared with surgery carried out on a non-irradiated area. These difficulties are even greater if the patient underwent prior ablative surgery. Nevertheless, on the score of results obtained, it can be stated that, with suitable technical expedients, neither a prior radiation treatment nor prior ablative surgery will significantly lead to a greater risk of postoperative complications on the free flaps

The Cleft Palate-Craniofacial Journal, 2021

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the... more Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in pa...

Cases presentation: Implant placement requires an adequate quantity and quality of alveolar bone.... more Cases presentation: Implant placement requires an adequate quantity and quality of alveolar bone. In case of severe maxillary or mandibular atrophy, several options are available to fill the alveolar defect: autologous, homologous or heterologous grafts or synthetic products. Each of these materials has advantages and disadvantages; currently homologous bone, provided by bone banks, is often used because of its immunological and viral safety. A total of 25 patients had been treated with fresh-frozen bone (FFB): 15 patients underwent reconstruction through tricortical iliac crest, while 10 through femoral bone. After a mean post-grafting period of 6 months for the ilaiac bone and 9 months for the femur, 20 patients underwent implant surgery. After an additional month, 16 of these have also delivered the final prosthetic restoration. Patients, who completed the implant loading time, were followed in a standardized clinical method for up to 9,25 months (range, 2-18 months). Results: All surgical phases were carried out following the standard protocols used for bone augmentation. Endosseous implants were placed adequately and bone biopsies were performed. In our sample we reported 1 post-operative tissue necrosis, 1 graft resorption, because of the delayed implant insertion time, and 23 positive results. Conclusion: Our experience, although limited in term of number of patients and follow up period, is certainly positive. This surgical procedure has been shown to be a predictable and reliable method for rehabilitation of patients with extreme resorption of the alveolar ridge. The use of homologous bone presents several potential advantages: cheap, available in unlimited amount, reduced surgical procedures and safe

Introduction: One of the most common causes of incomplete facial palsy is Bell\u2019s palsy. Alth... more Introduction: One of the most common causes of incomplete facial palsy is Bell\u2019s palsy. Although in most cases this idiopathic condition evolves towards complete restoration, almost 30% of these patients report some degree of functional and morphological sequelae, including, but not limited to, facial synkinesis and paresis. Different surgical techniques have been proposed to reanimate complete facial palsy this kind of facial weakness: neural neurorrhaphy between the hypoglossus nerve and the injured facial nerve, cross face nerve grafting, mini -temporalis flap rotation and free muscle transfer to restore facial symmetry and mimic movements. Others prefer to symmetries the face by injecting botulin toxin on the healthy side. Materials and Methods: Between 2011 and 2016, twenty -four patients (17 females; 7 males) affected by an incomplete unilateral facial palsy underwent surgical treatment in the Maxillofacial Surgery Department of the San Paolo Hospital of Milan (Italy) to restore the symmetry of the face at rest and during smiling. 20 patients were affected by an incom plete facial palsy of the middle third of the face. In these patients, a neural anastomosis between the masseteric nerve and a branch of the injured facial nerve directed to the zygomatic muscle was created to give new contractile strength to the midface mimic muscles. 4 patients were affected by an incomplete facial palsy of the lower third of the face. In these patients, a neural neurorrhaphy between the masseteric nerve and the marginalis mandibulae nerve was created. Furthermore, all patients received a cross face sural nerve graft to restore the spontaneity of smile: nerve graft was directed to the middle third of the face in 20 patients, while in 4 patients to the lower third, according to the paresis localization. Results: Surgery was uneventful in all cases. Follow up time ranged from 3 months to 5 years (only 4 patients, operated during the current year, have a follow up time lower than 18 months). A significant improvement of facial movement was achieved in all evaluated patients. Facial recovery began within 2 and 12 months after surgery with the restoration of facial symmetry at rest. All patients had to clench their teeth while smiling in the beginning. After 2 to 4 months of exercising with a physiotherapist, the patients had to think about smiling if they wanted to do it, but clenching was no longer necessary. From 6 to 12 months after the onset of paralysis, smiling became automatic. Spontaneous smile was restored through the use of the contralateral facial nerve. Conclusions: The nervous anastomosis between the masseteric nerve and a branch of the facial nerve represents a valid choice for the reanimation of the incomplete facial palsy; in addition, its association with a cross face nerve grafting allows not only to achieve an excellent symmetry during the voluntary movement but also to restore the emotional smile

La necrosi dei mascellari in seguito a trattamento con difosfonati \ue8 oramai divenuta una situa... more La necrosi dei mascellari in seguito a trattamento con difosfonati \ue8 oramai divenuta una situazione clinica di frequente riscontro. Spesso i pazienti affetti presentano scadenti condizioni generali e pertanto il loro trattamento \ue8 di tipo conservativo, che nelle prime fasi \ue8 limitato alla rimozione del sequestro osseo. Negli stadi avanzati della malattia la necrosi pu\uf2 portare alla formazione di fistole cutanee ed alla frattura mandibolare, con conseguente deterioramento delle condizioni di vita dei pazienti. Presentiamo un\u2019utile soluzione tecnica per la stabilizzazione delle fratture mandibolari causate dalla necrosi ossea nei pazienti che assumono difosfonati ,al fine di ridurre il dolore e consentire la ripresa dell\u2019alimentazione. Previa cervicotomia, su un piano superficiale al muscolo platisma, una placca mandibolare ricostruttiva autobloccante dello spessore di 2,4 mm viene modellata e successivamente posizionata, con l\u2019impiego di viti corticali posizionate lontano dalla frattura. Il sito di frattura \ue8 invece approcciato per via endorale, e la chirurgia \ue8 limitata al courettage, con la rimozione di un eventuale sequestro osseo presente ed al lavaggio abbondante con soluzione fisiologica. I vantaggi di lavorare su un piano extraplatismatico sono molteplici. Si tratta di un piano sicuro nei confronti del n. marginalis mandibulae che si trova profondamente. Non essendoci interruzione del periostio, l\u2019apporto ematico ai monconi residui della mandibola non viene compromesso. Inoltre questa tecnica consente di evitare il contatto diretto tra il sito di frattura spesso infetto e la placca ricostruttiva. Sebbene la guarigione della frattura non venga ottenuta , la fissazione della placca con questa tecnica \ue8 stabile nel tempo, i pazienti non hanno pi\uf9 dolore e possono riprendere ad alimentarsi, con un conseguente grande miglioramento della loro qualit\ue0 di vita. Riteniamo che questa tecnica sia veloce, semplice ed efficace, in grado di offrire ai pazienti un lungo periodo libero da malattia

Journal of Stomatology, Oral and Maxillofacial Surgery, 2019

The Journal of craniofacial surgery, Jan 9, 2017

The myomucosal buccinator flap, first described by Bozola in 1989, has become an important tool f... more The myomucosal buccinator flap, first described by Bozola in 1989, has become an important tool for intraoral defects reconstruction. In the literature, there is a variety of proposed myomucosal cheek flaps, both pedicled and island, based on the buccal or the facial arteries. From January 2007 to December 2011, the authors used a pedicled buccinator flap based posteriorly on the buccal artery to reconstruct partial lingual defects following tumor resection in 27 patients. The buccal fat pad was translated to cover the donor site defect. After 3 to 4 weeks from the original surgery, a second procedure under local anesthesia was performed to detach the pedicle and remodel the flap. The morphological and functional outcomes of the procedures were evaluated by the surgeons and a speech and language therapist. All patients presented satisfactory results. The authors consider the use of the described technique as the gold standard in the reconstruction of partial tongue defects after tum...

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2013

Resection and simultaneous reconstruction with free flaps of wide tumours of the scalp and poster... more Resection and simultaneous reconstruction with free flaps of wide tumours of the scalp and posterior neck region are difficult to perform through a single surgical approach. In such cases, the park-bench position - a lateral oblique position - could allow simultaneous resection and reconstruction of tumours of the scalp and occipital region without changing the patient's position. In the case described here, this position was used to treat microcystic adnexal carcinoma in a patient who presented with three scalp lesions and a lesion of the right scapular region. This arrangement allowed both resection and reconstruction with a microvascular flap without changing the patient's position, as a result of being able to find neck vessels suitable for microanastomosis. Reconstruction was carried out using a right latissimus dorsi myogenous and subcutaneous flap, and anastomoses were created between the thoracodorsal artery and vein, and the transverse cervical artery and vein. In t...

Minerva stomatologica

The aim of this paper was to compare histologically and histomorphometrically the osseointegratio... more The aim of this paper was to compare histologically and histomorphometrically the osseointegration of iliac crest fresh-frozen allografts and autografts in human pre-prosthetic maxillary and mandibular onlay bone blocks reconstruction. Twelve patients with edentulous atrophic ridges, scheduled for implant-supported prosthetic restorations, underwent reconstruction using iliac crest fresh-frozen allografts (group A, six patients) or autografts (group B, six patients). Four-to-nine months later implants were placed in the augmented areas and bone specimens were simultaneously obtained using trephine burs. The specimens were processed for ground sections and evaluated histologically and histomorphometrically. The postoperative course was uneventful in all patients in group B and in all except one in group A. Late complications occurred in 5 patients of group A. Dental implants could be inserted in all cases. Specimens from group A showed a vascularized bone with osteoprogenitor stem ce...

Minerva stomatologica, 2010

Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial su... more Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial surgery and in oral surgery. LN runs superficially into the lateral mouth floor just beneath the mucous layer and this position enhances damage frequency. This article lists the different aetiologies of iatrogenic LN injuries and it almost focuses on lesions due to surgical treatment of ranulas. In the case report a LN lesion due to oral ranula excision is discussed; the patient experienced anaesthesia and hyperpatia in the corrisponded tongue side. It was treated with a microneurosugical anastomosis of LN, after amputation neuroma excision. The partial and definitive recovery of perception happened in six months and was deemed satisfying with 70% of functionality restored (results compared with the functionality of the contralateral side). An algorithm for diagnosis and therapy indication for iatrogenic injuries to nerves is also proposed. In case of surgical treatment, funcitonal recover...

Minerva stomatologica

This article describes the successful surgical treatment of a case of damage to the inferior alve... more This article describes the successful surgical treatment of a case of damage to the inferior alveolar nerve, due to inadvertent extrusion of endodontic material into the mandibular canal. The accident was favoured by an anatomical variant of the nerve canal ending with a double mental foramen, already described in the literature. The complex surgical operation of uncertain outcome was dictated by neuralgia refractory to medical treatment, rather than hypoesthesia associated with compression of the nerve trunk. Problems related to loss of sensitivity and possible causes of nerve damage (traumatic, pathological and iatrogenic) are discussed.

Minerva stomatologica, 2008

In preprosthetic surgery the autologous bone is universally considered the gold standard. Calvari... more In preprosthetic surgery the autologous bone is universally considered the gold standard. Calvaria is, among many options, one of the preferred for its unique characteristics of hardness, easy of harvest and very low morbidity at donor site. Moreover, it gives the possibility of harvesting the pericranium. This technique, recently introduced in common practice in Milan, allows to harvest a large quantity of periosteum to cover bone grafts perioperativly. Periosteal tissue is used to cover bone grafts for two reasons. First, it would provide a layer of tissue that, thanks to its osteogenic potential, would prevent bone resorption. Second, this would interpose a layer of soft tissue to act as a cushion between the bone and mucosal flap to minimize the risk of wound dehiscence, that would bring to bone exposure and consequent failure of reconstruction. Five jaw reconstructions were performed with autologous bone and pericranium. In all cases the outcome was good, the grafts took with c...

International journal of oral and maxillofacial surgery, 2008

Ribs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral g... more Ribs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral graft is easy and safe. The main complications are related to pneumothorax and chest-wall deformity in children. A complication is described in a patient who underwent an orbito-zygomatic reconstruction with two contiguous ribs and a latissimus dorsi free flap, and who subsequently developed a transthoracic hernia that required reconstruction with polypropylene mesh.

Minerva stomatologica, 2007

A variety of benign lesions that are typically treated conservatively can affect the mandible. Th... more A variety of benign lesions that are typically treated conservatively can affect the mandible. The treatment must be radical when these lesions are locally aggressive and involve the perimandibular soft tissues or involve most of the thickness of the mandible. The main treatment is mandibular resection and reconstruction with bone grafts, mainly iliac crest bone grafts for segmental mandibulectomy or a calvaria bone graft for resection without interruption of the mandible body. These grafts are limited due to the possibility of infection and the unpredictable long-term resorption. Free flap surgery, particularly with fibula free flaps, represents a new era in mandibular reconstruction. This technique has similar donor site morbidity, while the transferred bone resists infection and bone resorption. These advantages are achieved at the cost of a procedure that is about 1 h longer when performed by an experienced microsurgical team. We report our experience with mandibular reconstruct...

The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requir... more The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requires removal of bone excess in the proximal segment by a subperiosteal dissection, preserving vascular connections between the pedicle and the bone and leaving well vascularized periosteum attached to the vascular pedicle. Among about 100 reconstructions with fibular flaps, 4 cases were observed of abnormal ossification along the vascular pedicle. Periosteum preserves its osteogenic capability after transposition, especially in a revascularized flap; this characteristic, together with the direct contact with the bone, allows the possibility of new bone formation along the pedicle. It would appear necessary to change the technique of reducing fibular excess, with removal of periosteum together with the bone, in order to avoid the complication described.

International Journal of Oral and Maxillofacial Surgery, 2010

NA. Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of th... more NA. Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of the literature. Surv Ophthalmol 2003: 48: 544-554. 5. Piperi E, Rohrer MD, Pambuccian SE, Koutlas IG. Vascular solitary fibrous tumor with ''floret'' cells or giant cell angiofibroma? A lingual example highlighting the overlapping characteristics of these entities and positive immunoreaction for estrogen and progesterone receptors.