Advantages of temporal muscle flap with no fascia in oral reconstruction after tumor removal

Abstract

Temporalis Muscle Flap is known to be a first choice rotational flap for oral reconstruction even though a few postoperative complications were reported in Literature. Among these, fascia necrosis may prolong recovery, increase discomfort and elevate sanitary cost. The aim of the study is to report the advantages of temporalis muscle flap without deep fascia in the reconstruction of the maxilla. The study group comprised seven patients aged between 43 and 64 years who underwent oral surgical reconstruction with TMF with no fascia. Reconstruction with the temporalis muscle flap was done in the same time of demolitive surgery and the same surgeon performed all the surgeries. In no case, TMF was covered with slough and this permitted to all our patients to undergo an easier rehabilitation with a low number of medications. Our experience showed that removing the fascia from TMF is a safe procedure that strongly decreased time of oral healing and improves patient comforts.

Branchiogenic carcinoma with rapid growth and skin involvement: a case report

Abstract

Branchiogenic carcinoma (BC) is an extremely rare and still controversial clinic entity with few cases reported in literature. This malignant squamous epithelial wall degeneration of a pre-existing second branchial cleft cyst (SBCC) was first described by Von Volk-mann in 1882. Here we present a case of cervical cystic mass that was histologically diagnosed as a primary branchial cleft cyst carcinoma. This is the first documented cases of primary BC presenting with skin involvement on initial examination.

Neonatal teeth: Importance of histological findings in management update

BACKGROUND

Presence of teeth in a newborn represents a rare finding and a disturbance of biological chronology of teeth. The aim of this paper is to report two cases with neonatal teeth histologically examined.

CASE REPORT

In this paper two cases of patients with neonatal teeth are reported and histological examinations of three extracted teeth are described. We report an exceptional finding in one of the neonatal teeth microscopically examined: a massive inflammatory infiltration in the pulp tissue similar to that in pulpitis.

RESULTS

The management of natal and neonatal teeth usually includes the extraction in case of ulceration on the tongue or severe tooth mobility to prevent accidental inhalation or feeding disturbances. The presence of an inflammatory infiltration of pulp tissue in one of teeth histologically examined suggests to review the indications for extraction considered to date.

CONCLUSION

The management of natal and neonatal teeth should consider the presence of an inflammatory infiltration of pulp tissue. An anamnestic interview is advisable in ordert to deeply investigate about possible behaviours of the child due to pain or discomfort.

A case of Invasive Cervical Root Resorption in a 12 y.o. female patient

Invasive Cervical Root Resorption (ICRR) has a poor known aetiology, compared with typical external root resorption it appears very aggressive, posing a high risk of tooth loss. ICCR is often misdiagnosed, the resorption is caused by cells of the peridontium penetrating the outer surface of the root in the cervical region, spreading out throughout the root dentin. ICCR is usually detected in the adulthood on permanent teeth, anyway in a small amount of cases is possible to observe ICCR on impacted permanent canines during the adolescence and first adulthood.The aim of this paper is to present our experience with a ICCR case occurred in a young woman previously treated for an impacted canine with orthodontic therapy.

Infantile swallowing: surgical meaning

AIMS

The aim of this retrospective work on 30 patients affected by dento-skeletal III class and Infantile Swallowing (I.S.), treated between 2006 and 2014, is to analyze the causes of eventual surgical relapses and to underline the consequences of untreated Infantile Swallowing. Infantile Swallowing can be correlated with a relapse in the surgical treatment and therefore requires investigation and treatment beforehand any surgical approach.

METHODS

Between the 2006 and 2014 a number of 30 patients affected by III dento-skeletal class and I.S. were treated with a pre-surgery protocol, surgery and a post-surgery protocol. The surgical protocol consisted of: Le Fort I and Bilateral Sagittal Split Osteotomy (BSSO). Out of the 30 patients 3 received previous surgical treatment in another locality without going through pre- and post-surgery protocols for I.S., and they presented themselves about 14 months post-surgery to the first examination having a relapse of the dento-skeletal III class.

RESULTS

No skeletal relapse has ever been recorded today in the 30 patients treated with pre and post-surgery protocols and Le Fort I and BSSO osteotomy.

CONCLUSIONS

Relapses are commonly attributed to surgical errors or inappropriate surgical program only; in our analysis we observed that the 100% of relapses were due to an untreated or undiagnosed I.S. that caused derangement of bicortical screw and incorrect bony formation and consequently a sort of an improper "distraction osteogenesis".

Nasal Papilloma due to HPV 11 infection

Human papillomaviruses cause almost all cervical carcinomas, but HPV infections have recently been established as a major etiologic factor for a subset of cancers arising from the oropharinx, including the base of tongue, tonsil, and other parts of the pharinx. Certain types of HPV are considered carcinogenic in humans: HPV 16 and HPV 18 are the most carcinogenic types; HPV 31, 33, 35,39,45,51,52,56,59,66 and 68 also are included in the group of carcinogenic HPV types (1,2,3,4,5). HPV 6 and 11 are associated with genital warts and papillomas are not believed to be carcinogenic (6). The aim of this paper is to show a case of a benignant papilloma of the nasal fossa due to a HPV 11 infection.

Normalization of Functional Independence Measure variation improves assessment of stroke rehabilitation outcome

BACKGROUND

Assessment of rehabilitation outcome is based on measuring the change in Functional Independence Measure (FIMTM) score between the start and end of rehabilitation. However, the raw FIMTM score gain is subject to a ceiling effect. Proposed solutions to this problem have incongruities that limit their use.

AIM

The aim of this study was to determine the factors that influence functional outcome in stroke rehabilitation, exploring the possibility of developing an outcome index free of the ceiling effect and of the incongruities revealed by the proposed solutions.

DESIGN

Retrospective study of the electronic clinical records of patients admitted to a rehabilitation unit over a period of 5 years.

SETTING

Rehabilitation unit.

POPULATION

A total of 224 patients admitted for first post-stroke rehabilitation of either ischaemic or hemorrhagic etiology.

METHODS

Rehabilitation outcome was evaluated based on changes in both raw and "normalized" FIMTM motor and cognitive scores observed between hospital admission and discharge. Normalized differences are in the range 0-1 and may be considered an estimate of the actually attained fraction of the maximum expected recovery, while the modified algebraic formula (+1 to both numerator and denominator) is intended to correct the incongruities observed in available solutions. Seventeen prognostic factors were selected as possible effect modifiers of the outcome. A multivariable model-building strategy, based on fractional polynomials, was adopted to select the significant factors, and the stability of the results.

RESULTS

The procedure adopted to normalize both FIMTM outcomes resolves the ceiling effect and corrects the incongruities noted with available solutions. The level of disability at admission is confirmed as the strongest prognostic factor associated with both cognitive and motor outcomes. The onset-admission interval negatively influence motor recovery, bat not cognitive one.

CONCLUSION

There is strong evidence to support the proposal that it is advantageous to measure functional recovery by means of the normalized change in FIMTM score. Following a rehabilitation programme, functional recovery should be evaluated separately for motor and cognitive domains. Rehabilitation program should begin as soon as possible.

CLINICAL REHABILITATION IMPACT

Improved assessment of rehabilitation outcome leads to increased achievement of a favourable treatment outcome.