Publications by authors named "Emanuele Zavattero"

51 Publications

Three-Dimensional Evaluation of Soft Tissue Malar Modifications after Zygomatic Valgization Osteotomy via Geometrical Descriptors.

J Pers Med 2021 Mar 13;11(3). Epub 2021 Mar 13.

Department of Surgical Sciences, Division of Maxillofacial Surgery, University of Turin, Città della Salute e della Scienza HOSPITAL, 10129 Turin, Italy.

Patients with severe facial deformities present serious dysfunctionalities along with an unsatisfactory aesthetic facial appearance. Several methods have been proposed to specifically plan the interventions on the patient's needs, but none of these seem to achieve a sufficient level of accuracy in predicting the resulting facial appearance. In this context, a deep knowledge of what occurs in the face after bony movements in specific surgeries would give the possibility to develop more reliable systems. This study aims to propose a novel 3D approach for the evaluation of soft tissue zygomatic modifications after zygomatic osteotomy; geometrical descriptors usually involved in face analysis tasks, i.e., face recognition and facial expression recognition, are here applied to soft tissue malar region to detect changes in surface shape. As ground truth for zygomatic changes, a zygomatic openness angular measure is adopted. The results show a high sensibility of geometrical descriptors in detecting shape modification of the facial surface, outperforming the results obtained from the angular evaluation.
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http://dx.doi.org/10.3390/jpm11030205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998522PMC
March 2021

Implant Dental Rehabilitation of Fibula-Free Flap Reconstructed Jaws.

J Craniofac Surg 2021 Mar-Apr 01;32(2):e134-e136

Maxillofacial Unit, Surgical Science Department, City of Health and Science University Hospital.

Background: The possibility of placing dental fixtures in the reconstructed regions allows us to overcome the problems related to dental rehabilitation with removable prosthesis. The aim of this study was to assess the clinic-radiological outcome in a series of patients who underwent fibula flap jaws reconstruction and rehabilitation with implant-supported prosthesis with a minimum follow-up of 24 months.

Material And Methods: The study included 10 patients who underwent reconstruction with fibula free flap between 2010 and 2018. Albrektsson criteria were used to define the implant survival. The follow-up evaluation was performed according to a standardized protocol including clinical examination, radiological evaluation (panoramic radiograph) and patient interview.

Results: A total of 45 implants were positioned.The time between mandibular reconstruction and implant placement ranged from 13 months to 39 months.The prosthesis used was fixed in 6 cases and supported overdenture in 4 cases.No implant failure was observed.Regarding implant survival no infections were observed in these series. Nine patients out of 10 had no pain and signs of mobility. Seven patients out of 10 had absence of peri-implant radiolucency at the panoramic radiograph.One patient presented with an overgrowth of granulomatous soft tissue around the implant abutments that caused pain.

Conclusions: Implant placed in vascularized bone grafts are a safe and reliable opportunity to rehabilitate patients following mandibular resection. The results of this series demonstrate a high survival rate for implants placed in reconstructed mandibles with an improvement of the quality of life.
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http://dx.doi.org/10.1097/SCS.0000000000006874DOI Listing
March 2021

Malar augmentation with zygomatic osteotomy in orthognatic surgery: Bone and soft tissue changes threedimensional evaluation.

J Craniomaxillofac Surg 2021 Mar 19;49(3):223-230. Epub 2021 Jan 19.

Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.

Background: The aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery.

Materials And Methods: From January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score. For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes.

Results: Considering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr - Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03. Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR).

Conclusion: The malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures.
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http://dx.doi.org/10.1016/j.jcms.2021.01.008DOI Listing
March 2021

Accuracy of Fibula Reconstruction Using Patient-Specific Cad/Cam Plates: A Multicenter Study on 47 Patients.

Laryngoscope 2021 07 16;131(7):E2169-E2175. Epub 2021 Jan 16.

Division of Maxillofacial Surgery, Fondazione IRCCS Ca' Granda, Policlinico Hospital, Milano, Department of Biomedical Dental Sciences, University of Milano, Italy.

Objectives: This prospective study evaluated the accuracy of mandibular reconstruction using free fibular flaps (by comparing virtual plans to the three-dimensional postoperative results), and the extent of bone-to-bone contact after computer-assisted surgery.

Methods: We included 65 patients who underwent partial-continuity mandibular resections from February 2013 to January 2017, and evaluated virtual planning, surgical techniques, and accuracy.

Results: Forty-seven patients were analysed. A total of 112 fibular segments received 54 implants. We measured 227 distances between landmarks to assess the accuracy of reconstruction. Postoperative reconstruction accuracy ranged from 0.5 to 3 mm.

Conclusion: Virtual surgical planning very accurately translated simulation into reality, particularly in patients requiring large, complex mandibular reconstructions using multiple fibular segments.

Level Of Evidence: 4 Laryngoscope, 131:E2169-E2175, 2021.
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http://dx.doi.org/10.1002/lary.29379DOI Listing
July 2021

In-hospital 3D Printing to Aid Maxillofacial Surgery during the COVID-19 Pandemic.

Plast Reconstr Surg Glob Open 2020 Nov 20;8(11):e3248. Epub 2020 Nov 20.

Division of Maxillofacial Surgery, Città della Salute e della Scienza University Hospital, University of Torino, Italy.

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http://dx.doi.org/10.1097/GOX.0000000000003248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722551PMC
November 2020

Navigation-Assisted Resection and Fibula Free-Flap Reconstruction of an Extensive Maxillary Tumor.

J Craniofac Surg 2020 Dec 3. Epub 2020 Dec 3.

Division of Maxillofacial Surgery.

Objective: Tumor resection and reconstruction as a one-step procedure requires accurate definition of the intended safety margins, precise location of osteotomy lines and reliable individual rehabilitation.In recent years, the role of image-guided surgery in the maxillofacial region has increased significantly. As this technology allows the surgeon to track the actual position of each instrument during the operation in real-time, it makes it possible to perform extensive bone structure resections and reconstructions in anatomically distorted or complex areas, such as the head and neck region, without unnecessarily damaging vital structures.The authors described a case of a 26-year-old woman presented to our Clinic with an extensive maxillary squamous cell carcinoma involving the infratemporal fossa. The patient underwent single-step navigation-guided en bloc resection of the tumor and defect reconstruction.The aim of this study is describe and discuss the unusual surgical planning and the challenging operative technique adding a new case to the currently limited scientific literature on the computer-assisted head and neck oncologic surgery.
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http://dx.doi.org/10.1097/SCS.0000000000007304DOI Listing
December 2020

The Shape of Things to Come: In-Hospital Three-Dimensional Printing for Mandibular Reconstruction Using Fibula Free Flap.

Laryngoscope 2020 12 6;130(12):E811-E816. Epub 2020 Apr 6.

Division of Maxillofacial Surgery, City of Health and Science of Turin Hospital, University of Turin, Turin, Italy.

Objectives/hypothesis: The aim of this study was to explore whether the production of in-hospital, low-cost surgical cutting guides would be possible and to assess different cutting guide shapes to facilitate the surgery and the application with instruments.

Study Design: Cohort study.

Methods: Using free computer-aided design software, surgical cutting guides for the mandible and fibula were designed and used to perform virtual segmental osteotomies and fibula transplants in seven patients.

Results: Fourteen virtual osteotomies were performed using the free software and the proposed workflow. Thirteen guides were then printed to transfer the virtual planning information to the operating room.

Conclusions: Virtual planning and the three-dimensional (3D) printing of guides for mandibular reconstruction is reliable with the aid of an in-hospital 3D laboratory. We also demonstrated that different guides with different shapes could be produced with benefits during surgery.

Level Of Evidence: 4 Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.28650DOI Listing
December 2020

Surgical Treatment of Massive Teratoma of the Orbit.

Ophthalmic Plast Reconstr Surg 2020 May/Jun;36(3):e68-e70

Division of Maxillofacial Surgery, Surgical Science Department, Maxillofacial Unit, University of Torino, Torino, Italy.

Orbital location of teratoma is extremely rare. The differential diagnosis can be difficult and they may be mistaken for other tumors as they may have both cystic and solid areas. The authors report a case of a 7-day-old neonate with a massive congenital orbital teratoma in which it was decided to apply a surgical technique that involves the aspiration of the cystic fluid, the subsequent infusion of fibrin glue, and the radical excision. The definitive histological examination reported a diagnosis of trifillic cystic teratoma. At fourth year of follow up the patient is free from disease.
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http://dx.doi.org/10.1097/IOP.0000000000001581DOI Listing
March 2021

Maxillofacial Injuries Due to Traffic Accidents.

J Craniofac Surg 2019 Jun;30(4):e288-e293

Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e delle Scienze Hospital.

Purpose: The purpose of this retrospective study was to analyze the epidemiology, patterns, and management of maxillofacial due to road traffic accidents over a 17-year period.

Methods: Between January 2001 and December 2017, 2924 patients with maxillofacial fractures were admitted to the Division of Maxillofacial Surgery, Turin, Italy.The following data were analyzed: age, gender, data of the trauma, alcohol and drug abuse, mechanism of injury, fracture site, facial injury severity scale, associated injuries, type of treatment, and length of hospital stay.

Results: Of the 605 patients included in the study, 419 were male and 186 were female (ratio, 2.2:1). The most common mechanism of injury was car accidents (62.6%).More than half of the patients had fractures of the middle third of the maxillofacial skeleton.Associated injuries were detected in 172 (45.5%) patients. In total 5.3% of patients did not undergo surgery. The average hospital stay was 7.3 days.

Conclusions: This study shows an important reduction in maxillofacial fractures following road traffic accidents since the turn of the new millennium. At least in north-western Italy, road safety policies implemented in the last 30 years seem to have affected the behavior of motorists and motorcyclists.
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http://dx.doi.org/10.1097/SCS.0000000000005158DOI Listing
June 2019

Evaluation of the Accuracy of Virtual Planning in Orthognathic Surgery: A Morphometric Study.

J Craniofac Surg 2019 Jun;30(4):1214-1220

Division of Maxillofacial Surgery, Fondazione IRCCS Ca' Granda, Policlinico Hospital Milano Department of Biomedical, Dental sciences University of Milano, Italy.

Background: The purpose of this study was to prospectively test the accuracy of computer-aided orthognathic surgery comparing the virtual surgical planning with the three-dimensional (3D) outcome.

Methods: Patients that underwent computer-assisted orthognathic surgery were retrospectively evaluated. The postoperative results were compared with the surgical plan, superimposing the postoperative computed tomography (CT) scan onto the virtual plan. Surface-based superimpositioning of the postoperative CT scan onto the 3D preoperative plan was carried out to visualize the discrepancy between preoperative virtual plan and postoperative 3D CT result.

Results: A total of 17 consecutive patients that underwent two-jaw computer-assisted orthognathic surgery were enrolled in the study.The average linear differences for selected points were <1 mm in 12 patients out of 17. In 5 patients out of 17, the average differences for selected points were <2 mm.

Conclusions: An overall high degree of accuracy between the virtual plan and the postoperative result was found.
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http://dx.doi.org/10.1097/SCS.0000000000005355DOI Listing
June 2019

Temporomandibular joint reconstruction with stock and custom-made devices: Indications and results of a 14-year experience.

J Craniomaxillofac Surg 2017 Oct 1;45(10):1710-1715. Epub 2017 Aug 1.

Division of Maxillofacial Surgery, Surgical Science Department University of Torino, Italy.

Purpose: Temporomandibular joint (TMJ) reconstruction with alloplastic implants is a reliable, safe and effective treatment option for selected debilitating pathologies of the TMJ. This study retrospectively analyzes our 14-year experience in total alloplastic reconstruction of the TMJ using stock and custom Biomet prostheses. Indications, results and rationale for the choice of stock and custom-made devices are discussed.

Material And Methods: Patients were enrolled in the study who underwent single-stage alloplastic total joint replacement from January 2000 to October 2014. The subjective and objective variables were as follows: TMJ pain, diet, jaw function, maximum interincisal opening (MIO), quality of life and occlusion. The minimum follow-up was 12 months.

Results: A total of 38 patients (55 joints) met the inclusion criteria and were enrolled in the study. Of the patients, 25 underwent Biomet total joint reconstruction system with stock prosthesis, 12 patients underwent total joint reconstruction system with custom made (patient matched) prosthesis, and 1 patient underwent bilateral total joint reconstruction using stock system on one side and custom system on the other side. The following adverse events and complications were recorded: bleeding, 2 cases; malocclusion, 1 case; postoperative infection with prosthesis removal, 1 case; heterotopic bone formation, 1 case; and contralateral TMJ overload in unilateral cases, 1 case. The occlusion was habitual unchanged in 29 of 38 cases. In 1 patient occlusion worsened with less stable functional contact. The patient refused postoperative orthodontic treatment. In 8 patients, a concomitant orthognatic procedure was planned in order to improve the occlusion. In all these patients, the occlusion improved. Quality of life and MIO relevantly improved in all cases.

Conclusions: This study supports the use of total joint reconstruction for end-stage TMJ disease. Both stock and custom implants allow consistent results, but there are precise indications for the use of custom implants.
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http://dx.doi.org/10.1016/j.jcms.2017.07.011DOI Listing
October 2017

Comparison of the Outcomes of Complex Orbital Fracture Repair with and without a Surgical Navigation System: A Prospective Cohort Study with Historical Controls.

Plast Reconstr Surg 2017 Apr;139(4):957-965

Torino, Italy.

Background: In severe orbital fractures, restoration of orbital shape and volume is required to avoid diplopia and posttraumatic enophthalmos. The purpose of this study was to compare outcomes between navigation-aided and conventional techniques for complex unilateral orbital fractures using titanium mesh.

Methods: The outcomes and the computed tomography-measured orbital volume of two groups of orbital complex unilateral reconstruction cases were compared. The study group consisted of a consecutive cohort of unilateral severe orbital fracture that underwent surgery with the aid of a Brainlab navigation system. A historical control group was composed of consecutive operations performed immediately before the beginning of navigation system use. A total of 55 operations were then identified and studied for patient characteristics, diplopia and globe position, preoperative and postoperative orbital volumes, complications, need for revision surgery, and the surgeon's performance.

Results: Postoperative diplopia severity was lower in the study group than in the control group. Orbital volume analysis showed that reconstructed orbital volume in the study group was closer to unaffected orbital volume compared with the control group. Significant orbital volume reduction in the reconstructed orbit could be achieved in the study group, and there was no significant reduction in the control group compared with the unaffected side. The globe projection was higher compared with the preoperative situation in the study group than in the control group. The navigational platform could also contribute to reduce the learning curve.

Conclusion: This study demonstrated that computer-assisted techniques improve outcomes compared with conventional techniques.

Clinical Question/level Of Evidence: Therapeutic, III.
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http://dx.doi.org/10.1097/PRS.0000000000003229DOI Listing
April 2017

Tips and Techniques in Oral Mucosa Harvest for Urological Reconstruction.

J Craniofac Surg 2017 Jun;28(4):1117-1118

Division of Maxillofacial Surgery, Surgical Science Department, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy.

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http://dx.doi.org/10.1097/SCS.0000000000003644DOI Listing
June 2017

Surgical Management of Myofibroma of the Gengiva.

J Craniofac Surg 2016 Oct;27(7):e646-e648

*Division of Maxillofacial Surgery, Surgical Science Department †Pathology Unit, Department of Medical Sciences ‡PhD Programme in Technologies applied to Surgical Sciences, Division of Maxillofacial Surgery, Surgical Science Department, Cittàdella Salute e dellaScienza Hospital, University of Torino, Torino, Italy.

The purpose of this paper is to report a rare patient of oral myofibroma in a 12-year old patient and to describe its clinical, histopathologic, and immunohistochemical features to establish the correct diagnosis and surgical management.Pathological and immunohistochemical examination is a mandatory method for establishing a definitive diagnosis of this lesion avoiding unnecessary treatment. Surgical excision and careful postoperative observation should be a treatment option.
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http://dx.doi.org/10.1097/SCS.0000000000002996DOI Listing
October 2016

An analysis of 711 victims of interpersonal violence to the face, Turin, Italy.

J Craniomaxillofac Surg 2016 Aug 6;44(8):1025-8. Epub 2016 Jun 6.

PhD programme in Technologies Applied to Surgical Science, Division of Maxillofacial Surgery, University of Torino, Italy. Electronic address:

Aim: The aim of this work is to analyze the risk factors in interpersonal violence and to describe the epidemiology, patterns and management of maxillofacial fractures in high volume trauma center of the northern Italy.

Material: This retrospective study recorded patients hospitalized with maxillofacial fractures, at the division of maxillofacial surgery, Città della Scienza e della Salute University Hospital, Torino, Italy, since January 2001.

Methods: Only patients who presented with "violence" in the database field for "cause of injury" and with "interpersonal violence" as a subtype of etiology were considered. Statistical analysis was determined using the χ(2) or Fisher's exact test.

Results: 2567 patients were admitted. 711 patients (27.7%) had undergone interpersonal violence that has increased from 20% to 35% in the study period. The male-to-female ratio was 11:1; the mean age was 32.7. 247 patients were foreigners (34.7%). 107 patients were enrolled in that study, referred alcohol or drugs abuse. IPV episodes account for 953 maxillofacial fractures localized in 55.3% of the cases in the midface, 43.1% in the lower third. Particularly the trauma involved the orbital region and the maxillo-orbito-zygomatic region. 4.4% of patients had combined trauma.

Conclusion: IPV maxillofacial fractures in Europe such as in Italy are becoming one of the first cause of injuries. This study shows that young males and foreigners are involved in violence mostly during the weekend. These fractures occur due to fists frequently involving the maxillo-zygomatic-orbital complex.
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http://dx.doi.org/10.1016/j.jcms.2016.05.021DOI Listing
August 2016

One stage treatment of temporomandibular joint complete bony ankylosis using total joint replacement.

J Craniomaxillofac Surg 2016 Apr 19;44(4):487-92. Epub 2016 Jan 19.

Division of Maxillofacial Surgery, Surgical Science Department, University of Torino, Italy.

Introduction: Temporomandibular joint ankylosis is a joint disorder due to bone or fibrous adhesion of the joint components that cause loss of function. There are many causes, such as trauma, infections and systemic diseases. To date, no uniform treatment protocol has been established.

Materials And Methods: We enrolled in the study patients that underwent single stage alloplastic total joint replacement for complete bony ankylosis. The subjective and objective variables were as follow: TMJ pain, diet, jaw function, quality of life, maximum interincisal opening (MIO) and occlusion. The minimum follow-up was 12 months.

Results: 12 patients met the inclusion criteria. Six patients underwent bilateral or monolateral total joint reconstruction with stock prosthesis, six patients underwent bilateral total joint reconstruction with custom made prosthesis. The mean preoperative MIO was 7.9 mm. The mean MIO reordered at 12-month follow-up was 26.5 mm (P < 0,0001). The occlusion was unchanged in 9 patients out of 12. In two patients the occlusion was changed by means of custom prosthesis design. In one patient occlusion worsened with less stable functional contact. Quality of life and diet relevantly improved in all cases.

Conclusions: Single stage resection and reconstruction with total alloplastic TMJ reconstruction is an effective and reliable method to reestablish stable long-term mandibular function in ankylotic patients.
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http://dx.doi.org/10.1016/j.jcms.2016.01.003DOI Listing
April 2016

Surgical Management of a Giant Residual Mandibular Cyst.

J Craniofac Surg 2016 Mar;27(2):e222-3

Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy.

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http://dx.doi.org/10.1097/SCS.0000000000002397DOI Listing
March 2016

Management of a Rare Case of Invasive Fungal Sinusitis.

J Craniofac Surg 2016 Mar;27(2):e220-1

Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy.

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http://dx.doi.org/10.1097/SCS.0000000000002390DOI Listing
March 2016

Treatment of Orbital Medial Wall Fractures with Titanium Mesh Plates Using Retrocaruncular Approach: Outcomes with Different Techniques.

Craniomaxillofac Trauma Reconstr 2015 Dec 28;8(4):326-33. Epub 2015 Apr 28.

Maxillofacial Unit, Department of Surgical Science, University of Turin, Torino, Italy.

Surgical management of medial wall orbital fractures should be considered to avoid diplopia and posttraumatic enophthalmos. Treatment of these fractures remains a challenge for the maxillofacial surgeon because of complex anatomy and limited vision. This article aims to retrospectively evaluate the outcomes in the repair of medial orbital wall fractures using a retrocaruncular approach and titanium meshes, comparing the placement of the titanium mesh with three different techniques: (1) conventional free hand under direct vision, (2) with the assistance of an endoscope, and (c) with the assistance of a navigation system. Eighteen patients who underwent surgery for orbital medial wall fracture were enrolled in the study. On the basis of the implant placement technique, three groups were identified: group 1 (CONV), conventional free hand under direct vision; group 2 (ENDO), endoscopically assisted; group 3 (NAVI), a navigational system assisted (BrainLab, Feldkirchen, Germany). The postoperative quality of orbital reconstruction was assessed as satisfactory in 12 cases, good in 4 cases, and unsatisfactory in 2 cases. Particularly in group 1 (CONV) in four patients out of eight, the posterior ledge of the fracture was not reached by the implant and in one patient the mesh hinged toward the ethmoid. In group 3 (NAVI), in one patient out of five, the posterior ledge of the fracture was not reached. In conclusion, titanium orbital mesh plates and retrocaruncular approach are a reliable method to obtain an accurate orbital medial wall reconstruction. The use of endoscopic assistance through the surgical incisions improves accuracy of treatment allowing better visualization of the surgical field. Navigation aided surgery is a feasible technique especially for complex orbital reconstruction to improve predictability and outcomes in orbital repair.
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http://dx.doi.org/10.1055/s-0035-1549014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631559PMC
December 2015

Surgical Treatment and Immediate Reconstruction of Keratocystic Odontogenic Tumor.

J Craniofac Surg 2015 Oct;26(7):e667-8

Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy.

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http://dx.doi.org/10.1097/SCS.0000000000002106DOI Listing
October 2015

Primary and secondary reconstruction of complex craniofacial defects using polyetheretherketone custom-made implants.

J Craniomaxillofac Surg 2015 Oct 8;43(8):1356-63. Epub 2015 Jul 8.

Division of Maxillofacial Surgery, University of Torino, Italy.

Purpose: The aim of this study was to evaluate the surgical outcomes using polyetheretherketone (PEEK) patient-specific prostheses produced by computer-aided design and manufacturing for primary and secondary reconstruction in patients with craniofacial defects.

Material And Methods: The study included 13 patients who underwent reconstruction for craniofacial defects using PEEK patient-specific implants (PSI). Eight patients underwent single-step primary reconstruction using individual custom-made surgical guides and custom-made prostheses during the same surgery; five patients underwent delayed reconstruction. The material used to manufacture the implants was PEEK in 13 cases. All patients underwent esthetic examination, ophthalmological examination, and radiological evaluation during the preoperative and follow-up periods. The operation duration and short- and long-term complications were recorded.

Results: The shape and global position of the implants were satisfactory in each case. Fitting of the implant during surgery required extensive adaptation in 1 case and minor in 11 cases. Of 13 implants, 11 adequately restored a morphological complex area with satisfactory cosmetic results. No complications related to the implants were reported.

Conclusion: Reconstruction for cranio-facial defects using PEEK computer-aided designed and manufactured implants is a promising new technique that allows for accurate restoration of the complex 3D anatomy of the craniofacial region.
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http://dx.doi.org/10.1016/j.jcms.2015.06.043DOI Listing
October 2015

To computer-aided design and manufacturing or not to computer-aided design and manufacturing? Free fibula flap with computer-aided technique for mandibular reconstruction.

J Craniofac Surg 2015 May;26(3):e206-9

Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy.

Aim: The purpose of this study was to analyze the accuracy of computer-assisted free fibula flap for reconstruction of large mandibular defects for benign tumors.

Materials And Methods: Between December 2012 and January 2014, a total of 4 free osteocutaneous computer-assisted fibula flaps have been used in an equal number of patients for reconstruction of the mandible at the Division of Maxillofacial Surgery, Città della Scienza e della Salute Hospital, University of Turin. Inclusion criteria were large mandibular defects due to benign tumors. The computer-assisted fibula flap was chosen when 2 or more osteotomies were requested. Intraoperative complication, mean ischemia time, operative time, and morphologic outcomes were analyzed in all cases. After surgery, a postoperative computed tomography compared the virtual plan with the surgical results.

Results: All 3 flaps were harvested and transplanted successfully. For the free flaps examined in this work, no intraoperative complications were noted. Postoperative computed tomography showed high correspondence in terms of bone contour according to the virtual plan. The immediate and long-term morphologic results were satisfactory.

Conclusions: Microsurgical mandible reconstruction using a computer-assisted fibula flap technique is the best available method to manage complex defects.
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http://dx.doi.org/10.1097/SCS.0000000000001431DOI Listing
May 2015

The Le Fort I osteotomy as surgical approach of an extensive pleomorphic adenoma of the palate.

J Craniofac Surg 2015 May;26(3):e262-4

*Division of Maxillofacial Surgery †Programme in Technologies applied to Surgical Sciences, Division of Maxillofacial Surgery ‡Student in Experimental Medicine and Therapy, Doctoral School in Life and Health Sciences, Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy.

Pleomorphic adenoma (PA) is the most common benign mixed salivary gland tumor. We describe here a peculiar case of a 72-year-old woman with a PA of the palate resected with palatal approach combined with Le Fort I osteotomy, adding to the currently limited scientific literature on intraoral approach for removal of extensive tumors of the midface. The Le Fort I osteotomy approach allows direct visualization of the tumor and ensures a wide excision, increasing safety and minimizing the possibility of recurrence.
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http://dx.doi.org/10.1097/SCS.0000000000001661DOI Listing
May 2015

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 May 24;119(5):499-504. Epub 2014 Dec 24.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.

Study Design: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.

Results: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.

Conclusions: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.
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http://dx.doi.org/10.1016/j.oooo.2014.12.012DOI Listing
May 2015

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Apr 11;119(4):385-91. Epub 2014 Dec 11.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.

Study Design: Demographic and injury data were recorded for each patient who was a victim of an assault.

Results: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.

Conclusions: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.
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http://dx.doi.org/10.1016/j.oooo.2014.12.004DOI Listing
April 2015

Maxillofacial Fractures due to Falls: does Fall Modality Determine the Pattern of Injury?

J Oral Maxillofac Res 2014 Oct-Dec;5(4):e5. Epub 2014 Dec 29.

Surgical Science Department, San Giovanni Battista Hospital, University of Turin, Turin Italy.

Objectives: In several epidemiological studies of maxillofacial trauma, falls were one of the most frequent causes of facial injury. The aim of this study is to analyse the patterns of fall-related maxillofacial injuries based on the height of the fall.

Material And Methods: Using a systematic computer-assisted database of patients hospitalised with maxillofacial fractures, only those with fall-related injuries were considered. The falls were divided into four groups: falls from slipping, tripping or stumbling (STSF), loss of consciousness (LOCF), stairs (SAF), and height (HF). Data on the age, gender, fracture site, Facial Injury Severity Scale (FISS), facial lacerations, associated lesions, type of treatment, and length of hospital stay were also analysed.

Results: This study included 557 patients (338 males, 219 females; average age 51.5 years [range 4 - 99 years]). In the over 60 age group, females were more prevalent in STSF than males. According to aetiology, STSF was the most frequent cause of maxillofacial fractures (315 patients; 56.5%) followed by LOCF (157; 28.2%), HF (55; 9.9%), and SAF (30; 5.4%). The middle third of the face was affected most frequently. After LOCF, however, the inferior third was prevalently involved. The majority of associated fractures, as well as the most severe injuries and greatest rate of facial lacerations, occurred secondary to HF.

Conclusions: This study showed that fracture severity and site are influenced not only by patient age, but also by the nature of the fall.
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http://dx.doi.org/10.5037/jomr.2014.5405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306323PMC
January 2015

Orbital trapdoor fracture: can it occur also in adults?

J Craniofac Surg 2015 Jan;26(1):e6-8

From the Division of Maxillofacial Surgery, Department of Surgical Science, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy.

We describe here a peculiar case of a 30-year-old woman presenting with an orbital trapdoor fracture. Preoperative and postoperative magnetic resonance images are provided to explain the mechanism of the injury.
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http://dx.doi.org/10.1097/SCS.0000000000001215DOI Listing
January 2015

Navigation-aided endoscopic sinus surgery.

J Craniofac Surg 2015 Jan;26(1):326-7

Division of Maxillofacial Surgery Surgical Science Department Città della Salute e della Scienza Hospital University of Torino Torino, Italy

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http://dx.doi.org/10.1097/SCS.0000000000001256DOI Listing
January 2015

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

J Craniomaxillofac Surg 2015 Jan 22;43(1):62-70. Epub 2014 Oct 22.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.
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http://dx.doi.org/10.1016/j.jcms.2014.10.011DOI Listing
January 2015