Publications by authors named "Giacomo Colletti"

71 Publications

Letter to the Editor: Intraosseous Cavernous Hemangioma of the Middle Turbinate: A Case Report.

Ear Nose Throat J 2021 Apr 13:1455613211009132. Epub 2021 Apr 13.

460280The Vascular Birthmark Foundation, Latham, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/01455613211009132DOI Listing
April 2021

A (Very) Brief History of the Nosography of Vascular Anomalies.

J Invest Surg 2021 Mar 9:1-2. Epub 2021 Mar 9.

Department of Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Modena, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08941939.2021.1893414DOI Listing
March 2021

Assessing the impact of COVID-19 on individuals and families affected by vascular anomalies: The VBF COVID-19 survey.

J Plast Reconstr Aesthet Surg 2021 05 13;74(5):1101-1160. Epub 2020 Dec 13.

Vascular Birthmarks Foundation (VBF), VBF Europe Co-Director; VBF Italy Medical Director (VBF Italy, Milan, Italy), VBF, Milan, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2020.12.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832352PMC
May 2021

Stop Calling Me Cavernous Hemangioma! A Literature Review on Misdiagnosed Bony Vascular Anomalies.

J Invest Surg 2020 Nov 5:1-10. Epub 2020 Nov 5.

Vascular Birthmark Foundation, New York, USA.

Vascular malformations of the bone most often involve the cranio-facial area. Even in relevant peer reviewed journals, venous malformations are often misdiagnosed as "hemangiomas" or "angiomas" of the bone. By reviewing literature from the past 5 years (2013-2018), we found many reports of vascular malformations of the bone where the diagnosis was incorrect. Unfortunately, there is still much confusion in understanding and/or diagnosing vascular malformations, despite the fact that in recent years many papers tried to clarify this topic. The purpose of this article is to make a review of the scientific literature concerning vascular malformations of the bone which have been reported as angioma, hemangioma, or hemangioendothelioma, and have been published between January 2013 to October 2018. Clinical features, imaging and histologic reports contained in the papers were reviewed. Subsequently, after reviewing every single paper we reclassified the diagnosis according to the 2018 ISSVA classification. Almost all of the vascular anomalies presented in the reviewed papers as angiomas, hemangiomas, or hemangioendotheliomas were venous (mostly) or arteriovenous malformations. Therefore, only 8 out of 58 papers (14.7%) had an accurate diagnosis. Interestingly, all of the papers reporting cavernous or capillary hemangiomas were actually presenting venous malformations. Making a correct diagnosis is of primary importance because depending on the type of vascular anomaly, the treatment and the prognosis for the patient are very different. Everyone who approaches or describes a vascular anomaly of the bone should know and should adopt a correct and updated nosography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08941939.2020.1824041DOI Listing
November 2020

Don't call me "Lymphangioma!"

Oral Maxillofac Surg 2020 09 13;24(3):371-372. Epub 2020 Jun 13.

The Vascular Birthmark Foundation, VBF Europe, VBF Italy, PO Box 106, Latham, NY, 12110, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10006-020-00867-2DOI Listing
September 2020

Do We Still Need to Study an Optimal Procedure for Jaw Alveolar Bone Reconstruction?

Authors:
Giacomo Colletti

J Invest Surg 2020 May 24:1-2. Epub 2020 May 24.

Private Practice,Milan, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08941939.2020.1770379DOI Listing
May 2020

SECg Staging System: A New Approach to the Management of Arteriovenous Malformations of the Head and Neck.

J Craniofac Surg 2020 Jun;31(4):e420-e424

Lenox Hill Hospital, New York, NY.

Objectives: Arteriovenous malformations (AVM) are the most troublesome vascular malformations to deal with. They tend to behave like low-grade malignancies with infiltrative and disruptive growth. Crucially, the clinical course of an AVM that has been improperly managed is usually characterized by a recurrence that is much more aggressive than the original disease. As in oncology, a comprehensive staging system is highly desirable and is to date lacking in the literature. The authors present a new comprehensive staging system.

Methods: A multicentric multidisciplinary team of experts in the field of vascular anomalies has created this new staging system. The SECg staging system defines the local extension of the disease (S1-S4), the vascular architecture of the malformation (E1, E2, E3), the severity of the symptoms (C0-C3) and the presence or absence of growth of the AVM (g+, g-).

Results: This staging system allows to address all the aspects of AVMs and, more importantly, to help building an appropriate, individualized treatment plan for affected patients. After being staged an AVM can be defined as (a) healable, (b) healable with predicted sequelae, or (c) unhealable. Then, the SECg system allows to outline (a) absolute indications, (b) relative indications, and (c) no indications for treatment. The purpose of the treatment (radical, palliative) is furthermore taken into consideration.

Conclusions: This multicentric, the SECg staging system that this multidisciplinary group of Authors has defined allows for a comprehensive staging of the disease which in turn has enabled to outline an algorithm to properly manage AVMs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000006446DOI Listing
June 2020

CD10 and CD34 as markers in vascular malformations with PIK3CA and TEK mutations.

Hum Pathol 2020 05 6;99:98-106. Epub 2020 Apr 6.

Unit of Human Pathology, Department of Health Sciences, Santi Paolo e Carlo Hospital Medical School, University of Milan, Milan, 20142, Italy.

Aims: Vascular malformations (vMs) encompass a wide range of diseases often associated with somatic or, more rarely, germinal genetic mutations. A mutation in the PIK3Ca/mTOR pathway is more often involved in various vMs. CD10 and CD34 are cellular markers that may play a role in mesenchymal differentiation and proliferation. The aim of our study was to find a possible link between the immunohistochemical expression of CD10 and CD34 in vMs and their relationship with mutations in the PIK3CA/mTOR signaling pathway.

Methods And Results: Our study on 58 samples of vMs showed that in endothelial cells, CD10 was significantly expressed in PIK3CA-mutated samples compared with samples without any mutation (p < 0.05), especially and even more consistently when compared with samples with mutation in other pathways (p < 0.0001). Conversely, in the same PIK3CA-mutated samples, CD34 expression in endothelial cells was significantly reduced compared with samples either without any mutation or mutations in other pathways (p < 0.05 and p < 0.0005). Compared with samples with mutations in other pathways, a significant overexpression of endothelial CD10 was also found in samples with TEK/TIE2 mutation, a gene linked to the PIK3CA/mTOR pathway (p < 0.01). However, CD34 expression was not altered. In samples with PIK3CA mutation, the CD10 expression was significantly increased in the stroma compared with samples with TEK/TIE2 gene or other gene mutations (p < 0.05).

Conclusion: Therefore, the CD10 and CD34 immunohistochemical profile could suggest/support the presence of mutations in the PIK3CA/mTOR pathway in samples of vMs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.humpath.2020.04.001DOI Listing
May 2020

The Never-Ending Issue in Nosography of Intramuscular Vascular Anomalies.

J Craniofac Surg 2020 May/Jun;31(3):886-887

Department of Maxillo Facial Surgery, Sassari Hospital, Sassari, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000006115DOI Listing
July 2020

Percutaneous sclerotherapy with gelified ethanol of low-flow vascular malformations of the head and neck region: preliminary results.

Diagn Interv Radiol 2019 Nov;25(6):459-464

Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy.

Purpose: We aimed to evaluate the safety and effectiveness of percutaneous sclerotherapy using gelified ethanol in patients with low-flow malformations (LFMs).

Methods: A retrospective study was performed, analyzing treatment and outcome data of 6 patients that presented with 7 LFMs (3 lymphatic and 3 venous). Median diameter of LFMs was 6 cm (interquartile range [IQR], 4.5-8.5 cm). Data regarding pain, functional and/or cosmetic issues were assessed. Diagnosis was performed clinically and confirmed by Doppler ultrasound, while extension of disease was assessed by magnetic resonance imaging (MRI). Percutaneous puncture was performed with 23G needle directly or with ultrasound guidance. All the LFMs were treated with gelified ethanol injection. The median volume injected per treatment session was 4.4 mL.

Results: Technical and clinical success were obtained in all cases. No recurrences were recorded during a median follow up of 17 months (IQR, 12-19 months). Among the 6 patients, 5 had complete relief (83%) and one showed improvement of symptoms. The median VAS score was 7 (IQR, 6-7.5) before and 0 (IQR, 0-0) after treatment. All patients had functional and esthetic improvement (100%). Four patients (66.7%) revealed very good acceptance and two patients (33.3%) good acceptance. No major complications or systemic side effects were observed.

Conclusion: Gelified ethanol percutaneous sclerotherapy was easy to handle, well-tolerated, safe and effective in the short-term follow-up. Longer follow-up of efficacy is mandatory for further conclusions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/dir.2019.18542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837297PMC
November 2019

Basal Cell Carcinoma Arising over a Venous Malformation of the Forehead Communicating with the Endocranial Veins.

J Craniofac Surg 2020 Jan/Feb;31(1):e92-e95

University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery, Italy.

Introduction: An increasing number of skin cancer arising over vascular anomaly has been reported in literature. In such cases, the oncologic radicality required to threat skin malignancies may be in contrast with the safety needed when dealing with vascular malformation. As a result, treatment of this association may be insidious and treacherous and imposes a sound knowledge and carefulness.

Materials And Methods: The authors report on a case of a 77-years-old woman affected by a basal cell carcinoma (BCC) arising over a vascular malformation of forehead. Preoperative radiological imaging revealed an underlying venous malformation (VM) communicating with intracranial district. Patient underwent sclerotherapy of the VM with gelified ethanol in order to reduce potentially fatal bleeding during surgery and, on the other hand, any leakage of the sclerosant in the intracranial veins. Excision of the BCC was then performed without complications.

Results: Neither intra-operative nor post-operative complications were observed. Current 3-years follow-up shows no recurrence of BCC whilst the residual VM is stable and clinically silent.

Conclusions: Mechanisms leading to the onset of skin cancers over venous malformations are still unclear. However, association between these 2 conditions may be underestimated with possible catastrophic consequences. Thorough knowledge of vascular malformations and a multidisciplinary approach is of the uttermost importance when dealing with such clinical challenges.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000005947DOI Listing
March 2020

Vascular malformations of the orbit (lymphatic, venous, arteriovenous): Diagnosis, management and results.

J Craniomaxillofac Surg 2019 May 20;47(5):726-740. Epub 2018 Sep 20.

University of Parma, Department of Maxillo Facial Surgery (Head: Prof. Enrico Sesenna), Italy.

Vascular malformations are often found inside the orbit. Isolated venous malformations (frequently misnamed as cavernous hemangiomas) are the most frequent among these. However, also lymphatic and arteriovenous malformations can affect the orbit. The complex anatomy of the orbit and the fact that its content easily suffers from compartmental syndrome explain why treating orbital vascular malformations can be challenging and technically demanding. In this study, two institutions have retrospectively collected their cases, consisting in a total of 69 vascular malformations of the orbit. Each type of malformation has been evaluated separately in terms of diagnosis, indications for treatment, techniques and outcomes. Moreover, the authors have analyzed in detail venous malformations, identifying three different types, named orbital venous malformation (OVM) 1, 2 and 3. These behave differently from each other, and a prompt differential diagnosis is mandatory to pose correct indications, minimize risks and improve results. Overall, surgery was the technique of choice for OVM1, microcystic lymphatic malformations (LM) and arteriovenous malformations (AVM). A pure transnasal approach with mass removal and reconstruction of the medial wall with polyethylene sheets was chosen for OVM1 (intra- or extraconal) located in the medial or superomedial compartment. Sclerotherapy had a role in treating macrocystic LM and OVM3.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2018.09.009DOI Listing
May 2019

Considerations on the 'corseting' or 'strangling' technique to treat large venous malformations.

Int J Oral Maxillofac Surg 2019 05 25;48(5):697. Epub 2018 Oct 25.

Department of Maxillofacial Surgery, University of Milan, Milan, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijom.2018.10.005DOI Listing
May 2019

Star flap: new reconstructive technique for defects of the scalp.

Br J Oral Maxillofac Surg 2018 12 8;56(10):982-984. Epub 2018 Nov 8.

Department of Maxillofacial Surgery, San Paolo Hospital, Via Di rudiní 8, 20143, Milan, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjoms.2018.10.278DOI Listing
December 2018

Surgical correction of hypertrophic upper lip in vascular malformations.

J Craniomaxillofac Surg 2018 Oct 3;46(10):1790-1792. Epub 2018 Aug 3.

University of Milan, Department of Maxillo-Facial Surgery, San Paolo Hospital (Head: Prof. F. Biglioli), Milan, Italy.

Capillary malformations (CMs) and Lymphatic malformations (LMs) are vascular malformations that share a common tendency to cause soft and hard tissue hypertrophy, expressed in the three dimensions of the space. The middle third of the face is the most commonly involved area, with a predominance of the upper lip. To our knowledge, no paper has previously focused on the surgical technique to correct such deformities. We propose and illustrate a surgical protocol, consisting in merging an asymmetric bikini upper lip reduction and a unilateral bull horn resection technique, that allowed to reduce the overall volume of the hypertrophied lip thus restoring lip symmetry. We adopted this technique in 2 patients affected by CMs and 4 patients with LMs, with satisfactory results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2018.07.023DOI Listing
October 2018

About hemangioma and vascular malformations.

Authors:
Giacomo Colletti

Radiol Med 2018 11 17;123(11):841-842. Epub 2018 Jul 17.

Maxillo Facial Surgery, San Paolo Hospital, University of Milan, Via A. DiRudinì 8, Milan, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11547-018-0922-3DOI Listing
November 2018

About venous malformations of the facial bones.

Oral Maxillofac Surg 2018 09 14;22(3):345. Epub 2018 Jun 14.

Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10006-018-0706-xDOI Listing
September 2018

Objective Assessment of Lingual Nerve Microsurgical Reconstruction.

J Craniofac Surg 2018 Nov;29(8):e740-e744

Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan.

Lingual nerve (LN) injury is one of the most serious consequences of oral surgery. Prompt microsurgical reconstruction of the nerve can alleviate most of those symptoms leading to satisfactory functional recovery.Thirty-five patients with partial to complete LN injury underwent surgery in the period between January 2006 and May 2015. All patients underwent a preoperative clinical and neurological evaluation with the assessment of lingual tactile and pain sensory thresholds and masseteric inhibitory reflex.All patients underwent explorative surgery and direct microneurorrhaphy of distal and proximal stumps in case of complete lesion, while the removal of traumatic neuroma and the following microneurorrhaphy of distal and proximal stumps of the injured nerve was performed in case of incomplete lesion. Nerve grafting has always been avoided because of distal stump mobilization obtained by severing the submandibular branch of the LN.All patients but 1 exhibited good recovery of tongue sensation, never complete, both clinically and electrophysiologically: recovery of the excitability of masseteric inhibitory reflex suppression components SP1 and SP2 was observed, often with increased latencies but consistent with a functional recovery.All patients feeling pain preoperatively experienced complete relief of algic symptoms.The early microsurgical approach is the most suitable choice for the treatment of LN injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000004663DOI Listing
November 2018

Regarding Hemangiomas and Vascular Malformations of the Facial Bones.

J Oral Maxillofac Surg 2018 08 7;76(8):1601. Epub 2018 May 7.

Milan, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2018.04.015DOI Listing
August 2018

Triple innervation for re-animation of recent facial paralysis.

J Craniomaxillofac Surg 2018 May 7;46(5):851-857. Epub 2018 Mar 7.

Maxillo-Facial Surgery Department (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy.

Recent facial palsies are those in which fibrillations of the mimetic musculature remain detectable by electromyography (EMG). Such fibrillations generally cease 18-24 months after palsy onset. During this period, facial re-animation surgery seeks to supply new neural inputs to the facial nerve. Neural usable sources were divided into qualitative (contralateral facial nerve) and quantitative (hypoglossus and masseteric nerve), depending on the type of stimulus provided. To further improve the extent and quality of facial re-animation, we here describe a new surgical technique featuring triple neural inputs: the use of the masseteric nerve and 30% of the hypoglossus nerve fibres as quantitative sources was associated with the contralateral facial nerve (incorporated via two cross-face nerve grafts) as a qualitative source in order to restore facial movements in 24 consecutive patients. The use of two quantitative motor nerve sources together with a qualitative neural source appears to improve re-animation after facial paralysis, despite earlier doubts as to whether patients could use different nerves to produce facial movements. In fact, movement was much improved. Smiling according to emotions and blinking seem to be better assured if cross-face nerve grafting is performed in two steps rather than one.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2018.02.014DOI Listing
May 2018

Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.

J Craniomaxillofac Surg 2018 Mar 14;46(3):398-412. Epub 2017 Nov 14.

Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

Purpose: The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches.

Materials And Methods: A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches.

Results: A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid approach with preauricular extension 2.3% for CNFs/CBFs. H) For preauricular approach a) deep subfascial dissection plane 0% in CHFs b) for subfascial approach using traditional preauricular incision 10% (8.5% in CHFs and 11.5% in CNFs). I) For retroauricular approach 3% for CHFs. PFNI rates reported in the literature were as follows: A) for low submandibular approach 2.2%, B) for retromandibular transparotid approach 1.4%; C) for preauricular approach 0.33%; D) for high submandibular approach 0.3%; E) for deep retroparotid approach 1.5%.

Conclusion: According to published data for CHFs, a retroauricular approach or deep subfascial preauricular approach was the safest to protect the facial nerve. For CNFs, a transmassetric anteroparotid approach with retromandibular and preauricular extension was the safest approach to decrease risk of FNI. For CBFs, high submandibular incisions with either transmassetric anteroparotid approach with retromandibular or transmassetric subparotid approach, followed by intraoral (with or without endoscopic/transbuccal trocar) were the safest approaches with respect to decreased risk of FNI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2017.10.024DOI Listing
March 2018

Endoscopic endonasal repair with polyethylene implants in medial orbital wall fractures: A prospective study on 25 cases.

J Craniomaxillofac Surg 2018 Feb 21;46(2):274-282. Epub 2017 Nov 21.

Unit of Maxillo-Facial Surgery, Department of Head & Neck Surgery, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

The aim of the study was to assess the mid-term effectiveness and safety of an original technique consisting of reconstructing fractures of the medial wall of the orbit with porous polyethylene implants with an exclusive transnasal approach. Twenty-five patients were treated. Each patient underwent a pre-operative ophthalmologic evaluation and a CT scan. The surgery started with an anteroposterior ethmoidectomy of the fractured side; all the fractured bone fragments were removed and all usual landmarks of healthy bony margins were identified. A Medpor sheet was placed endoscopically to reconstruct the fractured wall. Each patient received an immediate postoperative CT scan, and was evaluated at day 1, 7, 30 and 6 months after surgery clinically and with an endoscopic examination. In all patients, preoperative enophthalmos and/or diplopia were corrected. The CT scans showed excellent reconstruction of the fractured bony walls. The immediate postoperative period was characterized by a very high degree of subjective comfort. No perioperative complications were detected. At the 6 months follow up, all meshes appeared covered by epithelialized mucosa at the endoscopic inspection, and clinical results were stable. Scars or lid complications are always prevented. The technique described has become the standard to treat medial wall fractures in our department.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2017.11.017DOI Listing
February 2018

Surgical treatment of synkinesis between smiling and eyelid closure.

J Craniomaxillofac Surg 2017 Dec 18;45(12):1996-2001. Epub 2017 Sep 18.

Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address:

Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%. The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the masseteric nerve and a central branch of the facial nerve, as well as with the use of a cross-facial nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling. Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients. Neurorrhaphy of the masseteric nerve and the central branch of the facial nerve appears to produce favorable results. These initial data should be confirmed by further studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2017.09.008DOI Listing
December 2017

A Shift in the Orbit: Immediate Endoscopic Reconstruction After Transnasal Orbital Tumors Resection.

J Craniofac Surg 2017 Nov;28(8):2027-2029

*Maxillofacial Surgery Unit †Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan ‡Oncologic Neurosurgery Unit, Humanitas Clinical Institute, Rozzano §Oral Surgery Department, Florence Dental School, University of Florence, Florence, Italy.

Endoscopic endonasal resection of orbital lesions is a safe and common approach. Nevertheless, medial orbital wall defects following the procedure are not routinely addressed, potentially leading to diplopia and enophthalmos. In this article, the authors propose a new technique for purely endoscopic endonasal reconstruction of orbital wall defects following endoscopic endonasal resection of orbital lesions.The patient, a 43-year-old male, suffering from right exophthalmos and diplopia due to a venous malformation of the right orbit underwent endoscopic endonasal resection of the mass. Excision was followed by immediate transnasal endoscopic reconstruction with a commercially available porous polyethylene mesh (Medpor).The postoperative course was uneventful. The patient did not report any residual orbital asymmetry or diplopia. No recurrence of the venous malformation, mesh infection, or reconstruction instability was reported during the follow-up.The authors believe that this new technique could spur head and neck surgeons in strategically rethinking their approach to orbital tumors, proposing reconstruction to patients on a routine basis, and developing even more reliable and manageable solutions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000003879DOI Listing
November 2017

Complications After Treatment of Head and Neck Venous Malformations With Sodium Tetradecyl Sulfate Foam.

J Craniofac Surg 2017 Jun;28(4):e388-e392

*Departmentof Maxillo-Facial Surgery, University of Milan, San Paolo Hospital, Milan †Department of Otolaryngology, University of Florence, Careggi Hospital, Florence ‡Department of Maxillo Facial Surgery, San Paolo XXIII Hospital, Bergamo §Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza ||Private practice, Genoa ¶Phlebology Unit, Villa Donatello private clinic, Florence #Phlebology and Wound Healing Surgery Unit, Villa Fiorita private clinic, Prato **Vascular Surgery, Casa di Cura Guarnieri, Rome, Italy.

Purpose: The aim of this study was to evaluate complications in patients with head and neck venous malformations (VMs) treated with foam sclerotherapy using sodium tetradecyl sulfate (STS).

Methods: The authors retrospectively evaluated the complications, pain. and degree of satisfaction in 69 consecutive patients affected by cervicofacial VM managed with STS using the Tessari method in a single institution.

Results: The average number of procedures for each patient was 2.1. The most frequent complication was blistering. We observed 1 patient of temporary weakness of a facial nerve branch, 1 paradoxical embolism, and 1 orbital compartment syndrome.The average pain score was 0 (no pain at all) (51.5%). There was no statistically significant correlation between patient satisfaction and the presence of complications or the degree of pain.

Conclusions: Sclerotherapy with STS is an effective treatment that yields to very high patient satisfaction. This procedure has an overall low complication rate and is usually effective within a few sessions. However, severe complications may occur; these must be pointed out in the informed consent and the surgeon must be aware of and ready to quickly treat them to prevent long-term sequelae.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000003723DOI Listing
June 2017

Stereophotogrammetric Evaluation of Labial Symmetry After Surgical Treatment of a Lymphatic Malformation.

J Craniofac Surg 2017 Jun;28(4):e355-e358

*Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan †Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples ‡Surgical Unit of Maxillo-Facial Surgery, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan §Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy.

Lymphatic malformations (LMs) are rare, nonmalignant masses, frequently involving the head and neck, potentially causing impairment to the surrounding anatomical structures. Major LMs frequently cause facial disfigurement with obvious consequences on self-esteem and social functioning. The attempt to restore symmetry is thus one of the main goals of treatment. In this study, the authors present a not-invasive method to objectively quantify the symmetry of the labial area before and after surgical treatment of a LM, affecting a 16-year-old woman. This was done with sequential three-dimensional stereophotogrammetric imaging and morphometric measurements. The method showed a high reproducibility and supplied quantitative indicators of the local degree of symmetry, helping clinicians in its objective assessment, and facilitating treatment planning and evaluation. A quantitative appraisal of the results can additionally improve patient adherence to a usually multistage therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000003601DOI Listing
June 2017

Understanding venous malformations of the head and neck: a comprehensive insight.

Med Oncol 2017 Mar 8;34(3):42. Epub 2017 Feb 8.

Interventional Radiology Unit, University of Milan, San Paolo Hospital, Milan, Italy.

Venous malformations (VMs) are congenital vascular malformations. They are very often misnamed and thus incorrectly managed. The aim of the present paper is to provide the reader with the most updated literature available and to offer a detailed description of each single aspect of this disease. In detail, the paper discusses the epidemiology, the embryological origins and the physiopathology of VMs. Then, the clinical features of sporadic, inherited and syndromic VMs are discussed. The instrumental diagnosis is presented, and the role of US, CT, MRI and phlebography is pointed out. Differential diagnoses with other vascular malformations and tumors are described. The clinical session ends with the staging of VMs relying on MRI and rheological features. All aspects of treatment are described: conservative measures, medical treatment, sclerotherapy, laser and surgery are thoroughly discussed. A section is reserved to bony VMs. Their clinical aspects and the appropriate treatment are presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12032-017-0896-3DOI Listing
March 2017

Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery.

Otol Neurotol 2017 04;38(4):606-609

*Department of Maxillo-Facial Surgery, University of Milan †Otological and Skull Base Surgery Department, Azienda Ospedaliera Universitaria Senese, Siena ‡ENT Department, University of Verona, Verona §University of Firenze, Florence ||International Center for Performing and Teaching Auditory Brainstem Surgery in Children, Milan, Italy.

Objective: To present a child with cochlear nerve deficiency (CND) who received simultaneous bilateral simultaneous auditory brainstem implants (BS-ABI) and subsequently presented with bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard treatments. To propose a novel rigid retrosigmoid cranioplasty for treating and preventing CSF leaks in children at high risk for this complication.

Patient: A 3.5-year-old child with CND, vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality, Arnold Chiari malformation, previous treated tracheo-esophageal fistula underwent BS-ABI. Postoperatively, the child had recurrent bilateral retroauricular fluid collections. A standard revision procedure revealed breaches in the dural closure, migration of the auditory brainstem implantation (ABI) receiver stimulator on both sides and was unsuccessful in stopping the leak.

Interventions: Bilateral repair with free fat grafting filling the craniectomy space and two absorbable meshes of poly-L-D-lactic (PLDL) acid stabilized with PLDL pins on the surrounding cranium, one to stabilize the fat graft and one to fix the ABI receiver stimulators inside the subperiosteal pockets.

Main Outcome Measure: CSF leak recurrence, postoperative computed tomographic (CT) scans, intra- and postoperative simultaneous electrically evoked auditory brainstem responses (EABRs). Subjective and objective assessment of ABI function.

Results: No postoperative CSF leaks at 60 days follow-up. EABRs and consistent behavioral responses obtained at initial mapping on both sides.

Conclusions: The use of BS-ABI likely contributed to bilateral CSF leaks requiring revision surgeries in this child. Simultaneous bilateral craniotomies can put patients at risk for CSF leak. A novel cranioplasty technique employed finally proved successful in stopping the CSF leak in this case.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000001338DOI Listing
April 2017

Cavernous hemangioma: a term to be canceled.

Eur Arch Otorhinolaryngol 2017 04 3;274(4):2069-2070. Epub 2016 Oct 3.

ENT Department, University of Florence, Florence, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-016-4324-7DOI Listing
April 2017