Mandibular fractures are the third most frequents maxillo-facial fractures. Most frequent site is the subcondylar region. Different approaches to reach subcondylar region, have been described. In the study was evaluated the advantages of neuromuscular block during endoscopic surgery for subcondylar fractures. Twenty-five patients affected by subcondylar fractures were enrolled in this study and divided in 2 groups; group A: patients who received an intraoperative booster of curare during surgical procedure and group B patients who underwent surgery treated without the intraoperative booster of curare. All patients were treated successfully by endoscope-assisted transoral approach. The analysis of time required for surgery showed a reduction in group A comparing to group B. The mean time for surgery for the patients in group B with displacement between 0° and 45° was 170 minutes, and for 45° to 90° was 230 minutes. In group A, the mean time was 117.5 minutes for patients with condylar displacement between 0° and 45°, and 147.5 minutes for the other group. In conclusion, deep neuromuscular block seems to improve the surgical conditions in patients undergoing subcondylar endoscopic assisted surgery, further study needs to assess this surgical technique in order to better define this surgical protocol.
Abstract Purpose: the purpose of this study was to retrospectively analyze the clinical records of patients admitted for maxillo-facial fracture to 18 Italian center, evaluating the epidemiological differences between the different phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery deparments in Italy, from February 23, 2020 to February 23, 2022. According to the date of admission, all the data were stratified in four chronological periods encompassing the four different moments in terms of restriction in Italy: pre-pandemic, first wave, partial restrictions and post-pandemic groups. Differences in epidemiological data between the groups were analysed. Results: 2,938 patients were included. There was a statistically significant difference in the cause of hospitalization between pre-pandemic and first wave groups ( p =0.005) and between pre-pandemic and partial restriction groups ( p =0.002). The differences between the pre- and post-pandemic groups where instead not significant ( p =0.106). Compared to the pre-pandemic period, the number of Black patients was significantly higher during the first wave and the post-pandemic period. Differences between the periods in terms of gender, age, type of fracture, treatment modality, and length of hospital stay were not found to be statistically significant. Conclusions: during the COVID-19 pandemic there have been profound changes in the epidemiology of fractures influenced by the restrictive measures implemented by the government. At the end of the pandemic, the epidemiology of fractures returned to being the same as in the pre-pandemic period. Purpose: the purpose of this study was to retrospectively analyze the clinical records of patients admitted for maxillo-facial fracture to 18 Italian center, evaluating the epidemiological differences between the different phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery deparments in Italy, from February 23, 2020 to February 23, 2022. According to the date of admission, all the data were stratified in four chronological periods encompassing the four different moments in terms of restriction in Italy: pre-pandemic, first wave, partial restrictions and post-pandemic groups. Differences in epidemiological data between the groups were analysed. Results: 2,938 patients were included. There was a statistically significant difference in the cause of hospitalization between pre-pandemic and first wave groups ( p =0.005) and between pre-pandemic and partial restriction groups ( p =0.002). The differences between the pre- and post-pandemic groups where instead not significant ( p =0.106). Compared to the pre-pandemic period, the number of Black patients was significantly higher during the first wave and the post-pandemic period. Differences between the periods in terms of gender, age, type of fracture, treatment modality, and length of hospital stay were not found to be statistically significant. Conclusions: during the COVID-19 pandemic there have been profound changes in the epidemiology of fractures influenced by the restrictive measures implemented by the government. At the end of the pandemic, the epidemiology of fractures returned to being the same as in the pre-pandemic period.
Osteomas are common benign bone tumors of the skull and facial structures involving primarily the cranial vault, mandible, external auditory canal, paranasal sinuses, nasal cavity, and orbit.1,2 These neoplasms are usually asymptomatic and account for 0.43% of tumor in population with an incidental finding on 1% of radiographs and on 3% of computed tomography (CT) scans. [1] These solid nodular sclerotic lesions usually arise from the outer table and are usually < 10 mm; lesions larger than 30 mm in diameter are considered giant tumors.3,4,7 Most of patients with such a diagnosis have few or no symptoms, in general only 10% is symptomatic, in the second to fifth decades of life 5,6. In literature, endoscopic endonasal approaches are mainly indicated for small ethmoidal osteomas without significant orbital or frontal extension7, while large osteomas require Caldwell-Luc surgery8 or other more aggressive approaches25. We report our experience about the treatment of paranasal sinuses osteomas treated endoscopically or by endoscope-assisted Caldwell-Luc approach, achieving total removal of the neoplasms with all the advantages deriving by endoscopic technique such as closer visualization of the anatomy, no damage to the surrounding structures, better cosmetic results, less morbidity and shorter hospitalization17.
Complications after parotid surgery include deficit of the facial nerve, wound complications, as sialocele and salivary fistula, and Frey syndrome; the goal of this study was to evaluate the relationship between the type of parotid surgery performed and the incidence of each of these complications.A total of 184 patients were evaluated and 158 were included in the study. Four different kinds of intervention were made: extracapsular dissection, partial superficial parotidectomy; superficial parotidectomy and total parotidectomy. The incidence of each complication was studied and correlated to the type of surgery performed. Statistical analysis was done using the chi-square test of independence.From all cases examined, 86 patients developed facial nerve complications with 59 minor asymmetry, 19 partial weakness and 8 complete weakness. Forty patients had wound complications, 28 sialocele and 12 salivary fistula. Sixteen patients developed Frey syndrome.Facial nerve complications and Frey syndrome were significantly related to superficial or total parotidectomy, differently extracapsular dissection and partial superficial parotidectomy had more cases of wound complications.The kind of complications that occur after parotid surgery depends on surgery performed. Chi-square test has a statistically significant result and confirms this kind of relationship (P <.0001).Facial nerve, Parotid glands, Parotidectomy.L’obiettivo del nostro lavoro mira a definire le maggiori complicanze in seguito a chirurgia parotidea, in particolare ci siamo soffermati su un’attenta analisi sulla correlazione tra i diversi tipi di chirurgia: asportazione della neoformazione, parotidectomia superficiale parziale, parotidectomia superficiale e parotidectomia totale in relazione con deficit del VII nervo cranico ed altre complicanze quali il sialocele, le fistole salivari, e la sindrome di Frey. Sono stati selezionati 184 pazienti e di questi solo 158 sono stati inclusi nella nostra analisi. E’ stato osservato che 86 pazienti hanno sviluppato complicanze a carico del nervo facciale, tra questi 59 hanno presentato asimmetrie minori risoltesi in breve tempo, 19 una parziale sofferenza risoltesi in un tempo più lungo e 8 una sofferenza completa con deficit totale del nervo. Le altre complicanze sono comparse in 40 pazienti: 28 hanno sviluppato un sialocele, in 16 si è presentata la Sindrome di Frey, e in 12 hanno presentato una fistola salivare. La correlazione tra il tipo di intervento chirurgico e le complicanze comparse nei pazienti hanno evidenziato che la parotidectomia superficiale e totale ha comportato la maggior comparsa di complicanze a carico del nervo facciale e la comparsa di Sindrome di Frey. L’enucleoresezione d una neoformazione parotidea e la parotidectomia superficiale parziale sono connesse a minori complicanze. Dalla nostra esperienza è emersa una stretta correlazione statisticamente significativa (P value < 0.001) tra tipologia di intervento parotidea e complicanze connesse.
