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Giacomo COLLETTI
Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
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Pubblicazioni
2023
- Inferior Alveolar Canal Automatic Detection with Deep Learning CNNs on CBCTs: Development of a Novel Model and Release of Open-Source Dataset and Algorithm
[Articolo su rivista]
Di Bartolomeo, Mattia; Pellacani, Arrigo; Bolelli, Federico; Cipriano, Marco; Lumetti, Luca; Negrello, Sara; Allegretti, Stefano; Minafra, Paolo; Pollastri, Federico; Nocini, Riccardo; Colletti, Giacomo; Chiarini, Luigi; Grana, Costantino; Anesi, Alexandre
abstract
Introduction: The need of accurate three-dimensional data of anatomical structures is increasing in the surgical field. The development of convolutional neural networks (CNNs) has been helping to fill this gap by trying to provide efficient tools to clinicians. Nonetheless, the lack of a fully accessible datasets and open-source algorithms is slowing the improvements in this field. In this paper, we focus on the fully automatic segmentation of the Inferior Alveolar Canal (IAC), which is of immense interest in the dental and maxillo-facial surgeries. Conventionally, only a bidimensional annotation of the IAC is used in common clinical practice. A reliable convolutional neural network (CNNs) might be timesaving in daily practice and improve the quality of assistance. Materials and methods: Cone Beam Computed Tomography (CBCT) volumes obtained from a single radiological center using the same machine were gathered and annotated. The course of the IAC was annotated on the CBCT volumes. A secondary dataset with sparse annotations and a primary dataset with both dense and sparse annotations were generated. Three separate experiments were conducted in order to evaluate the CNN. The IoU and Dice scores of every experiment were recorded as the primary endpoint, while the time needed to achieve the annotation was assessed as the secondary end-point. Results: A total of 347 CBCT volumes were collected, then divided into primary and secondary datasets. Among the three experiments, an IoU score of 0.64 and a Dice score of 0.79 were obtained thanks to the pre-training of the CNN on the secondary dataset and the creation of a novel deep label propagation model, followed by proper training on the primary dataset. To the best of our knowledge, these results are the best ever published in the segmentation of the IAC. The datasets is publicly available and algorithm is published as open-source software. On average, the CNN could produce a 3D annotation of the IAC in 6.33 s, compared to 87.3 s needed by the radiology technician to produce a bidimensional annotation. Conclusions: To resume, the following achievements have been reached. A new state of the art in terms of Dice score was achieved, overcoming the threshold commonly considered of 0.75 for the use in clinical practice. The CNN could fully automatically produce accurate three-dimensional segmentation of the IAC in a rapid setting, compared to the bidimensional annotations commonly used in the clinical practice and generated in a time-consuming manner. We introduced our innovative deep label propagation method to optimize the performance of the CNN in the segmentation of the IAC. For the first time in this field, the datasets and the source codes used were publicly released, granting reproducibility of the experiments and helping in the improvement of IAC segmentation.
2023
- Letter to the Editor: Intraosseous Cavernous Hemangioma of the Middle Turbinate: A Case Report
[Articolo su rivista]
Di Bartolomeo, M.; Negrello, S.; Rozell-Shannon, L.; Nocini, R.; Chiarini, L.; Colletti, G.
abstract
2023
- Multiple General Anesthesia in Children: A Systematic Review of Its Effect on Neurodevelopment
[Articolo su rivista]
Colletti, G.; Di Bartolomeo, M.; Negrello, S.; Geronemus, R. G.; Cohen, B.; Chiarini, L.; Anesi, A.; Femino, R.; Mariotti, I.; Levitin, G. M.; Rozell-Shannon, L.; Nocini, R.
abstract
The effect of multiple general anesthesia (mGA) procedures administered in early life is a critical theme and has led the Food and Drug Administration (FDA) to issue an alert. This systematic review seeks to explore the potential effects on neurodevelopment of mGA on patients under 4 years. The Medline, Embase and Web of Science databases were searched for publications up to 31 March 2021. The databases were searched for publications regarding “children multiple general anesthesia OR pediatric multiple general anesthesia”. Case reports, animal studies and expert opinions were excluded. Systematic reviews were not included, but they were screened to identify any possible additional information. A total of 3156 studies were identified. After removing the duplicates, screening the remaining records and analyzing the systematic reviews’ bibliography, 10 studies were considered suitable for inclusion. Comprehensively, a total cohort of 264.759 unexposed children and 11.027 exposed children were assessed for neurodevelopmental outcomes. Only one paper did not find any statistically significant difference between exposed and unexposed children in terms of neurodevelopmental alterations. Controlled studies on mGA administered before 4 years of age support that there might be a greater risk of neurodevelopmental delay in children receiving mGA, warranting the need for careful risk/benefit considerations.
2023
- Surgery for Port-Wine Stains: A Systematic Review
[Articolo su rivista]
Colletti, G.; Negrello, S.; Rozell-Shannon, L.; Levitin, G. M.; Colletti, L.; Chiarini, L.; Anesi, A.; Di Bartolomeo, M.; Pellacani, A.; Nocini, R.
abstract
Background: Port-wine stains (PWS) are congenital low-flow vascular malformations of the skin. PWS tend to become thicker and darker with time. Laser therapy is the gold standard and the first-line therapy for treating PWS. However, some resistant PWS, or PWS that have tissue hypertrophy, do not respond to this therapy. Our aim is to evaluate the role of surgery in the treatment of PWS birthmarks. Methods: A literature search was performed in PubMed, Scopus, Web of Science (WOS) and Google Scholar for all papers dealing with surgery for port-wine stains, from January 2010 to December 2020 using the search strings: (capillary vascular malformation OR port-wine stains OR Sturge Weber Syndrome OR sws OR pws) AND (surgical OR surgery). Results: Ten articles were identified and used for analysis. They were almost all case series with a short follow up period and lacked an objective–systematic score of evaluation. Conclusions: Delay in treatment of port wine stains may result in soft tissue and bone hypertrophy or nodules with disfiguring or destructive characteristics. The correction of PWS-related facial asymmetry often requires bone surgery followed by soft tissue corrections to achieve a more harmonious, predictable result.
2022
- A Retrospective Evaluation to Assess Reliability of Electrophysiological Methods for Diagnosis of Hearing Loss in Infants
[Articolo su rivista]
Mandala, M.; Mazzocchin, L.; Ward, B. K.; Viberti, F.; Bindi, I.; Salerni, L.; Colletti, G.; Colletti, L.; Colletti, V.
abstract
Background: An electrophysiological investigation with auditory brainstem response (ABR), round window electrocochleography (RW-ECoG), and electrical-ABR (E-ABR) was performed in children with suspected hearing loss with the purpose of early diagnosis and treatment. The effectiveness of the electrophysiological measures as diagnostic tools was assessed in this study. Methods: In this retrospective case series with chart review, 790 children below 3 years of age with suspected profound hearing loss were tested with impedance audiometry and underwent electrophysiological investigation (ABR, RW-ECoG, and E-ABR). All implanted cases underwent pure-tone audiometry (PTA) of the non-implanted ear at least 5 years after surgery for a long-term assessment of the reliability of the protocol. Results: Two hundred and fourteen children showed bilateral severe-to-profound hearing loss. In 56 children with either ABR thresholds between 70 and 90 dB nHL or no response, RW-ECoG showed thresholds below 70 dB nHL. In the 21 infants with bilateral profound sensorineural hearing loss receiving a unilateral cochlear implant, no statistically significant differences were found in auditory thresholds in the non-implanted ear between electrophysiological measures and PTA at the last follow-up (p > 0.05). Eight implanted children showed residual hearing below 2000 Hz worse than 100 dB nHL and 2 children showed pantonal residual hearing worse than 100 dB nHL (p > 0.05). Conclusion: The audiological evaluation of infants with a comprehensive protocol is highly reliable. RW-ECoG provided a better definition of hearing thresholds, while E-ABR added useful information in cases of auditory nerve deficiency.
2022
- Ameloblastoma in a Three-Year-Old Child with Hurler Syndrome (Mucopolysaccharidosis Type I)
[Articolo su rivista]
Di Bartolomeo, Mattia; Pellacani, Arrigo; Negrello, Sara; Buchignani, Martina; Nocini, Riccardo; Di Massa, Gianluca; Gianotti, Greta; Pollastri, Giuseppe; Colletti, Giacomo; Chiarini, Luigi; Anesi, Alexandre
abstract
2022
- Guidelines for Vascular Anomalies by the Italian Society for the study of Vascular Anomalies (SISAV)
[Articolo su rivista]
Stillo, F.; Mattassi, R.; Diociaiuti, A.; Neri, I.; Baraldini, V.; Dalmonte, P.; Amato, B.; Ametrano, O.; Amico, G.; Bianchini, G.; Campisi, C.; Cattaneo, E.; Causin, F.; Cavalli, R.; Colletti, G.; Corbeddu, M.; Coppo, P.; De Fiores, A.; Di Giuseppe, P.; El Hachem, M.; Esposito, F.; Fulcheri, E.; Gandolfo, C.; Grussu, F.; Guglielmo, A.; Leuzzi, M.; Manunza, F.; Moneghini, L.; Monzani, N. A.; Nicodemi, E. M.; Occella, C.; Orso, M.; Pagella, F. G.; Paolantonio, G.; Pasetti, F.; Rollo, M.; Ruggiero, F.; Santecchia, L.; Spaccini, L.; Taurino, M.; Vaghi, M.; Vercellio, G.; Zama, M.; Zocca, A.; Aguglia, M.; Castronovo, E. L.; De Lorenzi, E.; Fontana, E.; Gusson, E.; Lanza, J.; Lizzio, R.; Mancardi, M. M.; Rosina, E.; Chiti, D.; Lugli, M.; Maleti, O.
abstract
2022
- Lymphatic malformations do not regress spontaneously
[Articolo su rivista]
Colletti, G.; Chiarini, L.
abstract
2022
- Stop Calling Me Cavernous Hemangioma! A Literature Review on Misdiagnosed Bony Vascular Anomalies
[Articolo su rivista]
Liberale, C.; Rozell-Shannon, L.; Moneghini, L.; Nocini, R.; Tombris, S.; Colletti, G.
abstract
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.
2022
- The vanishing port-wine stain birthmark—consideration for a rare type of congenital vascular anomaly
[Articolo su rivista]
Pellacani, Arrigo; Rozell-Shannon, Linda; Negrello, Sara; Di Bartolomeo, Mattia; Anesi, Alexandre; Feminò, Raimondo; Mariotti, Ilaria; Chiarini, Luigi; Colletti, Giacomo
abstract
2021
- A (Very) Brief History of the Nosography of Vascular Anomalies
[Articolo su rivista]
Colletti, G.; Chiarini, L.
abstract
2021
- Assessing the impact of COVID-19 on individuals and families affected by vascular anomalies: The VBF COVID-19 survey
[Articolo su rivista]
Rozell-Shannon, L.; Leahy, J.; Levitin, G. M.; Nocini, R.; Colletti, G.
abstract
2021
- Multidisciplinary, single center approach to 261 cases of peripheral arteriovenous malformations: A retrospective analysis
[Articolo su rivista]
Mattassi, R.; DI GIUSEPPE, P.; Grappolini, S.; Zurlo, T.; Pozzoli, W.; Crespi, L.; Zerbinati, F.; Zuliani, W.; Brambilla, G.; Colletti, G.
abstract
BACKGROUND: Treatment strategy of arteriovenous malformations (AVM) is difficult and discussed due to variability and different treatment possibilities. Results reported are often limited to an area or to a single technique. METHODS: Two hundred sixty-one cases of AVM treated by a multidisciplinary group were analyzed. Site of defect and type (limited, infiltrating and direct fistulas) were recorded as well as technique treatment, combination and results. Surgery, embolization, percutaneous alcohol and interstitial laser treatment were used. RESULTS: One hundred thirty-four (55%) were female and 118 (45%) males. One hundred fifty-four (58%) were infiltrating forms, 100 (39%) limited forms and 7 (3%) direct A-V fistulas. Main location in limited forms was: Head and neck (52 [52%]), lower limbs (24 [24%]) and upper limbs (14 [14%]); in infiltrating forms: Lower limbs (50 [33%]), upper limbs (43 [28%]) and head and neck (36 [23%]). Sixty-nine patients were not treated because asymptomatic or refuse of the patient. Treatment sessions were in limited forms: Percutaneous alcohol occlusion (79), surgery (34), catheter embolization (24) and interstitial laser (6 sessions). In infiltrating forms: Alcohol occlusion (119), catheter embolization (106), surgery (31) and interstitial laser (13). A single treatment was done in 48 (63%) of limited cases and in 29 (37%) of infiltrating forms. Combination of treatments was done in 26 (34%) of limited AVM and in 59 (55%) of infiltrating forms. In limited forms: 43 patients were healed with no residual AVM (56%), 18 asymptomatic with residual AVM (24%), 12 improved (15%), 0 unchanged; in infiltrating forms 19 were healed (17%), 26 asymptomatic (24%), 44 improved (41%), 14 unchanged (13%) and 5 amputated (5%). Recurrence was 5% in limited cases and 20% in infiltrating forms. CONCLUSIONS: Multidisciplinary approach to AVM, having access to all four techniques, is an effective form to treat these diseases. Recurrence had a reduced incidence in this study.
2020
- Basal Cell Carcinoma Arising over a Venous Malformation of the Forehead Communicating with the Endocranial Veins
[Articolo su rivista]
Cucurullo, M.; Colletti, G.
abstract
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.
2020
- CD10 and CD34 as markers in vascular malformations with PIK3CA and TEK mutations
[Articolo su rivista]
Moneghini, L; Tosi, D; Graziani, D; Caretti, A; Colletti, G; Baraldini, V; Cattaneo, E; Spaccini, L; Zocca, A; Bulfamante, Gp
abstract
2020
- Do We Still Need to Study an Optimal Procedure for Jaw Alveolar Bone Reconstruction?
[Articolo su rivista]
Colletti, G
abstract
2020
- Don't call me "Lymphangioma!"
[Articolo su rivista]
Colletti, G; Tombris, S; Rozell-Shannon, L
abstract
2020
- SECg Staging System: A New Approach to the Management of Arteriovenous Malformations of the Head and Neck
[Articolo su rivista]
Colletti, G; Biglioli, F; Ierardi, Am; Dessy, M; Tombris, S; Mattassi, R; Stillo, F; Dionisio, A; Rozell-Shannon, L; Carrafiello, G; Waner, M
abstract
2020
- The Neverending Issue in Nosography of Intramuscular Vascular Anomalies
[Articolo su rivista]
Dionisio, Ambra; Biglioli, Federico; Dessy, Margherita; Cucurullo, Marco; Liberale, Carlotta; Colletti, Giacomo; Giovanditto, Federica
abstract
2020
- The Reconstruction of the Medial Wall of the Orbit: A Change in Philosophy
[Articolo su rivista]
Colletti, G
abstract
2019
- Considerations on the 'corseting' or 'strangling' technique to treat large venous malformations
[Articolo su rivista]
Dessy, M; Giovanditto, F; Cucurullo, M; Dionisio, A; Liberale, C; Colletti, G
abstract
2019
- Intramuscuar hemangiomas are venous malformations
[Articolo su rivista]
Colletti, G; Dionisio, A; Liberale, C; Cucurullo, M; Dessy, M
abstract
2019
- Percutaneous sclerotherapy with gelified ethanol of low-flow vascular malformations of the head and neck region: preliminary results
[Articolo su rivista]
Ierardi, Am; Colletti, G; Biondetti, P; Dessy, M; Carrafiello, G
abstract
2019
- Vascular malformations of the orbit (lymphatic, venous, arteriovenous): Diagnosis, management and results
[Articolo su rivista]
Colletti, G.; Biglioli, F.; Poli, T.; Dessy, M.; Cucurullo, M.; Petrillo, M.; Tombris, S.; Waner, M.; Sesenna, E.
abstract
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.
2018
- About Hemangioma and Vascular Malformations
[Articolo su rivista]
Colletti, G
abstract
2018
- About venous malformations of the facial bones
[Articolo su rivista]
Dessy, M; Giovanditto, F; Cucurullo, M; Dionisio, A; Liberale, C; Colletti, G
abstract
2018
- Did Anton Raphael Mengs Suffer From a Vascular Malformation?
[Articolo su rivista]
Colletti, G; Dionisio, A; Liberale, C; Salbego Colletti, A
abstract
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
[Articolo su rivista]
Al-Moraissi, Essam Ahmed; Louvrier, Aurélien; Colletti, Giacomo; Wolford, Larry M.; Biglioli, Federico; Ragaey, Marwa; Meyer, Christophe; Ellis, Edward
abstract
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.
2018
- Endoscopic endonasal repair with polyethylene implants in medial orbital wall fractures: A prospective study on 25 cases
[Articolo su rivista]
Colletti, G; Saibene, Am; Giannini, L; Dessy, M; Deganello, A; Pipolo, C; Allevi, F; Lozza, P; Felisati, G; Biglioli, F
abstract
2018
- Objective Assessment of Lingual Nerve Microsurgical Reconstruction
[Articolo su rivista]
Biglioli, Federico; Lozza, Alessandro; Colletti, Giacomo; Allevi, Fabiana
abstract
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.
Lingual nerve injuries (LNI) are a potential clinical consequence in oral and maxillofacial surgery, leading to significant functional impairments (anaesthesia, hypoesthesia, dysesthesia, hyperesthesia, pain).1–5 Burning dysesthesia accompanies anaesthesia in almost 40% of patients. In 8% to 15% of patients, pain remains the most debilitating sequela, requiring adequate treatment.6,7
Patients experience the LNI-related functional impairment as a real psychological and physical discomfort.8 Knowledge gaps in the management of LNI patients lead to dissatisfaction with the service received and worsen the acceptance of neural deficits.
Our work aims to objectively assess lingual nerve (LN) deficits and results of related microsurgery. Based on those data, we propose a guideline for LNI management, emphasizing the importance of timely diagnosis and surgical intervention. Follow-up should concentrate on preventing chronic sensory deficits to maintain patients’ quality of life.9
2018
- Pilot study on microvascular anastomosis: performance and future educational prospects
[Articolo su rivista]
Berretti, G; Colletti, G; Parrinello, G; Iavarone, A; Vannucchi, P; Deganello, A
abstract
2018
- Regarding Hemangiomas and Vascular Malformations of the Facial Bones
[Articolo su rivista]
Colletti, G; Dessy, M
abstract
2018
- Star flap: new reconstructive technique for defects of the scalp
[Articolo su rivista]
Pedrazzoli, M; Colletti, G; Biglioli, F
abstract
2018
- Surgical correction of hypertrophic upper lip in vascular malformations
[Articolo su rivista]
Dessy, M.; Colletti, G.; Dionisio, A.; Liberale, C.; Biglioli, F.
abstract
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.
2018
- Triple innervation for re-animation of recent facial paralysis
[Articolo su rivista]
Biglioli, Federico; Allevi, Fabiana; Rabbiosi, Dimitri; Cupello, Silvia; Battista, Valeria Marinella August; Saibene, Alberto Maria; Colletti, Giacomo
abstract
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.
2017
- A Shift in the Orbit: Immediate Endoscopic Reconstruction After Transnasal Orbital Tumors Resection
[Articolo su rivista]
Colletti, G.; Saibene, A. . M.; Pessina, F.; Duvina, M.; Allevi, F.; Felisati, G.; Biglioli, F.
abstract
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.
2017
- Cavernous hemangioma: a term to be canceled
[Articolo su rivista]
Colletti, G; Deganello, A
abstract
2017
- Complications After Treatment of Head and Neck Venous Malformations With Sodium Tetradecyl Sulfate Foam
[Articolo su rivista]
Colletti, G; Deganello, A; Bardazzi, A; Mattassi, R; Dalmonte, P; Gazzabin, L; Stillo, F
abstract
2017
- Head and neck vascular anomalies : A multidisciplinary approach and diagnostic criteria
[Articolo su rivista]
Moneghini, L.; Sangiorgio, V.; Tosi, D.; Colletti, G.; Melchiorre, F.; Baraldini, V.; Graziani, D.; Alfano, R.; Vercellio, G.; Bulfamante, G.
abstract
Vascular anomalies represent a heterogeneous group of pathologies of the circulatory system that can affect any type of hematic and /or lymphatic vessel of different diameter or anatomic site. The extreme variability of tissue types and districts involved by these lesions determines a wide heterogeneity of clinical manifestations, resulting in involvement of different medical expertise. In this context, a commonly agreed terminology is crucial for the appropriate evaluation and multidisciplinary management of patients. The ISSVA Classification that has its roots in the previous Classification of Mulliken and Glowacky distinguishes vascular anomalies in two main groups: vascular tumors and vascular malformations. In head and neck, where vascular anomalies are the most common benign lesions of infancy and childhood, correct diagnosis with the use of unequivocal terminology is more crucial for treatment considering the relevance of structures that can be involved. The aim of this work has been to clarify information and knowledges currently available in the field of vascular anomalies. Referring to ISSVA Classification, clinico-histopathological aspects of each entity have been elucidated.
2017
- Intraoperative imaging O-Arm™ in secondary surgical correction of post-traumatic orbital fractures
[Articolo su rivista]
Cannizzaro, D.; Revay, M.; Mancarella, C.; Colletti, G.; Costa, F.; Cardia, A.; Fornari, M.
abstract
Purpose To determine the safety and efficacy of O-Arm™ intraoperative imaging in maxillofacial surgery of post-traumatic orbital fractures. In order to ensure correct placement of titanium plate, immediately after fixing, viewable, in the axial, sagittal and coronal images. Methods The authors evaluated 5 consecutive adult patients with orbital fractures who required a reoperation involving displacement of titanium mesh between January and December 2015. The displacement or incorrect positioning of titanium mesh was detected at post-operative CT scan or clinical neurological findings. Intraoperative O-Arm™ imaging was used for our patients who underwent secondary maxillofacial orbital fracture surgery due to the failure of first surgical approach. Results An eyelid incision was performed in order to obtain maximal exposure and minimizing cosmetic defects. Any previous fixation device was skeletonized and removed, any improperly reduced fracture was mobilized, reduced and refixated with 1.5 mm plates, screws and titanium mesh. The intra-operative O-Arm™ imaging technique was used at the end of the procedures. In 4 cases it confirmed the appropriateness of the newly obtained reconstruction, in 1 case a first scan showed a suboptimal result and the devices were correctly repositioned, guided by the O-Arm™ images. Conclusions Intraoperative O-Arm™ assisted craniofacial reconstruction surgery improves the assessment of neurovascular structure decompression, skeletal fragment identification, fixation procedures and for the correct re-establishment of facial symmetry in orbital floor fractures.
2017
- Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery
[Articolo su rivista]
Colletti, G; Mandalà, M; Colletti, V; Deganello, A; Allevi, F; Colletti, L
abstract
2017
- Stereophotogrammetric Evaluation of Labial Symmetry After Surgical Treatment of a Lymphatic Malformation
[Articolo su rivista]
Pucciarelli, V.; Tarabbia, F.; Codari, M.; Guidugli, G. A.; Colletti, G.; Dell'Aversana Orabona, G.; Bianchi, B.; Sforza, C.; Biglioli, F.
abstract
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.
2017
- Surgical treatment of synkinesis between smiling and eyelid closure
[Articolo su rivista]
Biglioli, F.; Kutanovaite, O.; Rabbiosi, D.; Colletti, G.; Mohammed, M. A. S.; Saibene, A. . M.; Cupello, S.; Privitera, A.; Battista, Vma; Lozza, A.; Allevi, F.
abstract
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.
2017
- Understanding venous malformations of the head and neck: a comprehensive insight
[Articolo su rivista]
Colletti, G; Ierardi, Am
abstract
2016
- Head and neck reconstruction with pedicled flaps in the free flap era
[Articolo su rivista]
Mahieu, R; Colletti, G; Bonomo, P; Parrinello, G; Iavarone, A; Dolivet, G; Livi, L; Deganello, A
abstract
2016
- Malformazione arterovenosa inizialmente diagnosticata come cisti follicolare = Mandibular arteriovenous malformation initially diagnosed as follicular cyst
[Articolo su rivista]
Colletti, Giacomo; M., Dessy; Allevi, Fabiana; P., Dalmonte; Bardazzi, Alessandro; A., Deganello; Biglioli, Federico
abstract
OBJECTIVES. The authors describe a paradigmatic case of a mandibular arteriovenous malformation (AVM) initially managed as a cyst. Starting from this, a diagnostic and therapeutic protocol for these dangerous diseases is proposed. MATERIALS AND METHODS. The case of a developmental patient affected by an intraosseous mandibular AVM is herein described. An initial wrong diagnosis led to managing the AVM as a cyst and this caused a cataclysmic haemorrhage. Subsequently the arterial feeders were closed and the nidus surgically removed. The pertaining literature is also reviewed. RESULTS AND CONCLUSIONS. At a 5-year clinical and radiological follow-up, the patient was free of disease. This paper aims to underline the importance of a proper clinical and radiological diagnosis for a correct management of these potentially dangerous diseases.
2016
- Nervus intermedius guides auditory brainstem implant surgery in children with cochlear nerve deficiency
[Articolo su rivista]
Colletti, G.; Mandalà, M.; Colletti, L.; Colletti, V.
abstract
OBJECTIVE:
To investigate the anatomic features of the nervus intermedius and cranial nerve VII in children with cochlear nerve deficiency and to verify whether the nervus intermedius can provide an additional landmark to help guide placement of the auditory brainstem implant electrode.
STUDY DESIGN:
Case series with chart review.
SETTING:
Tertiary referral center.
SUBJECTS AND METHODS:
High-definition video was captured during retrosigmoid surgery in 64 children (mean age, 3.91 ± 2.83 years) undergoing auditory brainstem implant placement. These videos were examined with particular reference to the number and variety of nervus intermedius bundles and any associated facial nerve anomalies.
RESULTS:
Absence of cranial nerves VI, VII, and VIII was observed in 3, 6, and all 64 children, respectively. Fifteen children had several abnormalities of the facial nerve in the cerebellopontine angle. Anatomic identification of the facial nerve and the bundles composing the nervus intermedius was possible in 46 children. In 12 children, identification was possible with the assistance of intraoperative monitoring. The number of bundles composing the nervus intermedius varied from 1 to 6. The nervus intermedius and cranial nerve IX were useful landmarks for identifying the foramen of Luschka of the lateral recess.
CONCLUSION:
The nervus intermedius provides an additional landmark during auditory brainstem microsurgery since it was identified in all subjects. The nervus intermedius anatomy and its topographic relationship with the neurovascular structures around the foramen of Luschka have been described for the first time in children with cochlear nerve deficiency.
2016
- Oral cavity reconstruction with the masseter flap
[Articolo su rivista]
Mahieu, R; Russo, S; Gualtieri, T; Colletti, G; Deganello, A
abstract
The purpose of this report is to highlight how an unusual, outdated, unpopular and overlooked reconstructive method such as the masseter flap can be a reliable, straightforward and effective solution for oral reconstruction in selected cases. We report the transposition of the masseter crossover flap in two previously pre-treated patients presenting a second primary oral squamous cell carcinoma; excellent functional results with satisfactory cosmetic appearance were obtained in both cases. In the literature, only 60 cases of oral cavity and oropharyngeal reconstructions using the masseter flap have been reported. The possible clinical utility of this flap, even in modern head and neck reconstructive surgery, is presented and discussed. We believe that the masseter flap should enter in the armamentarium of every head and neck surgeon and be kept in mind as a possible solution since it provides an elegant and extremely simple procedure in suboptimal cases for microvascular reconstruction.
2016
- Orbital medial wall fractures: purely endoscopic endonasal repair with polyethylene implants
[Articolo su rivista]
Colletti, Giacomo; Pipolo, Giorgia Carlotta; P., Lozza; Felisati, Giovanni; Allevi, Fabiana; Biglioli, Federico; A., Deganello; Saibene, Alberto Maria
abstract
2015
- Adjuvant role of anti-angiogenic drugs in the management of head and neck arteriovenous malformations
[Articolo su rivista]
Colletti, G.; Dalmonte, P.; Moneghini, L.; Ferrari, D.; Allevi, F.
abstract
Arteriovenous malformations (AVMs) are high-flow vascular malformations characterised by a complex vessel network directly connecting feeding arteries and draining veins, typically featured by a natural history of progression, while spontaneous regressions are purely anecdotal.AVMs are very aggressive entities that possess a locally infiltrative behaviour like neoplasms. Complete "radical" surgical excision presents the highest chance of cure, but nowadays there is still considerable controversy on how to treat large AVMs that are not amenable of "radical" excision.The aim of this paper is to propose a different approach to treat vast AVMs that cannot be removed radically.The association of an antiangiogenic drug (to be initiated before surgery and to be continued in the post-operative period), could prevent the feared "explosive" growth of the remaining nidus after its partial removal. This could make recontouring and other "aesthetically" focused procedures feasible in these patients, with an obvious leap in their quality of life.The most promising antiangiogenic drug seems to be Thalidomide, but other drugs such as Sirolimus, VEGF pathway inhibitors, Interferon or Matrix Metalloproteinase (MMP) Inhibitors could serve the purpose just as well. Even Propranolol could prove useful in this sense as suggested by some recent researches on retinopathy of prematurity and tumour biology.
2015
- Clinical Outcome of the Use of Fresh Frozen Allogeneic Bone Grafts for the Reconstruction of Severely Resorbed Alveolar Ridges: Preliminary Results of a Prospective Study
[Articolo su rivista]
Chiapasco, M; Colletti, G; Coggiola, A; Di Martino, G; Anello, T; Romeo, E
abstract
Purpose: The objectives of this study were to evaluate: (1) the clinical outcome of fresh frozen human allogeneic bone grafts (FFB) used for the reconstruction of severely atrophied edentulous ridges; (2) the survival rate of implants placed in the reconstructed areas; and (3) bone resorption. Materials and Methods: During a 2-year period, 19 patients with severely atrophied partially or totally edentulous ridges who were candidates for an implant-supported prosthesis were consecutively enrolled and reconstructed with FFB iliac blocks. Five to 7 months later, 117 implants were placed in the reconstructed areas, and prosthetic rehabilitation was started 5 to 6 months afterward. Results: The mean follow-up of patients after prosthetic loading was 27 months (range, 20 to 32 months). Prior to implant placement, graft exposure with partial or total loss of the graft occurred in four patients. After implant placement, bone graft exposures with partial loss of the grafts occurred in nine patients; in two patients, both grafts and implants were removed. The cumulative survival rate of implants was 90.2%. The mean (+/- standard deviation) graft resorption before implant placement was 0.98 +/- 0.77 mm (range, 0 to 4 mm), while these values were 1.21 +/- 1.05 mm (range, 0 to 6 mm) at loading, 1.55 +/- 1.57 mm (range, 0 to 8 mm) at 12 months, and 1.93 +/- 1.38 mm (range, 1 to 9 mm) at 24 months. Conclusion: Within the limits of this study (limited sample of patients and short follow-up), the reconstruction of severely atrophic edentulous ridges with FFB is associated with a relevant incidence of bone exposures and partial or total loss of the grafts, which may compromise the long-term survival of implants placed in the reconstructed areas.
2015
- Cross-tongue procedure : a new treatment for long-standing numbness of the tongue
[Articolo su rivista]
Biglioli, F.; Allevi, F.; Colletti, G.; Lozza, A.
abstract
The lingual nerve may be injured during oral procedures, usually during extraction of lower third molars. Patients often complain of numbness of the hemitongue postoperatively. If this persists for 3 months or more, microsurgical exploration and reconstruction of the lingual nerve is required, and better outcomes are achieved after early repair. After 18-24 months the production of axoplasmic fluid through the axons of the proximal stump is reduced, and neurorrhaphy between the proximal and distal stumps is not recommended. In such cases we suggest that a portion of the opposite lingual nerve should be used as an additional nerve source.
2015
- Regional flaps in head and neck reconstruction : a reappraisal
[Articolo su rivista]
Colletti, G.; Tewfik, K.; Bardazzi, A.; Allevi, F.; Chiapasco, M.; Mandalà, M.; Rabbiosi, D.
abstract
Purpose Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underlined the effectiveness and reliability of a variety of flaps. The marketing laws as applied to surgical innovations are reviewed to help in the understanding of why regional flaps are regaining wide popularity in head and neck reconstruction. Materials and Methods From January 2009 to January 2014, 45 regional flaps were harvested at San Paolo Hospital to reconstruct head and neck defects. These included 35 pectoralis major muscular and myocutaneous flaps, 4 lower trapezius island or pedicled flaps, 3 supraclavicular flaps, 2 latissimus dorsi pedicled flaps, and 1 fasciocutaneous temporal flap. The basic literature of marketing regarding the diffusion of new products was also reviewed. Results Two myocutaneous pectoralis major flaps were complicated by necrosis of the cutaneous paddle (one complete and one partial). No complete loss of any of the 45 flaps was observed. At 6 months of follow-up, 2 patients had died of multiple organ failure after prolonged sepsis. The 43 remaining patients had acceptable morphologic and functional results. Conclusions Regional and free flaps appear to compete in many cases for the same indications. From the results of the present case series, regional flaps can be considered reliable reconstructive choices that are less expensive than their free flap alternatives. The "resurrection" of regional flaps can be partially justified by the changes in the global economy and the required adaptation of developed and developing countries.
2015
- Retrobulbar haemorrage during or after endonasal or per-orbital surgery : what to do, when and how to do it
[Articolo su rivista]
Colletti, G.; Fogagnolo, P.; Allevi, F.; Rabbiosi, D.; Bebi, V.; Rossetti, L.; Chiapasco, M.; Felisati, G.
abstract
blood within the orbit posteriorly to the eyeball. It must be treated within 90-100 minutes to avoid irreversible visual loss. The present paper tries to pinpoint the key steps in diagnosis and treatment of RBM.On the wake of a new case, the authors review and update their clinical experience and propose a step-by-step protocol to diagnose and to treat RBH developing under different circumstances: during endoscopic sinus surgery, during periorbital surgery, immediately after the surgery, in the awakening room, or postoperatively in the ward.A therapeutic ladder is proposed that starts with lateral canthotomy and inferior cantholysis and progresses to a lower lid transconjunctival incision with retrocaruncular extension.Based on our experience, the proposed guidelines are effective in diagnosing and treating RBH. They allow to preserve vision and minimize reliquates of this rare and dangerous surgical emergency.
2015
- Surgical visual reference for auditory brainstem implantation in children with cochlear nerve deficiency
[Articolo su rivista]
Colletti, G.; Mandalà, M.; Colletti, L.; Colletti, V.
abstract
2014
- Clown nose : a case of disfiguring nodular squamous cell carcinoma of the face
[Articolo su rivista]
Colletti, G.; Allevi, F.; Moneghini, L.; Palvarini, M.
abstract
'Clown nose' (CN) is the common medical term referring to a reddish-brown bulge involving the tip of the nose, reminding of a clown's fake red nose. Reports about these tumours are scarce. Most reports refer to metastatic skin manifestation of systemic malignancies: this condition has been rarely described as a primary skin neoplasm. We report a case of a 31-year-old patient with a giant cutaneous squamous cell carcinoma of the nose which evolved into a CN. After ruling out genetic or immune risk factors, the patient was treated with surgical excision of the lesion and local reconstruction with good aesthetic outcome and no recurrence over a 2-year follow-up.
2014
- Comprehensive surgical management of cocaine-induced midline destructive lesions
[Articolo su rivista]
Colletti, G.; Autelitano, L.; Chiapasco, M.; Biglioli, F.; Giovanditto, F.; Mandalà, M.; Allevi, F.
abstract
Purpose This article presents a review of the literature and proposes a protocol for managing acute and chronic midfacial cocaine-induced injuries. Materials and Methods This report describes a series of 4 patients affected by cocaine-induced midline destructive lesions. Three patients came to the authors' attention after 18 months of drug withdrawal and underwent surgical treatments to restore nasal and palatal morphology and function, and the fourth patient was referred because of acute cocaine-induced destructive lesions and was treated by aggressive debridement. An 18-month drug-free period is planned before beginning any reconstructive procedures in this latter patient. Results Long-term follow-up showed stable results without relapse of palatal fistulas and good esthetic nasal appearance in all 3 patients undergoing reconstruction. The fourth patient did not show any disease progression and will be monitored for drug withdrawal. Conclusion Chronic cocaine consumption may cause multiple types of damage to the soft and hard tissues of the midface. Acute lesions must be addressed with aggressive debridement. As a result of chronic injury, the palate and nose are deformed in a very complex way and the vascularity of the remaining local tissues may be compromised or inadequate for flap harvesting. Palatal and nasal reconstructions are very delicate operations and should be addressed separately to maximize the predictability of the result.
2014
- Contemporary management of vascular malformations
[Articolo su rivista]
Colletti, G; Valassina, D; Bertossi, D; Melchiorre, F; Vercellio,
abstract
Purpose To review the literature on vascular malformations and to clarify their diagnosis, clinical presentation, and treatment options. Material and Methods The authors reviewed the current literature on vascular malformations looking for more innovative and credited diagnostic criteria and treatment protocols. Results The review is divided in 4 sections (capillary, venous, arteriovenous, and lymphatic malformations). In each section, the clinical presentation, radiologic features, and treatment options for each kind of vascular malformation are described. The experience and results of the authors also are presented. Conclusions Vascular malformations are a heterogeneous group of diseases. Each type of malformation has unique features that make it largely different from the others. Only a clear and correct diagnosis can lead to optimal results.
2014
- Epidermal nevus and ameloblastoma: A rare association
[Articolo su rivista]
Colletti, G; Allevi, F; Moneghini, L; Rabbiosi, D; Bertossi, D; Frau, I; Biglioli, F; Tadini, G
abstract
Epidermal nevi are clinical manifestations of a malformation affecting the embryonic ectoderm. They appear as linear verrucous lesions and are more often located in the skin of the trunk or the extremities. Rarely, verrucous lesions affect the oral mucosa. Epidermal nevi can be a component of epidermal nevus syndrome (ENS), which is characterized by malformations involving several organs, such as the central nervous system. ENS is rarely associated with other solid tumors. We present the case of a patient affected by ENS who developed maxillary and mandibular ameloblastomas. Epidermal nevi were located in the left middle and lower third of the face and in the left cervical region, whereas the ameloblastomas arose within the left maxillary mucosa and within the left mandibular ramus. Features of the syndrome are described and the relevant literature is reviewed.
2014
- Extraoral approach to mandibular condylar fractures : our experience with 100 cases
[Articolo su rivista]
Colletti, G.; Battista, V. M. A.; Allevi, F.; Giovanditto, F.; Rabbiosi, D.; Biglioli, F.
abstract
Introduction Mandibular condylar fractures are very common. The current literature contains many indications and methods of treatment. Extraoral approaches are complicated by the need to avoid injury to the facial nerve. On the other hand intraoral approaches can make fracture reduction and/or fixation difficult. The mini-retromandibular approach provides an excellent view of the surgical field, minimises the risk of injury to the facial nerve, and allows rapid and easy management of condylar fractures. We have collected and reviewed our first 100 condylar fractures treated by means of a mini-retromandibular approach. Patients and methods Between June 2006 and June 2012, Eighty-seven patients with extracapsular condylar fractures underwent open reduction and rigid fixation for 100 extracapsular condylar fractures via a mini-retromandibular approach. Results Dental occlusion and anatomic reduction were restored in all 100 condylar fractures. Postoperative infection developed in three patients. There was one sialocele and one case of plate fracture. Four patients experienced transient palsy of the buccal branch of the facial nerve. No permanent deficit of any facial nerve branch was observed. No patient showed condylar head resorption. Conclusions Our experience with the treatment of the first 100 condylar fractures using the mini-retromandibular approach has demonstrated that this technique has allowed the Authors to safely manage extracapsular condylar fractures at all levels.
2014
- Improved outcomes in auditory brainstem implantation with the use of near-field electrical compound action potentials
[Articolo su rivista]
Mandalà, M.; Colletti, L.; Colletti, G.; Colletti, V.
abstract
OBJECTIVE:
To compare the outcomes (auditory threshold and open-set speech perception at 48-month follow-up) of a new near-field monitoring procedure, electrical compound action potential, on positioning the auditory brainstem implant electrode array on the surface of the cochlear nuclei versus the traditional far-field electrical auditory brainstem response.
STUDY DESIGN:
Retrospective study.
SETTING:
Tertiary referral center.
SUBJECTS AND METHODS:
Among the 202 patients with auditory brainstem implants fitted and monitored with electrical auditory brainstem response during implant fitting, 9 also underwent electrical compound action potential recording. These subjects were matched retrospectively with a control group of 9 patients in whom only the electrical auditory brainstem response was recorded. Electrical compound action potentials were obtained using a cotton-wick recording electrode located near the surface of the cochlear nuclei and on several cranial nerves.
RESULTS:
Significantly lower potential thresholds were observed with the recording electrode located on the cochlear nuclei surface compared with the electrical auditory brainstem response (104.4 ± 32.5 vs 158.9 ± 24.2, P = .0030). Electrical brainstem response and compound action potentials identified effects on the neighboring cranial nerves on 3.2 ± 2.4 and 7.8 ± 3.2 electrodes, respectively (P = .0034). Open-set speech perception outcomes at 48-month follow-up had improved significantly in the near- versus far-field recording groups (78.9% versus 56.7%; P = .0051).
CONCLUSIONS:
Electrical compound action potentials during auditory brainstem implantation significantly improved the definition of the potential threshold and the number of auditory and extra-auditory waves generated. It led to the best coupling between the electrode array and cochlear nuclei, significantly improving the overall open-set speech perception.
2014
- Mesenchymal phosphaturic tumour : early detection of recurrence
[Articolo su rivista]
Allevi, F.; Rabbiosi, D.; Mandalà, M.; Colletti, G.
abstract
The case of a recurrent phosphaturic mesenchymal tumour of the maxillary sinus 10 years after the first surgical excision is reported. The neoplasm first presented with paraneoplastic osteomalacia causing a pathological femur fracture. A right maxillary sinus tumour was identified and treated thereafter. The patient had no local symptoms and serum electrolytes returned to normal after surgical removal of the tumour. However, 10 years later, the patient's urine Ca and P levels increased and an octreoscan detected a new tumour in the right maxillary sinus. Early diagnosis prevented the effects of the paraneoplastic activity of the neoplasm. This case emphasises the importance of specific, close follow-up, because the neoplasm rarely produces local signs indicating its position. To our knowledge, this is the first reported case of a late relapse presenting without relevant symptoms (local pain or swelling or pathological fractures).
2014
- Paradoxical embolism following intralesional sclerotherapy for cervical venous malformation
[Articolo su rivista]
Allevi, F.; Rabbiosi, D.; Mandalà, M.; Colletti, G.
abstract
We present a rare case of a 47-year-old woman admitted to our maxillofacial surgery department for a large cervicofacial venous malformation. The patient underwent fluoroscopy-guided intralesional foam sclerotherapy with sodium tetradecyl sulfate and air under general anaesthesia. On awakening, after 48 h of endotracheal intubation, she displayed dysarthria and dysmetria. Her brain CT scan showed no haemorrhagic lesions. A chest CT scan ruled out a potential pulmonary embolism. Suspicion for a paradoxical embolism was high and echocardiography confirmed a patent foramen ovale, which acted as a passageway for the embolus. Transcranial ultrasound showed mild right-to-left heart shunting. The dysarthria and dysmetria disappeared gradually over 48 h, thus confi rming a reversible ischaemic neurological deficit. A brain MRI performed 1 week later showed no ischaemic or haemorrhagic lesions. The patient recovered completely. She was advised cardiosurgical follow-up and discharged.
2014
- Sinus lift access in partial maxillectomies
[Articolo su rivista]
Colletti, G.; Autelitano, L.; Rabbiosi, D.; Bazzacchi, R.; Marelli, S.; Bardazzi, A.; Biglioli, F.
abstract
Maxillectomies often result in anatomical defects that need to be reconstructed. In partial maxillectomies, the most significant defect is the formation of an oronasal or oral-antral fistula. This creates discomfort and needs to be addressed secondarily with local or regional flaps. Here, we describe a technique adopted in 8 patients in which limited maxillectomies are carried out in a way that preserves the nasal and sinus mucosa, preventing the formation of fistulas and allowing the use of flaps that would normally carry a high risk of fistula formation. Contemporary bone reconstruction with grafts was used in 2 patients. Sparing the sinus and nasal mucosa during maxillectomies is an easy, safe procedure that can prevent a number of complications and can be recommended in selected cases.
2014
- Strangling technique to treat large cervicofacial venous malformations: A preliminary report
[Articolo su rivista]
Colletti, G; Colombo, V; Mattassi, R; Frigerio, A
abstract
Background. Surgical removal of large cervicofacial venous malformations might be hampered by massive intraoperative bleeding. Moreover, these lesions often insinuate within normal surrounding tissue, making complete resection impossible without causing significant morbidity. Methods. Two patients affected by facial venous malformations nonresponsive to sclerotherapy underwent surgery. Bleeding and critical branching of the facial nerve within the lesion prevented the surgeons from proceeding with the removal. The unresectable malformation was decompressed by means of a number of nonresorbable stitches from the surface of the lesion to the periosteum, tailoring a permanent pressure dressing. Results. Outcomes at 12-month follow-up were stable, with good cosmetic results and satisfaction reported by both patients. No long-term side effects related to the procedure were observed. Conclusion. Decompression of large venous malformations by means of a strangling technique might represent a safe and effective procedure for those cases where a removal cannot be accomplished.
2014
- Surgical treatment of vascular malformations of the facial bones
[Articolo su rivista]
Colletti, G.; Frigerio, A.; Giovanditto, F.; Biglioli, F.; Chiapasco, M.; Grimmer, J. F.
abstract
Purpose To characterize intraosseous vascular malformations and describe the most appropriate approach for treatment according to clinical experience and a review of the published data. Materials and Methods We performed a retrospective review of 11 vascular malformations (7 venous and 4 arteriovenous) of the facial bones treated during a 10-year period using en bloc resection or intraoral aggressive curettage alone or preceded by endovascular embolization. Corrective surgery was planned to address any residual bone deformities. The cases were reviewed at a mean follow-up point of 6 years. Results Facial symmetry was restored in the cases requiring reconstruction. Tooth sparing was possible in the case of jaw and/or maxillary localization. Recanalization occurred in 14% of the venous and 33% of the arteriovenous malformations. Conclusions Facial intraosseous venous malformations can be successfully treated using surgery alone. Facial intraosseous arteriovenous malformations will be better addressed using combined approaches. Aggressive curettage will obviate the need for extensive surgical resection in selected cases.
2014
- Technical refinements in mandibular reconstruction with free fibula flaps: Outcome-oriented retrospective review of 99 cases = Accorgimenti tecnici nelle ricostruzioni mandibolari con lembi liberi di fibula: analisi retrospettiva dei risultati su 99 casi
[Articolo su rivista]
Colletti, G.; Autelitano, L.; Rabbiosi, D.; Biglioli, F.; Chiapasco, M.; Mandalà, M.; Allevi, F.
abstract
Congenital disease, major trauma, tumour resection and biphosphonate-related osteonecrosis can lead to partial, subtotal, or total loss of the mandibular bone. Minor defects can be easily reconstructed using bone grafts, whereas microvascular free tissue transfer may be unavoidable in the case of major bone loss or poor quality of soft tissue. Simple bone or composite osteocutaneous fibula free flaps have proven invaluable and remain the workhorse for microvascular mandibular reconstruction in daily practice. Our experience with 99 consecutive fibular free flaps confirms the available data in terms of high success rate. In these cases, 90% had total success, while 7 had complete flap failures. Three of our patients showed skin paddle necrosis with bony conservation. This report focuses on the technical refinements used by the authors that can prove valuable in obtaining predictable and precise results: in particular, we discuss surgical techniques that avoid vascular pedicle ossification by removing the fibular periosteum from the vascular pedicle itself and reduce donor site morbidity and aid in management of the position in the new condylar fossa. Finally, new technologies such as intraoperative CT and custom premodelled fixation plates may also increase the predictability of morpho-functional results.
2014
- The therapeutic dilemma of cochlear nerve deficiency : cochlear or brainstem implantation?
[Articolo su rivista]
Colletti, L.; Colletti, G.; Mandalà, M.; Colletti, V.
abstract
Objective. To compare the outcomes between 2 age-matched cohorts of children with cochlear nerve deficiency: those receiving auditory brainstem implants (group A) or cochlear implants (group B). Study Design. Retrospective cohort study. Setting. Tertiary referral center. Subjects and Methods. Subjects were selected from a pool of 537 children fitted with cochlear implants (n = 443) or auditory brainstem implants (n = 94) over the past 14 years. Performance, examined with the Category of Auditory Performance scale, and complications were compared with a mean follow-up of 5 years. Results. All children had bilateral profound sensorineural hearing loss and cochlear nerve deficiency. Magnetic resonance imaging documented an absent cochlear nerve (n = 12) and a small cochlear nerve (n = 8) in group A and an absent cochlear nerve (n = 11) and a small cochlear nerve (n = 9) in group B (P = 1.000). Children with cochlear implants had Category of Auditory Performance scores spanning from 0 to 3 levels of performance, and all required manual communication mode and visual supplementation. Children with auditory brainstem implants had Category of Auditory Performance scores spanning from 2 to 7, and most patients demonstrated behavioral responses irrespective of inner ear malformations and an absent cochlear nerve or small cochlear nerve (P<.001). Conclusions. In children with cochlear nerve deficiency, patients fitted with cochlear implants did not develop speech understanding and production. Those fitted with auditory brainstem implants had the opportunity to develop open-set speech perception, acquiring verbal language competence using oral communication exclusively and participating in mainstream education. The overall complication rate of auditory brainstem implants was not greater than that of cochlear implants.
2014
- Vestibulotomy with ossiculoplasty versus round window vibroplasty procedure in children with oval window aplasia
[Articolo su rivista]
Colletti, L.; Mandalà, M.; Colletti, G.; Colletti, V.
abstract
OBJECTIVE: To review the surgical procedures and outcomes in children with bilateral oval window aplasia (OWA). STUDY DESIGN: Retrospective cohort review. SETTING: Tertiary referral center. PATIENTS: Children suffering from OWA between 1990 and 2010. INTERVENTION: Vestibulotomy with ossiculoplasty (V-OPL) or round window vibroplasty (RWV). MAIN OUTCOME MEASURES: Findings at radiology and surgery, preoperative and postoperative bone conduction (BC), air conduction (AC), and RWV-air conduction (RWV-AC) thresholds and speech discrimination scores (SDSs). RESULTS: Among 23 children, 11 underwent V-OPL and 8 RWV. Four children in the V-OPL group had aborted surgery and were excluded from the study. In all the remaining 19 children, the 6-month follow-up time showed postoperative AC and SDS values significantly better than the preoperative thresholds in both groups. At the 36-month long-term follow-up, AC and SDS were stable in the RWV group but showed a significant worsening in the V-OPL children compared with the 6-month follow-up results. Preoperative versus postoperative BC values showed a significant difference between the 2 groups at 36 months; 5 of the V-OPL group underwent revision following the same surgical principles, which did not result in improved outcome. CONCLUSION: In children with OWA, V-OPL provides modest long-term results and carries higher risks of BC degradation compared to RWV. Both procedures are technically challenging but considering the respective hearing results and morbidity of primary and revision surgery, we have abandoned the V-OPL procedure in favor of RWV. In infants and children younger than 5 years with OWA previously not considered candidates for hearing restoration, we consider RWV as the first-choice surgery. It has shown to provide significantly better hearing outcomes than traditional atresia surgery with minimal complication rate.
2013
- A new gyro-based method for quantifying eyelid motion
[Articolo su rivista]
Marcelli, E.; Cavallari, P.; Frigerio, A.; Colletti, G.; Biglioli, F.; Fanti, R.; Plicchi, G.; Cercenelli, L.
abstract
Purpose: We present an innovative method to quantify the eyeblink by using a miniature gyroscopic sensor (gyro), which is applied on the upper eyelid. Electrical Stimulation (ES) of the facial nerve is a promising technology to treat dysfunctional eyelid closure following facial paralysis. We used the new gyro-based method to evaluate the biomechanics of both the spontaneous and the ES-induced
eyeblink, and to identify the best ES protocol.
Methods: During blinking, eyelids rotate about the axis passing through the eye canthi, thus we propose
to use a gyro for measuring the angular velocity of the upper eyelid (ωe ). The angular displacement of the eyelid (θe ) was calculated by integrating the ωe signal. Two indices were derived from θe: 1) the eyelid angular displacement during eye closure (C), calculated as the peak value of θe ; 2) the eyelid closure duration (D), calculated as the time interval between zero signal and the peak value of θe. In a healthy volunteer we used this method to quantify both the spontaneous eyeblink and the blinks elicited by different ES patterns.
Results: For the spontaneous eyeblink, indices C = 14.0 ± 1.8° and D = 94.0 ± 10.8 ms were computed.
By comparing C and D indices for spontaneous and ES cases, trains of 10 pulses with a frequency ranging from 200 Hz to 400 Hz proved to induce the most effective and natural-like eyeblinks.
Conclusions: The new gyro-based method proved to be a valuable tool to provide dynamic and realtime quantification of eyelid motions. It could be particularly useful for evaluating the effective and natural-like eyeblink restoration provided by ES.
2013
- Bilateral auricular classic Kaposi's sarcoma
[Articolo su rivista]
Colletti, G.; Allevi, F.; Moneghini, L.; Rabbiosi, D.
abstract
In 2009, a 57-year-old man was referred to our maxillo facial surgery department for the appearance of a reddish-purplish swelling on his right helix. The lesion was more than 1 cm in length and did not show changes for 3 months. He was otherwise healthy, without any predisposing factors. The patient denied smoking, alcohol misuse and intravenous drug use. He had no family history of similar lesions or Kaposi's sarcoma. The lesion was completely excised and the surgical defect reconstructed with a localflap. In 2011 the same patient returned to our attention because of the appearance of a new lesion, similar to the first one on the other auricle. The lesion was completely removed. The same situation recurred in September 2012, when the patient presented a new little reddish-purplish swelling of 3 mm on the left helix. The lesion was excised. The patient has not reported further lesion at present.
2013
- Evaluation of quality of life in patients with total or partial edentulism treated with computer-assisted implantology.
[Articolo su rivista]
Bertossi, D; Rossetto, A; Piubelli, C; Rossini, N; Zanotti, G; Rodella, Lf; Bissolotti, G; Colletti, G; Chiarini, Luigi; Nocini, P. f.
abstract
Aim: The study deals with a preliminary analysis that compares quality of life of a randomized sample of patients with total or partial edentulism rehabilitated through conventional implantology or computer-assisted implantology. Methods: The first group was treated with conventional implantology, while the second group was treated with NobelGuide™ computer-assisted implantology. every patient has filled up a questionnaire about quality of life in presurgical period (sf-361), in postsurgical period (sf-361; tiq2) and about the gratification after prosthetic treatment. the questionnaire has evaluated physical, general and psycho-emotive health parameter. Results: sf-36 has demonstrated an improvement in quality of life after computer-assisted surgery. tiq has revealed that patients symptoms in post-surgical week were inferior in quality and in quantity in NobelGuide™ technique. gratification questionnaire has demonstrated that quality of life improvement matches patient full satisfaction after the treatment. Conclusion: NobelGuide™ protocol improves physical health after implantology with positive reflections on psycho-emotive health. furthermore prefabricated temporary prostheses reduces treatment time and patient discomfort.
2013
- Extensive rhabdomyoma of the head and neck region : a case report and a literature review [Rabdomioma del distretto testa-collo : caso clinico e revisione della letteratura]
[Articolo su rivista]
Allevi, F.; Rabbiosi, D.; Colletti, G.; Felisati, G.; Rezzonico, A.; Ronchi, P.; Biglioli, F.
abstract
Rhabdomyomas are rare mesenchymal benign tumors of striated muscle origin that can be classified into cardiac and extracardiac types. Cardiac rhabdomyomas are considered as hamartomatous lesion because of their association with phacomatosis. Extracardiac type is further classified into adult, fetal and genital form, depending on the individual tumor's degree of differentiation. Adult head and neck rhabdomyomas are rare pathologies of adult patients, with a male predominance. The occurrence of multifocality is a rare manifestation of this uncommon lesion. Presenting symptoms are related to the location and dimension of the tumors and they include upper airway obstruction, Eustachian tube dysfunction, dysphagia and mucosal and neck mass. Because of their high rate of recurrence, radical resection is the treatment of choice of this kind of tumors. In this article is reported a rare and particularly large case of head and neck adult rhabdomyoma, presenting with an history of sleep apnea and night-time stridor.
2013
- NobelGuide™ influence in the perception of postoperative pain.
[Articolo su rivista]
Bertossi, D; Gerosa, R; Schembri, E; Zanotti, G; Rossini, N; Colletti, G; Rossetto, A; Chiarini, Luigi; Nocini, P. f.
abstract
Aim: The aim of this study was to evaluate the perception of pain after Computer-aided-implantology Implant Surgery (NobelGuideTM, Nobel Biocare, Göteborg, Sweden) compared to the conventional implant surgery. Methods: Eighteen patients from dental and maxillo-facial clinic of Policlinico G. B. Rossi (Verona, Italy) have been recruited: 9 were treated with the NobelGuide™ Technique, and 9 with the conventional one (approved by Local Ethical Committee) After the operation, painkillers (Ibuprofene tablets of 400 mg) were prescribed to the patients. Patients were asked to answer a questionnaire during the postoperative days and to report on the Visual Analogue Scale form (VAS), the intensity of pain and the number of painkillers used. Results: The VAS mean one day after the operation (peak of maximum pain) was 47.22 for the conventional technique, and 12.77 for the NobelGuide™ technique, and also the number of painkillers assumed is smaller for the NobelGuide™ technique. The 5th day after the operation all the patients treated with the NobelGuide™ Technique stopped painkillers and nobody felt pain, while the patients treated with the conventional technique felt more pain and for a longer period. They also took painkillers until the 7th day. Conclusion: Pain is minor and disappears more quickly with the Nobelguide™ Implant Surgery compared with the conventional surgical technique. Nobelguide™ Implant Surgery can reduce hospitalization improving the compliance of odontophobic patients towards implant therapy.
2013
- Reconstruction of complex defects of the parotid region using a lateral thoracic wall donor site
[Articolo su rivista]
Biglioli, F; Pedrazzoli, M; Rabbiosi, D; Colletti, G; Colombo, V; Frigerio, A; Autelitano, L
abstract
Radical treatment of parotid neoplasms may lead to complex parotid defects that present functional and aesthetic reconstructive challenges. We report our experience using the lateral thoracic wall as a single donor site. Between 2003 and 2009, four patients with malignant tumours in the parotid gland underwent radical parotidectomy and simultaneous reconstruction using a perforator latissimus dorsi cutaneous free flap (de-epithelialized and entire skin paddle in two cases each). A thoracodorsal nerve graft was used in all cases to replace the intraglandular branches of the facial nerve. Costal grafts were used for mandibular reconstruction in two patients. All patients underwent postoperative physiotherapy. No donor-site complication occurred and all treatments achieved good aesthetic results. All patients recovered nearly complete symmetry at rest and partial facial mimetic function. The lateral thoracic wall is a good donor site for the reconstruction of complex parotid defects. (C) 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. OI Pedrazzoli, Marco/0000-0003-4819-9170; Frigerio, Alice/0000-0001-9202-9553; Colletti, Giacomo/0000-0001-6975-495X
2013
- Repair of cocaine-related oronasal fistula with forearm radial free flap
[Articolo su rivista]
Colletti, G.; Allevi, F.; Valassina, D.; Bertossi, D.; Biglioli, F.
abstract
BACKGROUND: Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions. MATERIALS AND METHODS: From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication. RESULTS: In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved. DISCUSSION: Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness.
2013
- The reconstruction of the spheno-orbital region using latissimus dorsi flap and costal graft
[Articolo su rivista]
Biglioli, Federico; Mortini, Pietro; Pedrazzoli, Marco; D’Alessandro, Luca; Bardazzi, Alessandro; Colletti, Giacomo
abstract
To minimize complications in skull base surgery, it is necessary to separate intracranial structures from the upper aerodigestive tract with well-vascularized tissue. The majority of defects can be reconstructed using local flaps using pericranium, galea, or temporalis muscle. However, there are conditions that affect the suitability of the previously mentioned flaps, for example, previous surgical procedures or radiotherapy. Local flaps may also be inadequate to reconstruct particularly large defects. Extensive bony demolitions produce aesthetic deformities that need accurate reconstructions. Orbital wall defects have to be reconstructed to avoid complications such as the transmission of cerebral pulsation, bulbar dystopias, diplopia, and ophthalmoplegia. The microvascular latissimus dorsi flap is ideal in all these cases, and the use of a costal graft allows simultaneous reconstruction of bony defects. From January 2000 to January 2008, 17 patients have undergone surgical ablation of the spheno-orbital region and reconstruction with latissimus dorsi flap and costal grafts. The flap survival rate was 100%. One patient required revision of the venous anastomosis. No cerebrospinal fluid leak or intracranial infections have been detected. The only complications registered were dystopias in 6 patients and diplopia in 4; all of these spontaneously resolved within 2 months. The microvascular latissimus dorsi flap with costal graft is an effective method for the reconstruction of the spheno-orbital region when local flaps are not indicated. It has a negligible donor-site morbidity, an ideal vascular pedicle, and an easy harvesting technique. The costal graft allows the simultaneous reconstruction of the orbital walls, giving good results.
2012
- Autonomized flaps in secondary head and neck reconstructions
[Articolo su rivista]
Colletti, G; Autelitano, L; Tewfik, K; Rabbiosi, D; Biglioli, F
abstract
Free flaps, with their very high rates of success and low donor site morbidity, are considered the gold standard in head and neck reconstruction, allowing the transfer of ideal tissues for head and neck reconstruction. Nonetheless, under certain circumstances they may be contraindicated or cannot be utilized. We describe four subjects in which delayed locoregional flaps were used to reconstruct head and neck defects after a previous flap failure. Due to adverse anatomic and systemic conditions these patients were not suitable for a free flap, and thus one delayed prelaminated temporalis fasciocutaneous flap placement and three delayed supraclavicular flap (one of which was prelaminated) placements to reconstruct large defects of the cheek and commissural region needed to be performed. All flaps and grafts were viable. All patients in this case series had acceptable functional and aesthetic outcomes. Donor-site morbidity was negligible. Delayed locoregional flap placement required a total of three surgical sessions. Although limited, our experience suggests that in cases in which a free flap is contraindicated or not ideal, locoregional flaps may be a valid and safe alternative. Limitations of these procedures include increased duration of hospitalization and, foremost, the need for three-step surgery.
2012
- Facial nerve reconstruction using a thoracodorsal nerve graft after radical parotidectomy
[Articolo su rivista]
Biglioli, F; Colombo, V; Rabbiosi, D; Colletti, G; Frigerio, A
abstract
2012
- Lemmo's flap for nasal dorsum reconstruction
[Articolo su rivista]
Colletti, G
abstract
Purpose: Reconstruction of nasal defects is an antique challenge for surgeons. The first reported technique is dated 600 B.C. Since then a number of reconstructive options have been proposed in the literature. Some principles, first stated by Buget and Menick must be always taken into account when planning such reconstructions. In detail, every reconstruction should respect the subunit principle and the scars should always be well hidden in the passage between adjacent subunits. The flap proposed in the present paper adheres to the cited principles and leads to optimal nasal dorsum reconstruction in selected cases. Materials and Methods: From April 2008 to March 2009, 5 patients were reconstructed with Lemmo's flap after local excision of 3 basal cell carcinomas and 2 squamous cell carcinomas affecting the the skin of the nasal dorsum in its caudal portion. Results: In all cases a pleasing aesthetic result was obtained, no postoperative deformity was observed and all the scars were unnoticeable. Conclusions: The Lemmo's flap described in the present paper can be considered a valid choice for nasal dorsum skin reconstruction and is preferable over other techniques for reconstruction of small to medium sized defects of the skin of the caudal dorsum.
2012
- Masseteric-facial nerve anastomosis for early facial reanimation
[Articolo su rivista]
Biglioli, F; Frigerio, A; Colombo, V; Colletti, G; Rabbiosi, D; Mortini, P; Dalla Toffola, E; Lozza, A; Brusati, R
abstract
Objective: Early repair of facial nerve paralysis when cortical neural input cannot be provided by the facial nerve nucleus, is generally accomplished anastomozing the extracranial stump of the facial nerve to a motor donor nerve. That is generally the hypoglossus, which carries a variable degree of morbidity. The present work aims to demonstrate the effectiveness of the masseteric nerve as donor for early facial reanimation, with the advantage that harvesting is associated with negligible morbidity. Methods: Between October 2007 and August 2009, 7 patients (2 males, 5 women) with unilateral facial paralysis underwent a masseter-facial nerves anastomosis with an interpositional nerve graft of the great auricular nerve. The interval between the onset of paralysis and surgery ranged from 8 to 48 months (mean 19.2 months). All patients included in the study had signs of facial mimetic muscle fibrillations on electromyography. The degree of preoperative facial nerve dysfunction was grade VI following the House-Brackmann scale for all patients. Results: At the time of the study, all the patients with a minimum follow-up time of 12 months after the onset of mimetic function had recovered facial animation. Facial muscles showed signs of recovery within 2-9 months, mean 4.8 months, with the restoration of facial symmetry at rest. Facial movements appeared while the patients activated their chewing musculature. Morbidity related to this intervention is only the loss of sensitivity of earlobe and preauricular region. Conclusion: The present technique seems to be a valid alternative to classical hypoglossal-facial nerve anastomosis because of similar facial nerve recovery and lower morbidity.
2012
- Mini-Retromandibular Access to the Condyle in Panfacial Fractures
[Articolo su rivista]
Colletti, G; Biglioli, F
abstract
Surgical management of panfacial fractures can be extremely challenging. The many fracture lines and lack of landmarks make it difficult to restore the facial skeletal morphology. Extracapsular fractures of the mandibular condyle require open reduction and internal fixation to restore the vertical and sagittal dimensions of the mandible, representing the base for further facial skeleton reconstruction. Six patients with panfacial fractures, including a bilateral extracapsular condylar fracture, were treated between January 2006 and November 2009. One patient underwent surgical procedure 60 days after the injury. The condylar fractures were treated via a mini-retromandibular access. Overall, the bone morphology restoration was good. In particular, all of the condylar fractures were reduced satisfactorily. No complication was detected, and no facial nerve lesion was observed. The literature contains many proposals for surgically accessing panfacial fractures. Open reduction and internal fixation of condylar fractures are crucial for restoring face height. The mini-retromandibular access is especially suitable, because it allows safe, rapid surgical management. OI Colletti, Giacomo/0000-0001-6975-495X
2012
- Orofacial Malformations
[Capitolo/Saggio]
Brusati, R; Colletti, G
abstract
2012
- O-0705 TOTAL NASAL RECONSTRUCTION WITH OR WITHOUT SKELETAL SUPPORT: OUR PROTOCOL
[Abstract in Atti di Convegno]
Colletti, G; Colombo, V; Valassina, D; Battista, V; Rabbiosi, D; Autelitano, L; Biglioli, F
abstract
The reconstruction of nasal skin is relatively easy when the defect involves one to two subunits. These cases are effectively managed with local flaps. However, when an extensive defect involves more than two subunits or the entire nose, a global nasal reconstruction must be consid- ered.
From January 2009 to December 2011 we have treated 10 patients who needed a total nasal reconstruction. In 5 patients the reconstruction involved the external skin only after extensive tumour removal. The remaining 5 patients needed a total nasal reconstruction including internal and external lining and the osteocartilaginous support. In detail we reconstructed 2 cases of congenital arhinia, 2 cases of nasal destruction secondary to cocaine abuse and one case of total nasal loss owing to a squamous cell carcinoma.
In all cases the nasal external skin was reconstructed with a paramedian forehead flap. In those patients where the hard tissue support was intact we only used cartilaginous grafts to support the alae.
In the cases of arhinia we performed a two-step surgery. In the first session we created a new nasal fossa by a LeFort Osteotomy and a skin graft; at the same time we posi- tioned a forehead expander. In the second intervention we: removed the skin expander; created an internal lining with local flaps; created a skeletal framework with osteocarti- laginous grafts; rotated a forehead flap to create the exter- nal lining.
In the two cocaine addicted we used the nasal remnants, deepithelialized, to create the internal lining, a costo- chondral graft to build the hard tissue framework and a paramedian forehead flap to create the external skin.
The patient who had his nose lost for oncological reasons was reconstructed with a prelaminated forehead parame- dian flap. In a second surgical session the flap was mod- elled and a costochondral graft positioned to build the skeletal support.
We have observed very good results in all cases with minimal donor site morbidity.
While the technique is by itself not new, we believe that our protocol, that we here present, is ideal if we look at the results and applicable to different conditions that lead to major nasal defects.
2012
- O-2207 THE NEED FOR TRACHEOSTOMY IN VASCULAR ANOMALIES: A LITERATURE META ANALYSIS
[Abstract in Atti di Convegno]
Colletti, G; Battista, V; Valassina, D; Colombo, V; Rabbiosi, D; Autelitano, L; Biglioli, F
abstract
Vascular anomalies encompass an extremely wide spec- trum of pathologies. There are simple single angiomas which do not pose any diagnostic and therapeutic diffi- culty.
On the other hand, there are extremely severe conditions such as congenital gigantic lymphatic malformations involving the upper respiratory tract that can require an Ex Utero Intrapartum Therapy (EXIT).
In general, when a vascular anomaly affects the airways, there could be the risk of asphyxia spontaneously, during certain physiological conditions such as the Valsalva manoeuvre, during intubation or during the surgical man- agement of the vascular anomaly.
The aim of the present paper was to extensively review the literature in the search for indications and techniques to see if a guideline can be proposed to protect the upper airways of patients affected by haemangiomas and vascu-
lar malformations.
In detail we tried to investigate the conditions that suggest a surgical airway versus a conservative management.
As to what pertains to haemangiomas we have thoroughly reviewed the literature regarding subglottic haemangiomas treated before and after the advent of propranolol.
For the vascular malformation we have considered the various clinical conditions that can suggest a surgical airway.
Eventually we try to see if a guideline can be proposed.
2012
- O-2614 EXTRA-PLATYSMATIC FIXATION OF BISPHOSPHONATE–RELATED MANDIBULAR FRACTURES: A SUGGESTED TECHNICAL SOLUTION
[Abstract in Atti di Convegno]
Biglioli, F; Pedrazzoli, M; Ferrari, M; Rabbiosi, D; Bazzacchi, R; Colletti, G; Tewfik, K; Valassina, D; Autelitano, L
abstract
Bisphosphonate-related osteonecrosis of the jaws (BRONJ ) is an evolving epidemic the maxillofacial surgeon is dealing with.
The causes of this disease are not fully understood; the most widely accepted etiopathological hypothesis is that in certain individuals bisphosphonates increase trabecular bone density to the point of inducing vascular insuffi- ciency with a consequent bone necrosis.
The current focus is on prevention and only conservative symptomatic treatment are advised.
When BRONJ occurs most surgeons agree with the simple removal of the necrotic bone.
Unfortunately sometimes conservative treatments aren’t successful, and the disease inexorably evolves to a clinical situation with the need of a more complex management.
The necrosis can evolve and produce an extraoral fistula and osteolysis extending to the inferior border and some- times a mandibular fracture may occur.
In the literature there are few reports of the treatment of pathological mandibular fracture caused by BRONJ .
This clinical situation usually occurs in oncologic patients in poor general conditions and the aim of the surgical treatment in generally limited to pain control, and allow- ance of feeding.
The local situation of BRONJ related fractures may pre- vent traditional open surgery with direct position of stabi- lization by plates because of the high risk of a further reduction of vascular flow to the bone stumps. Moreover the rigid fixation is likely to fail because of plate and screw infection due to the infection usually present into the surgical field. Under these conditions healing of the fracture is impaired and maintenance of infection almost guaranteed.
We present an useful surgical technique for the stabiliza- tion of BRONJ related mandibular fractures applying an extra-platysmatic reconstructive plate.
With this technique the healing of bone fracture is not achieved but the plates fixed with this technique are stable and may not get infected, while patients are pain free and can eat easily , with a great improvement of their quality of life.
2012
- O-3405 SURGICAL MANAGEMENT OF AMELOBLASTOMA: OUR EXPERIENCE AND PROTOCOL
[Abstract in Atti di Convegno]
Autelitano, L; Battista, V; Chiapasco, M; Annedda, T; Rabbiosi, D; Colletti, G; Biglioli, F
abstract
Introduction: Ameloblastoma is the second most frequent epithelial odontogenic tumours of the jaws, characterized by a high recurrence rate (11-18% of odontogenic tu- mours, incidence of 0,5-1 case/1,000,000 a year). This retrospective study reviews the features of the cases of ameloblastoma operated at San Paolo University Hospital in Milan, units of Maxillo Facial Surgery and Oral Surgery from 1995 to 2011. All patients were treated using the same protocol for diagnosis and surgical treatment.
Patients and methods: The studied parameters were sex, age at diagnosis, site distribution, histological type, treat- ment, and follow-up records.
Results: Fifty-nine patients were included (with 13 ameloblastoma recurrence of ameloblastoma treated pre- viously in other units). The mean age was 43 years. Ana- tomical site distribution was mandibular location in 79% of cases, maxillary bone location in 15,2% and maxillary sinus location in 1,7%. The most common histological type was follicular ameloblastoma. Patients were treated by enucleation and curettage in 25,4% of cases and by resection in 71,2% of cases with reconstruction in 66,6% of them (bone grafts or free flaps). The follow-up was recorded for all of the patients (with a range of 6 month-16 years) with a 16,9% recurrence rate. After enucleation the recurrence rate was 20% and after resection the recurrence rate was 16,7%.
Discussion: The treatment depends on imaging featuring (unicystic or multycystic lesion), anatomical site and dimension of the lesion. Conservative treatment is the first choice in primary cases with unicystic lesion of small dimension. In more complicated cases radical surgery (with immediate reconstruction if possible) is mandatory. Maxillary bone locations, due to the risk of basicranium recurrences, require more aggressive treatments.
2012
- O-3507 RECONSTRUCTION OF CRANIAL AND CRANIAL BASE DEFECTS USING PEDICLED FLAPS VERSUS FREE FLAPS AFTER TUMOUR RESECTION
[Abstract in Atti di Convegno]
Rabbiosi, D; Colletti, G; Colombo, V; Valassina, D; Autelitano, L; Bardazzi, A; Boari, N; Mortini, P; Biglioli, F
abstract
Objective. The harvesting of local flaps is the gold stan-
dard to reconstruct craniofacial or cranial base defects after ablative cancer surgery. A second effective recon- structive method, when defects are larger or local tissue conditions prevent to use local flaps is represented by free flaps, such as latissimus dorsi, forearm, anterolateral thigh ones. Traditional pedicled flaps (as latissimus dorsi, pec- toralis major, deltopectoral, superior trapezius, lower island trapezius myocutaneous flaps) are commonly the last reconstructive choice because their distal tissues (gen- erally located into the third angiosome) may by lost be- cause of poor vascularization. That may lead to fistulae, infections and life threatening complications. However, in some selected cases, pedicled flaps become an important surgical option. That is the case of patients previously treated with radiotherapy or with poor general health conditions (diabetes mellitus, hypertension, severe vascu- lophaty).
Methods. Between 2007 and 2012, 7 head and neck pedi- cle flap reconstruction procedures were carried out among our Maxillo-facial and Neurosurgical teams. The patients (4 females, 3 males) were affected by cranial or cranial base tumours. The histology was infiltrating basal cell carcinoma of the temporal region and scalp in 2 cases, squamous cell carcinoma of the occipital and parietal regions in 2 case, bone and soft tissue defects after abla- tive neurosurgery in 3 cases. The defect size ranged from 15 to 25 cm of major diameter. Three patients were recon- structed with pedicled latissimus dorsi muscolocutaneous flap, two with pectoralis major flap, two with lower island myocutaneous trapezius flap.
All patients included in the study have previously under- gone radiotherapy or were affected by systemic diseases which could impair the success of a local or microvascular flap.
Results. No patients had significant post-operative compli- cations. No total nor partial flaps failure occurred. The morbidity related to this technique was acceptable, with poor functional sequelae and great acceptance by all pa- tients.
Four patients have shown reduced motor function of the upper limbs, so they underwent physiotherapy with great functional improvements.
Conclusions. The use of pedicled flaps may offer a safe option in selected cases, offering some advantages such as a shorter duration of the procedure, a shorter hospitaliza- tion and reduction of post-operative complication.
2012
- Parosteal Osteoma Arising in an Iliac Bone Graft Used for Mandibular Reconstruction
[Articolo su rivista]
Colletti, G; Autelitano, L; Rabbiosi, D; Tewfik, K; Frigerio, A; Biglioli, F
abstract
2012
- Partial and Total Lower Lid Reconstruction: Our Experience with 41 Cases
[Articolo su rivista]
Fogagnolo, P; Colletti, G; Valassina, D; Allevi, F; Rossetti, L
abstract
Purpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30-60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results. Copyright (C) 2012 S. Karger AG, Basel OI Colletti, Giacomo/0000-0001-6975-495X; Rossetti, Luca/0000-0002-7027-3173
2012
- Recovery of Emotional Smiling Function in Free-Flap Facial Reanimation
[Articolo su rivista]
Biglioli, F; Colombo, V; Tarabbia, F; Autelitano, L; Rabbiosi, D; Colletti, G; Giovanditto, F; Battista, V; Frigerio, A
abstract
Purpose: Long-standing unilateral facial palsy is treated primarily with free-flap surgery using the masseteric or contralateral facial nerve as a motor source. The use of a gracilis muscle flap innervated by the masseteric nerve restores the smiling function, without obtaining spontaneity. Because emotional smiling is an important factor in facial reanimation, the facial nerve must serve as the motor source to achieve this fundamental target. Materials and Methods: From October 1998 to October 2009, 50 patients affected by long-standing unilateral facial paralysis underwent single-stage free-flap reanimation procedures to recover smiling function. A latissimus dorsi flap innervated by the contralateral facial nerve was transplanted in 40 patients, and a gracilis muscle flap innervated by the masseteric nerve in 10 patients. All patients underwent a clinical examination that analyzed voluntary and spontaneous smiling. Results: All patients who received a latissimus dorsi flap innervated by the contralateral facial nerve and recovered muscle function (92.5%) showed voluntary and spontaneous smiling abilities. All patients who received a gracilis free flap innervated by the masseteric nerve recovered function, but only 1 (10%) showed occasional spontaneous flap activation. During those rare activations, much less movement was visible on the operated side than when the patient was asked to smile voluntarily. Conclusions: The masseteric nerve is a powerful motor source that guarantees free voluntary gracilis muscle activation; however, it does not guarantee any spontaneous smiling. Single-stage procedures that use a latissimus dorsi flap innervated by the contralateral facial nerve have a lower success rate and obtain less movement; however, spontaneous smiling is always observed. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:2413-2418, 2012 OI Frigerio, Alice/0000-0001-9202-9553; Colletti, Giacomo/0000-0001-6975-495X
2012
- Surgical access to condylar fractures in panfacial traumas.
[L’accesso chirurgico al condilo nei fracassi facciali]
[Articolo su rivista]
Rabbiosi, D; Bardazzi, A; Valassina, D; Marelli, S; Colletti, G
abstract
AIM:
Surgical access to the condyle in panfacial fractures is a delicate and debated issue. The aim of the study was to propose a protocol which would apply in the treatment of panfacial fractures requiring access to the condyles.
METHODS:
A case series of 10 patients (8 males and 2 females) with panfacial fractures consisting of 16 extracapsular mandibular condylar fractures associated with 3 symphyseal, 7 parasymphyseal, 1 mandibular angle, 6 Le Fort II, 3 orbitomaxillomalar, 5 zygomatic arch fractures were included in this study. Reduction and fixation were achieved using the mini-retromandibular access in 6 patients with 10 extracapsular condylar fractures while in 4 patients with 6 extracapsular condylar fractures access to the condyles consisted in a face-lift-type preauricular access, as a caudal extension of a coronal or hemicoronal incision required for the reduction and fixation of other fractures of the upper and middle thirds.
RESULTS:
A good morphological and functional outcome was achieved in all patients. No surgical complication associated with access to the condyles or treatment of the condylar fractures was registered.
CONCLUSION:
The proposed protocol could be used as a guide in choosing access to the condyles in panfacial traumas.
2012
- The role of maxillary osteotomy in the treatment of arhinia
[Articolo su rivista]
Brusati, R; Colletti, G
abstract
Purpose: Arhinia is a very rare malformation, and only 41 cases are described in the literature. Given its rarity, there is no standardized surgical protocol. This article describes our preferred treatment, which underlines the importance of maxillary osteotomy for obtaining satisfactory results. Methods: We observed 3 girls with arhinia, 2 of whom were treated by a 2-step surgical protocol. During the first phase, the patients underwent maxillary osteotomy with the creation of a new epithelium-lined nasal cavity. A skin expander was also placed in the forehead. During the second step, an external nose was created in both patients from the expanded forehead flap with local perinasal flaps and costochondral grafts. Results: Both reconstructions were viable and esthetically acceptable. No internal nose restenosis was observed. Conclusions: On the basis of our experience, maxillary osteotomy should be considered part of an integrated approach in treating arhinia.
2012
- Traumatic and Iatrogenic Retrobulbar Hemorrhage: An 8-Patient Series
[Articolo su rivista]
Colletti, G; Valassina, D; Rabbiosi, D; Pedrazzoli, M; Felisati, G; Rossetti, L; Biglioli, F; Autelitano, L
abstract
2011
- A NEW METHOD TO QUANTIFY EYE-BLINK RESTORATION IN FACIAL PARALYSIS
[Articolo su rivista]
Marcelli, E; Cercenelli, L; Fanti, R; Cavallari, P; Frigerio, A; Brenna, S; Colletti, G; Biglioli, F; Plicchi, G
abstract
2011
- Deep-planes lift associated with free flap surgery for facial reanimation
[Articolo su rivista]
Biglioli, F; Frigerio, A; Autelitano, L; Colletti, G; Rabbiosi, D; Brusati, R
abstract
Between April 1999 and April 2008, 37 patients with long-standing facial paralysis underwent a one-stage facial reanimation with neuromuscular free flaps: 28 patients (group A) underwent flap transposition only; 9 patients (group B) underwent a deep-planes lift (DPL) composed of the superficial muscoloaponeurotic system + parotid fascia at the time of facial reanimation. The postoperative and final results were compared between groups A and B, following the classification of Terzis and Noah (1997). Before the onset of contraction, only group B patients (100%) showed good or moderate symmetry at rest, while none of the patients of group A had a symmetric face. The respective final results for patients in groups A and B who already showed the onset of flap contraction were excellent in 28.6% and 44.5%, good in 42.9% and 33.3%, moderate in 10.7% and 22.2%, and fair or poor and fair in 17.8% and 0% of patients, respectively. The DPL allows immediate symmetry of the face at rest and contributes to upgrading the final static and dynamic results in facial reanimation with free muscular flaps. (C) 2010 European Association for Cranio-Maxillo-Facial Surgery.
2011
- Il ruolo del chirurgo maxillo-facciale nelle malformazioni del distretto cranio facciale
[Abstract in Atti di Convegno]
Colletti, G
abstract
2010
- Functional results after condylectomy in active laterognathia
[Articolo su rivista]
Brusati, R; Pedrazzoli, M; Colletti, G
abstract
Introduction: Mandibular asymmetry due to overgrowth has two main forms, hemimandibular hyperplasia and hemimandibular elongation. It is necessary to distinguish between inactive and active forms, since surgical treatment of the latter, with a solely morphological aim, could lead to recurrence of further condylar growth. In these cases orthognathic surgery is performed in association with high condylectomy to interrupt the hyperactivity of the condyle. Condylectomy alone in growing patients stops the progression of deformities and sometimes achieves facial symmetry at the end of growth. Some authors have viewed condylectomy as a dangerous procedure, with the possibility of compromising articular function. We aimed to verify immediate and long-term results of condylar function after high condylectomy. Materials and methods: Between 1998 and 2007, 15 patients underwent high condylectomy for active laterognathia. All but one patient underwent postoperative Delaire functional rehabilitation. Long-term articular function was evaluated using subjective and objective criteria. Results: In 14 patients, articular function was subjectively satisfactory. In one case, this did not occur because the patient refused postoperative functional rehabilitation. Discussion and conclusions: Some authors have advised against condylectomy because of the possibility of temporomandibular joint dysfunction. High condylectomy in active laterognathia seems to be the procedure of choice in both adults and growing patients. In our experience, functional alterations of practical relevance are rare if the operation is followed by successful functional rehabilitation. (C) 2009 European Association for Cranio-Maxillo-Facial Surgery
2010
- Lingual nerve lesion during ranula surgical treatment : case report
[Articolo su rivista]
Biglioli, F.; Battista, V.; Marelli, S.; Valassina, D.; Colombo, V.; Bardazzi, A.; Tarabbia, F.; Colletti, G.; Rabbiosi, D.; Autelitano, L.
abstract
Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial surgery and in oral surgery. LN runs superficially into the lateral mouth floor just beneath the mucous layer and this position enhances damage frequency. This article lists the different aetiologies of iatrogenic LN injuries and it almost focuses on lesions due to surgical treatment of ranulas. In the case report a LN lesion due to oral ranula excision is discussed; the patient experienced anaesthesia and hyperpatia in the corrisponded tongue side. It was treated with a microneurosugical anastomosis of LN, after amputation neuroma excision. The partial and definitive recovery of perception happened in six months and was deemed satisfying with 70% of functionality restored (results compared with the functionality of the contralateral side). An algorithm for diagnosis and therapy indication for iatrogenic injuries to nerves is also proposed. In case of surgical treatment, funcitonal recovery manifests after 4-6 month; a functional recovery of 70% of total nerve function is possible. The variable that most affects nerve functional recovery is surgical treatment timing; it must be performed as soon as possible.
2010
- Maxillary Reconstruction and Placement of Dental Implants After Treatment of a Maxillary Sinus Fungus Ball
[Articolo su rivista]
Colletti, G.; Felisati, G.; Biglioli, F.; Tintinelli, R.; Valassina, D.
abstract
A fungus ball is one of the fungal diseases that can affect the paranasal sinuses. It requires surgical treatment. Because there is only one previously reported case of dental implant placement after treatment of a maxillary sinus fungus ball, the authors here report on a case of a maxillary sinus fungus ball with bone erosion that was treated surgically with a combined endoscopic endonasal and endoral (Caldwell-Luc) approach. One year later, a graft from the ilium was obtained and a sinus elevation was performed to allow the placement of dental implants. Three months later, the dental implants were placed, and they were all osseointegrated at the 9-month follow-up. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:1041-1044
2010
- Mesenchymal phosphaturic neoplasm in the maxillary sinus: A case report
[Articolo su rivista]
Pedrazzoli, M; Colletti, G; Ferrari, M; Rossetti, G; Moneghini, L; Autelitano, L
abstract
The authors describe a case of oncogenic osteomalacia due to a mesenchymal phosphaturic tumour in the maxillary sinus. This is a paraneoplastic syndrome in which a tumour produces a peptide hormone-like substance (phosphatonin) that causes a urinary loss of phosphates resulting in a debilitating systemic condition. In this case, the patient experienced muscle stiffness, reduction of muscle tone, loss of weight and pathological fractures. Clinical and radiological examination revealed a tumour in the right maxillary sinus; all other results were negative. The diagnosis following pathology examination was mesenchymal phosphaturic tumour with a haemangiopericytoma-like vascular pattern. Different histological types of mesenchymal tumours can be associated with paraneoplastic syndrome, but their localization in the paranasal sinuses is rare. The correct diagnosis allows the appropriate therapeutic approach, which can lead to an almost immediate resolution of the clinical situation after surgical removal of the neoplasm as in the present case. Oncogenic osteomalacia is rare, particularly in the maxillofacial region, and only a few cases have been reported. © 2010 International Association of Oral and Maxillofacial Surgeons.
2010
- Miniretromandibular access for mandibular condyle biopsies.
[Accesso miniretromandibolare per l'esecuzione di biopsie del condilo mandibolare]
[Articolo su rivista]
Biglioli, F.; Colombo, V.; Valassina, D.; Tewfik Hanna, K.; Battista, V.; Tarabbia, F.; Colletti, G.
abstract
Mandibular condylar biopsy is an important tool in defining various condylar lesions and it could become necessary in establishing a correct diagnosis to plan the adequate treatment of the condylar lesions.
METHODS: From May to June 2009, two patients affected by a miofibroma and an osteoma of the condyle underwent an open-field biopsy throught a mini-retromandibular access. The approach was deviced to be curative in case of benign lesion or just diagnostic in case of malignant or doubtfull hystology.
RESULTS: In both cases, mandibular condyle biopsies were diagnostic and curative at the same time, allowing both the hystologic diagnosis and the complete removal of the bony lesions.
CONCLUSION: The present technique seems to be a valid and ideal technique, because ease and quick while simultaneously leaves little esthetic reliquates
2010
- Repair of a perforated sinus membrane with a palatal fibromucosal graft : a case report
[Articolo su rivista]
Biglioli, F.; Pedrazzoli, M.; Colletti, G.
abstract
The sinus lift procedure in association with dental implant placement and autologous bone grafting enables clinicians to achieve the prosthetic rehabilitation of the posterior edentulous maxilla, when the vertical height of the atrophic crest is reduced. The most commonly reported intraoperative complication of sinus augmentation is membrane perforation, which may lead to infection, with the risk of graft loss or resorption, and acute or chronic sinusitis. We present a technique for repairing a perforated Schnei-derian membrane with a de-epithelialized fibromucosal graft harvested from the palate of a 50-year-old man. In the postoperative period, no wound infections, sinusitis, or bleeding were observed. This technique allowed good prosthetic rehabilitation 3 months postoperatively. This technical procedure is a quick and easy way to treat this surgical complication, allowing repair of the Schneiderian membrane perforation with autologous tissue, without other surgical accesses or need to modify the existing surgical access. In addition, our procedure causes no patient discomfort or adds significant morbidity, with only a moderate increase in surgical time compared to the planned procedure.
2009
- Multidisciplinary integration between maxillofacial and vascular surgery
[Articolo su rivista]
Biglioli, F.; Biglioli, P.; Settembrini, P.; Flor, N.; Tarabbia, F.; Colombo, V.; Colletti, G.
abstract
AIM: An increasing growth in medical notions as well as surgical techniques is leading to a deeper sectorialization among specialists in different branches. For this reason, cooperation between head and neck surgeons such as neurosurgeons, maxillofacial, ear, nose and throat surgeons and ophthalmologists is common. On the other hand, this kind of cooperation between maxillofacial and vascular surgeons is rare but nonetheless invaluable for an optimal result. The aim of this paper was to report the experience of the authors in terms of collaboration between maxillofacial and vascular surgery.
METHODS: Between January 2001 and July 2009 nine patients were operated by a team composed of maxillofacial and vascular surgeons. In five cases the maxillofacial surgeon performed a mandibular osteotomy to allow the access to the cranial tract of the internal carotid artery, treated by the vascular surgeon. In other three cases the maxillofacial surgeon performed a neck dissection for oral malignancies and the vascular surgeon subsequently performed a carotid tromboendarterectomy. In one case the multidisciplinary surgical team performed a modified radical neck dissection with common and internal carotid resection and reconstruction because of a neck metastasis of an oral squamous cell carcinoma with involvement of the carotid itself.
RESULTS: Outcomes were always favorable. In detail, in none of the osteotomy cases delayed bone healing or postoperative malocclusion was detected. None of the patients experienced signs of cerebral ischemia secondary to clamping freeing or reconstruction involving the common or internal carotid artery.
CONCLUSION: There are delicate contexts such as common or internal carotid pathologies as well as the need for carotid tromboendarterectomy and contextual neck dissection, which require a multidisciplinary approach. This allows to put in place the different competences which are invaluable in order to reach optimal results in terms of survival rate while minimizing complications and postoperative morpho-functional reliquates.
2009
- Pilomatrix carcinoma with visceral metastases: case report and review of the literature
[Articolo su rivista]
Autelitano, L; Biglioli, F; Migliori, G; Colletti, G
abstract
Pilomatrix carcinoma, the malignant equivalent of pilomatrixoma, is rare among skin cancers. In the literature, there have been 80 cases of pilomatrix carcinoma reported, and among them nine were with metastases. The clinical presentation of this case is suggestive for the biology and of the usual history of this neoplasm. The patient was a 53-year-old male who had been treated 2 years earlier for a pilomatrix carcinoma located in the posterior part of the neck. The clinical presentation had been characterised by sudden paraplegia caused by vertebral collapse at T4 due to bone metastases. The patient underwent a first surgery for vertebral stabilisation and medullary decompression; then, he had a second operation for the resection of the local relapse of the tumour. Literature review and analysis of this case show that the pilomatrix carcinoma should be regarded as a highly locally aggressive tumour, with a high rate of local recurrence as well as metastases. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
2009
- Transmasseter Approach to Condylar Fractures by Mini-Retromandibular Access
[Articolo su rivista]
Biglioli, F; Colletti, G
abstract
Purpose: The published data are full of evidence that surgical treatment of condylar fractures, performed through an intraoral or extraoral approach, leads to better results than nonoperative treatment. Intraoral surgery can be technically demanding, and an extraoral approach presents risks of facial nerve injuries and visible scarring The mini-retromandibular approach we have described allows the treatment of condylar fractures at. any level in a simplified and rapid manner while reducing the risk of complications common to the other techniques Patients and Methods: A tot-it of 33 patients with 38 condylar fractures were treated with a 20-mm mini-retromandibular approach The mean operative time was 33 minutes (range 17 to 56). One patient in the present study was only 14 years old at surgery, which was performed 25 days after the associated trauma. Results: Correct anatomic reduction and Occlusion were achieved in all cases. Additionally, all patients showed normal articular function Infection of the surgical site occurred in the first 2 Surgical cases. In another patient, an additional operation was necessary to fix an erroneously reduced fracture. which had occurred because of insufficient Surgical access (15 mm) No facial nerve injury Was observed, and all surgical scars were barely visible. Conclusions: We Suggest that the mini-retromandibular approach outlined in the present study should be the technique of Choice for condylar fracture management, because it allows for easy, fast reduction and synthesis while minimizing the risk of facial nerve injury and visible scars. (C) 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:2418-2424, 2009
2009
- Upper eyelid reconstruction with forehead galeal flap
[Articolo su rivista]
Brusati, R; Colletti, G; Redaelli, V
abstract
Introduction: Upper lid reconstruction depends on the size of the defect, and a general consensus holds that partial-thickness defects can be reconstructed using simple or composite grafts. Full-thickness defects involving up to 30% of the upper lid are repaired easily by direct suturing with or without upper lid sliding flaps. When defects affect more than 50-70% of the upper lid, complex reconstruction is needed. Traditionally, this devolves upon lower lid flaps, as in the Cutler-Beard and Mustardé techniques. These methods share intrinsic disadvantages, such as donor site morbidity and the need for two surgical sessions to detach the flap pedicle. To our knowledge, upper lid reconstruction with a grafted forehead galeal-pericranial flap has not been previously reported. This proves to be an excellent reconstructive option for extensive upper lip defects. Moreover, it has many advantages over other reconstruction techniques, such as technical ease and very low donor site morbidity. Furthermore, it is a single-stage procedure. We present our experience with five extensive upper lid reconstructions using galeal-pericranial forehead grafted flaps. Materials and methods: Five patients needed major upper lid reconstruction, which consisted of a galeal-pericranial forehead flap grafted with oral mucosa and retroauricular skin. Four of them had had the lid removed surgically for oncological reasons, while one patient suffered from orbital-periorbital fasciitis. Results: All of the flaps and grafts survived. The functional and morphological results were satisfying, and no complications were noted. Conclusions: The forehead galeal-pericranial flap appears to be an excellent instrument for upper lid reconstruction. Compared to other techniques, it has the advantages of simplicity and very minimal donor site morbidity. Moreover, it does not necessitate a two-stage surgical procedure.
2008
- Lesioni del nervo linguale nell'estrazione dell'ottavo: diagnosi e terapia
[Articolo su rivista]
Biglioli, F.; Colletti, G.; Pedrazzoli, M.
abstract
Diagnosis and therapy of the lingual nerve injuries during third molar surgery
There are well known anatomical connections between lingual nerve and the third
molars. The incidence of lingual nerve injuries during third molar surgery in the
literature is rated between 0.6 and 2 per cent. Functional nerve injury may be classified
according to Seddon classification (neurapraxias, assonotmesis and neurotmesis)
based on the kind of damage and thereby the related prognosis and potential surgical
indications. This paper analyses the types of lingual nerve injuries, the clinical and
instrumental diagnostic algorithm, the role of the microsurgeon in the evaluation of
potential surgical and medical treatment
2008
- Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection
[Articolo su rivista]
Chiapasco, M; Colletti, G; Romeo, E; Zaniboni, M; Brusati, R
abstract
Objectives: (a) To evaluate retrospectively the clinical outcome of non-vascularized bone grafts used for the reconstruction of mandibular defects following tumor resection; (b) to evaluate the clinical outcome of implants and implant-supported prostheses placed in the reconstructed areas; and (c) to evaluate patients' satisfaction regarding function and esthetics after oral rehabilitation. Material and methods: In a 9-year period (1995-2003), 29 patients affected by mandibular tumors involving to tooth bearing areas were treated by means of tumor resection and immediate or delayed reconstruction with autogenous non-revascularized calvarial or iliac bone grafts. Among these patients, 16 patients were selected for dental rehabilitation of the lost dentition with implant-supported 3fixed prosthese333s. For to 7 months later, the patients received 60 oral implants for the prosthetic rehabilitation of the reconstructed edentulous areas. Results: No total failure of the graft was observed, while partial loss of the graft was observed in one patient. The mean follow-up of patients after the start of prosthetic loading of implants treated was 94 months (range: 36-132 months). Two patients dropped out of the follow-up after 3 and 4 years of observation, respectively. Two implants were removed due to loss of osseointegration, while two implants, although still integrated, presented peri-implant bone resorption values higher than those proposed by Albrektsson et al. for successful implants. Cumulative survival and success rates of implants were 96.7% and 93.3%, respectively. Conclusion: Results from this study demonstrated that bone defects following resection of mandibular tumors can be predictably reconstructed with autogenous bone grafts taken from the calvarium or the anterior iliac crest. It has also been shown that the long-term survival and success rates of implants placed in the reconstructed areas (96.7% and 93.3%, respectively) may guarantee an excellent prognosis of implant-supported prostheses.
2008
- Mini-retromandibular approach to condylar fractures
[Articolo su rivista]
Biglioli, F.; Colletti, G.
abstract
Introduction: Among maxillofacial surgeons, a general agreement exists that the therapeutic strategy for intracapsular condylar fractures is conservative, while the treatment of extracapsular fractures of the mandibular condyle is extremely controversial. The indications and choice of treatment are less than uniform, often relying on the surgeon's personal experience and beliefs. The literature increasingly suggests that the surgical management of these fractures is superior to conservative management in functional terms. Nonetheless, the indications for surgically treating condylar fractures are limited by fear of potential pitfalls related to the access. Extraoral routes to the condyle involve the risk of facial nerve injuries or visible scars; transoral access is free from these pitfalls but is demanding technically, especially for higher neck fractures. In our experience, a 2-cm-long retromandibular access allows straightforward management of condylar fractures, providing as a result a well concealed scar. Materials and methods: From 2006 to 2007, 21 patients with 25 condylar fractures were treated surgically using the mini-retromandibular access. The mean operating time was 32 min (range 17-55 min). No facial nerve injuries were observed. The first two patients developed postoperative infections. One patient, in whom the first intervention resulted in malreduction of the fracture because the access was insufficient (15 mm incision), required a second operation to achieve correct reduction and rigid fixation of the condyle. Results: In all cases, good anatomical stump reduction was achieved. All the patients obtained good articular function, since the access was exclusively extra-articular. Conclusions: Condylar fracture reduction, fixation and healing can be managed comfortably using a limited retromandibular approach. Moreover, the risk of facial nerve injury is limited as the nerve fibres are viewed directly. (C) 2008 European Association for Cranio-Maxillofacial Surgery.
2008
- Mini-retromandibular approach to condylar fractures
[Abstract in Rivista]
Biglioli, F.; Colletti, G.
abstract
2008
- Ossification of vascular pedicle in fibular free flaps: A report of four cases
[Articolo su rivista]
Autelitano, L; Colletti, G; Bazzacchi, R; Biglioli, F
abstract
The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requires removal of bone excess in the proximal segment by a subperiosteal dissection, preserving vascular connections between the pedicle and the bone and leaving well vascularized periosteum attached to the vascular pedicle. Among about 100 reconstructions with fibular flaps, 4 cases were observed of abnormal ossification along the vascular pedicle. Periosteum preserves its osteogenic capability after transposition, especially in a revascularized flap; this characteristic, together with the direct contact with the bone, allows the possibility of new bone formation along the pedicle. It would appear necessary to change the technique of reducing fibular excess, with removal of periosteum together with the bone, in order to avoid the complication described.
2007
- Asimmetrie e deformità cranio-facciali
[Capitolo/Saggio]
Brusati, R; Ciancaglini, R; Colletti, G
abstract
2007
- Diagnosi e trattamento delle principali asimmetrie
[Capitolo/Saggio]
Brusati, R; Colletti, G
abstract
2007
- La sindrome di Eagle
[Capitolo/Saggio]
Colletti, G
abstract
2007
- Le asimmetrie cranio-facciali
[Capitolo/Saggio]
Brusati, R; Colletti, G
abstract
2007
- The free fibula flap for treating benign mandibular lesions.
[L’impiego del lembo microvascolare di fibula nel trattamento delle lesioni benigne della mandibola]
[Articolo su rivista]
Biglioli, F; Pedrazzoli, M; Autelitano, L; Colletti, G; Brusati, R
abstract
A variety of benign lesions that are typically treated conservatively can affect the mandible. The treatment must be radical when these lesions are locally aggressive and involve the perimandibular soft tissues or involve most of the thickness of the mandible. The main treatment is mandibular resection and reconstruction with bone grafts, mainly iliac crest bone grafts for segmental mandibulectomy or a calvaria bone graft for resection without interruption of the mandible body. These grafts are limited due to the possibility of infection and the unpredictable long-term resorption. Free flap surgery, particularly with fibula free flaps, represents a new era in mandibular reconstruction. This technique has similar donor site morbidity, while the transferred bone resists infection and bone resorption. These advantages are achieved at the cost of a procedure that is about 1 h longer when performed by an experienced microsurgical team. We report our experience with mandibular reconstruction following the surgical resection of benign lesions in 7 patients. All the reconstructions had good RESULTS: After reconstruction, the facial morphology showed restored symmetry of the lower third profile in all patients. The functional results were satisfactory, with restored mandibular function in all cases. No signs of recurrence have appeared in any patient after a mean follow-up of 24 months.
2005
- Intraoral surgical reduction
[Riduzione chirurgica intraorale di fratture del condilo mandibolare con o senza fissazione rigida]
[Articolo su rivista]
Brusati, R; Biglioli, F; Autelitano, L; Colletti, G
abstract
Aim. Treatment of mandibular condylar fractures is debated among maxillofacial surgeons. Nonsurgical management is indicated in certain cases but does not allow anatomical repositioning of fractured fragments and in more dislocated fractures results are less than satisfactory. Conversely, external surgical approaches to the condyle present surgical risks and frequent long term resorption. Intraoral approach is a safer procedure but can be technically demanding. The use of endoscope, increasing surgical view, can widen the indications for surgical treatment of these fractures.
Methods. From January 1999 to July 2003 11 patients have been treated by means of intraoral surgical reduction for 11 condylar fractures. In 5 cases endoscope was used to improve view. In 2 cases coronoidotomy was performed for the same reasons. In 5 patients osteosynthesis was performed after reduction; in 6 patients only self retentive reduction was performed. A period of intensive functional rehabilitation was mandatory.
Results. Good anatomical healing and functional results have been observed in all patients except one who could not follow functional rehabilitation. In one patient extraoral access had to be added.
Conclusion. Intraoral surgical reduction of mandibular condylar fractures, with the aid of endoscope and coronoidotomy in difficult cases, is a safe but not always easy procedure.
2005
- Maxillary setback osteotomy with fracture of pterigoid processes.
[Osteotomia con riposizionamento posteriore del mascellare superiore mediante frattura dei processi pterigoidei]
[Articolo su rivista]
Brusati, R; Biglioli, F; Autelitano, L; Colletti, G
abstract
In some cases a sagittal maxillary overgrowth can cause a facial deformity characterized by an acute nasal-labial angle, a protruted upper lip and a gummy smile. The patient typically present a 2nd class occlusion as is in mandibular hypoplasia, a condition with totally different clinical manifestations. The most commonly adopted surgical correction for a maxillary sagittal excess consist in a LeFort I osteotomy associated with bilateral first premolar extraction and bone segmentations. This as well as other similar techniques have inherent risks such as radicular lesions, periodontal resorptions, teeth pulp necrosis, pseudoarthrosis and avascular necrosis of the osteotomized bone. There are only a few reports in the literature regarding the LeFort I osteotomy with posterior repositioning of the entire maxilla. This procedure allows the correction of the occlusal disturbance and does not present the risks of the other procedures. Posterior repositioning can be obtained by fracturing and posteriorly dislocating the pterigoid processes. This is described as a risky procedure but, in our experience, if performed through particular technical steps, is to be considered as safe and quick. The authors present their clinical experience in selected cases treated by means of this technique.
2004
- Accesso al seno mascellare mediante sportello osseo peduncolato alla mucosa
[Abstract in Atti di Convegno]
Frigerio, A; Rabbiosi, D; Bazzacchi, R; Rabagliati, M; Colletti, G
abstract
2004
- La versatilità del lembo di latissimo del dorso nella chirurgia ricostruttiva della testa e del collo
[Abstract in Atti di Convegno]
Colletti, G; Autelitano, L; Ferrari, M; Carota, F; Rossetti, G.
abstract
2004
- Trattamento dell'osteoradionecrosi della mandibola con lembo libero di fibula: la nostra esperienza
[Abstract in Atti di Convegno]
Ferrari, M; Autelitano, L; Colletti, G; Carota, F; Coggiola, A; Rossetti, G; Pedrazzoli, M
abstract
2003
- La riduzione chirurgica con accesso endorale delle fratture condilari
[Abstract in Atti di Convegno]
Colletti, G; Biglioli, F; Autelitano, L; De Felice, C; Poggio, A
abstract
2003
- 234 Carcinoma pilomatriciale con metastasi ossee: case report
[Abstract in Atti di Convegno]
Autelitano, L; Colletti, G; Biglioli, F
abstract
2002
- Il trattamento palpebrale dell'esoftalmopatia Basedowiana
[Abstract in Atti di Convegno]
Tremolada, C; Brusati, R; Savoia, T; Carota, F; Colletti, G
abstract
2002
- P35. La ricostruzione microchirurgica per glossectomie parziali.
[Poster]
Biglioli, F; Autelitano, L; Liviero, F; Brusati, R; Colletti, G
abstract
2001
- Diseases of the oral cavity in the interest of medical training
[Malattie del cavo orale di interesse internistico]
[Articolo su rivista]
Fior, A; Viscuso, M; Colletti, G; Trevisiol, L; Bedogni, A; Di Crecchio, A; De Santis, D
abstract
In this article the Authors give a classification on diseases which can come out in the oral cavity, both as a primary or secondary localization.
2001
- Epulis [Epulide]
[Articolo su rivista]
Bedogni, A; Trevisiol, L; Toffanetti, G; Colletti, G; Valsecchi, S; Scala, R; Viscuso, M
abstract
Today an histological classification of the epulis is not clear. Thereby the epulis is considered as a reactive tissue to irritable local reaction and the different histological aspects are considered as different stages of maturation of the pathology itself.
2001
- La diagnosi nella chirurgia estrattiva del terzo molare
[Articolo su rivista]
Toffanetti, G; Trevisiol, L; Pacino, Ga; Scala, R; Colletti, G; Di Crecchio, A; Bucci, T; Viscuso, M
abstract
In this article the Authors describe the diagnostric technique to value third molars in the pre-surgery stage. This valuation allows preventing any difficulties to which the surgeon may go through during surgery.
2001
- Physiological decline of the maxillary bones
[Involuzione fisiologica delle ossa mascellari]
[Articolo su rivista]
Toffanetti, G; Pacino, Ga; Viscuso, M; Bucci, T; Valsecchi, S; Colletti, G; Trevisiol, L; Ferrari, F
abstract
The aim of this article is to point up the attention to the morphologic changes of the jaw bones and overline soft tissues during human been life.
2001
- Surgical technique in the extraction of superior third molar [Tecnica chirurgica nell'avulsione dell'ottavo superiore]
[Articolo su rivista]
D'Agostino, A; Valsecchi, S; Ferrari, F; Da Prato, Eb; Viscuso, M; Colletti, G; Fior, A
abstract
The extraction of the superior third molar is less frequent than the inferior third molar. The surgical extraction is necessary because of the compressive complications on the near structures (tuber maxillae, sinus maxillae, etc,) associated to pain of the temporomandibular joint or sinus infections.