New Advances in Oral and Facial Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 30 March 2025 | Viewed by 6831

Special Issue Editor


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Guest Editor
Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, University Hospital of Siena, Santa Maria Le Scotte, Italy
Interests: squamous cell carcinoma; tumors; plastic and reconstructive surgery; oncology; facial plastic surgery; reconstructive surgery; microsurgery; head and neck surgery; maxillofacial surgery; facial reanimation; aesthetic surgery
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Special Issue Information

Dear Colleagues,

Maxillo-facial surgery is a fascinating surgical branch that often faces challenging clinical scenarios. A modern approach to the oro-maxillofacial area, a complex region, requires a deep knowledge of anatomy, refined surgical skills and the handling of modern tools offered by technology. The skillful mix of these resources allows the modern surgeon to aspire to achieve better results. Today, we can combine volume and form with function and aesthetics with the aim of improving the patient’s quality of life.

In fact, the expectations of today’s patients have shifted from a mere replacement of the lost tissue to the desire to restore vital functions, facial appearance and psychological wellness as best as possible.

This new wave of holistic approach to the global health of patients should be applied in all the fields of our surgical discipline, from post-oncological reconstruction and orthognatic surgery, treatment of severe atrophies, facial paralysis reanimation and even to ethic aesthetic surgery.

The aim of this Special Issue is to emphasize all these improvements through the publication of papers from authors that support all these previous statements with solid scientific evidence. Basic research papers, clinical papers and reviews are all highly encouraged for submission when focused on new advances in oral and facial surgery.

Dr. Olindo Massarelli
Guest Editor

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Keywords

  • squamous cell carcinoma
  • oro-pharyngeal tumors
  • skin tumors
  • plastic and reconstructive surgery
  • facial plastic surgery
  • facial reanimation
  • facial nerve palsy
  • head and neck surgery
  • maxillofacial surgery
  • aesthetic surgery
  • orthognatic surgery
  • dental implant surgery

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Published Papers (6 papers)

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Research

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16 pages, 2674 KiB  
Article
Management of Mandibular Condyle Fractures in Pediatric Patients: A Multicentric Retrospective Study with 180 Children and Adolescents
by Gian Battista Bottini, Wolfgang Hitzl, Maximilian Götzinger, Constantinus Politis, Kathia Dubron, Mario Kordić, Anamaria Sivrić, Petia Pechalova, Angel Sapundzhiev, Valfrido Antonio Pereira-Filho, Luis Fernando de Oliveira Gorla, Emil Dediol, Boris Kos, Tabishur Rahman, Sajjad Abdur Rahman, Sahand Samieirad, Timothy Aladelusi, Vitomir S. Konstantinovic, Marko Lazić, Aleš Vesnaver, Anže Birk, Karpal Singh Sohal, Sean Laverick, Euan Rae, Maria Beatrice Rossi, Fabio Roccia and Federica Sobreroadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(18), 5455; https://doi.org/10.3390/jcm13185455 - 14 Sep 2024
Viewed by 813
Abstract
Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study [...] Read more.
Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment—stand-alone maxillomandibular fixation (MMF)—in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry. Full article
(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)
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10 pages, 3218 KiB  
Article
Long-Term Follow-Up of Computer-Assisted Microvascular Mandibular Reconstruction: A Retrospective Study
by Erika Crosetti, Pierluigi Tos, Mattia Berrone, Bruno Battiston, Giulia Arrigoni and Giovanni Succo
J. Clin. Med. 2024, 13(13), 3899; https://doi.org/10.3390/jcm13133899 - 3 Jul 2024
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Abstract
Background: Virtual surgical planning has become a well-established practice in head and neck surgery. In oncological surgery, it permits the achievement of safe margins resections and ensures functional reconstructions and optimal esthetic outcomes. This study aimed to evaluate the long-term outcomes after virtually [...] Read more.
Background: Virtual surgical planning has become a well-established practice in head and neck surgery. In oncological surgery, it permits the achievement of safe margins resections and ensures functional reconstructions and optimal esthetic outcomes. This study aimed to evaluate the long-term outcomes after virtually planned mandibular microvascular reconstruction, focusing on functional and esthetic results, as well as health-related quality of life. Methods: A long-term retrospective evaluation of 17 patients with oral cavity malignancy who underwent computer-assisted mandibular resection and reconstruction was performed. Functional and esthetic outcomes were analyzed using the EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. Results: Time since reconstruction ranged from 7 to 14 years. Patients reported high functional levels on the QLQ-C30 functional scales but lower scores on H&N35. On FACE-Q, patients demonstrated higher appraisal and satisfaction with their smiles compared to their overall facial appearance. Conclusions: In this retrospective case series, patients undergoing computer-assisted mandibular reconstruction for oral malignancies achieved good long-term functional and esthetic outcomes. Although limited by the small sample size, these results support the enduring benefits of virtual planning for mandibular reconstruction. To minimize declines in function and appearance, considerations should include immediate dental implants, enhanced reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia, and oral exercises to prevent trismus. Full article
(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)
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13 pages, 869 KiB  
Article
Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer
by Katharina Zeman-Kuhnert, Alexander J. Gaggl, Gian B. Bottini, Joern Wittig, Georg Zimmermann, Christoph Steiner, Wanda Lauth and Christian Brandtner
J. Clin. Med. 2024, 13(11), 3110; https://doi.org/10.3390/jcm13113110 - 25 May 2024
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Abstract
Background/Objectives: Dental rehabilitation after extended tumour resection and jaw reconstruction is challenging. The present study aimed to report the prosthetic outcome and quality of life (QoL) in patients with head and neck cancer (HNC) after microvascular alveolar ridge reconstruction. Methods: The [...] Read more.
Background/Objectives: Dental rehabilitation after extended tumour resection and jaw reconstruction is challenging. The present study aimed to report the prosthetic outcome and quality of life (QoL) in patients with head and neck cancer (HNC) after microvascular alveolar ridge reconstruction. Methods: The prosthetic outcomes of all consecutive patients with HNC who underwent microvascular alveolar ridge reconstruction at the University Hospital Salzburg between 2011 and 2018 were investigated. Oral health-related QoL (OHrQoL) and overall QoL were assessed using the validated Oral Health Impact Profile-49 (OHIP-49) and Short Form-36 questionnaires. Results: During the study period, 115 consecutive patients with head and neck cancer underwent microvascular jaw reconstruction. Among them, 23.3% and 27.4% received conventional tissue-borne prostheses and implant-supported prostheses, respectively, while 48.7% did not undergo dental rehabilitation. The prosthetic outcome was not associated with tumour stage (p = 0.32). Oral health-related quality of life (OHrQoL) was best in patients with implant-supported dental rehabilitation (OHIP-49 median score = 7) and worst in those with conventional removable dentures (OHIP-49 median score = 54). The corresponding OHIP-49 median score for patients who could not undergo dental rehabilitation was 30.5. All Short Form-36 subscale scores were equal to or higher than the malignancy norm scores. Conclusions: After microvascular jaw reconstruction, approximately one-third of the HNC patients received adequate implant-supported dental rehabilitation. However, the risk of dental rehabilitation failure was 50%. The different prosthetic outcomes affected OHrQoL, but not overall QoL. Full article
(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)
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10 pages, 1150 KiB  
Article
Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation
by Vittorio Ramella, Andrea Ferrari, Federico Cesare Novati, Zoran Marij Arnež, Grace Marchi, Agostino Rodda, Stefano Bottosso and Giovanni Papa
J. Clin. Med. 2024, 13(9), 2726; https://doi.org/10.3390/jcm13092726 - 6 May 2024
Viewed by 1031
Abstract
Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage [...] Read more.
Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors’ experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients’ quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes. Full article
(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)
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10 pages, 4615 KiB  
Article
Tetris Genioplasty: A New Paradigm for Chin Asymmetries Correction
by Valerio Ramieri, Linda Latini, Guido Gabriele, Vittoria Fantozzi, Tito Matteo Marianetti and Flavia Cascino
J. Clin. Med. 2023, 12(23), 7354; https://doi.org/10.3390/jcm12237354 - 28 Nov 2023
Viewed by 1812
Abstract
The chin plays a crucial role as a fundamental structural component that contributes to the overall aesthetics and harmony of the face. Recognizing its central position, medical science has seen the evolution of numerous surgical techniques over the years, all aimed at correcting [...] Read more.
The chin plays a crucial role as a fundamental structural component that contributes to the overall aesthetics and harmony of the face. Recognizing its central position, medical science has seen the evolution of numerous surgical techniques over the years, all aimed at correcting the range of structural irregularities that can affect the chin. In this contribution, the authors introduce an innovative osteotomy technique, aimed at cases of chin asymmetry in which the skeletal median diverges from the dental median. This technique, called “Tetris genioplasty”, involves performing the classic rectangular osteotomy, but includes an additional vertical osteotomy in order to obtain two distinct segments. Finally, these segments are translocated and repositioned to obtain a realignment between the skeletal median and the dental median. The results were entirely satisfactory for the patients, aligning perfectly with the expected appearance after the operation. Furthermore, no complications were reported, proving the success and safety of the procedure. The Tetris genioplasty aligns itself with this progressive trend by offering a minimally invasive method that nevertheless is able to achieve excellent results with a high impact on the patient’s quality of life, presenting a promising path in the pursuit of optimal aesthetic results with minimized patient morbidity and greater overall safety. Full article
(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)
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Review

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17 pages, 4803 KiB  
Review
Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making
by Gian Battista Bottini, Veronika Joos, Christoph Steiner, Katharina Zeman-Kuhnert and Alexander Gaggl
J. Clin. Med. 2024, 13(10), 2899; https://doi.org/10.3390/jcm13102899 - 14 May 2024
Viewed by 781
Abstract
This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 [...] Read more.
This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author’s expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps. Full article
(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)
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