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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: closed (30 March 2025) | Viewed by 15267

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Dr. Olindo Massarelli

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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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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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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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 (10 papers)

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Research

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12 pages, 1808 KiB

Open AccessArticle

Mesotherapy with HA and Choline Against Facial Skin Aging: An Open-Label Uncontrolled, Monocentric Study

by Antonio Scarano, Erda Qorri, Andrea Sbarbati, Vincenzo Desiderio and Domenico Amuso

J. Clin. Med. 2025, 14(7), 2303; https://doi.org/10.3390/jcm14072303 - 27 Mar 2025

Viewed by 746

Abstract

Background: Facial aging involves soft and hard tissues with changes that can affect an individual’s self-esteem and aesthetic appearance. Techniques used to counteract these changes include the use of solutions to be injected into the dermis, such as dermal matrix, vitamins, and antioxidants. B vitamins and choline are vital nutrition for humans and many other animals (vitamin B4), required to produce acetylcholine (ACh). It is considered a neurotransmitter universal methyl donator and of the major membrane constituent phosphatidylcholine (PC) and is crucial for the functioning of cell membranes, including those in skeletal muscle cells. The aim of this study is to evaluate the efficacy and safety of a fragment of HA amino acid and choline in a solution of phosphate buffer system used via mesotherapy. Specifically, state that the primary endpoint was the efficacy assessment using the Scientific Assessment Scale of Skin Quality (SASSQ), while secondary endpoints included safety assessments and patient-reported outcomes. Methods: Forty (40) subjects completed the study. In total, 40 subjects were screened and included in the study. The total duration of the study was 14 months. The first subject was included on 12 January 2019, and the last subject’s last visit was on 14 March 2020. All patients received the SKIN Colin^® products by mesotherapy technique for 8 weeks, providing the treatment with the use of 0.5 cc syringes and 13 mm long, 30 G diameter needles. The solution was inoculated into the deep layer of the dermis of the face with a suitable amount of at least 0.2/0.3 mL in the cutaneous points four times every 15 days. Each subject had to be followed for 168 days after the last mesotherapy session. Only enrolled subjects received the HA and choline via mesotherapy. The primary efficacy endpoint was the absolute change in the Scientific Assessment Scale of Skin Quality from Baseline (Day 0) to Day 168. A reduction of at least one point in the SASSQ was considered to reach the endpoint goal. Results: The results of the present investigation show Scientific Assessment Scale of Skin Quality (SASSQ) mean at baseline was 2463 with a standard deviation of 0.36, while at day 168, the mean was 1303 with a standard deviation of 0.36. The difference was statistically significant (p < 0.0001). Also, the GAIS was improved after treatment with Skin Colin^®. The assessment of “satisfaction with treatment” was very high by the majority of subjects. Conclusions: In conclusion, our results suggest that a course of treatment with choline via mesotherapy results in an improvement of the Scientific Assessment Scale of Skin Quality. This data is very important for possible fields of application in the treatment of skin and muscle aging. However, the present study has limitations due to the small sample size and the lack of a control group. Full article

(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)

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14 pages, 1811 KiB

Open AccessArticle

New Classification System and Defect-Oriented Algorithm for Functional Soft-Palate Reconstruction with Buccinator Myomucosal Flaps

by Olindo Massarelli, Lisa Catarzi, Guido Gabriele, Flavia Cascino, Andrea Frosolini and Paolo Gennaro

J. Clin. Med. 2024, 13(24), 7766; https://doi.org/10.3390/jcm13247766 - 19 Dec 2024

Viewed by 880

Abstract

Background/Objectives: Currently, there is a lack of a comprehensive classification system for soft-palate defects that provides synthetic information to guide functional reconstructive treatment. Our awareness, shaped by extensive experience, of the superiority of myomucosal flaps to fasciocutaneous flaps in functional palate reconstruction has driven us to introduce a new defect-based classification system and propose a new algorithm for reconstructing soft-palate defects using buccinator myomucosal flaps. Methods: Soft-palate defects were classified into five classes. A reconstruction algorithm employing buccinator myomucosal flaps—including axial, island, and tunnelized flaps along with their variants as described in previous studies—was utilized. Clinical records, including tumor stage, location, defect size, and details of the myomucosal flap used, were documented. Postoperative speech intelligibility, swallowing, and quality of life (QoL) were evaluated. Donor-site morbidity and complications were also assessed. Spearman’s rank correlation was employed to assess relationships between clinical parameters and functional outcomes. Results: Twenty-two patients who had undergone soft-palate resection and subsequent reconstruction were reviewed. Favorable recovery of swallowing and speech was reported in all cases, with a median deglutition score of 6.04 ± 0.85 and no severe velopharyngeal insufficiency observed (speech score: 0.36 ± 0.58). Quality of life assessments indicated satisfactory recovery across physical, social, emotional, and functional parameters. Donor-site morbidity was low (average score: 8.3), with only minor complications observed. Tumor stage showed a significant correlation with speech score (r = 0.44, p = 0.04). Conclusions: The proposed classification introduces a comprehensive, simple, and user-friendly categorization of soft-palate defects, accompanied by a myomucosal reconstructive algorithm designed to guide surgeons through the reconstructive process, aiming to provide optimal functional reconstruction. The study’s small sample size and monocentric design may have limited the detection of meaningful correlations, highlighting the need for larger, multicentric studies with objective methods to validate findings. Full article

(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)

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16 pages, 2674 KiB

Open AccessArticle

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 Sobrero Show full author list Hide full author list

J. Clin. Med. 2024, 13(18), 5455; https://doi.org/10.3390/jcm13185455 - 14 Sep 2024

Cited by 4 | Viewed by 1992

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 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

Open AccessArticle

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

Cited by 4 | Viewed by 1274

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 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

Open AccessArticle

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

Cited by 2 | Viewed by 1475

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 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

Open AccessArticle

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 1477

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 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

Open AccessArticle

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

Cited by 1 | Viewed by 2611

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 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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11 pages, 6455 KiB

Open AccessReview

Inferior Alveolar Nerve Impairment Following Third-Molar Extraction: Management of Complications and Medicolegal Considerations

by Alessandra Putrino, Simona Zaami, Michele Cassetta, Federica Altieri, Lina De Paola and Susanna Marinelli

J. Clin. Med. 2025, 14(7), 2349; https://doi.org/10.3390/jcm14072349 - 29 Mar 2025

Viewed by 856

Abstract

Background: Wisdom tooth extraction is a routine procedure with potential complications. In the lower arch, the displacement of a root or its fragment into the submandibular space is a relatively common occurrence that can lead to permanent damage to peripheral nerve fibers. Recent advancements in dental technologies, including CAD-CAM and artificial intelligence, have contributed to improved clinical outcomes in surgical procedures. Methods: Following a brief introductory narrative review, this clinical case describes the extraction of the left third inferior molar, which was sectioned by the oral surgeon to facilitate its removal. The procedure led to the progressive migration of a root fragment into the submandibular space, triggering an infective process. Efforts to retrieve the root fragment resulted in irreversible damage to the somatosensory motor nerves associated with the inferior alveolar nerve after the second surgery was performed by a maxillofacial surgeon. Results: Determining the responsibility for the damage (caused either by the oral or maxillofacial surgeon) involves both technical and ethical considerations, which are particularly relevant in cases involving re-intervention by different specialists. This case highlights the importance of a thorough preoperative evaluation of the patient’s anatomical, bone, and dental characteristics. The use of new technologies can significantly reduce the risk of complications that may otherwise lead to permanent damage and complex determinations of professional responsibility. Conclusions: Given the potential, albeit rare, for permanent disturbance of sensory and motor functions, managing complications and assessing the resulting damage are critical and sensitive steps in resolving such case both clinically and legally. Full article

(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)

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22 pages, 370 KiB

Open AccessReview

Management of Pediatric Mandibular Condyle Fractures: A Literature Review

by Gian Battista Bottini, Fabio Roccia and Federica Sobrero

J. Clin. Med. 2024, 13(22), 6921; https://doi.org/10.3390/jcm13226921 - 17 Nov 2024

Viewed by 1601

Abstract

This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks. Full article

(This article belongs to the Special Issue New Advances in Oral and Facial Surgery)

17 pages, 4803 KiB

Open AccessReview

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

Cited by 1 | Viewed by 1270

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 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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