Maxillofacial Surgery

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Facial trauma and post-traumatic deformity surgery
  • Orthognathic and OSAS surgery
  • Zygomatic implants surgery
  • Jaws Bone Reconstruction surgery

PROCEDURES PERFORMED PER YEAR:

  • About 3500 (1997-2017)

The Unit is widely recognised for its expertise in the treatment and surgery of maxillofacial pathologies in both, adult, and paediatric patients. Clinical activity focuses on facial skeleton surgery for severe dental malocclusion or Sleep Apnoea and major oral rehabilitation whit zygomatic implants. The prevailing clinical interests are pre-prosthetic reconstructive surgery in cases of severe maxillary atrophy and surgical treatment of craniofacial dysmorphias. All cases of complex dental inclusion and odontogenic pathology and not of the maxillary bones requiring hospitalization are also treated. In the field of oncological surgery, interventions are performed on the salivary glands, on the thyroid, and cervical neoformations.

 

treatmentS

OSAS: Obstructive Sleep Apnoea Syndrome

During sleep, the upper airway can be obstructed by excess tissue in the back of the throat, large tonsils and/or a large tongue; the obstruction will cause the diaphragm and chest muscles to work harder. In some patients, malposition of the jaw, a thick neck, and narrow nasal passages can contribute to the problem. The suspension of breathing or the reduction of airflow (apnoea), brought about by these factors initiate impulses from the brain to wake the person just enough to restart the breathing process. Sleep apnoea is generally defined as the presence of more than 30 apnoea episodes that decrease the delivery of oxygen to vital organs during a seven-hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night. Those who have Obstructive Sleep Apnoea are often unaware of their condition and think they sleep well. The symptoms that usually lead these individuals to seek help are daytime drowsiness or complaints of snoring and breathing problems observed by a bed partner. Obstructive sleep apnoea symptoms may include:

  • Snoring with pauses in breathing (apnoea)
  • Excessive daytime drowsiness
  • Gasping or choking during sleep
  • Restless sleep

The diagnosis of obstructive sleep apnoea syndrome includes a Polysomnography (PSG) supervised by a trained technologist and will measure various body functions. Patients undergoing PSG sleep at the clinic overnight while a video camera monitors sleep patterns and gathers data measuring airflow, blood oxygen levels, breathing patterns, electrical activity of the brain, eye movements, heart rate and muscle activity.

The therapy programme offered to patients include Maxillomandibular Advancement (MMA). MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.

Main Pathologies Treated:

  • Obstructive Sleep Apnoea Syndrome

Top Procedures:

  • Diagnosis
    • Plysomnography (PSG)
  • Treatment
    • Maxillmandibular Advancement (MMA)

Zygomatic Implants

Zygomatic implants have been documented as an alternative method for the rehabilitation of the atrophic posterior maxilla with both, the classical two-stage, and immediate loading protocols. Zygomatic implants avoid grafting and sinus lift procedures and therefore contribute to a shorter and more comfortable treatment. Further indications for zygomatic implants include failed conventional implant placement, failed sinus augmentation or grafting procedures, rehabilitation after tumour and trauma resections.

In the atrophic posterior maxilla, in general, one zygomatic implant is placed on each side of the maxilla, in combination with 2-4 conventional implants in the anterior region.

For the totally resorbed maxilla, when placement of anterior implants is not possible, the concept can be expanded by inserting 2 additional zygomatic implants in a more anterior position. Zygomatic implants, nowadays, are usually immediately loaded with a fixed bridge.

Main Pathologies treated:

  • Rehabilitation of atrophic posterior maxilla
  • Failed conventional implant placement
  • Failed sinus augmentation or grafting
  • Rehabilitation posttumour and trauma resections

Top Procedures:

  • Zygomatic implants placement
    • Tw-stage loading protocol
  • Immediate loading protocol

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Dedicated Software for preoperative study and modulation
  • CT Scan
  • 3D Skeleton Modulation for preoperative study