Bimaxillary orthognathic surgery is widely used for the correction of dentoskeletal deformities. Surgery sequencing (maxilla or mandible first) remains debated, and guidelines and consensus are lacking. This scoping review summarizes the state of the art and compares the advantages and disadvantages of both approaches. The review was conducted following PRISMA-ScR guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were searched using the PICO protocol and key words in orthognathic surgical sequencing. Four reviewers screened the records independently, and disagreement was resolved by consensus. A total of 23 records met the inclusion criteria. The advantages and disadvantages of the two approaches were compared and assessed for accuracy of reporting. Within the limitations of the present study, available evidence for the intrinsic advantages and the accuracy of the mandible-first sequence supports the choice of this approach in most cases. Nevertheless, each clinical case needs to be evaluated individually, as no dogmatic recommendations can be given for sequencing in bimaxillary orthognathic surgery.

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena.

The aim of this retrospective study is to evaluate long-term patient satisfaction after bimaxillary orthognathic surgery planned according to the Face-Airway-Bite (FAB) philosophy. A sample of 65 patients out of 80 consecutively treated between 2015 and 2017 met the inclusion criteria for the study. All patients suffered from different type of malocclusions and were treated with bimaxillary orthognathic surgery at the Unit of Maxillofacial Surgery, University of Verona. Each patient completed a 15-item ad hoc questionnaire investigating the reasons for undergoing treatment and evaluating presurgical and long-term postsurgical satisfaction with facial appearance, breathing, and chewing. Epworth sleepiness scale was administered before and after treatment. In the study group, 48% of patients underwent surgery to correct malocclusion, 22% to enhance facial appearance, 18% to resolve temporomandibular joint pain, and 12% for other reasons. Patients presenting for solely OSAS were excluded from the study to prevent skewing of the data. The mean score for long-term satisfaction was 9.06 ± 1.03/10. The mean facial appearance score was 5.26/10 before and 8.85/10 after surgery, respectively. The mean chewing score was 5.30/10 before and 8.81/10 after surgery. Although none of patients reported breathing problems before surgery, 65% of them referred postoperative breathing improvement. The mean follow-up period for questionnaire administration was 32months. Patients undergoing bimaxillary orthognathic surgery planned according to the FAB principles reported high satisfaction with treatment outcomes. Patients' outcome approval was primarily related to improvement in function and aesthetics; however, airway and pain complaints were additionally improved.

Background/Objectives: Frey’s syndrome surgical treatment may be either prophylactic or therapeutic. The aim of this study is to summarize the state of the art in Frey’s syndrome surgical treatment after parotidectomy and review indications, advantages, and disadvantages of different surgical options. Materials and Methods: The study was conducted following the PRISMA guidelines for scoping reviews; to fulfill the research enquiries, four different electronic databases (PubMed, Scopus, Cochrane, and Web of Science) were searched using the PICO protocol and key words in Frey’s syndrome surgical treatment. Results: A total of 15 articles met the inclusion criteria. Multiple surgical strategies have been developed over the last fifty years in an attempt to treat gustatory sweating; nevertheless, the surgical results are not always as effective as desired, and a gold standard has not been developed yet. Within the limitations of the study, a shift in surgical approaches over the years has been noted: tympanic neurectomy was the most frequently employed technique until the 1980s; more recently, local flaps interposed between the parotid tissue and skin layer have been the treatment of choice. Conclusions: Surgery is a viable option in Frey’s syndrome treatment, and it is indicated in cases of medical treatment inefficacy, tumor recurrence, invalidating symptoms, and unaesthetic surgical sequelae.

Introduction: Cancer metastatic to the orbit may be difficult to distinguish from idiopathic orbital pseudotumor at clinical and radiological examination. This case report describes clinical, radiological features, differential diagnosis, and treatment options for orbital neoplasms of unknown origin. Presentation of case: A 63-year-old woman presented to our Unit because of orbital swelling, ocular pain, globe displacement, conjunctival chemosis, and progressive vision loss. The patient had been seen by an ophthalmologist at another hospital. The initial diagnosis was idiopathic orbital pseudotumor. Steroid therapy did not resolve clinical symptoms. Her medical history held decisive clues: ten years before this presentation she had been diagnosed with double primary breast cancer, invasive lobular breast carcinoma, and invasive ductal breast carcinoma. Orbital biopsy was performed for differential diagnosis. Discussion: Considering the rapid onset and severity of symptoms, the radiological features of the orbit, and the patient's medical history of breast cancer, orbital metastasis should have been the most likely diagnosis. Orbital biopsy was performed because of the history of multiple primary cancers and because metastatic origin had to be determined to define the best treatment strategy. Conclusion: Biopsy is necessary under specific circumstances in the diagnosis of orbital metastasis, especially when presentation is ambiguous and when differential diagnosis is challenging. A patient's medical history may hold vital clues to correct diagnosis. Highlights:

Objectives: The application of fasciocutaneous free flaps for reconstruction of head and neck defects following oncological surgery has increased since the 1970s, coinciding with developments in microvascular techniques. Although reported success rates are between 90% and 99%, flap failure continues to occur, most frequently due to venous congestion. This study examines the rates of re-exploration and flap failure according to the number of venous anastomoses in patients receiving free flap reconstruction after head and neck cancer surgery. Materials and Methods: This retrospective analysis included 163 patients who underwent head and neck reconstruction with free flaps (radial forearm free flap [RFFF] and anterolateral thigh flap [ALTF]) at the University Hospital of Verona between January 2019 and June 2024. Variables examined comprised the type of flap performed, donor and recipient vessels utilized, and number of venous anastomoses, as well as the type (end-to-end [ETE] versus end-to-side [ETS]) and site (internal jugular vein versus external jugular vein) of venous anastomosis. Results: The overall success rate was 93.3%, with no significant difference between single and dual venous anastomosis groups. Prompt re-exploration upon detecting signs of flap failure is critical, as approximately one-third of such failures may be prevented through timely intervention. Conclusions: Single venous end-to-end anastomosis utilizing the internal jugular vein system is typically effective. Further research is warranted to clarify the indications for dual anastomosis involving the external jugular vein system.