Chronic recurrent temporomandibular joint (TMJ) dislocation is defined as the complete loss of articular relationships, during mouth-wide opening, between the articular fossa of the temporal bone and the condyle-disk complex. The most frequent pathogenetic factors involved in chronic recurrent dislocation of the TMJ are supposed to be trauma, abnormal chewing movements, TMJ ligaments, capsule laxity, and masticatory muscles disorders. In fact, TMJ dislocation occurs more frequently in people with general joint laxity and in patients with internal derangement of the TMJ or with occlusal disturbance. Management of TMJ dislocation remains a challenge. Eminectomy, whose validity has been demonstrated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to be the real cause of TMJ dislocation in most cases. The authors present a mini-invasive modified technique of eminectomy, which aims to act on both the obstacle and the cause with respect and restoration of TMJ biomechanical constraints.

Sphenoid isolated lesions are rare; they occur in 2% to 3% out of all paranasal sinus lesions. Diagnosis is based on the endoscopic examination and computed tomography scan or magnetic resonance imaging of the maxillofacial area. In this study, we present patients with sphenoid mucocele in the Maxillo-facial Surgery Department, University of Rome La Sapienza, treated with the endoscopic technique. Moreover, a literature review is performed, dealing with the evolution of approaches to the sphenoid sinus. From January 2001 to January 2007, we treated 75 patients affected by paranasal sinus mucocele. Out of this number, 8 patients (11%) presented an isolated localization in the sphenoid sinus. These patients were divided as follows: 5 involved the right sphenoid sinus and 3 involved the left sphenoid sinus. Isolated sphenoid sinus disease is a rare entity that can result in serious sequelae if diagnosis and treatment are inappropriately delayed. In our study, we highlighted how the endoscopic approach allows the removal of even large mucocele with the use of 45-degree angle optic and if it is possible to control and remove lateral walls of the sphenoid sinus. In our experience, we shifted from a traditional approach to the endoscopic approach. At the present time, the endoscopic approach represents the gold standard for sphenoid sinus mucocele treatment because it allows the best view of the sphenoid sinus and grants a better restoring of respiratory function and a higher compliance from the patient.

International guidelines for frontal sinus fractures, dealing with the indication of surgical treatment, obliteration of the frontal sinus, drainage, and cranialization, may differ.In this work, we describe our experience with frontal traumas, analyzing indications, type of treatment, and outcomes by reviewing all data of 112 patients treated for frontal fractures at the Department of Maxillo-Facial Surgery, Università degli studi di Roma Sapienza.We reviewed all clinical and surgical records of patients with traumatic frontal injury treated from 1997 to September 2008. Patients presenting displaced fractures of the anterior wall of the frontal sinus were treated through skin laceration, if existing, or through a coronal approach and fixed with rigid internal devices. Patients with fracture of the posterior wall of the frontal sinus underwent frontal sinus cranialization with galea pericranium pedicled flap to prevent eventful septic complications.Follow-up controls documented that 98 of 112 patients showed no neurologic impairment, no symptoms of cerebrospinal fluid leak, and no other complications after 6 months and 1 and 5 years when follow-up was possible.In the international literature, there is wide agreement about indications dealing with displaced fractures of the anterior wall, although there is a lively debate about posterior wall treatment. In our 10-year experience, the protocol we carried out showed satisfying outcomes, in particular, on the morphofunctional recovery and aesthetic results.