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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 December;20(3):157-62
Multidisciplinary integration between maxillofacial and vascular surgery
Biglioli F. 1, Biglioli P. 2, Settembrini P. G. 3, Flor N. 4, Tarabbia F. 1, Colombo V. 1, Colletti G. 1
1 Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy;
2 Monzino Heart Center, University of Milan, Milan, Italy;
3 Department of Vascular Surgery, University of Milan, San Carlo Hospital, Milan, Italy;
4 Department of Radiology, University of Milan, San Paolo Hospital, Milan, Italy
AIM: An increasing growth in medical notions as well as surgical techniques is leading to a deeper sectorialization among specialists in different branches. For this reason, cooperation between head and neck surgeons such as neurosurgeons, maxillofacial, ear, nose and throat surgeons and ophthalmologists is common. On the other hand, this kind of cooperation between maxillofacial and vascular surgeons is rare but nonetheless invaluable for an optimal result. The aim of this paper was to report the experience of the authors in terms of collaboration between maxillofacial and vascular surgery.
METHODS: Between January 2001 and July 2009 nine patients were operated by a team composed of maxillofacial and vascular surgeons. In five cases the maxillofacial surgeon performed a mandibular osteotomy to allow the access to the cranial tract of the internal carotid artery, treated by the vascular surgeon. In other three cases the maxillofacial surgeon performed a neck dissection for oral malignancies and the vascular surgeon subsequently performed a carotid tromboendarterectomy. In one case the multidisciplinary surgical team performed a modified radical neck dissection with common and internal carotid resection and reconstruction because of a neck metastasis of an oral squamous cell carcinoma with involvement of the carotid itself.
RESULTS: Outcomes were always favorable. In detail, in none of the osteotomy cases delayed bone healing or postoperative malocclusion was detected. None of the patients experienced signs of cerebral ischemia secondary to clamping freeing or reconstruction involving the common or internal carotid artery.
CONCLUSION: There are delicate contexts such as common or internal carotid pathologies as well as the need for carotid tromboendarterectomy and contextual neck dissection, which require a multidisciplinary approach. This allows to put in place the different competences which are invaluable in order to reach optimal results in terms of survival rate while minimizing complications and postoperative morpho-functional reliquates.