PMC7596435_01
Clinical preoperative assessment. Swelling of the maxillary alveolar process is clearly shown just above the central and lateral incisors.
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Intraoral inspection revealed swelling of the anterior alveolar process of the maxilla between the two lateral incisors (Figure 1), extended vertically until the anterior nasal floor.
(a) Preoperative panoramic X-ray documenting an osteolytic lesion of the premaxilla. (b) Postoperative panoramic X-ray documenting the correct position of graft and fixation means. (c) Panoramic X-ray after removal of plates and screws (24-month follow-up) revealing signs of resorption and lower radiopacity of the graft material.
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Panoramic X-ray (Figure 2(a)), CT scan (Figures 3(a) and 3(b)), and MRI (Figures 3(c) and 3(d)) documented an osteolytic lesion of the anterior alveolar process of the maxilla, 2.5 cm in width and 3.5 cm in height, extended cranially on the anterior maxilla and the anterior nasal floor. Complete wound healing was obtained without complications (Figure 7), and postoperative panoramic X-ray (performed 1 week later) showed good fixation and stability of the graft (Figure 2(b)). At 24-month follow-up, 20 months after mobile prosthesis application, exposition of the left titanium plate became clinically evident, as well as first signs of graft resorption revealed by the X-ray evaluation (Figures 2(c) and 9).
(a, b) Preoperative CT scan. (c, d) Preoperative MRI.
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Panoramic X-ray (Figure 2(a)), CT scan (Figures 3(a) and 3(b)), and MRI (Figures 3(c) and 3(d)) documented an osteolytic lesion of the anterior alveolar process of the maxilla, 2.5 cm in width and 3.5 cm in height, extended cranially on the anterior maxilla and the anterior nasal floor.
Intraoperative appearance of the neoplasm after the elevation of the mucoperiosteal flap, carried out until the exposure of the pyriform aperture.
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Surgical procedure was performed in December 2009 in general anesthesia, and complete removal of the neoformation was achieved (Figures 4 and 5).
Surgical defect after resection of the neoplasm, involving the anterior nasal floor.
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Surgical procedure was performed in December 2009 in general anesthesia, and complete removal of the neoformation was achieved (Figures 4 and 5).
Equine xenograft has been fixed by one titanium plate and four screws per side.
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Arcugnano, Italy) prepared starting from an equine femoral head cut by using Pirzosurgery  (Mectron, Vicenza, Italy), which has recently demonstrated better results among cutting devices. After implantation, the graft was fixed bilaterally by using titanium plates and screws (Figure 6).
Postoperative complete wound healing observed 2 weeks after surgery.
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Complete wound healing was obtained without complications (Figure 7), and postoperative panoramic X-ray (performed 1 week later) showed good fixation and stability of the graft (Figure 2(b)).
Postoperative CT scan, acquired 5 months after surgery, showing intense radiopacity and good integration of the grafted material.
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CT scan performed 5 months after surgery confirmed the adequate integration of the graft (Figure 8).
Postoperative dehiscence occurred after the removal of plates and screws, widely exposing the underlying equine graft.
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Plates and screws were removed in order to prevent complete graft failure, but this intervention was complicated by an ample mucosal dehiscence and graft was rejected within 3 weeks from surgery (Figures 10 and 11).
Intraoral appearance 2 weeks after graft rejection. Anterior mucosal envelope collapsed due to the lack of structural support, showing the wide anterior maxillary defect.
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Plates and screws were removed in order to prevent complete graft failure, but this intervention was complicated by an ample mucosal dehiscence and graft was rejected within 3 weeks from surgery (Figures 10 and 11).