Giovanni Salzano

Recent reports on secondary restorations with subperiosteal implants have demonstrated promising results in terms of esthetic and functional restoration. We report the case of a reconstruction of a total maxillectomy with a custom-made subperiosteal implant associated with a temporal muscle flap in a patient who could not undergo bone reconstruction with a free flap. This technique made it possible to restore the division between the oral cavity and the mouth, providing a solid anchorage to the dental prosthesis and correcting an oroantral communication with a small palatal obturator. The subperiosteal implant also granted proper soft tissue support in the middle-third of the face. Subperiosteal implants can be safe and effective even in primary maxillary reconstructions for patients who cannot undergo free bone flap reconstructions. In these difficult cases, this type of implant can provide support to the soft tissues of the middle-third of the face and a solid anchorage for dental prostheses or palatal obturators, thus improving the quality of life for patients.

Although scalp defects can vary in size and thickness, scalp avulsion represents a rare occurrence. This type of lesion may have different origins, but it is usually related to long hair being caught in agricultural machinery. The management of full-thickness scalp defects poses a challenge to the head and neck surgeon due to the possible involvement of neurovascular structures and scar retraction, which can affect the esthetic restoration of the area. Several algorithms for the choice of scalp reconstruction have been proposed in the literature and different techniques are available for extensive scalp defect reconstruction (local soft tissue flap, microvascular free flap, and skin graft combined with dermal substitutes), based upon the scalp defect type. Here we describe six cases of patients with total scalp avulsion, which required a combined reconstruction with a split-thickness skin graft (STSG) and Integra® matrix immediately after the trauma.