Mandible and Trachea, Covid-19 does not stop the surgery of excellence

For over a year, the public attention has been entirely for the Sars-Cov-2 virus, which has rewritten the daily life of the entire planet. Yet, Covid-19 has not canceled the other preexisting pathologies. On the contrary, in many cases, it has become the reason for diagnostic delays and slowdowns of therapies already in place. Fortunately, in this case, it failed to cancel advanced surgeries capable of restoring the patient’s quality of life.

It happened at the Policlinico San Camillo – Forlanini, where a 20-year-old patient, suffering from fibrous dysplasia of the mandible, was subjected to the oral-maxillofacial surgery. The surgical team, in collaboration with the plastic and reconstructive surgery team, removed the bone, fully affected by the tumor. The removal was carried out with an alloy prosthesis made in part also with vascularized bone tissue taken from the patient’s leg. On the one hand, the prosthesis provided for the replacement of the entire temporomandibular joint. On the other hand, the transplanted bone tissue was fundamental to ensure the correct positioning of the dental implants, allowing the return to optimal chewing activity.

The aforementioned surgery is a unique one in its kind that goes along with another incredible intervention that took place at the Policlinico Sant’Andrea. Here, doctors reconstructed the trachea to a 50-year-old man by performing a transplant. “The damage resulting from the Sars-Cov2 infection and the invasive ventilation techniques that became necessary during the hospitalization – explained the doctors presenting the surgical procedure – caused the thinning of the trachea that almost completely prevented breathing, making it necessary the surgery”. An important milestone for Erino A. Rendina, director of thoracic surgery of the hospital, because, “thanks to this intervention we are able to let people, who may need this surgery, know that we are able to intervene in this way”. The trachea may be the organ most affected by Covid-19.

According to Dr. Cecilia Menna, who is part of the Policlino Sant’Andrea’s surgical team, “this type of intervention has a high social impact in the months to come because we could have other cases of obstructive pathologies of the trachea in its entirety. In the operated patient the trachea was completely destroyed by the disease and by the complications of ventilation”.
Meanwhile, the data for monitoring the spread of the virus is improving. The control room has in fact photographed a decrease in the national R index from 0.92 to 0.85.

The incidence is slightly decreasing but it remains high and still far from levels (50 per 100,000) that would allow the complete restoration of the identification of cases and tracing of their contacts throughout the national territory. On the other hand, the number of Regions with an employment rate in intensive care and/or medical areas above the critical threshold remains high. The employment rate in intensive care nationwide is above the critical threshold (39%), although the number of people admitted to intensive care is decreasing from 3,743 (06/04/2021) to 3,526 (13/04/2021). The employment rate in medical areas nationwide is also above the critical threshold (41%) but decreasing. The number of people hospitalized in these areas goes from 29,337 (06/04/2021) to 26,952 (13/04/2021).