Publications by authors named "Andrea Cassoni"

61 Publications

Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review.

Trop Med Infect Dis 2021 Jun 21;6(2). Epub 2021 Jun 21.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, via Caserta 6, 00161 Rome, Italy.

Odontogenic infections have the potential to develop into deep-space infections and may cause severe diseases with possible life-threatening complications. Dental infections during pregnancy require special attention in terms of possible complications and treatments due to the potential to affect the lives of two individuals. A case of a 36-year-old pregnant patient with a submandibular abscess caused by an odontogenic infection is reported, followed by a comprehensive systematic review of the literature in order to retrieve information regarding severe odontogenic infections and adverse pregnancy outcomes. The review was conducted according to the PRISMA guidelines using PubMed, Scopus, and Google Scholar databases. A total of 69 cases were included in the qualitative analysis. The mean age was 27.72 years. Patients were managed with surgery in combination with antibiotics. Nine infectious-related cesarean sections were detected, and preterm birth was associated in 3 cases, low birth weight in 2 cases, death of the fetus in 9 cases (13%), and maternal death in 4 cases (5.8%). The possible compromise of oral health during pregnancy is well known; however, severe odontogenic infections are rarely considered in the literature, and they may be associated with severe and life-threatening complications for both mother and the fetus.
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http://dx.doi.org/10.3390/tropicalmed6020106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293338PMC
June 2021

Preoperative Multiparametric Ultrasound and Fine Needle Aspiration Cytology evaluation of parotid gland tumors: which is the best technique?

Med Ultrason 2021 Jun 10. Epub 2021 Jun 10.

Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Aims: To evaluate the pre-surgical diagnostic value of Multiparametric Ultrasound (MPUS) and Fine Needle Aspiration Cytology (FNAC) in differentiating parotid gland tumors, comparing the results with histology.

Materials And Methods: The study enrolled 84 patients with parotid gland lesions surgically treated in a single tertiary center and evaluated by MPUS. Each patient underwent FNAC. Histological examination was considered the gold standard.

Results: Histology identified 62 benign tumors and 22 malignancies. In the differential diagnosis between malignant and benign lesions, B-mode Ultrasound (US), Color-Doppler US, Contrast-Enhanced US (CEUS), Elastography (USE) and FNAC showed the following values of sensitivity: 82%, 81%, 86%, 77%, 73% respectively; specificity: 97%, 61%, 95%, 71%, 97% respectively; PPV: 90%, 43%, 86%, 50%, 89% respectively; NPV: 93%, 90%, 95%, 88%, 91% respectively; and accuracy: 89%, 71%, 90%, 78%, 84% re-spectively.

Conclusions: CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.
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http://dx.doi.org/10.11152/mu-3068DOI Listing
June 2021

Covid-19 pandemic and head and neck cancers, what should we expect?

Oral Oncol 2021 Mar 15:105263. Epub 2021 Mar 15.

Department of Oral and Maxillofacial Sciences. Sapienza University of Rome. Via Caserta 6, 00161 Rome, Italy; Oncological and Reconstructive Maxillofacial Surgery Unit. Policlinico Umberto I of Rome, D.A.I. testa e collo, Viale del Policlinico 155, 00161 Rome, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2021.105263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959278PMC
March 2021

A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: "Sapienza Head and Neck Unit" Proposal.

Int J Environ Res Public Health 2021 02 14;18(4). Epub 2021 Feb 14.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Roma, Italy.

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event associated with antiresorptive and antiangiogenic drugs. The use of these drugs in the treatment of cancer patients with bone metastasis is necessary and standardized in the literature. A multidisciplinary approach for the patient's management is strongly recommended. Therefore, it should be necessary to integrate the path of these subjects with a dedicated dental screening in order to first assess the individual risk of developing a MRONJ, and then to plan dental treatments and oral hygiene sessions, and finally to schedule a follow-up to intercept and treat early osteonecrosis. The aim of this manuscript is to propose a new simple medical report to evaluate patients affected by metastatic bone cancer in order to reduce the risk of developing MRONJ.
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http://dx.doi.org/10.3390/ijerph18041851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918934PMC
February 2021

Narrative review of multiparametric ultrasound in parotid gland evaluation.

Gland Surg 2020 Dec;9(6):2295-2311

Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Disorders affecting parotid gland represent a heterogeneous group comprising congenital, inflammatory and neoplastic diseases which show a focal or diffuse pattern of appearance. The differentiation of neoplastic from non-neoplastic conditions of parotid glands is pivotal for the diagnostic imaging. Frequently there is evidence of overlapping between the clinical and the imaging appearance of the various pathologies. The parotid gland is also often object of study with the combination of different techniques [ultrasound-computed tomography-magnetic resonance imaging (US-CT-MRI), ex.]. Compared to other dominant methods of medical imaging, US has several advantages providing images in real-time at lower cost, and without harmful use of ionizing radiation and of contrast enhancement. B-mode US, and the microvascular pattern color Doppler are usually used as first step evaluation of parotid lesions. Elastography and contrast-enhanced US (CEUS) has opened further possible perspectives to improve the differentiation between benign and malignant parotid lesions. The characterization of the parotid tumors plays a crucial role for their treatment planning and for the prediction of possible surgical complications. We present, here an updated review of the most recurrent pathologies of parotid gland focusing on the diagnostic power of multiparametric US including CEUS and ultrasound elastography (USE); limitations, advantages and the main key-points will be presented.
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http://dx.doi.org/10.21037/gs-20-530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804540PMC
December 2020

Head and Neck Cancer Treatment during COVID-19 Pandemic: A Central Experience in Rome. Emergency Management, Infection Prevention and Control.

Cancers (Basel) 2020 Dec 24;13(1). Epub 2020 Dec 24.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy.

The COVID-19 pandemic has significantly affected the surgical units, especially those operating on the airways. This study evaluates the series of patients with tumors of the head and neck treated by our unit during Phase-1 of the pandemic and the efficacy of the preventive measures implemented for protecting both the patients and staff. A screening program was administered to all the patients who had to undergo surgery. None of the patients tested and operated during Phase 1, between 10 March and 18 May 2020, were positive for COVID-19. A significant portion of the patients was suffering from tumors in advanced stages (T3 and T4). Two patients developed respiratory symptoms during their stay at the unit, so they were put in precautionary isolation and tested, but resulted negative for COVID-19. All the surgical department staff followed the Italian Ministry of Health's prevention protocol and underwent serological testing. IgG and IgM were negative in everyone, thus confirming that nobody had been exposed to the virus. This study highlights the commitment to efficiently treating patients suffering from tumors of the head and neck region and confirms the effectiveness of the safety measures used to protect our patients and staff's health.
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http://dx.doi.org/10.3390/cancers13010033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795055PMC
December 2020

Preoperative evaluation of tumor depth of invasion in oral squamous cell carcinoma with intraoral ultrasonography: a retrospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 Jan 9;131(1):130-138. Epub 2020 Jul 9.

Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.

Objective: The aim of this study was to evaluate the efficacy of preoperative intraoral ultrasonography (US) in the assessment of tumor depth of invasion (DOI) in oral squamous cell carcinoma (OSCC).

Study Design: Records of 32 patients with biopsy-proven OSCC who underwent preoperative intraoral US were retrospectively reviewed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy as indicated by receiver operating characteristic (ROC) analysis were measured for US in the assessment of the infiltration of the tumor beyond the lamina propria into the submucosa. The correlations between US and histologic DOI, and between US DOI and US diameter of the lesion, were assessed.

Results: US sensitivity, specificity, PPV, and NPV in the assessment of the infiltration of the tumor beyond the lamina propria into the submucosa were 93.1%, 100%, 100%, and 60%, respectively. The area under the ROC curve was 0.96. A significant correlation was found between the measurements of US DOI and histological DOI (r = 0.907). A moderate correlation was found between US DOI and US diameter (r = 0.591).

Conclusions: Intraoral US has potential in preoperatively determining tumor DOI and may provide additional guidance for optimal planning of therapy for OSCC patients .
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http://dx.doi.org/10.1016/j.oooo.2020.07.003DOI Listing
January 2021

Naso-Ethmoidal Phosphaturic Mesenchymal Tumor: A Rare Tumor Site for an Uncommon Paraneoplastic Syndrome.

Ear Nose Throat J 2020 Jul 30:145561320940869. Epub 2020 Jul 30.

Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.1177/0145561320940869DOI Listing
July 2020

Head and Neck Osteosarcoma-The Ongoing Challenge about Reconstruction and Dental Rehabilitation.

Cancers (Basel) 2020 Jul 18;12(7). Epub 2020 Jul 18.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy.

Head and Neck osteosarcoma is an uncommon disease. Hitherto, the treatment is surgical resection and survival is influenced by the presence of free margins. However, the dimension of the resection may represent a hurdle for an adequate Quality of Life (QOL). Maxillofacial district is a narrow space where the function, esthetics and patient's relational skills fit together like the gears of a clock. The functional results depend on the type of reconstruction and prosthetic rehabilitation that are both important to guarantee a good aesthetic result and finally increase the patient's self-esteem. This study aims to report our experience about head and neck (HN) osteosarcoma focusing the attention on reconstructive and dental-rehabilitative problems. It is a retrospective study all patients were surgically treated in our department. Subjects with histological diagnosis of HN osteosarcoma, treated between 2005 and 2017 were included. The demographic characteristics, surgical treatment, eventually secondary reconstruction and prosthetic rehabilitation, performed in the same department, have been collected. The QOL was assessed through the EORTC QLQ-H&N35 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35) questionnaire. Fifteen patients were enrolled, eight received a free flap microsurgical reconstruction. Dental rehabilitation was performed in five cases and a mobile prosthesis was always delivered. Eighteen implants were inserted in fibula bones for three patients; highly porous implants were used.
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http://dx.doi.org/10.3390/cancers12071948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409227PMC
July 2020

Masseter-facial neurorrhaphy for facial palsy reanimation: What happens after masseter denervation? Histomorphometric and stomatognathic functional analysis.

J Craniomaxillofac Surg 2020 Jul 2;48(7):680-684. Epub 2020 Jun 2.

Maxillo-facial Surgery Department, Univeristy of Rome "La Sapienza", Rome, Italy.

The aim of the present study was to analyse the consequences of masseter muscle denervation. In facial palsy surgical treatment, the masseteric nerve constitutes an important nerve source for facial reanimation due to its anatomical position and large amount of available axons. Computed tomography and/or magnetic resonance imaging were performed in 30 control subjects, and three radiologists separately measured the longitudinal diameter (LD), anteroposterior diameter (APD), transverse diameter (TD), and skeletal muscle area (SMA) of the masseter muscles as reference values. Regarding the facial palsy group, from 2009 to 2018, 11 patients (4 men and 7 women) were selected on the following inclusion criteria: diagnosis of unilateral facial paralysis, minimum follow-up of 14 months, absence of temporomandibular dysfunction, presence of complete dentition (to minimise bias of stomatognathic evaluation), complete clinical and radiological records. The mean LD, APD, TD, and SMA values of the healthy and denervated masseter muscles were obtained and compared. Stomatognathic function was clinically examined through mean mouth opening (MMO) and Maximum Bite Force (MBF). Furthermore, facial symmetry analysis (FSA) was carried out using EMOTRICS Software. Reference values obtained were as follows: mean LD = 69 ± 5.9 mm (range: 59-85 mm); mean APD = 40.2 ± 3.3 mm (range: 34-48 mm); mean TD = 15.5 ± 3.1 mm (range: 11-26 mm); and mean SMA = 43.8 ± 13.5 mm (range: 26-85.8 mm). No statistically significant difference was observed between the healthy facial palsy groups's masseter muscles and reference values. As the latter, in denervated masseter muscles, no statistically significant difference was observed for APD value in contrast to LD, TD and SMA that showed statistically significant difference in comparison with control population (p < 0.05, CI 95%). Moreover fibro-adipose degeneration was consistently observed, with its degree being directly proportional to the denervation time. MMO and MBF mean values were, respectively, 54.75 mm in men, 44.4 mm in women and 705N. None of the latter showed a statistically significant difference with respect to the control population and the parameters present in the literature, indicating that masseter-facial neurorrhaphy is a safe and effective procedure for facial reanimation with good functional and aesthetic outcomes.
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http://dx.doi.org/10.1016/j.jcms.2020.04.009DOI Listing
July 2020

Genetically driven CD39 expression shapes human tumor-infiltrating CD8 T-cell functions.

Int J Cancer 2020 11 8;147(9):2597-2610. Epub 2020 Jul 8.

Department of Internal Clinical, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.

In our study, we investigated the role of CD39 on tumor-infiltrating CD8 T lymphocytes (CD8 TILs) in colorectal, head and neck and pancreatic cancers. Partially confirming recent observations correlating the CD39 expression with T-cell exhaustion, we demonstrated a divergent functional activity in CD39 CD8 TILs. On the one hand, CD39 CD8 TILs (as compared to their CD39 counterparts) produced significantly lower IFN-γ and IL-2 amounts, expressed higher PD-1, and inversely correlated with perforin and granzyme B expression. On the other, they displayed a significantly higher proliferative capacity ex vivo that was inversely correlated with the PD-1 expression. Therefore, CD39 CD8 TILs, including those co-expressing the CD103 (a marker of T resident memory [TRM] cells), were defined as partially dysfunctional T cells that correlate with tumor patients with initial progression stages. Interestingly, our results identified for the first time a single nucleotide polymorphism (SNP rs10748643 A>G), as a genetic factor associated with CD39 expression in CD8 TILs. Finally, we demonstrated that compounds inhibiting CD39-related ATPases improved CD39 CD8 T-cell effector function ex vivo, and that CD39 CD8 TILs displayed effective suppression function in vitro. Overall these data suggest that the SNP analysis may represent a suitable predictor of CD39 CD8 T-cell expression in cancer patients, and propose the modulation of CD39 as a new strategy to restore partially exhausted CD8 TILs.
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http://dx.doi.org/10.1002/ijc.33131DOI Listing
November 2020

Why SLNB procedure is not currently used in early stage oral squamous cell carcinoma?

Oral Oncol 2020 10 8;109:104746. Epub 2020 May 8.

Odontostomatological and Maxillo-facial Sciences Dep, "Sapienza" University, Policlinico Umberto I. Viale del Policlinico, 155, Rome, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2020.104746DOI Listing
October 2020

Head and neck cancer cannot wait for this pandemic to end: Risks, challenges and perspectives of oral-maxillofacial surgeon during COVID-19.

Oral Oncol 2020 07 1;106:104758. Epub 2020 May 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; Oncological and Reconstructive Maxillo - Facial Surgery Unit, Policlinico Umberto I, 00161 Rome, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2020.104758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252117PMC
July 2020

Does Medication-Related Osteonecrosis of the Jaw Influence the Quality of Life of Cancer Patients?

Biomedicines 2020 Apr 24;8(4). Epub 2020 Apr 24.

Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, 00161 Rome, Italy.

The aim of this study is to observe the influence of Medication-Related Osteonecrosis of the Jaw (MRONJ) on the physical and mental conditions of cancer patients using a Quality of Life (QoL) questionnaire during regular dental practice measures. Twenty cancer patients (8 males and 12 females) with established MRONJ were enrolled in the "MoMax" (Oral Medicine and Maxillofacial) project of the Department of Oral Sciences and Maxillofacial Surgery at "Sapienza" University of Rome, and were included in the study. The 12-item Short Form Survey was used to evaluate the QoL. Statistical analysis revealed a significant difference for Mental Component Summary (MCS) scores based on age ( = 0.018). The regression analysis revealed that the Physical Component Summary (PCS) scores were negatively influenced by the anti-resorptive medication duration ( = 0.031 and β = -1.137). No significant differences were observed with the other variables considered. The QoL of cancer patients is generally deteriorated and MRONJ may cause a further negative impact. This study highlights the possible need to include psychosocial and physical evaluations in the management process of MRONJ in cancer patients.
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http://dx.doi.org/10.3390/biomedicines8040095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235831PMC
April 2020

Sinonasal Undifferentiated Carcinoma in a Patient Previously Treated for an Intestinal-Type Adenocarcinoma: Metachronous Neoplasms or Recurrence of a Different Tumor Type?

Indian J Otolaryngol Head Neck Surg 2019 Nov 20;71(Suppl 3):1779-1781. Epub 2017 Apr 20.

4Radiological, Oncological and Pathological Science Department, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00100 Rome, Italy.

A case of a sinonasal undifferentiated carcinoma occurring 2 years after a successfully surgically treated intestinal-type adenocarcinoma has never been reported. Treatment modality of paranasal sinus cancer strictly depends on histology so it is important to recognize a different tumor type in the follow-up of these patients.
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http://dx.doi.org/10.1007/s12070-017-1126-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848618PMC
November 2019

Free flaps in head and neck reconstruction in patients affected by vasculitis: To risk or not to risk?

Oral Oncol 2019 03 17;90:145-146. Epub 2018 Dec 17.

Odontostomatological Science and Maxillo-facial Surgery Dept., "Sapienza" University of Rome, Policlinico Umberto I, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2018.12.012DOI Listing
March 2019

Gingival Reactive Lesions in Orally Rehabilitated Patients by Free Revascularized Flap.

Case Rep Dent 2018 12;2018:2474706. Epub 2018 Aug 12.

Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy.

The aim is to discuss four cases of gingival reactive hyperplastic lesions in patients with a history of excision of oral neoplastic lesions and rehabilitation by a free revascularized flap of the iliac crest. One female and 3 male patients were referred due to the presence of exophytic lesions at the rehabilitated sites. The clinical examination revealed that the poor oral hygiene was the common trigger factor in all the cases, in addition to trauma from the upper left second molar in the first case, pericoronitis related to a partially erupted lower right third molar in the third case, and poor stability of an upper removable partial denture in the fourth case. All the cases were subjected to elimination of these suspected triggering factors, exclusion of dysplasia, excisional biopsy by CO2 laser, and five follow-up visits. The histological examination of all the cases confirmed the diagnosis of pyogenic granuloma. These presented cases suggest that the limitations in oral functions and maintaining the oral hygiene measures following the free revascularized flap reconstruction surgery probably played a role in the development of gingival reactive hyperplastic lesions with presence of trigger factors such as local trauma, chronic infection, or inadequate prosthesis.
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http://dx.doi.org/10.1155/2018/2474706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109530PMC
August 2018

The possible contemporary presence of BRONJ and oral squamous cell carcinoma.

Oral Oncol 2018 08 22;83:160-161. Epub 2018 Jun 22.

Odontostomatological Science and Maxillo-facial Surgery Dept, "Sapienza" University of Rome, Policlinico Umberto I, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2018.06.015DOI Listing
August 2018

Metastasis from pancreatic adenocarcinoma to the cheekbone.

Ann Ital Chir 2018 May 8;7. Epub 2018 May 8.

Skeletal metastasis by pancreatic adenocarcinoma are infrequent, and those located in the craniofacial region are very rare. We report the case of a 63-year-old Caucasian woman with a metastatic adenocarcinoma of the pancreatic head previously treated with surgery and chemotherapy presenting a skeletal metastasis in the left cheekbone 5 years after primary treatment. No other similar cases have been previously described. The therapeutic decision was not simple because of the uncommon site of pancreatic metastasis. Surgical resection was the only possibility after the radiotherapy failure.

Key Words: Cheekbone mass, Cheekbone metastasis, Pancreatic adenocarcinoma, Pancreatic adenocarcinoma metastasis.
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May 2018

Radiotherapy Controversies and Prospective in Head and Neck Cancer: A Literature-Based Critical Review.

Neoplasia 2018 03 12;20(3):227-232. Epub 2018 Feb 12.

Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. Electronic address:

In treating head and neck cancer (HNC), the objectives are provided for best functional results and minimal risk of serious complications. The choice of appropriate management depends primarily on specific site and stage of primary tumor at diagnosis. Radiation therapy (RT) with or without concomitant chemotherapy represents a classical treatment option. In this review, we provide an update of recent research strategies to counteract the existing damage caused by RT and highlight clinical trials currently in progress. We discuss the challenges in the evaluation of new stage system and RT-related toxicity onset. We mainly address the deficiencies and the advantages noted in the current treatment era.
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http://dx.doi.org/10.1016/j.neo.2018.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849807PMC
March 2018

Maxillo-Mandibular Reconstruction in Pediatric Patients: How To Do It?

J Craniofac Surg 2018 May;29(3):761-766

Odontostomatological Science and Maxillofacial Surgery Department, Sapienza University of Rome, Rome.

Maxillo-mandibular reconstruction in pediatric patients involves particular functional and cosmetic implications. Attention is required for the craniofacial growth over time, involvement of the permanent dentition, facial symmetry, and donor site morbidity. Our aim is to identify the best reconstructive options for maxilla-mandibular defects in children (<18 years) based on our experience with 25 pediatric patients. We believe that reconstruction has to be performed at the same time as resection in pediatric patients. Local flaps should be reserved for cases of maxillary defects because of malignant neoplasms, which ultimately have poor prognosis. In cases of large mandibular defects, radiotherapy is eventually required. When the condition of the soft tissues is poor (because of previous surgery, etc), free flaps potentially represent the best options. Nevertheless, in patients younger than 5 years old (with no damaged tissues), reconstruction with rib grafts should be performed, and the use of titanium plates should be reserved for very select cases (such as temporary reconstruction in toddlers).
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http://dx.doi.org/10.1097/SCS.0000000000004380DOI Listing
May 2018

Management of salivary gland malignant tumor: the Policlinico Umberto I, "Sapienza" University of Rome Head and Neck Unit clinical recommendations.

Crit Rev Oncol Hematol 2017 Dec 27;120:93-97. Epub 2017 Oct 27.

Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Salivary gland malignant tumor (SGMT) is a malignant disease requiring multidisciplinary approach. The rare incidence and the consequent lack of robust evidence-based medicine has called for a comprehensive update to draw recommendations for clinical practice. This paper is a summary of the XXX Head and Neck Unit guidelines regarding the management of SGMT. Recommendations include the indications for exclusive and adjuvant therapy, as well as metastatic management, for both major and minor SGMT.
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http://dx.doi.org/10.1016/j.critrevonc.2017.10.010DOI Listing
December 2017

The difficult management of radio-incuced head and neck sarcomas.

Oral Oncol 2017 10 5;73:173-174. Epub 2017 Aug 5.

Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2017.08.001DOI Listing
October 2017

Microsurgical SCIA/SIEA flap for facial contour correction in patient with hemifacial microsomia.

Ann Ital Chir 2017 ;88

Aim: We propose our experience in soft tissue reconstruction in Hemifacial microsomia using a free fascioadiposal flap.

Material Of Study: Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. A 18-year-old female presented with hemifacial microsomia involving the left side. A free SCIA/SIEA fascioadiposal flap was transferred to the left face for soft tissue augmentation.

Results: The immediate postoperative course of the patient was uneventful, with no complication and adequate augmentation in contour deformity was achieved. One year after the procedure, the patient presented a good resolution of the deformity with improved facial symmetry DISCUSSION: Reconstruction for facial contour deformities is still a challenging process and treatment for most cases is achieved only by soft tissue augmentation. Several microsurgical flaps have been proposed for restoration of facial asymmetry and improvement of facial volume and contour in these patients: deltopectoral, parascapular, anterolateral thigh, groin and deep inferior epigastric. This article reports our experience in facial soft tissue reconstruction with microsurgical superficial circumflex iliac artery/superficial inferior epigastric artery (SCIA/SIEA) fascioadiposal flap transfer in patient with HFM. This flap, which has a dual blood vascularization and pliant soft tissue, can provide an ideal treatment for soft tissue augmentation in hemifacial microsomia with optimal aesthetic results both in the face and at the donor site.

Conclusion: The free SCIA/SIEA fascioadiposal flap is a optimal choise option for soft tissue reconstruction with good esthetical outcome both in the face and at the donor site.

Key Words: Facial augmentation, Free flaps, Free SCIA/SIEA flap, Hemifacial microsomia.
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May 2018

Follow-up program in head and neck cancer.

Crit Rev Oncol Hematol 2017 May 14;113:151-155. Epub 2017 Mar 14.

Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Follow-up program in head and neck cancer (HNC) is an important issue in patients management. It represents the major dilemma in daily practice clinic. Many guidelines have been published in order to better define the best clinical protocol, but a consensus has not been attained yet. We constructed a follow-up program based on specific primary subsite, to standardize patients surveillance after treatment of HNC.
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http://dx.doi.org/10.1016/j.critrevonc.2017.03.012DOI Listing
May 2017

Oral cancer during pregnancy.

Oral Oncol 2016 08 2;59:e1-e3. Epub 2016 Jul 2.

Odontostomatological Science and Maxillo-facial Surgery Dept, "Sapienza" University of Rome, Policlinico Umberto I, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2016.06.018DOI Listing
August 2016

Squamous cell carcinoma arising on a forearm free flap 21 years after hemiglossectomy.

Ann Ital Chir 2016 Feb 4;87(ePub). Epub 2016 Feb 4.

Aim: Free and pedicled flap are methods of choice for reconstruction of post-surgical defects consequent to oral squamous cell carcinomas (SCCs), and missing intraoral mucosa is commonly reconstructed by the cutaneous component of the flap to guarantee an epithelial lining. Even if rare, cases of second tumors arising in the skin flap have been described. We present our experience reporting a clinical case.

Case Report: A squamous cell carcinoma arose on a forearm free flap 21 years after hemiglossectomy in a 72 years old woman. No smoking or alcohol habits were referred, and it was decided to perform surgical resection of the flap.

Results: Resection in free margins of a moderate differentiated (G2) SCC staged as pT2 was achieved and reconstruction with anterolateral thigh free flap was performed.

Discussion: Even if rare, secondary tumors arising in the skin flap in case of oral cavity defects reconstruction are described. It is important to recognize them early in order to perform surgical resection.

Conclusion: We think that it is fundamental to perform a prolonged follow-up of skin flap if a white patch or erythema raising clinical suspicion are present. Incisional biopsy has to be performed in order to identify those lesions potentially inclined to a malignant transformation, such as p53 expression and Ki67 index.

Key Words: Free flap, Oral cancer, Squamous cell carcinoma.
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February 2016

Adalimumab: Another Medication Related to Osteonecrosis of the Jaws?

Case Rep Dent 2016 21;2016:2856926. Epub 2016 Mar 21.

Odontostomatological Science and Maxillo facial Surgery Department, "Sapienza" University of Rome, 00161 Rome, Italy.

Objective. The acronym MRONJ has been created in order to identify "Medication-Related Osteonecrosis of the Jaw," observed after the use of Bisphosphonates, RANK ligand inhibitor, and antiangiogenic medications. Only a case of osteonecrosis of the jaw in a Chron's disease patient following a course of Bisphosphonate and Adalimumab therapy has been recently described, so that it has been supposed that also this medication could promote manifestation of osteonecrosis. Clinical Case. On August, 2014, a 63-year-old female with a history of idiopathic arthritis treated with medical treatment with Adalimumab from 2010 to 2013 presented referring pain in the right mandible. Results. This patient presented with nonexposed osteonecrosis of the jaw after placement, on September, 2010, of four titanium fixtures in the mandible. Conclusions. The authors suggest that the biologic therapy with an anti-TNF-α antibody might promote the manifestation of osteonecrosis and compromise oral healing capacity of the bone.
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http://dx.doi.org/10.1155/2016/2856926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819088PMC
April 2016

Contralateral botulinum injections in patients with residual facial asymmetry and contralateral hyperkinesis after primary facial palsy surgery.

Ann Ital Chir 2015 May-Jun;86(3):201-6

Aim: In patient with facial paralysis, facial appearance and muscular ability are impaired, and the psychological integrity is affected. Botulinum toxin A may be used to improve facial symmetry in patients suffering with facial palsy reducing the progressive contralateral hyperkinesis and facial asymmetry after primary surgery for facial paralysis.

Material Of Study: Six patients, whom have been suffering unilateral facial palsy with an House-Brackmann score grade from III to VI, were included in this study for a residual facial asymmetry and contralateral hyperkinesis after previous facial reanimation. They were treated with 50 units of botulinum toxin type A injected in muscles of the unaffected side of face to improve muscular ability and facial symmetry.

Results: This study demonstrated reduction in contralateral hyperkinesis and facial asymmetry that lasted approximately 120 days. All patients reported satisfactory results with the treatment.

Comments: Botulinum toxin type A injections improved facial asymmetry and muscular function in all patients.

Discussion And Comments: Botulinum toxin type A injections may be an indispensable technique as a nonsurgical treatment or as a complementary measure in postsurgical treatments and should be certainly considered for temporary or permanent asymmetries in patients who suffer from facial palsy.

Conclusions: Contralateral botulinum toxin type A injection was useful in reducing muscular hyperkinesis in patients with residual facial asymmetry after primary surgery for facial palsy, improving aesthetic and functional facial recovery with not widely common adverse events.
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September 2017

Basosquamous or Basal Cell Carcinoma? The Importance of the Differential Diagnosis.

J Craniofac Surg 2015 Sep;26(6):2026-7

Maxillofacial Surgery, Odontostomatological Science and Maxillofacial Surgery Department Radiotherapy Department, "Sapienza" University of Rome, Viale del Policlinico Rome, Italy. Maxillofacial Surgery, Odontostomatological Science and Maxillofacial Surgery Department, Radiotherapy Department, "Sapienza" University of Rome, Viale del Policlinico Rome, Italy.

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http://dx.doi.org/10.1097/SCS.0000000000001910DOI Listing
September 2015
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