Publications by authors named "Paolo Boffano"

136 Publications

Simple Parameters from Complete Blood Count Predict In-Hospital Mortality in COVID-19.

Dis Markers 2021 13;2021:8863053. Epub 2021 May 13.

Università del Piemonte Orientale UPO, Novara, Italy.

Introduction: The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions.

Materials And Methods: In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients ( 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded.

Results: At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) ( 10.4; < 0.001), neutrophil-to-lymphocyte (NL) ratio ( 7.6; = 0.006), and platelet count ( 5.39; = 0.02), along with age ( 87.6; < 0.001) and gender ( 17.3; < 0.001), accurately predicted in-hospital mortality. Hemoglobin levels were not associated with mortality. We also identified the best cut-off for mortality prediction: a NL ratio > 4.68 was characterized by an odds ratio for in-hospital mortality (OR) = 3.40 (2.40-4.82), while the OR for a RDW > 13.7% was 4.09 (2.87-5.83); a platelet count > 166,000/L was, conversely, protective (OR: 0.45 (0.32-0.63)).

Conclusion: Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment.
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http://dx.doi.org/10.1155/2021/8863053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123088PMC
June 2021

The use of mandibular advancement devices in adult patients affected by obstructive sleep apnea syndrome: our experience with "Thornton Adjustable Positioner" TAP Splint.

Minerva Dent Oral Sci 2021 Apr 30. Epub 2021 Apr 30.

Sant'Andrea Hospital, Vercelli, Italy.

Introduction: Obstructive sleep apnea syndrome (OSAS) is a sleep related disorder resulting in apneic and hypopneic episodes during sleep. The purpose of this article is to present and discuss our experience with the "Thornton Adjustable Positioner" TAP Splint in a consecutive series of patients affected by OSAS.

Methods: The data of all patients affected by OSAS and with indication to oral appliance (OA) treatment at the Dentistry Department of the Vercelli Hospital between January 1, 2019, and December 31, 2019 were collected. The following data were recorded for each patient: gender; age; smoke and/or alcohol assumption; BMI; comorbidities and current pharmacological therapy; initial AHI; OSAS category; eventual performed OSAS treatment options before OA treatment; indication to OA treatment; final AHI following OA treatment; complications and side effects.

Results: A total of 18 subjects (11 men, 7 women) with a mean age of 58,8 years were enrolled in this study with a mean AHI of 27,9 (range 5,8-84). Average BMI was 29. OA treatment reduced AHI in all patients (mean post treatment AHI, 5; range, 3,1-8). All patients were satisfied with the subjective improvement of OSAS symptoms.

Conclusions: Our results confirm the usefulness of a specific type of mandibular advancement device that can be considered as a valuable therapeutic modality in OSAS patients. Side effects are limited and they usually do not decrease the compliance of patients.
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http://dx.doi.org/10.23736/S2724-6329.21.04458-2DOI Listing
April 2021

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients.

Sci Rep 2020 11 26;10(1):20731. Epub 2020 Nov 26.

Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, 28100, Novara, NO, Italy.

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO/FiO ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.
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http://dx.doi.org/10.1038/s41598-020-77698-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692524PMC
November 2020

Optical Coherence Tomography Findings Following Orbital Fractures.

J Craniofac Surg 2020 Jul-Aug;31(5):e522-e525

Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità," University of Eastern Piedmont, Novara, Italy.

Introduction: A closed globe trauma is often associated with orbital wall fractures. In addition to diplopia, further eye disturbances can be observed. The aim of this preliminary prospective study was to investigate the optical coherence tomography (OCT) findings in patients that presented with orbital fractures in association with diplopia but without decreased visual acuity or further ocular symptoms.

Methods: Only patients who were admitted and surgically treated for orbital wall fractures and that presented diplopia were included in this study. Patients with post traumatic ocular symptoms were excluded. All the patients that were diagnosed with an orbital fracture underwent an ophthalmological assessment, including best-corrected visual acuity (BCVA), examination of fundus oculi, Hess Scheme, OCT, and OCT angiography.

Results: Five patients met the inclusion criteria and were enrolled. Hess Scheme examinations confirmed the presence of diplopia in all the included patients. The examination of fundus oculi did not reveal any pathology in 4 patients, whereas in a patient a commotio retinae (Berlin's Edema) was diagnosed in the infero-papillary field. Following OCT assessment, a pachycoroid was observed in 4 patients.

Conclusions: A thorough ophthalmological assessment in patients that have suffered from orbital fractures is fundamental. In particular, OCT examinations seem to provide more insight into the detection and monitoring of choroidal changes after ocular trauma without visible macular changes.
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http://dx.doi.org/10.1097/SCS.0000000000006695DOI Listing
November 2020

The various meanings and imperfections of words.

Oral Maxillofac Surg 2020 Sep 12;24(3):383-385. Epub 2020 Jun 12.

Division of Otolaryngology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy.

In this reply to a letter, the Authors discuss the raised points regarding the nomenclature and management of Lymphatic Malformations / Lymphangiomas.
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http://dx.doi.org/10.1007/s10006-020-00868-1DOI Listing
September 2020

The use of optical scanner for the fabrication of maxillary obturator prostheses.

Oral Maxillofac Surg 2020 Jun 9;24(2):157-161. Epub 2020 Mar 9.

Division of Maxillofacial Surgery, University Hospital "Maggiore della Carita", University of Eastern Piedmont, Novara, Italy.

Introduction: Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner.

Methods: Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6 months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction.

Results: Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing.

Conclusions: Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.
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http://dx.doi.org/10.1007/s10006-020-00836-9DOI Listing
June 2020

A single-center experience in the management of head and neck lymphangiomas.

Oral Maxillofac Surg 2020 Mar 20;24(1):109-115. Epub 2020 Jan 20.

ENT Division, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.

Introduction: Lymphangiomas are relatively uncommon head and neck region lymphatic malformations. Although surgery can be still considered the mainstay of treatment, sclerotherapy by OK-432 is becoming a widespread treatment option. The aim of this article is to present and discuss the management and outcomes of a series of cases of lymphangiomas.

Methods: All patients with lymphangiomas who were treated from 2010 to 2018 were reviewed. The following data were recorded: age, gender, subtype, staging, type of treatment, outcome, and recurrence.

Results: Fifteen patients (9 females, 6 males) were included with 2 microcystic and 13 macrocystic lymphangiomas. Six patients underwent surgery with excision (5 with a complete success, one with a fair success), whereas the remaining 9 subjects underwent sclerotherapy by OK-432 (6 with a complete success, 3 with a fair success). No postoperative complications were observed.

Conclusions: All modes of treatment are important in properly selected patients affected by lymphangiomas. OK-432 therapy is a safe and effective option in the treatment of head and neck lymphangiomas.
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http://dx.doi.org/10.1007/s10006-020-00832-zDOI Listing
March 2020

The Number of Platelets in Patient's Blood Influences the Mechanical and Morphological Properties of PRP-Clot and Lysophosphatidic Acid Quantity in PRP.

Int J Mol Sci 2019 Dec 24;21(1). Epub 2019 Dec 24.

Division of Maxillofacial Surgery, University of Eastern Piedmont, University Hospital "Maggiore della Carità", 28100 Novara, Italy.

The objectives of this study were to compare platelet-rich plasma (PRP) from patients with different concentrations of platelets and to assess the influence of these PRP preparations on human osteoblast (hOB) activity. In the literature, growth factors released by activated platelets have been considered responsible for the active role of PRP on bone regeneration but no specific role has been attributed to lysophosphatidic acid (LPA) as a possible effector of biological responses. In this study, patients were grouped into either group A (poor in platelets) or group B (rich in platelets). Clots from PRP fraction 2 (F2-clots), obtained with CaCl activation of PRP from the two groups, were compared macroscopically and microscopically and for their mechanical properties before testing their activity on the proliferation and migration of hOB. LPA was quantified before and after PRP fractioning and activation. The fibrin network of F2-clots from patients with a lower platelet concentration had an organized structure with large and distinct fibers while F2-clots from patients in group B revealed a similar structure to those in group A but with a slight increase in density. ELISA results showed a significantly higher plasma level of LPA in patients with a higher platelet concentration (group B) in comparison to those in group A ( < 0.05). This different concentration was evidenced in PRP but not in the clots. Depending on the number of platelets in patient's blood, a PRP-clot with higher or lower mechanical properties can be obtained. The higher level of LPA in PRP from patients richer in platelets should be considered as responsible for the higher hOB activity in bone regeneration.
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http://dx.doi.org/10.3390/ijms21010139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982162PMC
December 2019

Management of maxillofacial trauma in the elderly: A European multicenter study.

Dent Traumatol 2020 Jun 9;36(3):241-246. Epub 2020 Jan 9.

Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia.

Background/aims: Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017.

Results: A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P < .000005).

Conclusions: Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.
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http://dx.doi.org/10.1111/edt.12536DOI Listing
June 2020

Surgical management of unilateral body fractures of the edentulous atrophic mandible.

Oral Maxillofac Surg 2020 Mar 17;24(1):65-71. Epub 2019 Dec 17.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery.

Methods: This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications.

Results: A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases.

Conclusions: Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.
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http://dx.doi.org/10.1007/s10006-019-00824-8DOI Listing
March 2020

The potentialities of the Anatomage Table for head and neck pathology: medical education and informed consent.

Oral Maxillofac Surg 2020 Jun 12;24(2):229-234. Epub 2019 Dec 12.

Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.

Introduction: The understanding of anatomy of head and neck region and of the relative pathological conditions may be challenging for most medical students. Furthermore, patients may encounter great difficulties to understand their pathology, the proposed surgical technique, as well as the anatomy of this body district. The purpose of the present study was to present and discuss the use of the Anatomage Table for the assessment of several benign and malignant conditions of head and neck district.

Materials And Methods: The hospital database of Novara University Hospital, Novara, Italy, was searched for odontogenic keratocysts, thyroglossal duct cysts, and oral squamous cell carcinomas. A case for each pathology was randomly chosen, and preoperative computed tomography (CT) scans (in DICOM files) were retrieved. The DICOM data of preoperative CT examinations were uploaded in the Anatomage Table device, and an immediate 3-D reconstruction image was obtained from the Anatomage Table. Then, a workstation was used to obtain images of the body surface, "dissection cuts," or "vascular reconstructions," by the variations of the filters.

Results: The "dissection," "vascular," and "bony" images of three cases of odontogenic keratocyst, thyroglossal duct cyst, and mandibular oral squamous cell carcinoma were produced and presented.

Discussion: The examination of the different slices and the application of different filters represent a promising tool both for the education of students/residents and for an improved informed consent by the patients.
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http://dx.doi.org/10.1007/s10006-019-00821-xDOI Listing
June 2020

The epidemiology of edentulous atrophic mandibular fractures in Europe.

J Craniomaxillofac Surg 2019 Dec 29;47(12):1929-1934. Epub 2019 Nov 29.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented.

Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay.

Results: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries.

Conclusions: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.
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http://dx.doi.org/10.1016/j.jcms.2019.11.021DOI Listing
December 2019

Congenital nonvascular neck masses: a retrospective analysis.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Mar 12;129(3):192-199. Epub 2019 Jun 12.

Associate Professor and Director, ENT Division, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.

Objective: Congenital nonvascular neck masses are a challenge in head and neck diagnosis and management. The aim of this study was to analyze the clinical and epidemiologic findings in patients who were diagnosed with congenital nonvascular neck masses.

Study Design: All cases of patients with congenital nonvascular neck masses who were treated between 1996 and 2018 were reviewed. The following data were recorded: age, gender, final pathologic diagnosis (thyroglossal duct cysts, branchial cleft cysts, dermoid cysts), side of the lesion, subtype according to branchial arch (for branchial cleft cysts), and need for second surgery.

Results: In total, 226 patients were included: 100 with thyroglossal duct cysts, 97 with branchial cysts, and 29 with dermoid cysts. Excision surgery was performed in all cases. Recurrence and subsequent second surgery was necessary in 5 cases.

Conclusions: Appropriate knowledge of clinical and epidemiologic data regarding congenital nonvascular neck masses is crucial. Surgical resection is the optimal choice of therapy. Early referral of these patients to a head and neck surgeon is crucial for timely treatment.
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http://dx.doi.org/10.1016/j.oooo.2019.06.001DOI Listing
March 2020

The relationship between the status and position of third molars and the presence of mandibular angle and condylar fractures.

Oral Maxillofac Surg 2020 Mar 15;24(1):31-36. Epub 2019 Nov 15.

Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.

Introduction: The aim of this study was to assess the relationship between the status and position of third molars, and the presence of mandibular angle and/or condylar fractures, in a group of patients treated for mandibular fractures, thus hoping to contribute to the knowledge of potential predictors of these fractures.

Methods: A retrospective study was designated to include all the patients who were diagnosed and treated with open reduction and internal fixation for isolated mandibular angle fractures or isolated mandibular condylar fractures between 1st of January 2012 and 31st of December 2018. The following data were collected for each included patient: gender, age, etiology, site and side of the fracture, and presence and eruption state of third molars in the fracture side.

Results: Seventy patients were diagnosed with a condylar fracture, 48 with an angle fracture. No statistically significant difference was observed as for etiology and gender distribution between angle fracture and condyle fracture patients (p > 0.05). Angle fractures were statistically associated with the presence of third molars, whereas condylar fractures with the absence of third molars (p < 0.000005). The presence of completely erupted 3Ms was associated with condylar fractures (p < 0.05), and partially impacted 3Ms were associated with angle fractures (p < 0.0005).

Conclusions: Mandibular angle fractures and third molar presence are associated in patients who present with mandibular fractures, especially if the third molar is incompletely erupted. This information should be kept in consideration as for the diagnosis and management of patients with mandibular fractures.
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http://dx.doi.org/10.1007/s10006-019-00811-zDOI Listing
March 2020

Endoscopic septoplasty as a routine approach: Our experience on 647 patients.

J Craniomaxillofac Surg 2019 Oct 19;47(10):1530-1534. Epub 2019 Jul 19.

ENT Division, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.

Introduction: A variety of surgical techniques of septoplasty have been described. The aim of the present study was to assess the feasibility of endoscopic septoplasty as a routine approach both alone and during other sinonasal - skull base endoscopic procedures.

Methods: A retrospective study of all patients admitted for endoscopic septoplasty that were performed between January 2011 and December 2017 was conducted. Patients that performed septoplasty either alone or in combination with sinus surgery or skull base surgery were included. Data regarding postoperative major complications such post-operative hemorrhage, synechiae, and septal tears or perforation were collected.

Results: 647 patients were included. Postoperative hemorrhage was observed in 0,3% of patients, synechiae in 5,2% of cases, and septal tears and/or perforations in 6,2% of the whole study population. An incomplete septal correction was observed in 27 patients (4,2%).

Conclusions: The endoscopic technique provides a better visualization allowing to observe fewer complications. It can also be considered as an excellent and effective teaching tool.
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http://dx.doi.org/10.1016/j.jcms.2019.07.018DOI Listing
October 2019

The use of teleradiology for triaging of maxillofacial trauma.

J Craniomaxillofac Surg 2019 Oct 19;47(10):1535-1541. Epub 2019 Jul 19.

Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.

Purpose: The aim of this study was to assess and discuss our experience with a teleradiology technique applied to facial trauma patients referred to an oral and maxillofacial surgery hub center.

Materials And Methods: All trauma patients with maxillofacial fractures from the hospitals of Vercelli, Biella, Borgosesia, Borgomanero, Verbania, and Domodossola who were referred between July 2014 and September 2018 to the hub maxillofacial center of Novara were reviewed. The following data were recorded for each patient: sex, age, referral hospital, etiology, etiology mechanisms, site of facial fractures, date of injury, indications for surgery according to teleradiology consultation, indications for surgery following clinical maxillofacial assessment, date of eventual surgery, timing of surgery from trauma, type of surgical intervention.

Results: A total of 467 patients with a total of 605 fractures were triaged and managed by the Tempore telemedicine system. The most frequent cause of maxillofacial injury was fall. The most frequently observed fracture involved the zygoma. Following remote computed tomography assessment, surgical indications were suggested in 68 patients; 223 patients were not considered suitable candidates for surgery; and 176 patients needed a clinical assessment for the establishment of definitive eventual indications for surgery. Following clinical assessment, the absence and presence of surgical indications was confirmed in all 223 and 68 patients, respectively. Within the 176 patients with "possible" surgical indications, only 27 patients were referred for surgery.

Conclusion: Teleradiology may be helpful for an appropriate triaging of trauma patients from peripheral hospitals for the correct referral to a maxillofacial trauma hub center.
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http://dx.doi.org/10.1016/j.jcms.2019.07.007DOI Listing
October 2019

Voluminous maxillary radicular cysts removal under local anesthesia.

Minerva Stomatol 2019 Aug;68(4):213-216

Department of Translational Medicine, University of Eastern Piedmont (UPO), Novara, Italy.

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http://dx.doi.org/10.23736/S0026-4970.19.04239-0DOI Listing
August 2019

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Sep 13;128(3):199-204. Epub 2018 Dec 13.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objectives: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures.

Study Design: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1.

Results: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures.

Conclusions: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.
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http://dx.doi.org/10.1016/j.oooo.2018.12.009DOI Listing
September 2019

Psychological profiles in patients undergoing orthognathic surgery or rhinoplasty: a preoperative and preliminary comparison.

Oral Maxillofac Surg 2019 Jun 23;23(2):179-186. Epub 2019 Apr 23.

Division of Maxillofacial Surgery, Universita degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy.

Objective: The aim of this study was to assess, identify, and compare the personality traits and psychosocial status of two groups of patients undergoing orthognathic surgery and rhinoseptoplasty respectively.

Study Design: This prospective study recruited patients referred for orthognathic surgery and for rhinoseptoplasty. The research protocol included the administrations of questionnaires to the patients during their last visit before surgery, including the Minnesota Multiphasic Personality Inventory (MMPI-2), the Myers-Briggs Type Indicator (MBTI), the tree drawing test (or Baum test), and the BC Scale.

Results: As for MMPI-2, the highest (pathological) percentages were encountered in Hypochondriasis and Psychasthenia scales within the Orthognathic Surgery Group, whereas in the rhinoseptoplasty group, the highest scores were obtained in the Hypochondriasis, Psychasthenia, Psychopathic Deviate, and Schizophrenia scales.

Conclusions: It would be important to assess some characteristics of the patients' mental health and emotional state prior to surgery, including depression, anxiety, panic, and aggression. The overview of these factors may give an insight into the psychological and emotional capacity of the patients undergoing orthognathic and rhinoseptoplasty surgery.
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http://dx.doi.org/10.1007/s10006-019-00758-1DOI Listing
June 2019

The "European Mandibular Angle" research project: the analysis of complications after unilateral angle fractures.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jul 28;128(1):14-17. Epub 2019 Feb 28.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objective: The aim of this study was to analyze the complications and outcomes of surgical treatment of angle fractures managed at departments of maxillofacial surgery in several European countries.

Study Design: Patients hospitalized with unilateral isolated angle fractures between 2013 and 2017 were included. The following data were recorded: gender and age of patients, fracture etiology, presence of the third molar, maxillomandibular fixation, osteosynthesis technique, and complications.

Results: In total, 489 patients were included in the study. The Champy technique was found to be the most frequently chosen osteosynthesis technique. Sixty complications were observed, at a rate of 12.3%. Complications were associated with the absence of third molars (P < .05). Instead, the Champy technique was associated with fewer complications (P < .05), in comparison with the other adopted techniques.

Conclusions: The management of angle fractures still represents a challenging task with a significant complication rate. The Champy technique still seems to be a valid option for the treatment of such injuries.
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http://dx.doi.org/10.1016/j.oooo.2019.02.027DOI Listing
July 2019

Use of neuron-specific enolase to predict mild brain injury in motorcycle crash patients with maxillofacial fractures: A pilot study.

Chin J Traumatol 2019 Feb 10;22(1):47-50. Epub 2019 Feb 10.

Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Purpose: Mild traumatic brain injury (TBI) is common but accurate diagnosis and its clinical consequences have been a problem. Maxillofacial trauma does have an association with TBI. Neuron-specific enolase (NSE) has been developed to evaluate neuronal damage. The objective of this study was to investigate the accuracy of NSE serum levels to detect mild brain injury of patients with sustained maxillofacial fractures during motor vehicle accidents.

Methods: Blood samples were drawn from 40 healthy people (control group) and 48 trauma patients who had sustained isolated maxillofacial fractures and mild brain injury in motor vehicle accidents. Brain injuries were graded by Glasgow Coma Scale. In the trauma group, correlations between the NSE serum value and different facial fracture sites were also assessed.

Results: The NSE serum level (mean ± SD, ng/ml) in the 48 patients with maxillofacial fractures and mild TBI was 13.12 ± 9.68, significantly higher than that measured in the healthy control group (7.72 ± 1.82, p < 0.001). The mean NSE serum level (ng/ml) in the lower part of the facial skeleton (15.44 with SD 15.34) was higher than that in the upper facial part (12.42 with SD 7.68); and the mean NSE level (ng/ml) in the middle-and lower part (11.97 with SD 5.63) was higher than in the middle part (7.88 with SD 2.64).

Conclusion: An increase in NSE serum levels can be observed in patients sustained maxillofacial fractures and mild brain injury.
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http://dx.doi.org/10.1016/j.cjtee.2018.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529579PMC
February 2019

The "European zygomatic fracture" research project: The epidemiological results from a multicenter European collaboration.

J Craniomaxillofac Surg 2019 Apr 30;47(4):616-621. Epub 2019 Jan 30.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Purpose: Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.

Results: A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005).

Conclusion: The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.
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http://dx.doi.org/10.1016/j.jcms.2019.01.026DOI Listing
April 2019

The "European Mandibular Angle" Research Project: The Epidemiologic Results From a Multicenter European Collaboration.

J Oral Maxillofac Surg 2019 Apr 27;77(4):791.e1-791.e7. Epub 2018 Dec 27.

Full Professor, Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Purpose: The aim of this study was to analyze the demographic variables and causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.

Materials And Methods: This study was based on a multicenter systematic database that allowed the recording of data from all patients with mandibular angle fractures between January 1, 2013, and December 31, 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, and osteosynthesis.

Results: The study included 1,162 patients (1,045 male and 117 female patients). A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (P < .0000005). Furthermore, assaults were associated with the presence of voluptuary habits (P < .00005), a younger mean age (P < .00000005), male gender (P < .00000005), and left-sided angle fractures (P < .00000005).

Conclusions: Assaults and falls actually represent the most frequent causes of angle fractures. The presence of a third molar may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.
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http://dx.doi.org/10.1016/j.joms.2018.12.013DOI Listing
April 2019

Psychodynamic Features Associated With Orthognathic Surgery: A Comparison Between Conventional Orthognathic Treatment and "Surgery-First" Approach.

J Oral Maxillofac Surg 2019 Jan 12;77(1):157-163. Epub 2018 Jun 12.

Full Professor, Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy.

Purpose: The aims of this study were to assess the personality traits of orthognathic patients and to investigate and compare the changes related to psychosocial well-being, self-esteem, anxiety, and quality of life between presurgical and postsurgical phases in patients undergoing traditional and surgery-first orthognathic treatments.

Patients And Methods: This prospective study recruited patients referred for traditional 3-stage orthognathic treatment and surgery-first orthognathic treatment. Patients were administered psychological and quality-of-life tests 3 times: during the last visit before surgery, about 4 weeks after surgery, and 6 months after surgery.

Results: Of the 33 patients included, 14 presented parameters that were suggestive of personality (borderline, compulsive, antisocial, passive-aggressive) disorders. The results of the 36-item Short Form Health Survey showed significant differences with better scores for the "surgery-first" group for bodily pain, vitality, social functioning, and mental health (P < .05). As for the Beck Depression Inventory second edition results, at final check, surgery-first patients reported fewer depressive symptoms too.

Conclusions: A surgery-first orthognathic approach allows a precocious re-establishment of harmonic esthetics of the face, thus positively influencing the compliance and psychological status of the patients.
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http://dx.doi.org/10.1016/j.joms.2018.06.005DOI Listing
January 2019

Plasma rich in growth factors (PRGF) for the promotion of bone cell proliferation and tissue regeneration.

Oral Maxillofac Surg 2018 Sep 4;22(3):309-313. Epub 2018 Aug 4.

Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy.

Objectives: Over the past few years, studies about growth factors have been increasingly developed and the knowledge of their role in stimulating cell proliferation and differentiation used for therapeutic purposes. This study aims to compare a platelets concentrate, the plasma rich in growth factors (PRGF) to a control, consisting of cellulose membranes, to evaluate in vitro the cellular adhesion and migration of human osteoblasts (hOb) and understand if the use of platelets concentrates could be an advantage in view of bone tissue regeneration.

Study Design: Twenty-seven human donors provided 27 blood samples used to make 54 samples: 27 for PRGF and 27 for the control group. PRGFs and controls were incubated for 48 h in sterility in 1 ml of culture with 10 hOb and hOb in the scaffolds were then quantified.

Results: In PRGF samples, hObs were more numerous than in controls. (T = 6.6964, p < 0.0001).

Conclusions: Human osteoblasts are driven to colonize PRGFs with a greater efficacy than negative controls, probably due to the presence of chemokines and growth factors in PRGFs.
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http://dx.doi.org/10.1007/s10006-018-0712-zDOI Listing
September 2018

The Anatomage Table and the placement of titanium mesh for the management of orbital floor fractures.

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 Oct 2;126(4):317-321. Epub 2018 May 2.

University of Eastern Piedmont, Novara, Italy.

Objective: The anatomy of the head and neck region is complex as are its implications for maxillofacial pathologic conditions and their surgical treatments. We hypothesize that the assessment of the surgical management of orbital floor fractures by using titanium mesh could represent an appropriate first experimental field for the use of the Anatomage Table in maxillofacial surgery.

Study Design: Patients with unilateral orbital floor fractures were searched for in the hospital database of Novara University Hospital, Novara, Italy. The Digital Imaging and Communications in Medicine data of preoperative and postoperative computed tomography examinations were retrieved and were uploaded in the Anatomage Table device. Then, a workstation was used to create anatomic dissection coronal and sagittal images together with the corresponding computed tomography scans. Finally, 10 maxillofacial surgery residents and young surgeons were involved in the assessment of the images.

Results: The young surgeons reported a higher clarity of anatomic dissection images in comparison with computed tomography scans both in preoperative and postoperative images.

Conclusions: The fields of application of this new technology are wide and promising, ranging from the education, to the follow-up, to patient informed consent.
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http://dx.doi.org/10.1016/j.oooo.2018.04.006DOI Listing
October 2018

Management of head and neck cancer in older patients.

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 04 1;125(4):369-375. Epub 2018 Feb 1.

Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy.

Objective: A progressive increase in the number of older patients with head and neck cancer has been observed in the last few years. The aim of this study was to assess our experience in the management of older patients with head and neck cancer (HNC) in comparison with younger patients.

Study Design: A retrospective review was conducted for all patients admitted and treated for newly diagnosed HNC between January 2008 and December 2012. The clinical characteristics, management approaches, and outcome data were recorded.

Results: In total, 316 patients with HNC (232 males, 84 females) were enrolled: 203 (64%) were in the young group, whereas 113 patients (36%) were in the older group. Comorbidities (P < .000005) and stage IV tumors (P < .0005) were more frequently observed in the older group. Treatment options were uniformly distributed within the 2 groups; only radiotherapy alone was more frequently administered in older patients (P < .0005).

Conclusions: Chronologic age should not be a reason to deny appropriate treatments that could prevent death in older patients. A careful pretreatment assessment should always be performed.
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http://dx.doi.org/10.1016/j.oooo.2018.01.022DOI Listing
April 2018

The Role of Intra-articular Surgery in the Management of Mandibular Condylar Head Fractures.

Atlas Oral Maxillofac Surg Clin North Am 2017 Mar 20;25(1):25-34. Epub 2016 Dec 20.

Division of Otolaryngology, Maxillofacial Surgery and Dentistry, Aosta Hospital, viale Ginevra 3, Aosta 11100, Italy.

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http://dx.doi.org/10.1016/j.cxom.2016.10.001DOI Listing
March 2017

Sport-Related Maxillo-Facial Fractures.

J Craniofac Surg 2016 Jan;27(1):e91-4

*Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hasanuddin, Makassar, Indonesia †Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA) ‡Department of Medical-Dental Interaction, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Sports and exercise are important causes of maxillofacial injuries. Different types of sports might differ in frequency and type of fractures. The aim of the present study was to explore the possible relation between the types of sport practiced and the frequency and nature of the facial bone fractures of patients presenting in an oral and maxillofacial surgery department of a Dutch university center. This study is based on an analysis of patient records containing maxillofacial fractures sustained between January 1, 2000 and April 1, 2014 at the Vrije Universiteit University Medical Center (VUmc) in Amsterdam, The Netherlands. The present study comprised data from 108 patients with 128 maxillofacial fractures. Seventy-nine percent of the patients were male and 21% were female. The patients ranged in age from 10 to 64 years old with a mean age of 30.6 ± 12.0. The highest incidence of sport-related maxillofacial fractures occurred in individuals between the ages of 20 and 29. The most common sport-related fractures were zygoma complex fractures, followed by mandible fractures. Soccer and hockey were the most prominent causes of sport-related maxillofacial trauma in the present study. Coronoid process fractures were only observed in soccer players and not in other sports groups. Mandible angle fractures were relatively more frequent in rugby than in other sports. The results of this study suggest a relation between type of sport and the nature and frequency of the fractures it causes.
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http://dx.doi.org/10.1097/SCS.0000000000002242DOI Listing
January 2016

Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture.

J Craniomaxillofac Surg 2015 Dec 9;43(10):1952-60. Epub 2015 Sep 9.

Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address:

Purpose: Many studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains.

Material And Methods: In this study, an attempt was made to quantify the level of agreement between a sample of maxillofacial surgeons worldwide, on the classification and treatment decisions in three different unilateral mandibular condyle fracture cases.

Results: In total, 491 of 3044 participants responded. In all three mandibular condyle fracture cases, a fairly high level of disagreement was found. Only in the case of a subcondylar fracture, assuming dysocclusion was present, more than 81% of surgeons agreed that the best treatment would be open reduction and internal fixation.

Conclusions: Based on the study results, there is considerable variation among surgeons worldwide with regard to treatment of unilateral mandibular condyle fracture. 3D imaging in higher fractures tends to lead to more invasive treatment decisions.
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http://dx.doi.org/10.1016/j.jcms.2015.08.031DOI Listing
December 2015