Publications by authors named "Riccardo Nocini"

48 Publications

An Overview of Artificial Intelligence Applications in Liver and Pancreatic Imaging.

Cancers (Basel) 2021 Apr 30;13(9). Epub 2021 Apr 30.

Department of Radiology, G.B. Rossi University Hospital, University of Verona, 37129 Verona, Italy.

Artificial intelligence (AI) is one of the most promising fields of research in medical imaging so far. By means of specific algorithms, it can be used to help radiologists in their routine workflow. There are several papers that describe AI approaches to solve different problems in liver and pancreatic imaging. These problems may be summarized in four different categories: segmentation, quantification, characterization and image quality improvement. Segmentation is usually the first step of successive elaborations. If done manually, it is a time-consuming process. Therefore, the semi-automatic and automatic creation of a liver or a pancreatic mask may save time for other evaluations, such as quantification of various parameters, from organs volume to their textural features. The alterations of normal liver and pancreas structure may give a clue to the presence of a diffuse or focal pathology. AI can be trained to recognize these alterations and propose a diagnosis, which may then be confirmed or not by radiologists. Finally, AI may be applied in medical image reconstruction in order to increase image quality, decrease dose administration (referring to computed tomography) and reduce scan times. In this article, we report the state of the art of AI applications in these four main categories.
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http://dx.doi.org/10.3390/cancers13092162DOI Listing
April 2021

Effects of oral function on pupil response: a new view on bruxism pathophysiology.

Minerva Dent Oral Sci 2021 Apr 28. Epub 2021 Apr 28.

School of Dentistry, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Verona, Italy.

Background: There are increasing evidences of the influence of the oropharyngeal stimulations on the autonomic nervous system and an easy approach to evaluate the balance between parasympathetic and sympathetic system is the measurement of the pupil diameter. The aim of this analytic observational study is to define the effects of clenching and swallowing on pupil diameter, and how an oral appliance can affect the outcome of these tasks, to establish their influence on the sympathetic-parasympathetic balance.

Methods: We measured the pupil diameter in 30 healthy subjects during clenching and swallowing, both with and without oral appliance. We compared the results with the mandibular rest position. The respective positions with and without oral appliance were also compared.

Results: Pupillometry showed a mydriatic effect of swallowing (rest=6.94 mm, swallowing=7.26 mm, p=0.04) and oral appliance, more relevant in scotopic conditions. On the contrary, clenching seemed to enhance miosis, especially in intense brightness condition (rest=3.95 mm, clenching=3.83 mm, p=0.02).

Conclusions: Swallowing and oral appliance facilitate the sympathetic system, while clenching activates the parasympathetic branch. We argue that probably the locus coeruleus is the main hub. These results could have practical implications in bruxism physiology, because it could be an attempt to counteract the activation of the sympathetic system.
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http://dx.doi.org/10.23736/S2724-6329.21.04506-4DOI Listing
April 2021

Letter to the Editor: Intraosseous Cavernous Hemangioma of the Middle Turbinate: A Case Report.

Ear Nose Throat J 2021 Apr 13:1455613211009132. Epub 2021 Apr 13.

460280The Vascular Birthmark Foundation, Latham, NY, USA.

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http://dx.doi.org/10.1177/01455613211009132DOI Listing
April 2021

Pain, Smell, and Taste in Adults: A Narrative Review of Multisensory Perception and Interaction.

Pain Ther 2021 Feb 26. Epub 2021 Feb 26.

Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

Every day our sensory systems perceive and integrate a variety of stimuli containing information vital for our survival. Pain acts as a protective warning system, eliciting a response to remove harmful stimuli; it may also be a symptom of an illness or present as a disease itself. There is a growing need for additional pain-relieving therapies involving the multisensory integration of smell and taste in pain modulation, an approach that may provide new strategies for the treatment and management of pain. While pain, smell, and taste share common features and are strongly linked to emotion and cognition, their interaction has been poorly explored. In this review, we provide an overview of the literature on pain modulation by olfactory and gustatory substances. It includes adult human studies investigating measures of pain threshold, tolerance, intensity, and/or unpleasantness. Due to the limited number of studies currently available, we have structured this review as a narrative in which we comment on experimentally induced and clinical pain separately on pain-smell and pain-taste interaction. Inconsistent study findings notwithstanding, pain, smell, and taste seem to interact at both the behavioral and the neural levels. Pain intensity and unpleasantness seem to be affected more by olfactory substances, whereas pain threshold and tolerance are influenced by gustatory substances. Few pilot studies to date have investigated these effects in clinical populations. While the current results are promising for the future, more evidence is needed to elucidate the link between the chemical senses and pain. Doing so has the potential to improve and develop novel options for pain treatment.
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http://dx.doi.org/10.1007/s40122-021-00247-yDOI Listing
February 2021

An unusual case of gardening ocular injury during Covid-19 lockdown.

Int J Surg Case Rep 2021 Mar 5;80:105619. Epub 2021 Feb 5.

G.B. Rossi Hospital and Medical University of Verona, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Introduction: Facial trauma are an important cause of serious ocular morbidity. In particular domestic trauma are a small part of total. COVID-19 pandemic has been influencing our life in a way never seen before, people need to remain at home due to lockdown restrictions. In this scenario we are seeing an increase in the percentage of domestic facial trauma. In other hand pandemic has influenced the possibility of hospitalization, so daily based procedures increased their importance in global treatment planning.

Case Presentation: A 58 yo man presented to our ward with a foreign body in left eyebrow. Trauma happened during gardening.

Clinical Discussion: The importance of imaging to perform the right procedure has become more important during pandemic to reduce time of hospitalization.

Conclusion: CT scan and ophtalmology consult have been the guideline to avoid a more invasive treatment which was performed in an outpatient regimen with local anesthesia.
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http://dx.doi.org/10.1016/j.ijscr.2021.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893445PMC
March 2021

Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up.

J Craniomaxillofac Surg 2021 Feb 5. Epub 2021 Feb 5.

Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.

This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction. The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined. A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund-Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm. According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.
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http://dx.doi.org/10.1016/j.jcms.2021.01.020DOI Listing
February 2021

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid 19.

Nutr Metab Cardiovasc Dis 2021 03 20;31(3):762-768. Epub 2020 Nov 20.

Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy.

Background And Aims: Recent studies show that obesity is a risk factor for hospital admission and for critical care need in patients with coronavirus disease 2019 (COVID-19). The aim was to determine whether obesity is a risk factor for unfavourable health outcomes in patients affected by COVID-19 admitted to ICU.

Methods And Results: 95 consecutive patients with COVID-19 (78 males and 18 females) were admitted to ICU and included in the study. Height, weight, BMI, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, CRP, CPK, ICU and hospital length of stay and comorbidities were evaluated. Participants with obesity had a lower 28 day survival rate from ICU admission than normal weight subjects. Cox proportional hazard model-derived estimates, adjusted for age, gender and comorbidity, confirmed the results of the survival analysis (HR:5.30,95%C.I.1.26-22.34). Obese subjects showed longer hospital and ICU stay as compared with normal weight counterpart.Subjects with obesity showed significantly higher CRP and CPK levels than normal weight subjects.

Conclusion: In individuals with obesity, careful management and prompt intervention in case of suspected SARS-CoV-2 infection is necessary to prevent the progression of the disease towards severe outcomes and the increase of hospital treatment costs.
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http://dx.doi.org/10.1016/j.numecd.2020.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677044PMC
March 2021

Intraparotid Osteolipoma: Treatment Option and Surgical View.

J Craniofac Surg 2021 Feb 2. Epub 2021 Feb 2.

Maxillofacial Surgery Unit, Policlinico San Marco University Hospital, University of Catania, Catania Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, Borgo Trento Hospital of Verona, Verona Anatomical Pathology Unit, Policlinico San Marco University Hospital, University of Catania, Catania, Italy.

Abstract: Osteolipoma is a benign neoplasm originating from the mesenchymal fat tissue cells and characterized by the presence of bone formation. In the head and neck district osteolipoma has been described as parapharyngeal, nasopharinx, submandibular gland, eyelid, floor of the mouth, and skull base lesion. Only 1 case of osteolipoma was reported as a neoplasm of the parotid region. Considering the rarity of the osteolipoma, our purpose was to describe the first case of totally intraparotid gland localization of osteolipoma and summarize and review the actual literature concerning the presence of this tumor in the region of major salivary glands. A 56-years-old male patient was treated for intraparotid osteolipoma. Surgical removal of tumor was done with a standard preauricular/cervical incision and blunt dissection. The facial nerve was identified and preserved completely. In the reviewed series, all cases were reported in adult patients with a relative long history of slow progression. According to our paper and the review of the literature, we can assess that Osteolipoma is an extremely rare lesion affecting the major salivary glands, which should be considered along with common salivary gland tumors in the differential diagnosis.
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http://dx.doi.org/10.1097/SCS.0000000000007519DOI Listing
February 2021

Enhanced Osteogenic Differentiation of Human Bone Marrow-Derived Mesenchymal Stem Cells by a Hybrid Hydroxylapatite/Collagen Scaffold.

Front Cell Dev Biol 2020 11;8:610570. Epub 2021 Jan 11.

Department of Medical Sciences, School of Medicine, University of Ferrara, Ferrara, Italy.

Human bone marrow-derived mesenchymal stem cells (hBMSCs) and their derivative enhanced green fluorescent protein (eGFP)-hBMSCs were employed to evaluate an innovative hybrid scaffold composed of granular hydroxylapatite and collagen hemostat (Coll/HA). The cellular morphology/cytoskeleton organization and cell viability were investigated by immunohistochemistry (IHC) and AlamarBlue metabolic assay, respectively. The expression of osteopontin and osteocalcin proteins was analyzed by IHC and ELISA, whereas osteogenic genes were investigated by quantitative PCR (Q-PCR). Cell morphology of eGFP-hBMSCs was indistinguishable from that of parental hBMSCs. The cytoskeleton architecture of hBMSCs grown on the scaffold appeared to be well organized, whereas its integrity remained uninfluenced by the scaffold during the time course. Metabolic activity measured in hBMSCs grown on a biomaterial was increased during the experiments, up to day 21 ( < 0.05). The biomaterial induced the matrix mineralization in hBMSCs. The scaffold favored the expression of osteogenic proteins, such as osteocalcin and osteopontin. In hBMSC cultures, the scaffold induced up-regulation in specific genes that are involved in ossification process (BMP2/3, SPP1, SMAD3, and SP7), whereas they showed an up-regulation of MMP9 and MMP10, which play a central role during the skeletal development. hBMSCs were induced to chondrogenic differentiation through up-regulation of gene. Our experiments suggest that the innovative scaffold tested herein provides a good microenvironment for hBMSC adhesion, viability, and osteoinduction. hBMSCs are an excellent cellular model to assay scaffolds, which can be employed for bone repair and bone tissue engineering.
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http://dx.doi.org/10.3389/fcell.2020.610570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849836PMC
January 2021

Role of the temporoparietal fascia free flap in salvage total laryngectomy.

Head Neck 2021 May 12;43(5):1692-1694. Epub 2021 Jan 12.

Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy.

The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx.
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http://dx.doi.org/10.1002/hed.26602DOI Listing
May 2021

Invisalign appliance: aesthetic and efficiency.

Minerva Stomatol 2020 Dec;69(6):329-334

Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Background: The patients' request for treatment with clear aligners is constantly increasing. The aligners permit to the clinicians a valid way to solve a lot of orthodontic cases but the patients' compliance and the clinicians' capabilities and knowledge of the technique is fundamental for the outcome.

Methods: Seventy-two digital models of 18 consecutive patients treated with Invisalign and Smart Track aligners for 14 weeks were analyzed. The operator positioned 24 points on each model and were obtained the values of arch depth and perimeter of arch before and after the treatment. The variations of measurement were calculated with t student test.

Results: A decrease of arch depth and perimeter was found from t0 to t1 and the most relevant difference was observed in the upper arch depth with a decrease of 1.3 mm and in the upper arch perimeter with a difference of 1.1 mm.

Conclusions: There was always a decrease of the values of arch depth and arch perimeter at the end of the treatment, especially in the upper arch. These changes must be considered by the clinicians to perform a better treatment to obtain the most predictable results and a patient's higher satisfaction.
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http://dx.doi.org/10.23736/S0026-4970.20.04128-XDOI Listing
December 2020

Assessing the impact of COVID-19 on individuals and families affected by vascular anomalies: The VBF COVID-19 survey.

J Plast Reconstr Aesthet Surg 2021 05 13;74(5):1101-1160. Epub 2020 Dec 13.

Vascular Birthmarks Foundation (VBF), VBF Europe Co-Director; VBF Italy Medical Director (VBF Italy, Milan, Italy), VBF, Milan, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2020.12.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832352PMC
May 2021

Stop Calling Me Cavernous Hemangioma! A Literature Review on Misdiagnosed Bony Vascular Anomalies.

J Invest Surg 2020 Nov 5:1-10. Epub 2020 Nov 5.

Vascular Birthmark Foundation, New York, USA.

Vascular malformations of the bone most often involve the cranio-facial area. Even in relevant peer reviewed journals, venous malformations are often misdiagnosed as "hemangiomas" or "angiomas" of the bone. By reviewing literature from the past 5 years (2013-2018), we found many reports of vascular malformations of the bone where the diagnosis was incorrect. Unfortunately, there is still much confusion in understanding and/or diagnosing vascular malformations, despite the fact that in recent years many papers tried to clarify this topic. The purpose of this article is to make a review of the scientific literature concerning vascular malformations of the bone which have been reported as angioma, hemangioma, or hemangioendothelioma, and have been published between January 2013 to October 2018. Clinical features, imaging and histologic reports contained in the papers were reviewed. Subsequently, after reviewing every single paper we reclassified the diagnosis according to the 2018 ISSVA classification. Almost all of the vascular anomalies presented in the reviewed papers as angiomas, hemangiomas, or hemangioendotheliomas were venous (mostly) or arteriovenous malformations. Therefore, only 8 out of 58 papers (14.7%) had an accurate diagnosis. Interestingly, all of the papers reporting cavernous or capillary hemangiomas were actually presenting venous malformations. Making a correct diagnosis is of primary importance because depending on the type of vascular anomaly, the treatment and the prognosis for the patient are very different. Everyone who approaches or describes a vascular anomaly of the bone should know and should adopt a correct and updated nosography.
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http://dx.doi.org/10.1080/08941939.2020.1824041DOI Listing
November 2020

How to deal with coronavirus disease 2019: A comprehensive narrative review about oral involvement of the disease.

Clin Exp Dent Res 2021 02 5;7(1):101-108. Epub 2020 Oct 5.

Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynaecology, University of Verona, Verona, Italy.

Objectives: The aim of this narrative review was to collect all findings from literature about oral signs and symptoms of COVID-19, in order to draw a picture of oral involvement of this challenging viral infection, to help oral professionals in a better triage and early diagnosis.

Material And Methods: The search for international literature was made including articles written in English and reporting about oral manifestations in patients with a diagnosis of COVID-19. The publication time was limited to 2019 and 2020, up to May 20, 2020. A narrative review was performed.

Results: Twenty-three articles were included in this review. Three different oral manifestations were found: taste alteration, oral blister and ulcers, and oral lesions associated with Kawasaki-like diseases (erythema, bleeding of lips, "strawberry tongue"). The higher expression of Angiotensin-converting enzyme 2 in the oral cavity and in endothelial cells might be responsible for oral manifestation and the major report of signs and symptoms in the occidental countries.

Conclusions: Detecting oral signs and symptoms of COVID-19 could be useful to perform a better preliminary triage in dental setting, and in recognizing possible early manifestations of the disease. However, considering the outbreak of COVID-19 and the consequent difficulty of undergoing oral examinations, the oral manifestations might be misdiagnosed; then, we would encourage oral professionals to perform other studies about this topic.
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http://dx.doi.org/10.1002/cre2.332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675550PMC
February 2021

Free flap head and neck microsurgery with VITOM 3D: Surgical outcomes and surgeon's perspective.

Auris Nasus Larynx 2021 Jun 25;48(3):464-470. Epub 2020 Sep 25.

Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy.

Objective: To report on the application of the 3D exoscopic system to microsurgery in a cohort of head and neck cancer patients; to analyse the performance of microvascular anastomoses, flap harvesting and insetting under exoscopic view and to evaluate the surgeon's feedback after procedures.

Methods: An observational study was performed on 10 consecutive patients undergoing exoscopic microsurgical free flap reconstruction. The VITOM 3D system was applied to all procedures for microsurgical anastomoses, flap harvesting and insetting. Data about the type of resection and reconstruction, intraoperative and post-operative complications were recorded. Surgeon's feedback on exoscopic experience was collected through a questionnaire.

Results: Reconstruction after oncologic demolition was performed by radial forearm flap in 3 cases (30%), antero-lateral thigh flap in 4 cases (40%), composite fibula flap in 2 cases (20%) and chimeric scapula flap in 1 case (10%). The mean surgical time for the microsurgical anastomoses (1 vein and 1 artery) was 34 min (range: 32-38). No intraoperative complications occurred and only two patients experienced pharyngo-cutaneous fistula in the post-operative time. There were neither cases of loss of flap, nor need of surgical revision. None of the cases had to be converted to OM technique. The surgeon never experienced back/neck pain, headache and nausea/vertigo. Occasionally, he felt tired and stressed and he reported eyestrain after one procedure only.

Conclusions: VITOM 3D is easy to apply in the field of head and neck microsurgery and provides optimal stereoscopic view and anatomical details. Further studies are needed to validate indications and advantages of 3D exoscope as compared to OM.
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http://dx.doi.org/10.1016/j.anl.2020.09.010DOI Listing
June 2021

Periodontal Disease and Venous Thromboembolism.

Semin Thromb Hemost 2021 Feb 23;47(1):110-111. Epub 2020 Sep 23.

Haematology, Sydney Centers for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.

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http://dx.doi.org/10.1055/s-0040-1714399DOI Listing
February 2021

Periodontitis, coronary heart disease and myocardial infarction: treat one, benefit all.

Blood Coagul Fibrinolysis 2020 Sep;31(6):339-345

Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.

: Periodontal disease is conventionally defined as an inflammatory condition affecting the tissues surrounding and supporting the teeth (i.e. gum and periodontium). Recent statistics show that the prevalence of this condition is continuously growing worldwide, thus raising severe healthcare concerns, not only for local problems emerging from poor oral health, but also for the potential risk of developing systemic complications. Therefore, this article aims to provide an update on the intriguing association between periodontitis, coronary heart disease (CHD) and/or myocardial infarction (MI). Taken together, the available published information seems to support the existence of a significant association between periodontitis and CHD, whilst the risk of acute ischemic cardiac events appears magnified in patients with preexisting coronary artery disease. This epidemiological link is supported by reliable biological evidence, showing that periodontal disease may unfavourably modulate the cardiovascular risk, whereby patients with periodontitis have increased frequency of overweight, hypertension, endothelial dysfunction, dyslipidaemia, platelet hyper-reactivity, and may also be characterized by a prothrombotic state. Apart from these critical atherogenic factors, translocation of periodontal microorganisms into the bloodstream, and their further accumulation within atherosclerotic plaques, would contribute to enhance plaque instability and the risk of developing acute ischemic coronary events. Interesting evidence is also emerging that local or systemic statins administration could be beneficial for safeguarding periodontal health, thus enlightening the intriguing relationship existing between CHD and periodontitis.
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http://dx.doi.org/10.1097/MBC.0000000000000928DOI Listing
September 2020

Role of Telemedicine and Smartphone for Distant Patient Management in Dentistry: The New Way of Triage.

J Int Soc Prev Community Dent 2020 May-Jun;10(3):376-378. Epub 2020 Apr 30.

Department of Surgical Sciences, Pediatrics, and Gynecology, University of Verona, Verona, Italy.

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http://dx.doi.org/10.4103/jispcd.JISPCD_6_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402248PMC
April 2020

Secondary Rhinoplasty in Binder Syndrome: Considerations and Management of Complex Problem With Heterologous Bone Graft.

J Craniofac Surg 2021 Jan-Feb 01;32(1):e5-e8

Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.

Abstract: Binder Syndrome occurs in less than 1 per 10,000 live births. Mean features of the syndrome include arhinoid face, abnormal position of the nasal bones, intermaxillary hypoplasia with associated malocclusion, reduced or absent anterior nasal spine, atrophy of the nasal mucosa and absence of the frontal sinus. Treatment of these facial deformities is obviously surgical. In the present work, the authors describe, step by step, their technique in secondary rhinoplasty in a 36-years-old patient affected by Binder Syndrome. In this case, the authors used autologous cartilage graft and heterologous bone graft.Satisfying results are achieved in 12 months of follow-up: graft resorption is acceptable, position of the graft is stable, the authors have no signs of infection and the patient is satisfied with the aesthetical and functional results. The authors believe that the first option, in complex nose's reconstruction, is the use of autologous grafts but, the use of cartilage heterologous bone graft should be taken in account, in the future, as a secondary option in Binder Syndrome and in malformed patients.
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http://dx.doi.org/10.1097/SCS.0000000000006789DOI Listing
July 2020

A Snapshot of Knowledge about Oral Cancer in Italy: A 505 Person Survey.

Int J Environ Res Public Health 2020 07 7;17(13). Epub 2020 Jul 7.

Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynaecology, University of Verona, 37134 Verona, Italy.

: Patients' knowledge about oral squamous cell carcinoma (OSCC) plays an important role in primary prevention, early diagnosis, and prognosis and survival rate. The aim of this study was to assess OSCC awareness attitudes among general population in order to provide information for educational interventions. : A survey delivered as a web-based questionnaire was submitted to 505 subjects (aged from 18 to 76 years) in Italy, and the answers collected were statistically analyzed. Information was collected about existence, incidence, features of lesions, risk factors of oral cancer, and self-inspection habits, together with details about professional reference figures and preventive behaviors. : Chi-square tests of independence with adjusted standardized residuals highlighted correlations between population features (age, gender, educational attainment, provenance, medical relationship, or previous diagnoses of oral cancer in family) and knowledge about oral cancer. : Knowledge about OSCC among the Italian population is limited, and it might be advisable to implement nudging and sensitive customized campaigns in order to promote awareness and therefore improve the prognosis of this disease.
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http://dx.doi.org/10.3390/ijerph17134889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370055PMC
July 2020

Nonsurgical Rhinoplasty With the Novel Hyaluronic Acid Filler VYC-25L: Results Using a Nasal Grid Approach.

Aesthet Surg J 2020 Jul 6. Epub 2020 Jul 6.

Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy.

Background: Nonsurgical aesthetic treatment of the nose is becoming increasingly popular. VYC-25L is a novel hyaluronic acid product with the high G' and cohesivity required of a nasal filler.

Objectives: To assess the safety and efficacy of VYC-25L for treatment of the nose using a previously published grid-based protocol.

Methods: This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the nose with VYC-25L between February and April 2019, using the grid system as the reference for injection quantity and sequencing. Specific procedures included correction of inadequate projection, deep glabella treatment, correction of a nasal hump, and adjustment of the nasolabial angle and columella. Patients were followed up for 6-9 months.

Results: Sixty-one patients were included in the analysis (mean age, 32 ± 3 years; n=45 females [74%]). At 2 weeks post-treatment, a high degree of defect correction was confirmed based on independent evaluation, with all patients scoring 9 or 10 on a 10-point Visual Analog Scale. Fifty-nine of 61 patients (97%) self-assessed the degree of correction as 'adequate'. Results were stable at 3- and 6-month follow-up visits. Complications recorded were bruising (n=15, 25%), asymmetry (n=2, 3%), and hematoma (n=1, 2%). All resolved rapidly. There were no cases of infection, bumps, or skin necrosis.

Conclusions: VYC-25L is safe and efficacious for treatment of the nose, with high levels of patient satisfaction. It has potential to be a valuable tool in nonsurgical rhinoplasty.
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http://dx.doi.org/10.1093/asj/sjaa196DOI Listing
July 2020

Can Surgical Management Improve Resolution of Medication-Related Osteonecrosis of the Jaw at Early Stages? A Prospective Cohort Study.

J Oral Maxillofac Surg 2020 Nov 1;78(11):1986-1999. Epub 2020 Jun 1.

Associate Professor, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Purpose: There is no clarity on which protocol is proper to use in the management of medication-related osteonecrosis of the jaw (MRONJ) at early stages (ie, stages 1 and 2) to halt disease progression. The aim of this study was to evaluate the success of surgical treatment in terms of time to mucosal integrity and downstaging in patients with MRONJ at early stages.

Materials And Methods: The study was implemented as a prospective, single-center cohort study. The sample included patients who presented at Magna Graecia University of Catanzaro with a clinical diagnosis of MRONJ and underwent surgical treatment. The primary predictor variables were gender, age, medical history, drug administration, MRONJ localization, trigger factors, and stage. The outcome variables were 1) time to mucosal integrity after surgery with time-to-event analysis and 2) time to downstaging of MRONJ lesions. Descriptive, bivariate, and regression statistics were performed.

Results: The study sample included 129 MRONJ patients (90 women and 39 men; mean age, 71.2 ± 12.7 years), of whom 57 had stage 1 and 72 had stage 2. The mean time to achieve mucosal integrity was 71.6 ± 67.7 days, considering the survival probability always to be 93% or greater. The mean time to achieve downstaging of the lesion was 43.6 ± 38.4 days. Patients older than 70 years, those affected by osteometabolic disorders, and those treated with oral antiresorptive therapy showed a significantly shorter time to mucosal healing and downstaging (P < .05). In patients with stage 2 MRONJ, we recorded a significantly longer time to mucosal integrity (56.4 ± 54.5 days) but shorter time to lesion downstaging (33.6 ± 9.9 days) than in patients with stage 1 MRONJ (P < .05).

Conclusions: Surgical treatment of patients in the early stages of MRONJ guarantees benefits in outcomes such as mucosal integrity and lesion downstaging, improvement in quality of life, and faster reuptake of medication therapy, especially for oncologic patients.
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http://dx.doi.org/10.1016/j.joms.2020.05.037DOI Listing
November 2020

Nonsurgical Redefinition of the Chin and Jawline of Younger Adults With a Hyaluronic Acid Filler: Results Evaluated With a Grid System Approach.

Aesthet Surg J 2020 Jun 27. Epub 2020 Jun 27.

Background: Aesthetic treatment of the lower face is increasingly in demand, particularly owing to age-related changes in appearance. VYC-25L is a novel hyaluronic acid filler with high G' and high cohesivity, specifically designed for sculpting and contouring of the chin and jaw.

Objective: To assess the use of grid traced onto the chin and jaw for guiding treatment with VYC-25L.

Methods: This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the lower third of the face with VYC-25L. A grid system of horizontal and vertical lines was used to systematize the process of treatment planning and performance.

Results: Thirty subjects were enrolled (53.3% female; mean age, 34.4 ± 2.8 years). The mean quantity of VYC-25L used was 4.0 ± 0.8 mL. Using the 5-point Global Aesthetic Improvement Scale, 29 patients (96.7%) rated their appearance at 20 days post-treatment as 'much improved' or 'very much improved'. The only complications recorded were early transient soft-tissue edema (n=14; 46.7%) and bruising (n=6; 20.0%). There were no cases of infection, paresthesia, asymmetry, hematoma, necrosis, or skin discoloration.

Conclusions: Treatment of the chin and jawline with VYC-25L, using a grid-based standardized approach, appears to be effective and safe with high rates of patient satisfaction. It offers a potentially high-impact approach for patients across a variety of biologic and economic circumstances.
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http://dx.doi.org/10.1093/asj/sjaa179DOI Listing
June 2020

Prevalence of PD-L1 expression in head and neck squamous precancerous lesions: a systematic review and meta-analysis.

Head Neck 2020 10 22;42(10):3018-3030. Epub 2020 Jun 22.

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.

Background: Studies concerning programmed death-ligand 1 (PD-L1) expression in precancerous lesions of head and neck (HN) region have shown variable results.

Methods: We systematically reviewed the published evidence on PD-L1 expression in HN precancerous lesions.

Results: Of 1058 original articles, 14 were included in systematic review and 9 in meta-analysis. The pooled estimate of PD-L1 expression was 48.25% (confidence interval [CI] 21.07-75.98, I 98%, tau2 0.18). PD-L1 expression appeared to be more frequent in precancerous lesions than in normal mucosa (risk ratio [RR] 1.65, CI 0.65-4.03, I 91%, tau2 0.82) and less frequent than in invasive squamous cell carcinoma (RR 0.68, CI 0.43-1.08, I 91%, tau2 0.22).

Conclusions: PD-L1 expression could reflect a point of balance between host immune response and cancer escape ability. High heterogeneity and moderate quality suggest that further studies with larger sample size and more rigorous case selection will allow more precise assessment of PD-L1 expression in HN precancerous lesions.
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http://dx.doi.org/10.1002/hed.26339DOI Listing
October 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

The worldwide burden of smoking-related oral cancer deaths.

Clin Exp Dent Res 2020 04 26;6(2):161-164. Epub 2019 Nov 26.

Service of Clinical Governance, Provincial Agency for Social and Sanitary Services, Trento, Italy.

Objectives: Although it is now established that cigarette smoking enhances the risk of oral malignancies, less is known on this epidemiologic interplay. Therefore, this brief report aims to provide an update on the worldwide burden of smoking-related deaths for lip and oral cavity cancers.

Material And Methods: We performed an electronic search in Global Health Data Exchange registry using the keywords "lip and oral cavity cancer" and "smoking," combined with "deaths," "year," and "location."

Results: Global mortality for lip and oral cavity cancers has considerably grown during the past three decades, exhibiting a 1.40-fold increase. Although up to one third (i.e.,30.5%) of worldwide deaths for these malignancies are still attributable to cigarette smoking, smoking-related mortality for oral malignancies has decreased during the past three decades. The impact of cigarette smoking on these deaths is lower (i.e.,18.7%, gradually decreasing) in Africa, whereby the burden is higher in Europe (i.e.,43.7%) and Western Pacific (40.9%, gradually escalating).

Conclusions: Despite recent policies of smoking dissuasion may have contributed to mitigating the negative impact of smoking on oral cancers, additional healthcare interventions shall be planned to reduce the still high mortality, especially in Western Pacific.
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http://dx.doi.org/10.1002/cre2.265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133730PMC
April 2020

Double free flaps in oral cavity and oropharynx reconstruction: Systematic review, indications and limits.

Oral Oncol 2020 05 24;104:104637. Epub 2020 Mar 24.

Otorhinolaryngology Unit, University Hospital AOUI Borgo Trento, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.

The simultaneous use of two different free flaps, harvested from distinct donor sites, has demonstrated a reasonable degree of safety and success rates in head and neck composite defects reconstruction. Unfortunately, their relatively low frequent use, together with the lack of proper statistics on their management strategies, make their indications weak of robust conclusions to better define their role in common practice. The aim of the present study was to review the literature of the last 15 years regarding simultaneous free flap transposition, presenting advantages, disadvantages, and results of this technique, with the final purpose to propose an up-to-date panorama for the use of double free flap for complex head and neck defects reconstruction. Depending on which factors are present, surgeons may choose to select an approach that is theoretically safer, but yields less-than-ideal functional outcomes, such as local flap. Two free flaps may be necessary when the defect contains both a large, complex bony defect, large soft tissue needs, and proper surgical planning and meticulous monitoring continues to be the cornerstone of success.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104637DOI Listing
May 2020

Updates on larynx cancer epidemiology.

Chin J Cancer Res 2020 Feb;32(1):18-25

Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona 37134, Italy.

Objective: Laryngeal cancer is an important oncologic entity, whose prognosis depends on establishing appropriate preventive and diagnostic measures, especially in populations at higher risk.

Methods: Epidemiologic information including worldwide incidence, prevalence, burden of health loss (disability-adjusted life year; DALYs) and mortality of larynx cancer was obtained from the Global Health Data Exchange (GHDx) database.

Results: The current incidence, prevalence and mortality of laryngeal cancer are estimated at 2.76 cases/year per 100,000 inhabitants, 14.33 cases/year per 100,000 inhabitants and 1.66 deaths/year per 100,000 inhabitants, respectively, averaging 3.28 million DALYs each year. Incidence and prevalence have increased by 12% and 24%, respectively during the past 3 decades, whilst mortality has declined by around 5%. The epidemiologic burden of this malignancy is approximately 5-fold higher in males and increases in parallel with ageing, peaking after 65 years of age. Both incidence and mortality rates are higher in Europe and lower in Africa, but the ratio between deaths and incidence is the highest in Africa. Incidence has gradually declined in Europe during the past 3 decades, whilst it has increased in South-East Asia and Western Pacific. Cigarette smoking and alcohol abuse contribute for about 90% of overall worldwide mortality for laryngeal cancer.

Conclusions: Laryngeal cancer still poses a high clinical and societal burden, with an escalating temporal trend not expected to reverse soon.
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http://dx.doi.org/10.21147/j.issn.1000-9604.2020.01.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072014PMC
February 2020

Malignant transformation evidences of Oral Lichen Planus: When the time is of the essence.

Oral Oncol 2020 May 14;104:104594. Epub 2020 Feb 14.

Department of Surgical Sciences, Paediatrics and Gynaecology, University of Verona, Policlinico G. B. Rossi, Piazzale L. Scuro n.10, 37134 Verona, Italy.

Oral Lichen Planus (OLP) is an inflammatory chronic disease, its potential of malignant transformation is widely known, especially for lesions affecting mucosa. This letter aims to highlight, thanks to results obtained from a long-term observation of one hundred patient suffering from OLP, the importance to set proper and sufficiently long follow-ups. An important evidence observed is the malignant developing after 4 years of observation in 4 cases of 8. This leads to conclude that follow-up for OLP lesions is required to be as long as possible in order to timeously intercept malignant transformations of these lesions and to perform a realistic early diagnosis. Final suggestion is to design more prospective studies based of long observation period.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104594DOI Listing
May 2020

Physical activity and laryngeal cancer.

Ann Transl Med 2019 Dec;7(23):791

Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.

Although an active lifestyle physical has been convincingly associated with a decreased risk of developing many forms of cancers, including neck and head malignancies, uncertainty surrounds the relationship between physical activity (PA) and laryngeal carcinogenesis. Epidemiologic evidence, garnered from some well-conducted cross-sectional, prospective and retrospective studies, seemingly attests that the impact of PA may be not so straightforward in lowering laryngeal cancer risk as for other malignancies. Reasonable consensus has been reached that moderate-intensity PA may generate the larger potential benefits, whilst the effect of high-intensity PA appears more controversial and even contradictory. This is mainly attributable to the fact that moderate PA may have more favorable effects than high-intensity exercise in decreasing the impact of some risk factors of laryngeal cancer such as metabolic syndrome, cigarette smoking, inflammation, and gastroesophageal reflux disease. Significant biological and psychological benefits from moderate-intensity exercise have also been described in patients surviving from primary laryngeal cancers. This would hence lead us to conclude that promotion of an active lifestyle, characterized by performance of moderate-intensity PA (e.g., between 3 and 6 metabolic equivalents, equaling short distance running), may be beneficial for lowering the risk of developing laryngeal cancer and for improving the quality of life of larynx cancer survivors.
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http://dx.doi.org/10.21037/atm.2019.11.65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990019PMC
December 2019