Clinical Evaluation of the Optical Filter for Autofluorescence Glasses for Oral Cancer Curing Light Exposed (GOCCLES®) in the Management of Potentially Premalignant Disorders: A Retrospective Study.

BACKGROUND: Any oral potentially malignant disorders (OPMDs) must be regularly monitored through clinical examination to detect any possible malignant transformation. Conventional intraoral exams, however, can be difficult because these conditions may resemble benign lesions. For this reason, several non-invasive diagnostic technologies have been developed to help the clinician in detecting and distinguishing between cancerous and benign lesions. Epithelial dysplasia can be considered the most important predictor of malignant evolution. Therefore, in this study we aim to evaluate the ability of an optical filter for autofluorescence Glasses for Oral Cancer Curing Light Exposed (GOCCLES®) and of toluidine blue staining in identifying dysplastic areas in patients with OPMDs. METHODS: In this retrospective study, medical records, photographs and videos of 25 patients with oral lesions were analyzed. Forty-two biopsy samples in 25 patients with OPMDs and at least one suspicious oral mucosa lesion that were evaluated in white light, autofluorescence with optical filter GOCCLES®, toluidine blue staining and then biopsied with histopathological analysis were analyzed. RESULTS: The sensitivity and specificity for the autofluorescence evaluation with GOCCLES® for identifying dysplasia or carcinoma were 66% and 48%, respectively. The positive and negative predictive values were 34% and 77%, respectively, and the accuracy was 53%. The sensitivity and specificity for toluidine blue staining were 91% and 68%, respectively. The positive and negative predictive values were 55% and 95%, respectively, and the accuracy was 75%. CONCLUSIONS: The optical filter for autofluorescence (GOCCLES®) and toluidine blue staining are simple, inexpensive, rapid and non-invasive procedures that can assist the clinician in distinguishing OPMDs from healthy mucosa but they are not able to distinguish benign and malignant lesions.

Use of an Oral Device in the Stabilization of Facial Advancement after Early Removal of the Osteodistraction Device for Postoperative Sequelae.

The aim of this study is to present an oral device that improves splanchnocranium stability after osteodistraction in children treated for correction of craniofacial malformations. When removal of the distraction device before the end of the treatment is necessary, the reposition of a new fixation system might not be possible. In these cases, regrown bone is immature, and relapse of malformation occurs frequently. We have been treating these cases by the application of an oral device named Maxillary Advancement Contention (MAC). MAC is used in every patient when any complication interrupts the protocol of osteodistraction before the end of the stabilization time. The device is placed immediately after the removal of the distraction device and left in place for at least three months. We used MAC in six children surgically treated for correction of craniosynostosis with facial or craniofacial advancement. To establish the relapse of malformation we analyzed relations Sella-Nasion-Orbitale (SNOr) and Sella-Nasion-A point (SNA) angles before application of the MAC and after one year. The analysis of stability was excellent in every patient. This device might help, with a minimally invasive procedure, to maintain the obtained advancement allowing stabilization of the regrown bone.

Monolithic CAD-CAM lithium disilicate versus monolithic CAD-CAM zirconia for single implant-supported posterior crowns using a digital workflow: A 3-year cross-sectional retrospective study.

STATEMENT OF PROBLEM: Dentistry has evolved significantly with the introduction of digital technologies and materials; however, clinical evidence for the performance of the complete digital workflow for single implant-supported posterior crowns is lacking. PURPOSE: The purpose of this cross-sectional retrospective clinical study was to compare the clinical outcomes of 2 types of implant-supported crown used to replace a single missing posterior tooth in a completely digital workflow: transocclusal screw-retained monolithic lithium disilicate crowns versus transocclusal screw-retained monolithic zirconia crowns. MATERIAL AND METHODS: A total of 38 participants who had been provided with dental implants and transocclusal screw-retained monolithic lithium disilicate or zirconia single crowns were evaluated in the study. Clinical and esthetic outcomes were recorded after a 3-year follow-up. RESULTS: Both groups had comparable clinical outcomes with a survival rate of 100%. In the lithium disilicate group, 89% of the participants were free of technical complications, and 95%, in the zirconia group. Only 1 patient experienced minor chipping affecting a lithium disilicate crown. All complications were considered minor and were easily resolved, and none of the participants required replacement of a crown. No biological complications were recorded in either group. CONCLUSIONS: Within the limitations of this cross-sectional retrospective clinical study, monolithic lithium disilicate and zirconia screw-retained single crowns fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM) and a fully digital workflow were found to be reliable and suitable clinical options for restoring a posterior missing tooth on a dental implant.

Use of Navigation System in Craniofacial Surgery.

The use of navigated surgery in the treatment of craniofacial malformations can help obtain optimal results. In this article, the authors will discuss a case of anterior plagiocephaly, corrected with frontorbital bandeau remodeling. Navigation was used during the osteotomy and the reposition phase to ensure the correct positioning of the osteotomy instruments. It was also used to ensure that the bandeau was correctly repositioned in accordance with the surgical plan determined during the virtual simulation phase of the surgery.

The Rules of Attractiveness: A Study on the Lower Facial Third.

What is considered attractive may not fall into the "norm," and it can vary from culture to culture and depending on the historical time, for this reason the standard cephalometric and antropometric references may not be sufficient in these cases.Lately some techniques have arose to popularity that are aimed to changing the frontal and lateral aspect of the facial lower third, such as V-line or the Chin-Wing Osteotomy technique, but no reference system exists at the moment to define to which extent a modification of the lower third falls within what is considered beautiful, and everything is left to the patient's will or to the surgeon's sensitivity.The aim of this article is to study which antropometric value is considered attractive by the most for what concerns the frontal shape of the lower third of the face.Twenty-four female models were enrolled in this study and the angle taken into consideration was the one at the intersection between the 2 lines connecting the cutaneous gonial angle of each side of the face and the most external part of the chin on the same side. Measures were made on pictures in frontal view.Two hundred two random examiners were asked to see the pictures and rate them as attractive or nonattractive.Results were then paired with the angles values.Among the models the higher angle measured was 107.5° (found in 1 individual) while the lower angle was 76° (found in 1 individual), the average measure calculated was 88.3° while the median angle was 89.5°.According to the result the subjects considered more attractive were those with an angle between 84.5 and 91.5 (92 for male examiners).This could be an important starting point for studies who can evaluate attractiveness from a numerical point of view.

The Use of Ropivacaine in Therapeutic Treatment of Oral Aphthosis.

The use of anaesthetic drugs in the treatment of oral aphthosis is one of the pharmaceutical possibilities that a doctor can use for the most painful forms. Normally, Lidocaine or Diclofenac is used to treat this disease, but they can be used for a very limited time and so they are of little practical use. In this study, the authors have used Ropivacaine whose pharmaceutical kinetics allows the analgesic effect to be active for 60 to 90 minutes. In our research, we compared 8 groups of patients who have been given 3 principal pharmaceutical products: one group was given an anaesthetic drug, one had a topical medication administered which is often used for the treatment of aphthous lesions, and the last group was given a multivitamin. These pharmaceutical products were used alone and in various possible combinations in the 8 groups. The results of this study are very interesting and show that in all the groups that used anaesthetics there was more satisfaction on the patients' part because their pain level became more manageable right after the first application of the drug and the patients could carry on with their normal lives.

Navigation System Approach in Zygomatic Implant Technique.

In some patients, the resolution of severe maxillary atrophies can be hardly achieved without the use of zygomatic implants. Although many scientific studies have already demonstrated the excellent immediate stability in long term, the use of zygomatic implants is not yet widespread. Among the complications of this technique, the most threatening is the risk of damaging the eyeball or the maxillary nerve.The use of the navigator system as a surgical aid for implant placement allows to control, at any time, the position of the drill in the bone, avoiding any injury to ocular and nervous structures. The authors present a clinical report which shows a patient affected by a very severe form of post-traumatic maxillary atrophy that has been solved through the of zygomatic implants placement using the "Implant Bone Navigation" system. This procedure allows both to cut down the risks on ocular and nervous structures of the maxilla and also to reach excellent rehabilitation results in such severely compromised patients.

Use of N-Butyl-2-Cyanoacrylate (Glubran2(®)) in Fractures of Orbital-Maxillo-Zygomatic Complex.

INTRODUCTION: Fractures of the orbital-maxillo-zygomatic complex are among the most common fractures affecting the facial skeleton. Goal of surgical treatment is the realignment of fracture lines for a complete functional and aesthetic rehabilitation. MATERIALS AND METHODS: From January 2008 to January 2011 in the Department of Maxillofacial Surgery of Complesso Integrato Columbus of the Università Cattolica del Sacro Cuore in Rome, 25 patients, affected by comminute fractures of the anterior wall of the maxillary sinus associated with fractures of the orbital-maxillary complex were selected. The synthesis of the larger fracture fragments was performed by plates and screws (1.5 mm) while a biocompatible glue (N-Butyl-2-Cyanoacrylate-Glubran2(®)) was applied to treat the comminute fractures of the anterior wall of the maxillary sinus. RESULTS AND CONCLUSION: The aim of our article is to report our experience and a review of the literature on application of-Butyl-2-Cyanoacrylate for treatment of comminute fractures of the anterior wall of the maxillary sinus. According to the results achieved in our study the N-Butyl-2-Cyanoacrylate can be indicated to treat comminuted fractures of the anterior wall of the maxillary sinus which could not easily be treated with internal rigid fixation.

OSAS surgery and postoperative discomfort: phase I surgery versus phase II surgery.

INTRODUCTION: This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. MATERIAL AND METHODS: A pool of 46 patients affected by OSAS was divided into two groups: "surgery patients" who accepted surgical treatments of their condition and "no surgery patients" who refused surgical procedures. The "surgery patients" group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and "no surgery" group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. RESULTS: The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. CONCLUSION: IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

Long term follow-up in inferior alveolar nerve transposition: our experience.

INTRODUCTION: Inferior alveolar nerve transposition (IANT) is a surgical technique used in implantoprosthetic rehabilitation of the atrophic lower jaw which has not been well embraced because of the high risk of damage to the inferior alveolar nerve (IAN). There are cases in which this method is essential to obtain good morphologic and functional rebalancing of the jaw. In this paper, the authors present their experience with IANT, analyzing the various situations in which IANT is the only surgical preprosthetic option. METHODS: Between 2003 and 2011, 35 patients underwent surgical IANT at our center. Thermal and physical sensitivity were evaluated in each patient during follow-up. The follow-up ranged from 14 to 101 months. RESULTS AND CONCLUSION: Based on our experience, absolute indications of IANT are as follows: (1) class IV, V, or VI of Cawood and Howell with extrusion of the antagonist tooth and reduced prosthetic free space; (2) class V or VI of Cawood and Howell with presence of interforaminal teeth; (3) class V or VI of Cawood and Howell if patient desires fast implantoprosthetic rehabilitation with predictable outcomes; (4) class VI of Cawood and Howell when mandibular height increase with inlay grafts is advisable.

Giant neglected desmoplastic ameloblastoma: reconstruction with free fibula flap.

The desmoplastic ameloblastoma (DA) is a rare variant of the conventional ameloblastoma. It accounts for only 4% to 13% of all ameloblastomas. In this article, we describe the case of a young child affected by a giant neglected DA of the jaw. Preoperative biopsy demonstrated the extremely rare osteoplastic variant of DA. The patient was submitted to segmental mandibulectomy and immediate reconstruction with a free fibula osseous flap. The postoperative period was uneventful. The patient was very satisfied with the functional and aesthetic results of the procedure. In case of such rare variants of ameloblastoma, it is mandatory to preoperatively recognize them to allow the adequate treatment modality to be provided.

Clinical evaluation of obstructive sleep apnea in children.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is often found in children affected by congenital or acquired craniomaxillomandibular malformations. This disease carries different levels of risk, ranging from attention problems at school to growth problems and serious disorders, such as cor pulmonale or sudden infant death. The examination that is most commonly used to evaluate the severity of OSAS is polysomnography, and the therapeutic course is often determined by the disease state. Considering the discrepancy between clinical history and polysomnographic findings, we felt the need to identify an instrument for evaluating OSA to be used as a support for polysomnography. MATERIALS AND METHODS: This study was carried out on pediatric patients affected by congenital or acquired craniomaxillofacial malformations. We selected 34 pediatric patients, including 15 boys and 19 girls, aged between 1 and 16 years, with a mean age of 7.3 years. The study consisted of individuation of common clinical history data obtained from each patient and associating those data with the level of OSA severity identified by polysomnography. We were able to isolate certain symptoms and signs that can be predictive of OSA from research in the literature and our clinical experience with pediatric patients. In the clinic, we have found that the clinical history, given by the parents, often differs significantly from the instrumental findings obtained with polysomnography. From the previously expressed considerations and comparison of clinical history data and questionnaires, we have extracted the most significant questions for our questionnaire, which are present in the literature but formulated for adults. RESULTS AND CONCLUSIONS: The obstructive airway child test was found to be a very efficient method to evaluate and diagnose OSA. In all patients, it consistently revealed the pathology and never underestimated OSA severity. The examination focuses on clinical signs and symptoms because, in our opinion, clinical history, reported by the parents, can be more accurate than any instrumental examination.

Three-dimensional analysis and treatment planning of hemimandibular hyperplasia.

INTRODUCTION: The advent of computed tomography (CT) provided a useful instrument for diagnosis and surgical treatment of patients with craniofacial malformations. The development of software for three-dimensional graphic simulation applied to CT scan has made possible the three-dimensional computerized analysis, surgical planning, and simulation. This kind of analysis is particularly useful in case of complex facial malformations, making reliable a surgical treatment in 1 step. The purpose of this report was to present the diagnosis and treatment planning on a patient with hemimandibular hyperplasia by three-dimensional cephalometric analysis. METHODS: A 20-year-old young woman who presented with hemimandibular hyperplasia was investigated with CT scan and plaster cast mounted on an articulator; a two-dimensional manual and computerized cephalometric analysis was also developed on frontal and lateral cephalograms. Images in DICOM format were processed on a PC by means of commercial software, thus obtaining the three-dimensional reconstruction of the skeletal structures. RESULTS: Three-dimensional CT permits to program skeletal corrections and to foresee surgical outcomes with adequate realism. Surgical planning based on three-dimensional CT makes it easy and reliable to achieve the correction of the malformation in a single surgical intervention. CONCLUSIONS: The virtual three-dimensional CT model, a versatile diagnostic aid, has proven to be effective in the exact reproduction of bone and soft tissue anatomy, thus helping in the diagnosis, surgical planning, and simulations. Three-dimensional analysis is particularly indicated in case of complex asymmetric malformations, in which the more accurate reproduction of the individual anatomy can be very useful in implementing surgical results.

Hilotherm efficacy in controlling postoperative facial edema in patients treated for maxillomandibular malformations.

BACKGROUND: A cooling system based on polyurethane preshaped masks for postoperative cryotherapy, named Hilotherm, has been recently introduced. The purpose of this study was to evaluate the effectiveness of this equipment in controlling postoperative edema and compare the results with those obtained with a group treated with conventional cryotherapy and a group not treated with cryotherapy. METHODS: Ninety patients were included in this randomized controlled trial. The 90 patients were divided into 3 groups. Group A was treated with Hilotherm. Group B was treated with conventional cryotherapy. Group C was not treated with cryotherapy. Using a tape measure, we measured for both sides of the face the distances in centimeters between point 0 and external canthus ([alpha]), most lateral point on the ala of the nose ([beta]), commissura labialis ([gamma]), and Pos ([delta]). We performed a Kruskal-Wallis test comparing the average variation of edema on the right and left sides of the face for each facial segment of patients of the 3 groups from time 0 to time 24 hours. RESULTS: No cryotherapy is the worst treatment for every segment studied. In anatomic regions defined [beta], [gamma], and [delta], Hilotherm was more effective in containing edema than the ice pack 24 hours after the first measurement. Opposite results were seen on district [alpha], the site not completely enclosed in the mask. CONCLUSIONS: The substantial difference between different treatments probably consisted in the greater reliability of the Hilotherm system, which is characterized by easy handling, constant temperature control, comfort, and practicality of the masks.

Retrobulbar lipofilling to correct the enophthalmos.

In this article, we describe an alternative procedure to restore the retrobulbar volume in enophthalmic patients. We report the case of a patient with a late enophthalmos we submitted to retrobulbar lipofilling to correct the defect. The preoperative assessment and the surgical technique are described in detail. The volume of fat injected was 3.2 mL, with a satisfying increase in exophthalmometry measurements. The procedure was well tolerated without complications. Retrobulbar lipofilling for enophthalmos appears to be a safe alternative technique for orbital volume enhancement. It avoids the use of alloplastic materials and allows to obtain good cosmetic results with an easy technique and minimal donor-site morbidity.

Nasal and ethmoidal alterations in anterior synostotic plagiocephaly.

BACKGROUND: Nasal deviation plays an important role in plagiocephaly nosography, and it is frequent in plagiocephaly and objectivable both in early treated patients and in those patients who did not undergo any surgical correction. PATIENTS AND METHODS: The group analyzed consisted of 12 patients affected by anterior synostotic plagiocephaly. All of them had reached the end of growth. A morphological analysis was made by using anthropometry. All patients were asked to undergo computed tomography, and all the scans were then reconstructed into three-dimensional models using a dedicated software. We made two-dimensional assessments on coronal and axial slices, and three-dimensional reconstruction was used to evaluate the volumetry of ethmoidal cells. RESULTS AND DISCUSSION: From anthropometry, we realized that, in all patients, not only that the tip of the nose is deviated to the not affected side but also that the root itself does not lie on the midline and it is tilted to the synostotic side. Analysis of the computed tomographic scan results shows that the ethmoid bone, as much as the vomer and the upper maxilla, is deeply involved in these nasal abnormalities, presenting a deviated position and an altered development. CONCLUSIONS: We concluded that nasal morphology in plagiocephaly is strictly related to basicranium dysmorphism.

Zygomatic sagittal split osteotomy: a novel and simple surgical technique for use in midface corrections.

BACKGROUND: The correction of many craniofacial malformations requires the improvement and stabilization of the midface area. In this article, we present a simple surgical technique for improving and correcting the orbitozygomatic area. This technique is called zygomatic sagittal split osteotomy (ZSSO). METHODS: Between September 2003 and June 2008, we performed ZSSO on 12 patients. The technique is described in the article. We performed a clinical evaluation of the technique using the following criteria: postsurgical complications, loss of stability, and sagittal prominence. In addition, a radiologic evaluation was performed on axial computed tomographic images. We considered a 1-year follow-up. RESULTS: We performed 15 ZSSO procedures. No evidence of postsurgical complications, loss of stability, or sagittal prominence was reported during the 1-year follow-up. CONCLUSIONS: Zygomatic sagittal split osteotomy is a simple surgical technique to be used in the correction and stabilization of the midface area. It can be performed without using graft or osteodistraction device.

Autofluorescence and early detection of mucosal lesions in patients at risk for oral cancer.

Loss of autofluorescence as an early phenomenon associated with tissue degeneration seems to be promising for the diagnosis of oral cancer. The method seems to make visible early structural and biochemical alterations of the oral mucosa not always evident under direct inspection of the oral cavity. For this reason, the margins of the mucosal lesions usually appear wider compared with direct visualization. Actual extension of the potentially malignant lesions must be precisely perceived to avoid any underestimation of the tumor. In this study, 32 patients at risk for oral cancer underwent autofluorescence test. Of these patients, 12 (group A) experienced potentially malignant diseases. The other 20 patients (group B) were previously operated on for oral cancer. In addition, 13 patients showed loss of autofluorescence (8 patients from group A and 5 patients from group B). Among these 13 patients, 12 were affected with lesions of relevance (in group A, 6 had squamocellular carcinoma and 2 had low-grade dysplasia; in group B, 2 patients had high-grade dysplasia, 2 had low-grade dysplasia, and 1 had an epithelial hypertrophy with inflammatory cells). Preliminary results seem to indicate that autofluorescence is a high-performing test for the individuation of oral cancer in populations at risk (sensibility up to 100% and specificity up to 93% in this study).

Techniques on modeling the vascularized free fibula flap in mandibular reconstruction.

In mandibular reconstruction with bone grafts, the functional and aesthetic outcomes are clearly influenced by reconstructive techniques. Vascularized free fibular flaps are considered the most suitable choice for mandible reconstruction because of their good aesthetic and functional outcomes. Several techniques have been described in literature. According to various authors, shaping of the fibular graft can be performed by means of computer-aided design/computer-aided modeling procedures for the evaluation of the presurgery anatomy and three-dimensional models of fibula graft. However, these models are expensive, require a strict realization of the programmed intervention, and are not easily adaptable to a surgical treatment different from the planned one. We report our experience on a technique for mandibular reconstruction using a free fibular flap, obtained by modeling a template on the resected mandible. Our operative technique consists of 5 steps: preplating, resection, template modeling, contouring of the fibula, and fixing the flap on the mandible.Template modeling is performed to record the length of the resected bone, the mandibular curvature on the 3 space planes, and the width of the basal bone. On the basis of the template, the fibula flap was modeled while still attached to the pedicle. The plates, positioned at the level of the fibular osteotomies, were preformed to make the fibula precisely fit in the template. Once the fibula was shaped, mandibular reconstruction was completed by positioning the fibula graft on the mandibular stumps. Bone graft modeling by means of template is a rapid, safe, and flexible method to reconstruct the mandible.

BaS analysis: suggesting a new cephalometric model in follow-up of patients with craniostenosis who underwent craniofacial advancement surgery after 1 year from the end of the distraction protocol.

Evaluation of the relapse in patients with craniofacial malformation who underwent craniofacial advancement surgery is very difficult, and data are often unreliable. This is because common skeletal landmarks move from their original position, making standard cephalometries completely useless. To solve this problem, some authors proposed evaluations based on 2- and 3-dimensional computed tomographies, but the biologic risk and the economic outcome do not consent to repeat this kind of examination too often. In this paper, the authors propose a new cephalometric model based on the evaluation of facial skeletal landmarks on the BaS axis. This method, named BaS analysis, might be useful in evaluating improvements of the splanchnocranium in patients who underwent craniofacial advancement.