Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial.

BACKGROUND: Postoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient's quality of life. PURPOSE: The study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field (PEMF) therapy following M3 removal and compares it to patients who did not receive PEMF. STUDY DESIGN, SETTING, SAMPLE: The single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES: The predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy. MAIN OUTCOME VARIABLES: The pain was quantified using a 100 mm visual analog scale and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the visual analog scale and the number of analgesic tablets taken. COVARIATES: The study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s. ANALYSES: Student's t test was used, placing the statistical significance for P value < .05. The primary planned analysis was a 2-group, continuity-corrected, χ2 test of equality of proportions. RESULTS: The study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a P value = .0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a P value = .0062). CONCLUSIONS AND RELEVANCE: The study's results attest to the effectiveness of PEMF therapy in pain control after M3 surgery.

Orbital fractures treated in a university hospital of southern Italy: epidemiology, outcomes and prognostic factors resulting from 538 retrospectively analyzed cases.

PURPOSE: Orbital fractures are common injuries and represent an interesting chapter in maxillofacial surgery. This retrospective study analyses data collected from 528 patients surgically treated at the University Hospital "Magna Graecia", Catanzaro, Italy, from 1st January 2007 to 31st January 2021. METHODS: The inclusion criteria were a diagnosis of orbital bone fracture, complete clinical and radiological records, and a minimum follow-up of 12 months. We analyzed gender, age, etiology, fracture type, treatment, timing of repair, and associated complications. RESULTS: The most frequent cause of trauma was road accidents (37.88%), followed by domestic accidents (25.95%). The manifestation of diplopia (72.35%), infraorbital nerve hypoesthesia (53.41%), extrinsic eye movement limitation (51.70%), and enophthalmos (41.29%), determined the indication for surgery. Our trauma team preferred the sub-eyelid approach (79.36%). The study shows a statistical significance in the correlation between the severity of the herniation of the lower rectus muscle and the presence of preoperative diplopia (p-value = 0.00416); We found the same statistical significance for the post-postoperative diplopia (p-value = 0.00385). Patients treated two weeks after the trauma show a higher rate of diplopia and a greater limitation of long-term post-operative eye movements than those treated within two weeks (diplopia 23.08% vs. 15.56%; eye movements limitation 13.33% vs. 7.69%). Early surgical treatment (> 14 days) reduces the likelihood of functional and structural damage to the lower rectus muscle. CONCLUSION: Our data will support future maxillofacial traumatology studies, and the education and prevention measures taken will reduce the incidence of orbital trauma.

SOX2 promotes a cancer stem cell-like phenotype and local spreading in oral squamous cell carcinoma.

Emerging evidence shows that oral squamous cell carcinoma (OSCC) invasiveness can be attributed to a small subpopulation of cancer stem cells (CSCs) in the bulk of the tumor. However, the presence of CSCs in the OSCC close resection margins is still poorly unexplored. Here, we found that BMI1, CD44, SOX2, OCT4, UBE2C, CXCR4 CSCs marker genes are significantly upregulated, while IGF1-R, KLF4, ALDH1A1, CD133, FAM3C are downregulated in the tumor core vs healthy mucosa of 24 patients with OSCC. Among these, SOX2 appears also upregulated in the tumor close margin vs healthy mucosa and this significantly correlates with tumor size and lymph node compromise. In vitro analyses in CAL27 and SCC15 tongue squamous cell carcinoma cell lines, show that SOX2 transient knockdown i) promotes the mesenchymal-to-epithelial transition, ii) smooths the invasiveness, iii) attenuates the 3D tumor sphere-forming capacity, and iv) partially increases the sensitivity to cisplatin treatment. Overall, our study highlights that the OSCC close margins can retain CSC-specific markers. Notably, SOX2 may represent a useful CSCs marker to predict a more aggressive phenotype and a suitable target to prevent local invasiveness.

Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients.

PURPOSE: The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic. METHODS: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed. RESULTS: The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Design and Simulate Intracranial Support to Guide Maxillo Surgery: A Study Based on Bioengineering.

BACKGROUND: Intraoperative navigation allows for the creation of a real-time relationship between the anatomy imagined during diagnosis/planning and the site of surgical interest. This procedure takes place by identifying and registering trustworthy anatomical markers on planning images and using a point locator during the operation. The locator is calibrated in the workspace by placing a Dynamic Reference Frame (DRF) sensor. OBJECTIVE: This study aims to calculate the localization accuracy of an electromagnetic locator of neuro-maxillofacial surgery, moving the standard sensor position to a different position more suitable for maxillofacial surgery. MATERIALS AND METHODS: The upper dental arch was chosen as an alternative fixed point for the positioning of the sensor. The prototype of a bite support device was designed and generated via 3D printing. CT images of a skull phantom with 10 anatomical landmarks were acquired. The testing procedure consisted of 10 measurements for each position of the sensor: precisely 10 measurements with the sensor placed on the forehead and 10 measurements with the sensor placed on the bite support device. It also evaluated the localization error by comparing the two procedures. RESULTS: The localization error, when the sensor was placed on the bite support device, was lower in the sphere located on the temporal bone. It was the same in the spheres located on the maxillary bone. The test analysis of the data of the new device showed that it is reliable; the tests are reproducible and can be considered as accurate as the traditional ones. In addition, the sensor mounted on this device has proven to be slightly superior in terms of accuracy and accuracy in areas such as the middle third of the face and jaw. DISCUSSION AND CONCLUSION: The realization of the bite support device allowed the sensor to change position concerning its natural site. This procedure allows us to explore structures, such as the frontal site, which were initially difficult to approach with neuronavigation and improves the approach to midface structures, already studied with neuronavigation. The new calibration, with the position of the sensor on the support device in the same reference points sphere, highlighted the reduction in the location error. We can say that the support proposed in this study lays the foundations for a new navigation approach for patients in maxillofacial surgery, by changing the position of the sensor. It has strong points in improving the localization error for some reference points without determining disadvantages both in the calibration and in the surgical impediment.

Apocrine adenocarcinoma of the head and neck district: Our experience with two cases.

INTRODUCTION: Apocrine adenocarcinoma (AA) is a rare gland cancer that appears in the elderly, especially males. Surgery is considered the first option for the management of this tumor. CASE PRESENTATION: We report two cases of AA that occurred at our Unit of Maxillofacial Surgery. Precisely a case of a woman with AA with a usual presence at the eyelid level and a case of a man with AA with an unusual presence at the neck level. DISCUSSION: This cancer generally arises in some specific areas of the body that present high concentrations of apocrine glands (such as in Case No.2). But it can also occur in less typical areas, such as the neck (such as in Case No.1). CONCLUSION: We discuss the surgical management of our cases: both based on our experience and literature data, we recommend extensive surgical excision.

Unusual presentation of pulmonary adenocarcinoma metastases in the mandibular condyle: A case report.

INTRODUCTION: Mandibular bone metastases should be suspected in all patients with temporomandibular joint disorder symptoms and lung cancer history. The purpose of this report is to present a case of metastasis to the mandibular condyle following pulmonary adenocarcinoma. CASE PRESENTATION: In December 2020, a 71-year-old patient was evaluated by the Department of Maxillofacial Surgery for the presence of a large osteolytic lesion in the left mandibular condyle. There were no changes to the face or occlusion, and mandibular movements were preserved. After surgical removal, histology revealed pulmonary adenocarcinoma metastasis. DISCUSSION: To date, only 7 cases of condylar metastases are described by lung cancer. This pathology's clinical and radiological features are almost always shaded and not specific. CONCLUSION: This study also focuses on rare conditions, such as metastases to the mandibular condyle. It also stresses the importance of a multidisciplinary approach both in the diagnostic and therapeutic process.

The Correlation between Oral Lichen Planus and Thyroid Pathologies: A Retrospective Study in a Sample of Italian Population.

OBJECTIVES: The association between oral lichen planus and thyroid disorders, especially hypothyroidism and Hashimoto's thyroiditis, has been discussed in current literature with conflicting outcomes. MATERIALS AND METHODS: The study retrospectively evaluated the thyroid status in patients diagnosed with oral lichen planus and oral lichenoid lesions. A case-control approach was used to prove that thyroid disorders were statistically significant risk factors for oral lichen planus and oral lichenoid lesions. STATISTICAL ANALYSIS: To evaluate these associations, odds ratios (ORs) were used. ORs precision and statistical significance were estimated using a 95% confidence interval (CI) and p-value, respectively. RESULTS: A total of 307 patients were involved in the study: 158 females and 149 males. OR, 95% CIs, and p-values were analyzed. Patients with thyroid diseases showed an increased risk of developing oral lichen planus (OR: 4.29, 95% CI: 1.85-9.96, p-value: 0.0007) and oral lichenoid lesions (OR: 2.76, 95% CI: 1.24-6.13, p-value: 0.0129). This association was maintained in patients with oral lichen planus, while also considering hypothyroidism (OR: 3.74, 95% CI: 1.46-9.58, p-value: 0.0059) and Hashimoto's thyroiditis (OR: 4.57, 95% CI: 1.58-13.23, p-value: 0.005) alone. The correlation of hypertension, diabetes, dyslipidemia, and smoking status with oral lichen planus and oral lichenoid lesions was also evaluated but no statistical significance was found. CONCLUSION: Even if further investigations are needed, the association between oral lichen planus and oral lichenoid lesions with thyroid pathologies should be taken into consideration by endocrinologists due to the potential malignancy of these disorders.

An Unusual Asymptomatic Case of Unilateral Parotid Gland Agenesis.

Congenital absence of the major salivary glands, especially of the parotid gland, is a very infrequent condition of poorly understood etiology. This condition may be unilateral or bilateral and may occur alone or in association with the absence of other salivary glands or with other developmental craniofacial deformities of maxillofacial first and second branchial arch. Only 24 cases are documented in the literature. The authors present a case of a 79-year-old female who was referred to the Neurosurgery Department for neurocognitive impairment. The brain computed tomography with contrast enhancement incidentally showed a complete absence of the left parotid gland. The medical history and physical and radiographic examinations were indicative of nonsyndromic and nonfamilial asymptomatic unilateral aplasia of the parotid gland.

A rare case of secondary ameloblastic carcinoma in a young Man.

Ameloblastic carcinoma is a rare and aggressive malignant odontogenic tumour that can arise de novo or from a preexisting benign lesion. It most frequently involves the mandible, and its clinical course is aggressive with extensive local destruction. Although rare, these lesions have been known to metastasize, mostly to regional lymph nodes or lungs. Surgical therapy, eventually followed by radiotherapy, is the treatment modality most frequently used, while the role of chemotherapy remains unclear. Here we present a case of secondary ameloblastic carcinoma of the mandible in a 33-year-old male patient with typical aggressiveness and extensive local destruction and metastasis with a follow-up period of 93 months. KEY WORDS: Ameloblastic Carcinoma, Head and Neck Cancer, Maxillofacial Surgery, Oncological Surgery.

Electrochemotherapy as an Effective Alternative in the Treatment of Local Advanced Oral Squamous Cell Carcinoma: A Retrospective Analysis of Treated Cases.

Advanced oral squamous cell carcinomas represent a major challenge for maxillofacial surgeons, oncologists and radiation therapists. They also account for a large share of healthcare costs. They respond little and/or poorly to conventional therapies (surgery, radiotherapy and chemotherapy). Electrochemotherapy is a new method used as a palliative treatment in patients with advanced cancer of the neck/head region who are not eligible for standard therapies. It combines the use of cytotoxic drugs with the physical principle of electroporation; it effectively controls the tumour locally and preserves organ function. To date, ECT has been little used for oral mucosal tumours, as this is difficult to access for electrodes. We report six cases of advanced oral squamous cell carcinoma treated with electrochemotherapy. This study aims to assess the debulking effect of cancer via ECT in patients with advanced oral squamous cell carcinoma. It also aims to assess the safety and tolerability of this treatment.

Extra-Nodal Lymphomas of the Head and Neck and Oral Cavity: A Retrospective Study.

Disease Overview: Lymphomas, both Hodgkin's and non-Hodgkin's lymphomas, are one of the most common cancers in the head and neck area. The extra-nodal variant of lymphoma is rare, but it is the most common non-Hodgkin's lymphoma (ENHL). Furthermore, it is difficult to diagnose due to its non-specific clinical and radiological features, which can mimic other benign or malignant clinical manifestations. The study: This retrospective study involved 72 patients affected by head and neck ENHL in the period between 2003 and 2017. All patients underwent a diagnostic-therapeutic procedure according to the guidelines, and a 5-year follow-up. Based on the location of the swelling at the time of diagnosis, patients were divided into two groups: oral and non-oral ENHLs. Statistical analysis was performed using Kaplan-Meier analysis with the log-rank test. In addition, Fisher's exact test was applied to the two groups to evaluate and compare variances (the acceptable significance level was set at p < 0.05). Conclusion: ENHL with oral localization is much more aggressive than ENHL with non-oral localization, with a death rate of 40% (versus 4.76 for the non-oral one). In fact, between the two groups, there is a statistically significant difference in mortality, with a p-value of 0.0001 and 0.0002, respectively.

Effect of COVID-19 Italian Lockdown on Maxillofacial Trauma Related to Domestic Violence: A Retrospective Cohort Study.

Background: This retrospective study aims to identify the potential reasons for the increase in maxillofacial trauma from domestic violence in the first COVID-19 lockdown and propose some strategies that could be effective in fighting it during any future pandemic events. Materials and Methods: The study was conducted on patients with maxillofacial trauma who arrived at the Maxillofacial Unit of the Magna Graecia University of Catanzaro from 9 March to 3 May 2020, who were compared with those registered in the same period in 2019. Inclusion criteria were: patients of both sexes and admission diagnosed with maxillofacial trauma with or without bone fracture. Exclusion criteria were: patients less than 7 years of age, maxillofacial trauma that occurred outside the established period, and patients unconscious or with unclear clinical history. Patients were divided into two groups according to the mechanism of injury (MOI): "domestic" and "non-domestic" trauma. Both descriptive and regressive statistical analysis was conducted using a Student's t-test with a significance level set at p < 0.05. Results: The total number of maxillofacial fractures in 2020 was similar to 2019 (31 pcs in 2020 vs. 38 pcs in 2019). Before the lockdown, most of the trauma occurred in non-domestic settings (25% in 2020 vs. 76.67% in 2019), especially in road accidents (4.17% in 2020 vs. 20% in 2019). During the lockdown, most of the trauma occurred in a domestic setting (75% in 2020 vs. 23.33% in 2019), especially interpersonal violence (31.58% in 2020 vs. 14.28% in 2019). There were 7 cases of interpersonal violence recorded in 2020 (1 male and 6 female), compared to only one case (female) recorded in 2019, with a statistically significant p-Value (0.0475). Conclusions: The first COVID-19 lockdown has provided the opportunity to study the aetiology of domestic trauma due to interpersonal violence attributable to economic and social problems, all of which were aggravated by the impediment to requesting help due to the difficulty of contacting the services and the general slowdown in the ways out of violence. The analysis conducted and compared with data in the literature suggests the adoption of a proactive (and non-reactive) approach to combat domestic violence during pandemic events.

A case of kuttner tumour misdiagnosed as malignant neoplasia with a review of the literature.

AIM: The aim of this study is to demonstrate how surgery is fundamental in case of Kuttner Tumour (KT). In literature, there are few reported cases of KT and for this reason, diagnostic errors could occur with subsequent underestimation of the disease. MATERIALS OF THE STUDY: We review cases of KT published from 1976 to today in order not to run into diagnostic errors. It was carried out a systematic review of the literature on chronic sclerosing sialadenitis, also known as KT. RESULTS: KT is an immune-mediated localized fibro inflammatory condition that often mimics other pathological processes, such as neoplasms. DISCUSSION: The variables analysed in each article included in this review were the age and gender of the patients, the location of the disease, the type of study; clinical presentation, instrumental tests performed, presence of IgG4, surgery performed and the evolution of patients after treatment were also assessed. Diagnosis should be based on clinical, serological and pathological findings, but in a small percentage of cases (just as in the case presented) the cytological data provided by FNAB and serum IgG4 levels do not allow a diagnosis. CONCLUSIONS: Our experience shows that only surgery with subsequent histological examination makes it possible to correctly diagnose the disease. KEY WORDS: Kuttner Tumour, Salivary glands, Immunoglobulin G4-related disease, Maxillofacial surgery.

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study.

It is well known that malnutrition is a frequent co-morbidity in cancer patients, especially in those with head and neck neoplasms. This may be due both to the presence of dysphagia symptoms and to the appearance of adverse effects on chemotherapy and / or radiotherapy. The aim of this retrospective observational multicentric study is to evaluate the nutritional status between dysphagia cancer patients and non-dysphagia cancer patients. Data from 60 patients were analysed, 31 of which without dysphagia and 29 with dysphagia. Results highlight that patients with dysphagia had higher involuntary body weight loss than non-dysphagia ones (p < 0.001). By analysing the entire population, it stands out a weight loss rate of 12 ± 9% compared to the usual weight was observed and a prevalence of moderate / severe malnutrition diagnosis of 53%. Furthermore, 76% of the population who manifested the symptom of dysphagia presented severe malnutrition already at the first visit, compared to 32% of non-dysphagia subjects.

Immunohistochemical Analysis of the Beclin-1 Expression Predicts the Progression of Oral Squamous Cell Carcinoma.

BACKGROUND: Autophagy is a cellular process responsible for maintaining homeostasis; a dysregulation of this process is involved in the development and progression of neoplasms. Beclin-1 is one of the major proteins linked to autophagy. However, the data regarding the association between the role of Beclin-1 and the progression of Oral Squamous Cell Carcinoma (OSCC) are rather low. For this reason, the objective of this study is to evaluate, through immunohistochemical techniques, the prognostic role of the expression of Beclin-1 autophagy marker in patients with OSCC. METHODS: This is a single-centre retrospective study that includes patients with OSCC admitted to the Maxillofacial Unit of "Magna Graecia" University between January 2019 and September 2020. All the samples obtained from surgery were treated with anti Beclin-1 antibodies and subjected to immunohistochemical methods. RESULTS: A total of 26 samples were analysed and the following variables were evaluated for each: percentage of positive Beclin-1 expression by tumour cells, signal strength of tumour cells, and total score. The variables considered were first normalised according to the D'Agostino and Pearson test, then analysed using the Pearson linear correlation coefficient: a statistically significant correlation was found between the parameters infiltration-intensity (p = 0.0088), infiltration-percent (p = 0.0123), intensity-total score (p = 0.0060). CONCLUSIONS: The immunohistochemical evaluation of Beclin-1 revealed a statistically significant correlation between the intensity of the molecule's expression and a greater degree of infiltration of the neoplasm. Beclin-1 can, therefore, be considered a valid prognostic index of disease.

A rare case of mandibular dentinogenic ghost cell tumor: Histopathological, clinical and surgical management.

Dentinogenic ghost cell tumor (DGCT) is a rare benign tumorous form of calcifying odontogenic cyst (COC) characterized by the presence of ghost cells but it seems to have more aggressive behavior. It represents 11.5% of COCs. In this work, we report a case of a 60-year-old male patient with DGCT in the posterior region of the right mandible treated with surgical enucleation.

Maxillofacial surgical oncology during Covid-19 phase-1 and phase-2 of Italian lockdown. Single centre experience.

AIM: The aim of this retrospective study is to analyse the impact of Covid-19 on oncological surgical activity of Oral and Maxillofacial Surgery Unit of Magna Graecia University of Catanzaro, Italia. MATERIALS OF THE STUDY: This single-centre study includes patients treated for head and neck cancer (HNC) during lockdown months of March, April, May 2020 (Phase-1) and October, November and December 2020 (Phase-2); the data were compared with the same months for the previous two-year period (2018-2019). RESULTS: 35 oncological surgeries were performed at our Maxillofacial Surgery Unit in 2020. Applying both analysis of t-Student and ANOVA emerged an increase in activity for 2020. DISCUSSION: The epidemic of the 2019 novel coronavirus infection, declared a global pandemic by WHO on March 2020, has interfered with ordinary medical practice, in particular, with head and neck surgical oncology. Data for all three years (2018-19-20) were normalized for the number of beds available (in 2020, half compared to 2018-19) and were compared. CONCLUSIONS: The study demonstrates how it is possible, following strict guidelines and standard surgical protocols, to address the growing demand for surgery on cancer patients and to contain the spread of Covid-19 infection. KEY WORDS: Head and neck cancer, Oral oncology, Covid-19 infection, Maxillofacial surgery, Prevention and control, Telemedicine.

Expression of PLAG1, HMGA1 and HMGA2 in minor salivary glands tumours.

BACKGROUND: Diagnosis of minor salivary gland (MSG) tumours is often difficult, due to the scarce tissue obtained from bioptic excision and complex histopathological differential diagnosis. In our study we performed an immunohistochemical analysis of PLAG1, HMGA1 and HMGA2 on a series of MSG tumours, in order to develop a new helpful diagnostic panel. METHODS: A retrospective series of 17 surgical specimens of MSG tumours were analysed for the expression of PLAG1, HMGA1 and HMGA2. Three control cases were enrolled and analysed. An intensity and percentage-based approach was performed, creating a combined score panel. RESULTS: PLAG1 facilitate the diagnosis of benign tumours, discriminating it from malignant histotypes, with a defined cut-off value. Similarly, HMGA1 is significantly higher in benign histotypes than in malignant ones. HMGA2 in our series, did not reveal any association in identifying benign from malignant histotypes. CONCLUSIONS: In this study we assessed the diagnostic role of PLAG1, HMGA1 and HMGA2 immunohistochemical analysis. The score panel facilitate histopathological diagnosis of these rare tumours, helping to distinguish benign tumours from malignant ones and ameliorating the differential diagnosis of specific histotypes.

Protective Effects of Helmet Type on Facial Injuries.

ABSTRACT: The compulsory use of helmet by motorcyclists has lowered the incidence of facial trauma, but there are few studies evaluating the effects of different helmet types on such injuries. The authors collected retrospective data from the medical records of 287 motorcyclists presenting facial injuries treated at the maxillofacial surgery department of the "University Magna Graecia" of Catanzaro city in South Italy between 1 January 2007 and 1 August 2018. Patients were wearing 2 types of crash helmets at the time of the trauma, full face ones or open-face ones, and were compared using the Facial Injury Severity Scale (FISS). Those wearing open-face helmet were 3 times more than those wearing full-face helmet, with a higher FISS score.The purpose of this study was to investigate the impact of Italy's compulsory helmet law on the change in helmet use and in particular if protection offered by helmets w4as different according to helmet type. The authors correlated the FISS scores among motorcyclists wearing these 2 tipologies of crash helmet.