A multicenter observational study on Medication-Related Osteonecrosis of the Jaw (MRONJ) in advanced cancer and myeloma patients of a cancer network in North-Western Italy.

BACKGROUND: Incidence of Medication-Related Osteonecrosis of the Jaw (MRONJ) related to cancer and myeloma treatments is undetermined, with scarce data varying from 2 to 7.8/million/year in limited investigated populations. A 9-years [2009-2018] regional-wide survey was conducted, deploying the North-Western Italy Cancer Network ("Rete Oncologica Piemonte e Valle d'Aosta"), to assess number and main characteristics of MRONJ cases among myeloma/cancer patients, within a population of 4.5 million inhabitants. MATERIAL AND METHODS: MRONJ cases were collected retrospectively from January 2009 to June 2015; from July 2015 to December 2018, data were collected prospectively. Number of new MRONJ cases per year, underlying disorder, drug(s) administered, treatment duration, site and onset timing of MRONJ were detailed. RESULTS: 459 MRONJ cases were identified. Primary diseases were breast cancer (46%), prostate cancer (21%), myeloma (19%), and other types of carcinoma (14%). Patients received antiresorptive treatment either alone (399; 88.47%) or in combination with biological agents (52; 11.53%); 8 patients (1.7%) received only antiangiogenic drugs. Zoledronic acid [388] and denosumab [59] were the most frequently administered drugs. Mandible was involved in 296 (64,5%) cases. Number of new MRONJ cases was stable from 2009 to 2015, with a mean of 51.3 cases per year (raw incidence: 11.6/million/year), declining in the 2016-2018 years to 33.3 cases per year (raw incidence: 7.5/million/year). CONCLUSIONS: With such discrepancy of cases overtime being partially explicable, number of new MRONJ cases per year are consistent with those observed in a previous study [2003-2008] in the same region, being instead higher than those reported in other populations.

Phenotypic variability of Pai syndrome: report of two patients and review of the literature.

Pai syndrome is a rare form of frontonasal dysplasia, first described in 1987. It is a triad consisting of midline cleft of the upper lip, facial skin polyps and central nervous system lipomas. Only 14 cases have been reported in the literature. The authors describe the clinical features, diagnostic workup and treatment of two patients. A review of all cases reported in literature is presented to show the phenotypic variability of this rare syndrome.

[Mandibular cysts treated by decompression]. / Cisti mandibolare trattata con terapia decompressiva.

The authors reports a case of mandibular keratocystis treated using decompressive therapy and subsequent cystectomy after subtotal reduction of the cystic lacuna. The bone regenerative process was probably aided by the young age of the patient.

[Tuberculous lesions of the cervico-facial area. A case load of 20 years]. / Lesioni tubercolari del distretto cervico-facciale. Presentazione di una casistica di 20 anni.

BACKGROUND: Tuberculosis is a granulomatous inflammatory process consequent to infection by Mycobacterium tuberculosis (human or bovine type). In the maxillofacial district easily the most frequent localisation is the laterocervical and submandibular lymph nodes. MATERIALS AND METHODS: The series presented here includes cases of specific tubercular infection of the maxillo-facial district observed by the Division of Maxillo-Facial Surgery of the University of Turin during the period 1975 and 1995. RESULTS: 121 surgically-treated benign cervical lesions were examined of which 25 cases were found to be specifically tubercular, representing 21% of the total. In addition to the cases treated surgically during the period in question a further 12 cases of specific tubercular adenopathy were diagnosed which were treated using medical treatment alone. The clinical trend observed in these patients was variable but almost constantly characterised by scarce subjective symptomatology. CONCLUSIONS: Diagnostic ascertainment, according to our experience, must be complete and include an accurate family and individual anamnesis, a careful objective examination, hematochemical tests (hemochrome, ESR), cervical and lung X-rays and bacterioscopic tests using fine needle aspiration. From a therapeutic point of view, in agreement with the majority of papers, the authors affirm that surgery appears to be the most indicated form of treatment.

[Evaluation of the posture of patients before and after orthodontic surgery]. / Valutazione della postura in soggetti disgnatici prima e dopo intervento ortochirurgico.

INTRODUCTION AND AIMS: The term "craniomandibular disorder" is used to describe a series of symptoms and signs that directly affect the stomatognathic apparatus with possible repercussions on the otovestibular and oculomotor apparatus and on the cervical spine that may condition the entire body posture. The aim of this study was to evaluate a series of parameters correlated to the occlusal situation and to verify how these factors are affected by a change following the correction of occulusal ratios. METHODS: The paper reports a series of 15 patients suffering from facial dysmorphia treated surgically in the Division of Maxillofacial Surgery of S. Giovanni Battista Hospital in Turin in which an evaluation was made of posture and symptoms linked to craniomandibular disorders before surgery and six months after. At the preoperative evaluation a high incidence of this type of symptoms and signs was observed, and in particular a high percentage of patients with postural imbalance and asymmetry of the frontal body segments. RESULTS AND CONCLUSIONS: From the results obtained it emerges that the surgical re-adaptation of occlusion is followed by esthetic improvement and also by a good recovery of frontal postural symmetry in conformity with the reduced frequency and intensity of symptoms classified as craniomandibular disorders.

[Fracture of the glenoid fossa without condylar dislocation and with intact mandibular condyle. Report of a case]. / Frattura della fossa glenoidea senza dislocazione condilare e con condilo mandibolare integro. Presentazione di un caso clinico.

The osteomuscular structure of the cranium presents peculiar anatomic characteristics that aim to preserve the noble organs that are housed inside or are adjacent to them. This is also true of the condylar region which protects the cranial cavity from forces transmitted to the glenoid cavity by the condyle in traumatism to the facial region and above all the genial symphysis. These factors act as "force breakers" to prevent the condyle penetrating the middle cranial fossa. Of these the most important is the presence of a line of minor resistance at the level of the condyle neck which is often the site of a protective fracture. However, the dislocation of the condyle in the middle cranial fossa is an occurrence that is reported in the literature, albeit very rarely; the fracture of the glenoid fossa with an intact mandibular condyle and without evident dislocation of the latter is even more rare. The paper reports the case of a 22-year-old male patient who was injured in the submental area leading to loss of conscience. CT revealed that the left mandibular condyle was intact whereas there was a comminuted fracture of the roof of the glenoid fossa and two fractures at the mandibular level. The patient also presented left otoliquorrhea. The glenoid fracture was not complete and therefore the mandibular condyle did not show evident dislocation nor was it necessary to resort to surgical or non-surgical treatment. After the reduction and restraint of the two mandibular fractures, occlusion was correct and the position of the left condyle was appropriate following X-ray control, even if the glenoid cavity was partially fractured. Otoliquorrhea resolved spontaneously after about three days and did not require any treatment. The case described here, which was recontrolled after some time, presented excellent functional results demonstrating that conservative treatment of the glenoid cavity fracture was the correct therapeutic choice.

[Equilibrium and orthognathodontic surgery: correlations in a group of patients undergoing treatment]. / Posturologia e chirurgia ortognatodontica. Correlazioni in un gruppo di pazienti trattati.

BACKGROUND: The aim of this study was to evaluate the main parameters provided by the static stabilometric test (mean X, mean Y, mean velocity, length of tracing, standard deviation of velocity, ellipse area) in the follow-up of patients suffering from skeletal occlusive pathology undergoing orthognathodontic surgery to confirm the re-establishment of postural equilibrium. METHODS: Fifteen patients with skeletal dysgnathia were correlated with a group of 10 healthy subjects. The same parameters were analysed in the dysgnathic subjects at 6 and 12 months after surgical correction. The patients enrolled in this study underwent surgery at the Division of Maxillofacial surgery of Turin University. Student's "t"-test and multivariate statistical analysis (Cox regression) were used for the statistical analysis of results. RESULTS: A significant variability was noted in some of the main parameters analysed (mean X, mean Y, tracing length) between the two populations (healthy and dysgnathic) compared to visual signs (eyes opened-closed). The change in stabilometric values within the group of dysgnathic patients was highly significant 6 and 12 months after surgery, not only in terms of visual signs but also the cervical component (retroflexion of the head), above all the value of mean Y (p = 0.001). CONCLUSIONS: An analysis of these results shows that static stabilometry can be a valuable aid both during the preoperative evaluation and during the follow-up in patients undergoing jaw surgery since it can quantify the improvement of body balance.

[Transvesical prostatic adenomectomy: general or local anesthesia].

A transvesical prostatic adenomectomy is defined as an "open-sky" surgical procedure performed to remove a benign prostatic nodule that, growing up, could represent an obstacle to the normal emptying of the bladder. This operation can be carried out under general or loco-regional anesthesia conditions: the second option, however, does not provide the curarization of the patient, and could result in a higher endoabdominal pressure, which could significantly reduce the surgeon's visual field. Nevertheless, this technique allows for a complete analgesia and anesthesia during the first postoperative hours, avoiding the occurrence of abdominopelvic contractions and pain-linked hypertension, which can cause dangerous postoperative bleedings. As opposed to this, during surgery under general anesthesia conditions, the curarization ensures a wider operating field, free from abdominopelvic contractions, but with important postoperative pain, the main cause of which is the continuous bladder washing; this kind of pain is very difficult to treat even with oppioids: it is certainly the most important cause of bleedings, resulting in patient's discomfort, risk of blood transfusion or even reoperation. The two techniques have been compared in a randomized study on 40 patients: the subarachnoid technique seems definitely to be more favorable, with its optimal antalgic effect even during the first postoperative hours, with no need to use high doses of antalgic iv drugs, and, most important, with no subsequent postoperative hypertension and bleedings.

[Intravenous treatment of postoperative pain in urologic surgery: comparison between analgesics].

The need for efficaciously treating acute postoperative pain arises primarily from the observation that pain is associated with modifications of organs and systems that can become extremely detrimental to the patients; the antalgic treatment, besides its ethic aspect, plays therefore an essential role since it can enormously improve the patient's outcomes, significantly reducing mortality, morbidity and discomfort. In the postoperative antalgic therapy, it is possible to associate molecules of different pharmacological classes: the aim of our study is to compare different combinations between opioids, Ketorolac and Paracetamol in 75 operations of urologic surgery; to assess any side effects and the postoperative pain (through the VNS scale) and, if necessary, to administer supplementary doses of Tramadol in order to complete the pre-arranged pain therapy. The statistical analysis of data demonstrates first how different antalgic medicaments can enhance each other, highlighting the greater effectiveness of Ketorolac compared to Paracetamol during the awakening period, at the pre-established dosages. Moreover, the study presents the slight occurrence of side effects during the postoperative period, of no importance in most cases: we can therefore come to the conclusion that the association between different drugs could result in a reduction in the single given dosages, and would probably be co-responsible of the low incidence of iatrogenic sequelae.