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Trimarchi M, Vinciguerra A, Rampi A, Arrigoni G, Doglioni C, Bussi M. Use of a Fiberoptic-Laser Approach During Endoscopic Sinus Surgery: A Cadaver Feasibility Study. Indian J Otolaryngol Head Neck Surg 2023; 75:1047-1052. [PMID: 37206746 PMCID: PMC10188677 DOI: 10.1007/s12070-023-03593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
Aims The aim of the present study is to evaluate the clinical applicability of laser energy during an oro-nasal endoscopic approach (ONEA) in the management of the anterior maxillary sinus wall. Methods An experiment on three adult human cadavers was performed to study the nasal cavities with angled rigid scopes and using the ONEA technique. In order to evaluate the effectiveness of laser energy on the bone, the drilling effect was compared to laser energy (1470 nm diode laser, continuous wave, power 8, 9 and 10 W). Results Compared to a rigid angled scope, the ONEA technique allowed complete visualization of the anterior wall of the maxillary sinus. Microscopic analysis of frontal bone revealed similar bone Exeresis with high-speed drilling (270.28 μm) and laser approaches (285.73-456.6 μm). Conclusions The laser ONEA technique is an innovative, mini-invasive, and safe approach to the anterior wall of the maxillary sinus. Additional study is warranted to further develop this technique.
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Affiliation(s)
- Matteo Trimarchi
- Present Address: Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Vinciguerra
- Present Address: Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Rampi
- Present Address: Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluigi Arrigoni
- Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Doglioni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Present Address: Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Sologova D, Diachkova E, Gor I, Sologova S, Grigorevskikh E, Arazashvili L, Petruk P, Tarasenko S. Antibiotics Efficiency in the Infection Complications Prevention after Third Molar Extraction: A Systematic Review. Dent J (Basel) 2022; 10:dj10040072. [PMID: 35448066 PMCID: PMC9031928 DOI: 10.3390/dj10040072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/02/2022] [Accepted: 04/11/2022] [Indexed: 01/18/2023] Open
Abstract
(1) Background: Antibiotics are used in every medical field including dentistry, where they are used for the prevention of postoperative complications in routine clinical practice during the third molar extraction. (2) Methods: This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The present systematic review aimed to evaluate and systematize the use of antibacterial drugs in order to prevent postoperative complications in outpatient oral surgery for wisdom teeth extraction. We conducted a systematic review using electronic databases such as Medline PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Considering inclusion and exclusion criteria, we included randomized clinical trials published up to 2021 investigating the antibiotic prescription for third molar extraction. (3) Results: We selected 10 studies after the application of inclusion and exclusion criteria. The results showed that the most widely used antibiotic was amoxicillin both with and without clavulanic acid, in different dosages and duration. There were no statistically significant differences between treatment groups for development of postoperative complications. (4) Conclusions: Based on the analysis of the included studies, penicillin is currently the most widely prescribed group of antibiotics. The widespread use of this antibiotic group can lead to antimicrobial resistance (AMR). Due to increasing prevalence of bacteria resistance to penicillins, clinicians should carefully prescribe these antibiotics and be aware that the widespread use of amoxicillin may do more harm than good for the population.
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Affiliation(s)
- Diana Sologova
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
- Correspondence: ; Tel.: +7-919-9975781
| | - Ekaterina Diachkova
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
| | - Ilana Gor
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
| | - Susanna Sologova
- Department of Pharmacology, Nelyubin Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.S.); (E.G.)
| | - Ekaterina Grigorevskikh
- Department of Pharmacology, Nelyubin Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.S.); (E.G.)
| | - Liana Arazashvili
- Maxillofacial Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Str., 119991 Moscow, Russia; (L.A.); (P.P.)
| | - Pavel Petruk
- Maxillofacial Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Str., 119991 Moscow, Russia; (L.A.); (P.P.)
| | - Svetlana Tarasenko
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
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Cold Ablation Robot-Guided Laser Osteotome (CARLO ®): From Bench to Bedside. J Clin Med 2021; 10:jcm10030450. [PMID: 33498921 PMCID: PMC7865977 DOI: 10.3390/jcm10030450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.
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Holzinger D, Ureel M, Wilken T, Müller AA, Schicho K, Millesi G, Juergens P. First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies. J Craniomaxillofac Surg 2021; 49:531-537. [PMID: 33994295 DOI: 10.1016/j.jcms.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/21/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess the clinical applicability of robot guided laser osteotomy for clinical application. This is the initial report on 14 consecutive patients requiring an orthognathic procedure with a midface osteotomy (no restrictions made on the surgical indication itself) who have undergone surgery by means of the Cold Ablation Laser Osteotome CARLO® (AOT Advanced Osteotomy Tools, Basle, Switzerland), which is an integrated system, functionally comprising: an Er:YAG laser source, intended to perform osteotomies using cold laser ablation, a robot arm that controls the position of the laser source, an optical tracking device that provides a continuous and accurate measurement of the position of the laser source and of reference elements attached to instruments or bones, a navigation system (software) that is able to read preoperatively defined planned osteotomies, and - under the control of a surgeon - performs the planned osteotomies. Safety was assessed by unimpaired postoperative healing and the absence of device related injuries; performance was assessed as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Cold ablation robot-guided laser osteotomy could successfully be performed in 14 consecutive patients. No intraoperative complications or technical failure occurred. All osteotomies were within an average deviation of 0.80 mm (±0.26 mm) of the virtually preplanned location. The registration procedure to set up the robot at the beginning of the operation required a mean time of 4.6 min (±5.3min). In this report we describe the effective and successful routine use of Cold ablation robot-guided laser osteotomy in an actual clinical setting. It is a promising technical innovation that has the potential to set new standards for accuracy and safety in orthognathic surgery.
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Affiliation(s)
- Daniel Holzinger
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria.
| | - Matthias Ureel
- Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland
| | | | - Andreas A Müller
- Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland
| | - Kurt Schicho
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria
| | - Gabriele Millesi
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria
| | - Philipp Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital, Basel, Switzerland; MKG Arabellapark - Private Clinic for Oral & Maxillofacial Surgery, Germany
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Pantawane MV, Ho YH, Robertson WB, Khan RJK, Fick DP, Dahotre NB. Thermal Assessment of Ex Vivo Laser Ablation of Cortical Bone. ACS Biomater Sci Eng 2020; 6:2415-2426. [PMID: 33455309 DOI: 10.1021/acsbiomaterials.9b01559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As a potential osteotomy tool, laser ablation is expected to provide rapid machining of bone, while generating minimal thermal damage (carbonization) and physical attributes within the machined region conducive to healing. As these characteristics vary with laser parameters and modes of laser operation, the clinical trials and in vivo studies render it difficult to explore these aspects for optimization of the laser machining parameters. In light of this, the current work explores various thermal and microstructural aspects of laser-ablated cortical bone in ex vivo study to understand the fundamentals of laser-bone interaction using computational modeling. The study employs the Yb-fiber Nd:YAG laser (λ = 1064 nm) in the continuous wave mode to machine the femur section of bovine bone by a three-dimensional machining approach. The examination involved thermal analysis using differential scanning calorimetry and thermogravimetry, phase analysis using X-ray diffractometry, qualitative analysis using X-ray photoelectron spectroscopy, and microstructural and semiquantitative analysis using scanning electron microscopy equipped with energy-dispersive spectrometry. The mechanism of efficient bone ablation using the Nd:YAG laser was evaluated using the computational thermokinetics outcome. The use of high laser fluence (10.61 J/mm2) was observed to be efficient to reduce the residual amorphous carbon in the heat-affected zone while achieving removal of the desired volume of the bone material at a rapid rate. Minimal thermal effects were predicted through computational simulation and were validated with the experimental outcome. In addition, this work reveals the in situ formation of a scaffold-like structure in the laser-machined region which can be conducive during healing.
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Affiliation(s)
- Mangesh V Pantawane
- Laboratory for Laser Aided Additive and Subtractive Manufacturing, Virtual Center for Advanced Orthopedics, Department of Materials Science and Engineering, University of North Texas, 1155 Union Circle-305310, Denton, Texas 76203-5017, United States
| | - Yee-Hsien Ho
- Laboratory for Laser Aided Additive and Subtractive Manufacturing, Virtual Center for Advanced Orthopedics, Department of Materials Science and Engineering, University of North Texas, 1155 Union Circle-305310, Denton, Texas 76203-5017, United States
| | - William B Robertson
- Laboratory for Laser Aided Additive and Subtractive Manufacturing, Virtual Center for Advanced Orthopedics, Department of Materials Science and Engineering, University of North Texas, 1155 Union Circle-305310, Denton, Texas 76203-5017, United States.,Australian Institute of Robotics Orthopedics, 2 Centro Avenue, Subiaco, Western Australia 6008, Australia.,Department of Computing School of Electrical Engineering and Computing, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
| | - Riaz J K Khan
- Laboratory for Laser Aided Additive and Subtractive Manufacturing, Virtual Center for Advanced Orthopedics, Department of Materials Science and Engineering, University of North Texas, 1155 Union Circle-305310, Denton, Texas 76203-5017, United States.,Australian Institute of Robotics Orthopedics, 2 Centro Avenue, Subiaco, Western Australia 6008, Australia.,Department of Computing School of Electrical Engineering and Computing, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.,The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, Western Australia 6009, Australia
| | - Daniel P Fick
- Laboratory for Laser Aided Additive and Subtractive Manufacturing, Virtual Center for Advanced Orthopedics, Department of Materials Science and Engineering, University of North Texas, 1155 Union Circle-305310, Denton, Texas 76203-5017, United States.,Australian Institute of Robotics Orthopedics, 2 Centro Avenue, Subiaco, Western Australia 6008, Australia.,Department of Computing School of Electrical Engineering and Computing, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.,The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, Western Australia 6009, Australia
| | - Narendra B Dahotre
- Laboratory for Laser Aided Additive and Subtractive Manufacturing, Virtual Center for Advanced Orthopedics, Department of Materials Science and Engineering, University of North Texas, 1155 Union Circle-305310, Denton, Texas 76203-5017, United States
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