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Tewfik K, Rampinelli V, Burlini D, Buffoli B, Rezzani R, Deganello A, Felisati G, Piazza C. Video-Assisted Cleft Palate Surgery: Preclinical Comparison Between Endoscope- and Exoscope-Based Approaches. Cleft Palate Craniofac J 2024; 61:639-645. [PMID: 36417321 DOI: 10.1177/10556656221139340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Using both endoscope and exoscope in cleft soft palate surgery is not widespread, despite the potential advantages related to view magnification, ergonomic posture of the surgeon, and involvement of the surgical team. The aim of the current study is to compare endoscopic (Olympus Visera©) and exoscopic (Karl-Storz Vitom©) assistance in cleft soft palate surgery in a preclinical cadaver setting. A formalin fixed specimen was dissected to mimic the anatomical conditions of a cleft soft palate. Ten young surgeons with limited experience in transoral surgery were involved in the exercitation on the specimen. The exercitation consisted of 4 tasks: (1) device setting; (2) identification of muscle plane; (3) muscle suturing; (4) oral mucosa suturing. Participants were timed while performing each task both with exoscope and endoscope and asked to fill in 2 questionnaires related to the visual systems used (NASA Task Load System TLS and VAS 1-10). All surgeons completed the 4 tasks with both the endoscope and exoscope. The execution times were similar except for faster setting of the exoscope. Participants felt that completing surgical exercises using the exoscope required less physical, intellectual, and temporal efforts compared to the endoscope. The exoscope was also more appreciated for its handling, 3D visualization, and limited encumbrance. Exoscope scored better both at NASA TLS and VAS 1-10 and required a faster setting than endoscope. Further clinical in-vivo studies are required to explore the advantages of these devices in cleft palate repair.
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Affiliation(s)
- Karim Tewfik
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Dante Burlini
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Otorhinolaryngology Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Giovanni Felisati
- Otorhinolaryngology Unit, Head and Neck Department Santi Paolo e Carlo Hospital of Milan, University of Milan DISS, Milano, Italy
| | - Cesare Piazza
- Otorhinolaryngology Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Tewfik K, Giampaoli G, Burlini D. Can the exoscope be a game-changer for cleft palate surgery? Br J Oral Maxillofac Surg 2023; 61:503-505. [PMID: 37419834 DOI: 10.1016/j.bjoms.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Karim Tewfik
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Italy.
| | - Giorgio Giampaoli
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Italy
| | - Dante Burlini
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Italy
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Tewfik K, Peta C, De Giuli MC, Rossini M, Giampaoli G, Covelli C, Burlini D. Impact of Covid-19 pandemic on children with special needs requiring general anaesthesia for the treatment of dental disease: the experience of the Brescia Children's Hospital, Lombardy, Italy. Eur Arch Paediatr Dent 2023; 24:133-138. [PMID: 36434491 PMCID: PMC9702869 DOI: 10.1007/s40368-022-00770-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Special needs children presenting with dental problems were penalised during the Covid-19 pandemic due to the reduction of clinical activity and the risks of nosocomial infection. The aim of this study is to evaluate the impact of the pandemic on oral healthcare in paediatric special needs patients. METHODS We retrospectively assessed and compared the outpatient clinic activity and dental procedures performed under general anaesthesia in children with special needs at Brescia Children's Hospital (Italy) in 2019, 2020, and 2021. Any delay between expected waiting time based on assigned priority and surgery was recorded. The efficacy of the protocol adopted to reduce the spread of Covid-19 was evaluated by reporting any infections in patients, parents, and health care providers. RESULTS In 2020, 270 outpatient visits were performed, and 40 patients were treated under general anaesthesia, with a 26% and 65% reduction, respectively, compared to 2019. In 2021, 362 visits were performed (similar to 2019) and 48 patients were treated under general anaesthesia (58% compared to 2019). The mean delay in the planned treatment was 1.0 month in 2019 (pre-pandemic period), 2.1 months in 2020, and 1.1 month in 2021. No cases of Covid-19 infection were reported in the cohort of patients and parents or among the operators related to nosocomial infection. CONCLUSIONS The Covid-19 pandemic has profoundly reduced the activity of general anaesthesia in paediatric special need patients during 2020, with a gradual return to normal pre-pandemic activity in 2021. The adopted protocol prevented the spread of COVID-19 during hospitalisation.
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Affiliation(s)
- K Tewfik
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - C Peta
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M C De Giuli
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Rossini
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Giampaoli
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital, ASST Spedali Civili of Brescia, Brescia, Italy
| | - C Covelli
- Pathology Unit, ASST del Garda, Desenzano del Garda, Italy
| | - D Burlini
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital, ASST Spedali Civili of Brescia, Brescia, Italy
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Tewfik K, Covelli C, Rossini M, Burlini D. Lump on the scalp of a child arising over a previous parietal fracture: growing skull fracture or post-traumatic lipoma? BMJ Case Rep 2022; 15:e246283. [PMID: 35379677 PMCID: PMC8981367 DOI: 10.1136/bcr-2021-246283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
A young girl was referred to our Institution for the appearance of a painless soft swelling in the right parietal region of the scalp. In the same site, the patient had a parietal bone fracture 1 year ago. In the suspicion of a growing skull fracture, the patient underwent radiological investigations. Ultrasound showed a soft, poorly vascularised swelling with parenchymatous content. The skull X-ray showed an apparent healing of the previous fracture. CT scan and MRI confirmed the correct healing of the fracture and described the presence of a lipomatous mass. The mass was surgically removed and histology confirmed the diagnosis of encapsulated lipoma. The postoperative period was uneventful, with no evidence of infections or recurrence in the 6-month follow-up.
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Affiliation(s)
- Karim Tewfik
- Head&Neck Department, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- Pediatric Maxillofacial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudia Covelli
- Pathology Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Manuela Rossini
- Pediatric Maxillofacial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Dante Burlini
- Pediatric Maxillofacial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
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Tewfik K, Covelli C, Rossini M, Peta C, Burlini D. Multidisciplinary management of an orbitocranial penetrating injury by a pencil in a paediatric patient - A case report. Ann Maxillofac Surg 2022; 12:72-75. [PMID: 36199462 PMCID: PMC9527848 DOI: 10.4103/ams.ams_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/28/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale: Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections. Patient Concerns: We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve. Diagnosis: Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery. Treatment: Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments. Outcomes: Left eye vision was lost. The 1-year follow-up was uneventful. Take-away Lessons: Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.
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Bocchialini G, Ferrari L, Rossini M, Bozzola A, Burlini D. Chronic nonbacterial osteomyelitis involving the mandible: A case report. Int J Surg Case Rep 2017; 37:149-153. [PMID: 28675846 PMCID: PMC5496487 DOI: 10.1016/j.ijscr.2017.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes. CASE PRESENTATION We report the discovery of this very rare disease following a mandibular abscess in a 10-year-old female. We initially focus on the difference between the preoperative orthopantomography and the maxillofacial computed tomography and magnetic resonance images obtained, and then on the improvement of strategies for correct diagnosis and treatment of this disease. DISCUSSION Bone pain and localised swelling can occur in a single bone or can spread to soft tissue and adjacent bone; areas commonly affected by CMRO include the metaphyseal plates of the long bones, as well as the spine, clavicle and, rarely, the maxillofacial area. The clinical presentation of CMRO includes pain, functional impairment, and swelling, similar to our case. CONCLUSIONS We report a very rare case of this unifocal mandibular disease in a child who presented for an abscess and was then diagnosed and treated for CNO.
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Affiliation(s)
| | - Luca Ferrari
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
| | - Manuela Rossini
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
| | - Anna Bozzola
- Department of Molecular and Translational Medicine, Section of Pathology, University Spedali Civili Di Brescia, Spedali Civili di Brescia, Unità Operativa di anatomia patologica- Brescia, Italy
| | - Dante Burlini
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
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Burlini D, Conti G, Amadori F, Bardellini E, De Giuli C. Management of paediatric maxillofacial fractures: conventional methods and resorbable materials. Eur J Paediatr Dent 2015; 16:24-28. [PMID: 25793949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To compare the outcomes between the use of resorbable plates and screws and the conventional methods in children with paediatric maxillofacial fractures. STUDY DESIGN a retrospective observational study was designed reviewing the clinical records from June 2007 and June 2011. Data collected included aepidemiological data, type of treatment, outcome and satisfaction questionnaire. Descriptive statistics and bivariate analysis were performed. RESULTS A total of 1122 children (0-17 years old) were studied. Children treated by conventional methods were 912, while children treated by resorbable materials were 210. The frequency of complications during recovery was similar and no statistically significant difference was noted. The satisfaction questionnaire revealed similar percentages of satisfaction, with a high degree of satisfaction. CONCLUSION Our experience suggests that resorbable devices should be considered as a treatment option, which avoids the need of further surgery to remove metallic fixation, limits hospital spending and increases children's quality of life.
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Affiliation(s)
- D Burlini
- Department of Paediatric Maxillofacial Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - G Conti
- UOC Maxillofacial Surgery and Dentistry, IRCCS Fondazione Ca Granda Ospedale Maggiore, University of Milan, Milan, Italy
| | - F Amadori
- Department of Paediatric Dentistry, Dental School, University of Brescia, Brescia, Italy
| | - E Bardellini
- Department of Paediatric Dentistry, Dental School, University of Brescia, Brescia, Italy
| | - C De Giuli
- Department of Paediatric Maxillofacial Surgery, Spedali Civili di Brescia, Brescia, Italy
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Burlini D, Conti G, Bardellini E, Amadori F. Rare case of desmoid-type fibromatosis of the mandibular region in a child: diagnosis and surgical management. Eur J Paediatr Dent 2013; 14:333-334. [PMID: 24313589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Desmoid-type fibromatosis is a broad group of rare disorders that originate from musculoaponeurotic structures. They represent less than 0,1% off all tumors and the annual incidence is 2-4 cases per million, with two peaks between 6 and 15 years of age and between puberty and age 40. They are rare in the oral and maxillofacial regions. Its pathogenesis is multifactorial. The treatment is still mainly represented, both in children and adults, by surgical excision. CASE REPORT A case is reported of a 8-year- old girl with desmoid fibroma in the mandible who presented at the Department of Pediatric Dentistry with a swelling measuring 4x4 cm on the lower edge of the right mandible which had appeared a few months earlier and slowly developed. The family dentist had initially diagnosed it as an odontogenic abscess from the lower right deciduous molars, but the antibiotic therapy was unsuccessful. After x-ray examination, which showed a large osteolytic lesion, mandibular CT revealed a solid expanding mass. The child was referred to the Department of Paediatric Maxillofacial Surgery where the whole mass was surgically removed. At the 2-year follow-up no relapse was noted. CONCLUSION This case stresses the importance, especially for paediatric dentists, of further diagnostic steps if suspect lesions do not heal after conventional treatment.
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Affiliation(s)
- D Burlini
- AO Spedali Civili Brescia, Dep. Pediatric Maxillo Facial Surgery, Brescia, Italy
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Signorelli M, Magri R, Taddei F, Groli C, Rebufflni E, Zuccarino L, Merulla V, Burlini D. O.073 Prenatal diagnosis accuracy of apparently isolated facial CLP. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Burlini D. Therapeutic objectives and surgical treatment of mandibular condyle fractures. Personal experience. Minerva Stomatol 2004; 53:581-90. [PMID: 15531873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM A review of condylar fractures treated ''non-surgically'' and ''surgically'' over the last 5 years (1996-2001) at the Maxillofacial Surgery Division of the Brescia Civil Hospital (Italy) is presented. The non surgical and surgical treatments carried out, as well as their effectiveness and therapeutic aims, are illustrated. METHODS From June 1996 to June 2001, at the Maxillofacial Surgery Division of the Brescia Civil Hospital, 179 fractures of the mandibular condyle were treated. Of the 179 cases treated, a distinction was immediately made between ''non-surgical'' (103 cases) and ''surgical'' cases (76 cases). The 76 ''surgical'' cases were all treated with the same surgical technique. Out-patient follow-up was at days 20, 60, 90, and 1 year, together with a radiographic check-up at 60 days. Of the 76 condylar fractures treated surgically, 15 patients selected at random were re-examined; the medical history was investigated and clinical and radiological examinations performed. For each patient, the type of condylar fracture and whether this was associated with other mandibular fractures were recorded. The following data were also recorded: age of the patient; pain at the surgical site or at the mandible at the time of check-up; presence of normal occlusion and laterodeviation; any surgical sequelae at the facial nerve on the operated side; maximum mouth opening; any radiological defect; time since surgery. Then, the patient was asked to give his/her own evaluation of the surgical outcome, by expressing adequate, good or excellent result. RESULTS In patients treated surgically the indication is almost absolute in the following cases: condylar fractures types II and IV of the Spiessl/Schroll classification, low or high condylar fractures with medial dislocation of the condyle; non-surgical treatment cannot be applied for reasons of patient's health; condylar fracture associated with other open fractures of the face. The use of rigid fixation also may help in the success of the technique adopted. In all the cases (surgical and non-surgical) it is important to achieve early mobilization of the mandible and carry out a rehabilitation program for masticatory function. CONCLUSION The goals of condylar treatment may therefore be summarized as follows: to achieve a good occlusion; to eliminate pain; to achieve a proper mandibular symmetry; to achieve good mandibular movement in the 3 planes of space.
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Affiliation(s)
- D Burlini
- Division of Pediatric Maxillofacial Surgery, Civil Hospital, Brescia, Italy.
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Affiliation(s)
- U Zanetti
- Department of Maxillofacial Surgery, Spedali Civili Brescia, Italy
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Grazioli L, Olivetti L, Matricardi L, Zanetti U, Burlini D, Negrini S, Fugazzola C, Chiesa A. [Comparison of ultrasonography, computerized tomography, and magnetic resonance in the study of parotid masses]. Radiol Med 1993; 86:268-80. [PMID: 8210536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
One hundred and seven patients were examined to compare advantages and pitfalls of the imaging methods currently used to stage parotid masses. Thirty patients underwent US and CT, 44 were investigated with US and MRI and 33 with US, CT and MRI. The accuracy of the three techniques was analyzed in detecting and assessing the intra-/extraglandular location of the parotid lesions and their benign/malignant nature. The intraglandular lesion spread to superficial/deep lobes was also investigated, together with its relationship to the surrounding structures. The findings were correlated with the cytohistological data from US-guided biopsy or from surgical resection. US was less accurate than CT and MRI, the latter being not statistically superior to the former. Because of the low incidence of pitfalls, US with fine-needle aspiration cytology should be the technique of choice; CT and MRI must be used for lesions > 3 cm or for masses in the deep gland lobes. In conclusion, CT accurately assesses parotid lesions but MRI demonstrates the relationship to adjacent structures better.
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Affiliation(s)
- L Grazioli
- Cattedra di Radiologia, Università di Brescia
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Ferrari Parabita G, Derada Troletti G, Cattaneo R, Burlini D. [Endoscopic diagnosis of the temporomandibular joint]. Minerva Stomatol 1990; 39:593-600. [PMID: 2280757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Clinical and radiographic examinations of the temporo-mandibular joint are difficult to perform. Alternative diagnostic methods, for example, double contrast arthrotomography, computerized tomography, magnetic resonance imaging, and arthroscopy raise hopes for improved diagnostic accuracy. The purpose of this paper is to review and evaluate the potentials and limitations of this new technique.
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Affiliation(s)
- G Ferrari Parabita
- Divisione di Chirurgia Maxillo-Facciale, Ente Regionale Spedali Civili, Brescia
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