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Paladini I, Schirò S, Ledda RE, Leo L, Milanese G, Epifani E, Andreone A, Capurri G, Fantoni M, Gemignani A, Gritti A, Sesenna E, Menozzi R. Percutaneous injection of sclerosant agents as an effective treatment for cystic malformations of the head and neck. Oral Maxillofac Surg 2024:10.1007/s10006-024-01210-9. [PMID: 38261079 DOI: 10.1007/s10006-024-01210-9] [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: 07/06/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE To evaluate the clinical and aesthetic outcome of percutaneous injection of sclerosant agents to treat head and neck cystic malformations (HNCM) and to assess their recurrence rate based on histology and site. METHODS Fifty-four subjects (mean age 46 years) with HNCM treated by percutaneous injection of sclerosant agents between January and December 2017 were included. Imaging and clinical data before and after the procedure were collected. Quality of Life Index, Pain Visual Analogue Scale, and Aesthetic Scale scores were measured to assess clinical and aesthetic outcomes. A size reduction of ≥ 70% assessed through the visual scale was considered significant. RESULTS Of the 54 HNCM, there were 26 (48%) lymphatic malformations (LM), 13 (24%) salivary epithelial duct cysts of the parotid gland, 12 (22%) salivary mucoceles, and 3 (5%) branchial cysts. A significant size reduction and a satisfactory clinical-aesthetic outcome were observed in all types of LM. The number of reinterventions was significantly associated with the number of lesions (p < 0.001). The lowest number of interventions was observed in macrocystic lymphatic malformations (average of 1.2 interventions). All salivary epithelial duct cysts showed a significant reduction in size, a satisfactory clinical-aesthetic outcome, and an average of 1.16 interventions per patient. Mucoceles had a worse response, with only 3/14 patients showing a satisfactory and long-lasting clinical outcome (average of 1.16 interventions). Treatment of branchial cysts showed the worst outcome with a limited clinical response (3/3). CONCLUSION Percutaneous injection of sclerosant agents may be considered as a first-line treatment for LM and salivary epithelial duct cysts.
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Affiliation(s)
- Ilaria Paladini
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Silvia Schirò
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy.
| | - Roberta Eufrasia Ledda
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy
| | - Ludovica Leo
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy
| | - Gianluca Milanese
- Unit of "Scienze Radiologiche", Department of Medicine and Surgery (DiMeC), University Hospital of Parma, Parma, Italy
| | - Enrico Epifani
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Andreone
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Giulia Capurri
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Matteo Fantoni
- Neuroradiology Unit, Diagnostic Department, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
| | - Andrea Gemignani
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy
| | - Alessandro Gritti
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma,, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Roberto Menozzi
- Interventional Neuroradiology Unit, Diagnostic Department, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
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Bergonzani M, Anghinoni ML, Pedrazzi G, Maglitto F, Varazzani A, Sesenna E, Ferri A. Nebulized hyaluronic acid improves nasal symptoms after orthognathic surgery: a randomized clinical trial. Oral Maxillofac Surg 2023; 27:617-623. [PMID: 35835925 DOI: 10.1007/s10006-022-01093-8] [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] [Received: 10/14/2021] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE After maxillary osteotomy in orthognathic surgery, patients report nasal breathing discomfort in early postoperative period. Topical hyaluronic acid (HA) has been proven to have beneficial effects on the upper airway tract mucosa. This prospective randomized controlled study was designed to analyze the effect on nasal obstruction of nebulized HA during the recovery process after maxillary osteotomy. METHODS Patients were randomized to control and treatment groups. The postoperative treatment differed only for additional nebulized HA provided to the treatment group. The level of nasal obstruction, and its impact on quality of life, was assessed every 3 days for the first 15 days postoperatively using a questionnaire. Demographic and other variables (maxillary osteotomy type and surgical movements) were analyzed. Differences in quantitative data were tested using Student's t-test, the Mann-Whitney U test, and mixed repeated measures ANOVA. RESULTS Twenty-four subjects were included in each group; differences in age, sex, type of maxillary osteotomy, and movements were non-statistically significative. At the beginning of treatment (T0), the two groups had comparable questionnaire scores regarding nasal breathing discomfort (p >0.05), whereas statistically significant differences were found at days 3, 6, 9, and 12 (p <0.05). A significant decrease in nasal breathing discomfort over time was observed in both groups, with trends that differed between the two, indicating faster improvement in the treatment group. CONCLUSION Nebulized HA can be a useful additional treatment in early postoperative period after orthognathic surgery. Patients reported more rapid improvement of nasal respiratory symptoms, indicating a potential role for HA in reducing recovery time and patient discomfort after maxillary surgery.
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Affiliation(s)
- Michela Bergonzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy.
| | - Marilena Laura Anghinoni
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
| | - Giuseppe Pedrazzi
- Unit of Neuroscience and Interdepartmental Center of Robust Statistics (Ro.S.A.), Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Maglitto
- Division of Maxillo-Facial and ENT Oncological Surgery, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Andrea Varazzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
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Meoli A, Ciavola L, Rahman S, Masetti M, Toschetti T, Morini R, Dal Canto G, Auriti C, Caminiti C, Castagnola E, Conti G, Donà D, Galli L, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Simonini A, Venturini E, Caramelli F, Gargiulo GD, Sesenna E, Sgarzani R, Vicini C, Zucchelli M, Mosca F, Staiano A, Principi N, Esposito S. Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention. Antibiotics (Basel) 2022; 11:antibiotics11070863. [PMID: 35884117 PMCID: PMC9311619 DOI: 10.3390/antibiotics11070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.
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Affiliation(s)
- Aniello Meoli
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Lorenzo Ciavola
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Sofia Rahman
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Marco Masetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Tommaso Toschetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Riccardo Morini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Giulia Dal Canto
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Nicola Petrosillo
- Infection Prevention and Control—Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, 00128 Rome, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | | | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
- Correspondence: ; Tel.: +39-0521-903524
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Rigotti E, Bianchini S, Nicoletti L, Monaco S, Carrara E, Opri F, Opri R, Caminiti C, Donà D, Giuffré M, Inserra A, Lancella L, Mugelli A, Piacentini G, Principi N, Tesoro S, Venturini E, Staiano A, Villani A, Sesenna E, Vicini C, Esposito S. Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11030382. [PMID: 35326845 PMCID: PMC8944694 DOI: 10.3390/antibiotics11030382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022] Open
Abstract
Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days−18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children.
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Affiliation(s)
- Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Francesca Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90134 Palermo, Italy;
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139 Florence, Italy;
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Alberto Villani
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
- Correspondence: ; Tel.: +39-0521-903524
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Bianchi B, Bergonzani M, Stella E, Perlangeli G, De Stefani E, Sesenna E, Ferri A. Supercharged massetric-facial cross-graft for gracilis reinnervation in unilateral facial palsy treatment. Microsurgery 2022; 42:231-238. [PMID: 35014737 DOI: 10.1002/micr.30849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/21/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The choice of neurotization source for gracilis neuromuscular transplant is a key point in the treatment of unilateral long-standing paralysis. To combine the advantages of different donor nerves and overcome their disadvantages, mixed neurotization sources have been described with encouraging results. The authors present a preliminary report of a novel technique, the "supercharged" cross-graft, a two-step technique consisting of a double powered cross nerve graft provided by a zygomatic branch of the healthy facial nerve and the masseter nerve of the healthy side. PATIENTS AND METHODS From January 2015 to December 2019 eight patients, aged between 19 and 61 years old (mean age at surgery 33.62) suffering unilateral established paralysis (congenital or acquired, >24 months) underwent gracilis reinnervation with the supercharged cross grafting technique. Subjects underwent a two-step surgical rehabilitation: in the first operation sural nerve was harvested and used as cross-graft cooptated by healthy side facial nerve branch and masseteric nerve. During second procedure gracilis neuromuscular transplant was performed reinnervarting the muscle with the cross-graft. Patients were evaluated using Emotrics software, which allowed for automated facial measurements on post-operative pictures taken at the last follow-up. The results of the different poses were compared to assess the contribution to smile excursion by the masseter and facial nerve, together and separately. Finally, we analyzed spontaneous smile to assess whether masseteric contribution is used in daily life. RESULTS No major or minor complications occurred. Follow-up time ranged from 12 to 41 months, with a mean of 22.75 months. A good commissure excursion (mean 33.84 mm) was obtained during smile with no teeth clenching (without masseter activation), as well as during teeth clenching without smiling (activation of gracilis only - mean 32.55). When smiling and biting simultaneously the excursion was greater than the single two components (mean 35.91). In spontaneous smile, commissure excursion was higher (mean 34.23) than that provided by only the facial nerve (smile only) in most patients. CONCLUSIONS This novel technique of mixed neurotization for gracilis transplant shows consistent results with powerful contraction and good smile coordination. It also allows us to extend the indications for mixed neurotization techniques.
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Affiliation(s)
- Bernardo Bianchi
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Michela Bergonzani
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Enrica Stella
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Elisa De Stefani
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy
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Brevi B, Bergonzani M, Zito F, Varazzani A, Sesenna E. Infant mandibular distraction in absence of ascending ramus: case series. Oral Maxillofac Surg 2021; 25:401-410. [PMID: 33128656 DOI: 10.1007/s10006-020-00916-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 09/05/2019] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Severe microretrognathia with the absence of ascending mandibular ramus is a challenging deformity and treatment must aim to avoid tracheostomy or remove it as soon as possible. Although it is not often reported, mandibular distraction osteogenesis represents a valid treatment option in infants affected by hypoplastic mandible Pruzansky-Kaban type IIb and III. CASE PRESENTATION The authors describe 3 cases of infants affected by severe respiratory insufficiency due to congenital mandibular hypoplasia, with follow up ranging from 4 to 8 years. Clinical and technical considerations on treatment choices and outcomes are discussed starting from review of the literature and direct clinical experience. CONCLUSION Early mandibular distraction, specifically bidirectional distraction, is an effective and repeatable technique that leads to mandible lengthening with counterclockwise rotation, pogonion projection increase, anteropositioning of the tongue base, and expansion of oropharyngeal volume with positive effect on the respiratory problems of the infant. Even in Treacher Collins patients, known to have a low decannulation rate, all of these elements are essential for effective speech and swallowing therapy and for a subsequent attempt of decannulation.
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Affiliation(s)
- Bruno Brevi
- Complex Operating Unit of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Michela Bergonzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy.
| | - Francesca Zito
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
| | - Andrea Varazzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy
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Ferri A, Perlangeli G, Bianchi B, Zito F, Sesenna E, Ferrari S. Maxillary reconstruction with scapular tip chimeric free flap. Microsurgery 2021; 41:207-215. [PMID: 33443784 DOI: 10.1002/micr.30700] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/25/2020] [Accepted: 12/10/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Purpose of the article is to discuss the use of the scapular tip free flap (STFF) for the reconstruction of maxillary defects. METHODS A retrospective evaluation of patients who underwent maxillary reconstruction with STFF is presented. Patients were evaluated with respect to complications, function, and cosmesis. RESULTS Study population consisted of 53 patients. All flaps survived and partial bone resorption only occurred in a young patient. Minor complications included two instances of partial muscular necrosis. The donor site was primarily closed in all patients. Mouth opening was assessed as good (>3 cm) in 41 patients, partially limited (2-3 cm) in 9 patients, and limited (<2 cm) in 3 patients. Dental rehabilitation was achieved in 35 patients; esthetic results were assessed by patient as excellent in 19 patients, good in 28 patients, and poor in 6 patients. CONCLUSIONS The scapular tip chimeric free flap represents an indispensable tool for reconstructive head and neck microsurgery. The main advantages of this technique are very low donor site morbidity and a long pedicle, as well as the potential for harvesting multiple flaps in a chimeric design; STFF represents the first choice for treatment of small postero-lateral defects of the maxilla, and of wide and complex through-and-through defects involving all components of the midface.
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Affiliation(s)
- Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Francesca Zito
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Silvano Ferrari
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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8
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Prezioso G, Petraroli M, Bergonzani M, Davino G, Labate M, Ormitti F, Anghinoni M, Sesenna E, Esposito S. Duplication of the Pituitary Gland (DPG)-Plus Syndrome Associated With Midline Anomalies and Precocious Puberty: A Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2021; 12:685888. [PMID: 34122353 PMCID: PMC8187777 DOI: 10.3389/fendo.2021.685888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022] Open
Abstract
Duplication of the pituitary gland (DPG)-plus syndrome is a very rare developmental disorder with few cases described in the literature and characterized by multiple midline and central nervous system malformations. The hypothalamus and hypophysis involvement may be clinically associated with endocrine abnormalities. A 5.9-year-old female child was admitted to our Clinic for premature thelarche and acceleration of growth. DPG-plus syndrome with paired infundibula and pituitary glands was diagnosed after birth, when she appeared small for gestational age and she presented with lingual hypoplasia, cleft palate, right choanal stenosis, nasopharyngeal teratoma, and facial dysmorphisms. Neuroimaging revealed a duplication of the infundibula, the pituitary gland, and the dens of the epistropheus despite surgical removal of a rhino-pharyngeal mass performed at the age of two months. An array-CGH revealed a 2p12 deletion. At our evaluation, bone age assessment resulted advanced and initial pubertal activation was confirmed by Gonadotropin-Releasing Hormone stimulation test. Hormonal suppression treatment was started with satisfactory results. This case shows that DPG-plus syndrome must be considered in presence of midline and craniofacial malformations and endocrinological evaluations should be performed for the prompt and appropriate management of pubertal anomalies.
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Affiliation(s)
- Giovanni Prezioso
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maddalena Petraroli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Michela Bergonzani
- Maxillo-Facial Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giusy Davino
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marialuisa Labate
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Marilena Anghinoni
- Maxillo-Facial Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Susanna Esposito,
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9
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Bianchi B, Zito F, Perlangeli G, Pedrazzi G, Ferrari PF, De Stefani E, Sesenna E, Di Tano A, Ferri A. Long-term results of facial animation surgery in patients with Moebius syndrome. J Craniomaxillofac Surg 2020; 48:1132-1137. [PMID: 33191114 DOI: 10.1016/j.jcms.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 06/08/2020] [Revised: 06/30/2020] [Accepted: 10/25/2020] [Indexed: 12/19/2022] Open
Abstract
Gracilis neuromuscular transplant is considered the gold standard for facial animation in Moebius syndrome patients. However, long-term evaluation of the results has not been critically examined in the international literature. Thus, it remains unknown how the transplanted flap changes with facial growth, and whether contraction (smiling) is maintained. Pediatric patients with Moebius syndrome who underwent facial animation surgery with at least 5 years of follow-up were retrospectively examined. Photographs taken at the 1-year and most recent follow-up visits were analyzed and compared using Emotrics software. Analyses focused on the rest position, and on gentle and maximum smiles. Eighteen patients were enrolled. Seven patients had bilateral and 11 unilateral Moebius syndrome; therefore, 25 gracilis transplants were analyzed. The latest follow-ups ranged from 5 to 13.2 years (mean 7.6 years). The three principal facial expressions that were examined did not differ significantly between 1 year and a mean of 7.6 years after surgery, but tended to improve in most patients. Commissure excursion and smile angle for the maximum smile did improve significantly (p = 0.002 and 0.029, respectively). The series examined in this study supports the limited literature regarding the long-term stability of gracilis transplantation to animate the faces of Moebius syndrome children.
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Affiliation(s)
- Bernardo Bianchi
- Maxillo-Facial Specialist in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Francesca Zito
- Resident in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Italy.
| | - Giuseppe Perlangeli
- Resident in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Italy.
| | | | | | | | - Enrico Sesenna
- Head of the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Italy.
| | | | - Andrea Ferri
- Maxillo-Facial Specialist in the Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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10
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Allevi F, Dionisio A, Baciliero U, Balercia P, Beltramini GA, Bertossi D, Bozzetti A, Califano L, Cascone P, Colombo L, Copelli C, De Ponte FS, De Riu G, Della Monaca M, Fusetti S, Galié M, Giannì AB, Longo F, Mannucci N, Nocini PF, Pelo S, Ramieri G, Sesenna E, Solazzo L, Spinelli G, Tarsitano A, Tartaro G, Valentini V, Verrina G, Biglioli F. Impact of COVID-19 epidemic on maxillofacial surgery in Italy. Br J Oral Maxillofac Surg 2020; 58:692-697. [PMID: 32414539 PMCID: PMC7196423 DOI: 10.1016/j.bjoms.2020.04.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
Maxillofacial departments in 23 surgical units in Italy have been increasingly involved in facing the COVID-19 emergency. Elective surgeries have been progressively postponed to free up beds and offer human and material resources to those infected. We compiled an inventory of 32 questions to evaluate the impact of the SARS-COV2 epidemic on maxillofacial surgery in 23 selected Italian maxillofacial departments. The questionnaire focused on three different aspects: the variation of the workload, showing both a reduction of the number of team members (-16% among specialists, -11% among residents) due to reallocation or contamination and a consistent reduction of elective activities (the number of outpatient visits cancelled during the first month of the COVID-19 epidemic was about 10 000 all over Italy), while only tumour surgery and trauma surgery has been widely guaranteed; the screening procedures on patients and physicians (22% of maxillofacial units found infected surgeons, which is 4% of all maxillofacial surgeons); and the availability of Personal Protective Equipment, is only considered to be partial in 48% of Maxillofacial departments. This emergency has forced those of us in the Italian health system to change the way we work, but only time will prove if these changes have been effective.
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Affiliation(s)
- F Allevi
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - A Dionisio
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - U Baciliero
- Maxillofacial Surgery Department, Azienda ULSS 8 Berica, Vicenza, Italy
| | - P Balercia
- Maxillofacial Surgery Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G A Beltramini
- Maxillofacial Surgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - D Bertossi
- Maxillofacial Surgery Department, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - A Bozzetti
- Maxillofacial Surgery Department, Ospedale San Gerardo di Monza, University of Milan Bicocca, Milan, Italy
| | - L Califano
- Maxillofacial Surgery Department, Azienda Ospedaliera Universitaria, University of Naples "Federico II", Naples, Italy
| | - P Cascone
- Maxillofacial Surgery Department, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy
| | - L Colombo
- Maxillofacial Surgery Department, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - C Copelli
- Maxillofacial Surgery and Otolaryngology Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg), Italy
| | - F S De Ponte
- Maxillofacial Surgery Department, Policlinico Gaetano Martino, University of Messina, Messina, Italy
| | - G De Riu
- Maxillofacial Surgery Department, Policlinico di Sassari, University of Sassari, Sassari, Italy
| | - M Della Monaca
- Maxillofacial Surgery Department, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy
| | - S Fusetti
- Maxillofacial Surgery Department, Padua Hospital, University of Padua, Padua, Italy
| | - M Galié
- Maxillofacial Surgery Department, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - A B Giannì
- Maxillofacial Surgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - F Longo
- Maxillofacial Surgery and Otolaryngology Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg), Italy
| | - N Mannucci
- Maxillofacial Surgery Department, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - P F Nocini
- Maxillofacial Surgery Department, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - S Pelo
- Maxillofacial Surgery Department, Policlinico Universitario Agostino Gemelli, Università del Sacro Cuore, Rome, Italy
| | - G Ramieri
- Maxillofacial Surgery Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - E Sesenna
- Maxillofacial Surgery Department, Azienda Ospedaliera Universitaria di Parma, University of Parma, Parma, Italy
| | - L Solazzo
- Maxillofacial Surgery Department, Ospedale Civico di Palermo, Palermo, Italy
| | - G Spinelli
- Maxillofacial Surgery Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - A Tarsitano
- Maxillofacial Surgery Department, Azienda Universitaria Ospedaliera Sant'Orsola, Università Alma Mater Studiorum, Bologna, Italy
| | - G Tartaro
- Maxillofacial Surgery Department, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - V Valentini
- Maxillofacial Surgery Department, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy
| | - G Verrina
- Maxillofacial Surgery Department, E.O. Ospedali Galliera, Genoa, Italy
| | - F Biglioli
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
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11
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Ferri A, Perlangeli G, Montalto N, Carrillo Lizarazo JL, Bianchi B, Ferrari S, Nicolai P, Sesenna E, Grammatica A. Transoral resection with buccinator flap reconstruction vs. pull-through resection and free flap reconstruction for the management of T1/T2 cancer of the tongue and floor of the mouth. J Craniomaxillofac Surg 2020; 48:514-520. [DOI: 10.1016/j.jcms.2020.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/26/2020] [Accepted: 02/14/2020] [Indexed: 01/18/2023] Open
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12
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Rauso R, Zerbinati N, Franco R, Chirico F, Ronchi A, Sesenna E, Colella G, Tartaro G. Cross-linked hyaluronic acid filler hydrolysis with hyaluronidase: Different settings to reproduce different clinical scenarios. Dermatol Ther 2020; 33:e13269. [PMID: 32061001 DOI: 10.1111/dth.13269] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/10/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
Skin necrosis is the most severe complication arising from hyaluronic acid (HA) injection. To avoid skin necrosis, hyaluronidase should be injected along the course of the involved artery, to allow blood flow restoration. We evaluated the ability of hyaluronidase to degrade a HA filler in two simulated clinical situations-a compression case and an embolization case-to identify differences in the hyaluronidase injection. In the compression case, a bolus of HA filler was directly soaked in hyaluronidase solution; in the embolization case, a vein harvested from a living patient was filled with the same HA filler and then soaked in hyaluronidase. We then evaluated the quantity of HA remaining after 2 hr. While we found hydrolysis of HA in both cases, in the compression case, we detected almost complete hydrolysis, whereas in the embolization case we observed a reduction of the 60%. Our results support the hypothesis that vessel compression can be resolved with only one injection of hyaluronidase, while in the case of vascular embolization, repeated perivascular injections should be performed owing to the reduction of hyaluronidase activity.
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Affiliation(s)
- Raffaele Rauso
- Maxillo-Facial Complex Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Zerbinati
- Department of Dermatology, University of Insubria, Varese, Italy
| | - Renato Franco
- Pathological Anatomy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Andrea Ronchi
- Pathological Anatomy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Complex Unit, University of Parma, Parma, Italy
| | - Giuseppe Colella
- Maxillo-Facial Complex Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianpaolo Tartaro
- Maxillo-Facial Complex Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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13
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Abstract
Aims and background The aim of this study was to describe a case of primary orbital liposarcoma in Li-Fraumeni syndrome. Methods and study design In July 1998 a 20-year-old woman with a histological diagnosis of orbital myxoid liposarcoma underwent surgical treatment in our department. Since the patient's family pedigree met the clinical criteria for the diagnosis of LFS, molecular analysis was performed, which resulted in a molecular profile consistent with Li-Fraumeni syndrome. Results The patient underwent orbital exenteration extended to the upper eyelid; surgical reconstructive steps were performed to permit placement of an orbital prosthesis. Two years after primary surgery the patient underwent a quadrantectomy with lymphadenectomy of the right axilla because of the presence of a nodule of 1.5 cm in diameter in the upper-lateral quadrant of the right breast. One year after the last surgery, the patient is disease free. Conclusion The diagnosis of an orbital malignancy in a young patient with a family history of cancer should suggest the presence of an underlying genetic disorder like LFS; with molecular analysis we can now determine the genetic disorder and the exact location of the mutation, and also obtain important prognostic data using specific cellular markers. More prognostic information increases the chances of adequate personalized treatment.
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Affiliation(s)
- Tito Poli
- Division of Maxillofacial Surgery, University of Parma, Italy.
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14
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Colletti G, Biglioli F, Poli T, Dessy M, Cucurullo M, Petrillo M, Tombris S, Waner M, Sesenna E. Vascular malformations of the orbit (lymphatic, venous, arteriovenous): Diagnosis, management and results. J Craniomaxillofac Surg 2018; 47:726-740. [PMID: 30770258 DOI: 10.1016/j.jcms.2018.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/18/2018] [Revised: 08/02/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022] Open
Abstract
Vascular malformations are often found inside the orbit. Isolated venous malformations (frequently misnamed as cavernous hemangiomas) are the most frequent among these. However, also lymphatic and arteriovenous malformations can affect the orbit. The complex anatomy of the orbit and the fact that its content easily suffers from compartmental syndrome explain why treating orbital vascular malformations can be challenging and technically demanding. In this study, two institutions have retrospectively collected their cases, consisting in a total of 69 vascular malformations of the orbit. Each type of malformation has been evaluated separately in terms of diagnosis, indications for treatment, techniques and outcomes. Moreover, the authors have analyzed in detail venous malformations, identifying three different types, named orbital venous malformation (OVM) 1, 2 and 3. These behave differently from each other, and a prompt differential diagnosis is mandatory to pose correct indications, minimize risks and improve results. Overall, surgery was the technique of choice for OVM1, microcystic lymphatic malformations (LM) and arteriovenous malformations (AVM). A pure transnasal approach with mass removal and reconstruction of the medial wall with polyethylene sheets was chosen for OVM1 (intra- or extraconal) located in the medial or superomedial compartment. Sclerotherapy had a role in treating macrocystic LM and OVM3.
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Affiliation(s)
- Giacomo Colletti
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy.
| | - Federico Biglioli
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy
| | - Tito Poli
- University of Parma, Department of Maxillo Facial Surgery (Head: Prof. Enrico Sesenna), Italy
| | - Margherita Dessy
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy
| | - Marco Cucurullo
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy
| | - Mario Petrillo
- University of Milan, San Paolo Hospital, Department of Radiology (Head: Prof G.P. Carrafiello), Italy
| | | | - Milton Waner
- New York Vascular Birthmark Institute, United States
| | - Enrico Sesenna
- University of Parma, Department of Maxillo Facial Surgery (Head: Prof. Enrico Sesenna), Italy
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15
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Ferri A, Varazzani A, Valente A, Pedrazzi G, Bianchi B, Ferrari S, Sesenna E. Reply to comments on "Perioperative pain management after fibular free flap harvesting for head-and-neck reconstruction using mini-catheters to inject local anesthetic: A pilot study". Microsurgery 2018; 38:722. [PMID: 29959795 DOI: 10.1002/micr.30343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/08/2018] [Accepted: 06/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
- A Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - A Varazzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - A Valente
- Anesthesiologist Department, University Hospital of Parma, Parma, Italy
| | - G Pedrazzi
- Department of Neuroscience, University Hospital of Parma, Parma, Italy
| | - B Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - S Ferrari
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - E Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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16
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Brevi B, Di Blasio A, Di Blasio C, Piazza F, D'Ascanio L, Sesenna E. Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome? Acta Otorhinolaryngol Ital 2017; 35:332-7. [PMID: 26824915 PMCID: PMC4720930 DOI: 10.14639/0392-100x-415] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperatively by both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner's SNA angle increased from 78.18° to 85.58° (p < 0.001), while mean Delaire's C3/FM-CPA angle increased from 81.19° to 89.71° (p < 0.001). The mean value of Steiner's SNB angle increased from 74.33° to 80.73° (p < 0.001), while Delaire's C3/FM-Me angle increased from 80.10° to 87.29° (p < 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p < 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA.
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Affiliation(s)
- B Brevi
- Department of Maxillo-Facial Surgery, University Hospital of Parma, Italy
| | - A Di Blasio
- Department of Dentistry, University Hospital of Parma, Italy
| | - C Di Blasio
- Department of Maxillo-Facial Surgery, University Hospital of Parma, Italy
| | - F Piazza
- Department of Otolaryngology-Head & Neck Surgery, "Carlo Poma" Civil Hospital of Mantova, Italy
| | - L D'Ascanio
- Department of Otolaryngology-Head & Neck Surgery, "Carlo Poma" Civil Hospital of Mantova, Italy
| | - E Sesenna
- Department of Maxillo-Facial Surgery, University Hospital of Parma, Italy
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17
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Bianchi B, Ferri A, Poddi V, Bergonzani M, Pedrazzi G, Ferrari S, Sesenna E. Masseteric nerve for gracilis muscle re-innervation in unilateral facial palsy: Impact on quality of life. J Craniomaxillofac Surg 2017; 45:1051-1057. [DOI: 10.1016/j.jcms.2017.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/03/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022] Open
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18
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Bianchi B, Ferri A, Varazzani A, Bergonzani M, Sesenna E. Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications. J Craniofac Surg 2017; 28:1365-1368. [DOI: 10.1097/scs.0000000000003672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Ferri A, Varazzani A, Valente A, Pedrazzi G, Bianchi B, Ferrari S, Sesenna E. Perioperative pain management after fibular free flap harvesting for head-and-neck reconstruction using mini-catheters to inject local anesthetic: A pilot study. Microsurgery 2017. [DOI: 10.1002/micr.30192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Andrea Varazzani
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Adriana Valente
- Anesthesiologist Department; University Hospital of Parma; Parma Italy
| | | | - Bernardo Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Silvano Ferrari
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
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20
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Amit M, Na'ara S, Trejo-Leider L, Ramer N, Burstein D, Yue M, Miles B, Yang X, Lei D, Bjoerndal K, Godballe C, Mücke T, Wolff KD, Eckardt AM, Copelli C, Sesenna E, Patel S, Ganly I, Gil Z. Defining the surgical margins of adenoid cystic carcinoma and their impact on outcome: An international collaborative study. Head Neck 2017; 39:1008-1014. [PMID: 28252829 DOI: 10.1002/hed.24740] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 03/04/2016] [Revised: 09/08/2016] [Accepted: 12/29/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck. METHODS We conducted univariate and multivariate analyses of international data. RESULTS Data of 507 patients with ACC of the head and neck were analyzed; negative margins defined as ≥5 mm were detected in 253 patients (50%). On multivariate analysis, the hazard ratios (HRs) of positive margin status were 2.68 (95% confidence interval [CI], 1.2-6.2; p = .04) and 2.63 (95% CI, 1.1-6.3; p = .03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4-3.0; p = .12) and 1.07 (95% CI, 0.3-3.4; p = .23) for OS and DSS, respectively, relative with negative margins. CONCLUSION In head and neck ACC, positive margins are associated with the worst outcome. Negative or close margins are associated with improved outcome, regardless of the distance from the tumor. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1008-1014, 2017.
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Affiliation(s)
- Moran Amit
- The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Shorook Na'ara
- The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Naomi Ramer
- Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - David Burstein
- Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Ma Yue
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Brett Miles
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Xinjie Yang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Delin Lei
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Kristine Bjoerndal
- Department of Otolaryngology, Head and Neck Surgery, Odense University Hospital Denmark, Denmark, Germany
| | - Christian Godballe
- Department of Otolaryngology, Head and Neck Surgery, Odense University Hospital Denmark, Denmark, Germany
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - André M Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Chiara Copelli
- Department of Maxillofacial Surgery, University Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Department of Maxillofacial Surgery, University Hospital of Parma, Parma, Italy
| | - Snehal Patel
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ziv Gil
- The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel
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Silva M, Zambrini EI, Chiari G, Montermini I, Manna C, Poli T, Lanfranco D, Sesenna E, Thai E, Sverzellati N. Pre-surgical assessment of mandibular bone invasion from oral cancer: comparison between different imaging techniques and relevance of radiologist expertise. Radiol med 2016; 121:704-10. [DOI: 10.1007/s11547-016-0654-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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22
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Amit M, Na'ara S, Trejo-leider L, Ramer N, Ramer I, Agbetoba A, Miles B, Xinjie Y, Delin L, Bjoerndal K, Godballe C, Mücke T, Klaus-Dietrich W, Eckardt A, Copelli C, Sesenna E, Patel S, Ganly I, Gil Z. The Significance of Close Margins on Outcome of Patients with Adenoid Cystic Carcinoma of the Skull Base: An International Collaborative Study. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579800] [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: 10/22/2022]
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23
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Bianchi B, Varazzani A, Ferri A, Menozzi R, Sesenna E. Endovascular embolization for the management of inferior alveolar artery bleeding after a third molar extraction: A case report. Quintessence Int 2015; 47:227-31. [PMID: 26665260 DOI: 10.3290/j.qi.a35261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Removal of third molars is a common surgical procedure with low complication rates. Localized alveolar osteitis, infection, bleeding, and paresthesia are the four most common postoperative complications of third molar extraction reported in the literature. Postoperative severe hemorrhages are rare and are usually related to inferior alveolar artery damage. Although most bleeding is usually managed effectively by local compression or packing of the socket, even life-threatening complications may occur. Endovascular embolization has been rarely reported as treatment for such a complication and represents an ideal solution, with a low complication rate and excellent control of bleeding. The authors report a case of potentially life-threatening hemorrhage continuing 4 days after extraction of the mandibular right third molar, resulting in significant anemia (Hb 6.6 g/dL) and treated successfully with endovascular embolization of the inferior alveolar artery. The authors consider it important for general practitioners to know this treatment and how to manage this rare complication in the correct way, saving time if satisfactory hemostasis cannot be reached with common procedures.
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Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, Miles B, Yang X, Lei D, Bjoerndal K, Godballe C, Mücke T, Wolff KD, Fliss D, Eckardt AM, Copelli C, Sesenna E, Palmer F, Patel S, Gil Z. Erratum: adenoid cystic carcinoma of the nasal cavity and paranasal sinuses: a meta-analysis. J Neurol Surg B Skull Base 2015; 75:e1. [PMID: 24967153 DOI: 10.1055/s-0034-1372486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Moran Amit
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
| | - Yoav Binenbaum
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
| | - Kanika Sharma
- Department of Radiotherapy & Oncology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Naomi Ramer
- Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
| | - Ilana Ramer
- Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
| | - Abib Agbetoba
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York, USA
| | - Brett Miles
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York, USA
| | - Xinjie Yang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Delin Lei
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Kristine Bjoerndal
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Dan Fliss
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - André M Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Chiara Copelli
- Maxillo-Facial Surgery, University-Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery, University-Hospital of Parma, Parma, Italy
| | - Frank Palmer
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ziv Gil
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
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Ferrari S, Lanfranco D, Bianchi B, Ferri A, Sesenna E. Reconstruction of the maxillo-facial region in children: our experience. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.544] [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: 11/17/2022]
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Ferrari S, Ferri A, Bianchi B, Varazzani A, Giovacchini F, Sesenna E. Oncologic safety of facial artery myomucosal flaps in oral cavity reconstruction. Head Neck 2015; 38 Suppl 1:E1200-2. [PMID: 26286219 DOI: 10.1002/hed.24191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Buccinator myomucosal flaps are routinely used for oral cavity reconstruction and are indicated mainly in patients classified as having stage N0 cancer. This purpose of this study was to investigate whether preservation of the vascular pedicle of the flap (facial artery and vein) during stadiative neck dissection alters the oncologic safety in these patients. METHODS Fifty patients underwent resection of T1 to 3, N0 squamous cell carcinoma of the tongue or floor of the mouth, stadiative neck dissection, and reconstruction with a facial artery musculomucosal (FAMM) flap were retrospectively analyzed concerning rate of occult neck metastasis and recurrences. RESULTS Occult metastasis was detected in 10 patients. Mean follow-up was 41 months. The overall survival rate was 88%, and the disease-specific survival rate was 92%. CONCLUSION Neck dissection with preservation of the facial artery and vein does not alter the rate of regional recurrences, confirming the oncologic safety of myomucosal flaps in oral cavity reconstruction. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1200-E1202, 2016.
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Affiliation(s)
- Silvano Ferrari
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Andrea Varazzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Francesco Giovacchini
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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Ferrari S, Ferri A, Bianchi B, Varazzani A, Perlangeli G, Sesenna E. Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction. Microsurgery 2015; 35:447-50. [DOI: 10.1002/micr.22454] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Silvano Ferrari
- Maxillo-Facial Surgery Division; Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division; Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Division; Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Andrea Varazzani
- Maxillo-Facial Surgery Division; Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Giuseppe Perlangeli
- Maxillo-Facial Surgery Division; Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division; Head and Neck Department; University Hospital of Parma; Parma Italy
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Licitra LF, Favales F, Sesenna E, Spriano G, Ansarin M, Benazzo M, Nicolai P, Corvò R, Grandi C, Grando G, Squadrelli M, Marchetti C, Ionna F, Simon C, Richetti A, Presutti L, Meregaglia M, Mariani L, Rognoni C, Bossi P. Health and economic outcomes of two different follow up strategies in effectively cured advanced head and neck cancer patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps6625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Federica Favales
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Sesenna
- Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Mohssen Ansarin
- Division of Otolaryngology Head and Neck surgery, European Institute of Oncology, Milan, Italy
| | - Marco Benazzo
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Renzo Corvò
- Irccs Azienda Ospedaliera Universitaria San Martino IST - Istituto Nazionale per La Ricerca Sul Cancro, Genova, Italy
| | | | - Giuseppe Grando
- Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | | | | | - Franco Ionna
- Istituto Nazionale Tumori IRCCS - Fondazione Pascale, Napoli, Italy
| | - Christian Simon
- CHUV - Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | | | | | - Michela Meregaglia
- CERGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carla Rognoni
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Farnedi A, Rossi S, Bertani N, Gulli M, Silini EM, Mucignat MT, Poli T, Sesenna E, Lanfranco D, Montebugnoli L, Leonardi E, Marchetti C, Cocchi R, Ambrosini-Spaltro A, Foschini MP, Perris R. Proteoglycan-based diversification of disease outcome in head and neck cancer patients identifies NG2/CSPG4 and syndecan-2 as unique relapse and overall survival predicting factors. BMC Cancer 2015; 15:352. [PMID: 25935541 PMCID: PMC4429505 DOI: 10.1186/s12885-015-1336-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/22/2015] [Indexed: 01/07/2023] Open
Abstract
Background Tumour relapse is recognized to be the prime fatal burden in patients affected by head and neck squamous cell carcinoma (HNSCC), but no discrete molecular trait has yet been identified to make reliable early predictions of tumour recurrence. Expression of cell surface proteoglycans (PGs) is frequently altered in carcinomas and several of them are gradually emerging as key prognostic factors. Methods A PG expression analysis at both mRNA and protein level, was pursued on primary lesions derived from 173 HNSCC patients from whom full clinical history and 2 years post-surgical follow-up was accessible. Gene and protein expression data were correlated with clinical traits and previously proposed tumour relapse markers to stratify high-risk patient subgroups. Results HNSCC lesions were indeed found to exhibit a widely aberrant PG expression pattern characterized by a variable expression of all PGs and a characteristic de novo transcription/translation of GPC2, GPC5 and NG2/CSPG4 respectively in 36%, 72% and 71% on 119 cases. Importantly, expression of NG2/CSPG4, on neoplastic cells and in the intralesional stroma (Hazard Ratio [HR], 6.76, p = 0.017) was strongly associated with loco-regional relapse, whereas stromal enrichment of SDC2 (HR, 7.652, p = 0.007) was independently tied to lymphnodal infiltration and disease-related death. Conversely, down-regulated SDC1 transcript (HR, 0.232, p = 0.013) uniquely correlated with formation of distant metastases. Altered expression of PGs significantly correlated with the above disease outcomes when either considered alone or in association with well-established predictors of poor prognosis (i.e. T classification, previous occurrence of precancerous lesions and lymphnodal metastasis). Combined alteration of all three PGs was found to be a reliable predictor of shorter survival. Conclusions An unprecedented PG-based prognostic portrait is unveiled that incisively diversifies disease course in HNSCC patients beyond the currently known clinical and molecular biomarkers. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1336-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Farnedi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Silvia Rossi
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy.
| | - Nicoletta Bertani
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy.
| | - Mariolina Gulli
- Department of Life Sciences, Division of Genetics and Environmental Biotechnology, University of Parma, Parma, Italy.
| | - Enrico Maria Silini
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy. .,Department of Pathology and Laboratory Medicine, University of Parma, Parma, Italy.
| | - Maria Teresa Mucignat
- S.O.C. of Experimental Oncology 2, The National Tumour Institute Aviano - CRO-IRCCS, Aviano, Pordenone, Italy.
| | - Tito Poli
- Maxillofacial Surgery Section, Head and Neck Department, University of Parma, Parma, Italy.
| | - Enrico Sesenna
- Maxillofacial Surgery Section, Head and Neck Department, University of Parma, Parma, Italy.
| | - Davide Lanfranco
- Maxillofacial Surgery Section, Head and Neck Department, University of Parma, Parma, Italy.
| | - Lucio Montebugnoli
- Unit of Maxillo-Facial Surgery, Department of Oral Sciences, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Elisa Leonardi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Claudio Marchetti
- Department of Biomedical and Neuromotor Sciences, Unit of Maxillo-Facial Surgery, University of Bologna, S. Orsola Hospital, Bologna, Italy.
| | - Renato Cocchi
- Unit of Maxillo-facial Surgery at Bellaria Hospital, Bologna, Italy. .,Unit of Maxillo-facial Surgery, "Casa Sollievo della Sofferenza", San Giovanni in Rotondo, Italy.
| | - Andrea Ambrosini-Spaltro
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Roberto Perris
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy. .,S.O.C. of Experimental Oncology 2, The National Tumour Institute Aviano - CRO-IRCCS, Aviano, Pordenone, Italy.
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Bianchi B, Ferri A, Ferrari S, Leporati M, Ferri T, Sesenna E. Ancillary Procedures in Facial Animation Surgery. J Oral Maxillofac Surg 2014; 72:2582-90. [DOI: 10.1016/j.joms.2014.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/18/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
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Bianchi B, Ferri A, Leporati M, Ferrari S, Lanfranco D, Ferri T, Sesenna E. Upper eyelid platinum chain placement for treating paralytic lagophthalmos. J Craniomaxillofac Surg 2014; 42:2045-8. [DOI: 10.1016/j.jcms.2014.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022] Open
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Amit M, Na'ara S, Sharma K, Ramer N, Ramer I, Agbetoba A, Glick J, Yang X, Lei D, Bjoerndal K, Godballe C, Mücke T, Klaus-Dietrich W, Eckardt AM, Copelli C, Sesenna E, Palmer F, Ganly I, Gil Z. Elective neck dissection in patients with head and neck adenoid cystic carcinoma: an international collaborative study. Ann Surg Oncol 2014; 22:1353-9. [PMID: 25249259 DOI: 10.1245/s10434-014-4106-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC) accounts for 3-5 % of all head and neck malignancies. Investigations of outcomes from elective neck dissection (END) for patients with ACC are sparse. This study aimed to assess the impact of END on the survival of patients with ACC. METHODS This retrospective multicentered study investigated 270 patients who underwent neck dissection. A multivariate analysis assessed associations of clinical and histopathologic characteristics with survival outcomes. RESULTS The primary tumor sites included the oral cavity in 250 patients (55 %), the major salivary glands in 133 patients (29 %), the sinonasal mucosa in 68 patients (15 %), and the larynx in six patients (1 %). The overall rate of occult nodal metastases among the patients who underwent END was 17 % (38/226). The highest incidence of occult nodal metastases was with the oral cavity (66 %). The 5-year overall survival (72 and 79 % for patients with or without END, respectively) and disease-specific survival (74 and 81 % for patients with or without END, respectively) were similar in the two groups. The subgroup analysis of patients according to the primary site showed no significant impact of END on outcome. In the multivariate analysis, primary site, T classification, and N classification were the only variables associated with outcome. CONCLUSIONS The incidence of occult neck metastases among patients with ACC is 17 %. The highest incidence of occult metastases is with the oral cavity. Statistical analysis showed no survival advantage for patients who underwent END compared with those who did not.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Clinical Research Institute at Rambam (CRIR), Rambam Medical Center, The Technion, Israel Institute of Technology, Haifa, Israel
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Ferrari S, Copelli C, Bianchi B, Magri A, Ferri A, Varazzani A, Poli T, Ferri T, Sesenna E. The submental island flap: Pedicle elongation and indications in head and neck reconstruction. J Craniomaxillofac Surg 2014; 42:1005-9. [DOI: 10.1016/j.jcms.2014.01.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 10/21/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022] Open
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Amit M, Binenbaum Y, Trejo-Leider L, Sharma K, Ramer N, Ramer I, Agbetoba A, Miles B, Yang X, Lei D, Bjørndal K, Godballe C, Mücke T, Wolff KD, Eckardt AM, Copelli C, Sesenna E, Palmer F, Ganly I, Patel S, Gil Z. International collaborative validation of intraneural invasion as a prognostic marker in adenoid cystic carcinoma of the head and neck. Head Neck 2014; 37:1038-45. [PMID: 24710845 DOI: 10.1002/hed.23710] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [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: 07/22/2013] [Revised: 01/19/2014] [Accepted: 04/04/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize the incidence, pattern of spread, and prognostic correlation of nerve invasion in patients with adenoid cystic carcinoma (ACC). METHODS Using 3 different pathological categories of perineural invasion, intraneural invasion, and perineural inflammation, we investigated the prognostic value of nerve invasion in a total of 495 ACCs from 9 international patient cohorts with median follow-up 90 months (range, 12-288 months). RESULTS Of 239 patients (48%) with nerve invasion, 174 (73%) had perineural invasion, 65 (27%) intraneural invasion, and 37 (15%) perineural inflammation. Multivariate Cox regression analysis identified tumor site (p = .008; hazard ratio [HR] = 1.8; 95% confidence interval [CI] = 0.07-3.7) and intraneural invasion (p < .001; HR = 5.9; 95% CI = 0.8-12.3) as independent prognostic markers for both overall survival (OS) and disease-specific survival (DSS), but not of distant metastases. CONCLUSION Although perineural invasion has no impact on survival, intraneural invasion is an independent predictor of poor prognosis. Recognition of intraneural invasion may help optimize treatment of patients with head and neck ACC.
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Affiliation(s)
- Moran Amit
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Yoav Binenbaum
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Kanika Sharma
- Department of Radiotherapy and Oncology, Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, India
| | - Naomi Ramer
- Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Ilana Ramer
- Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Abib Agbetoba
- Department of Otolaryngology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Brett Miles
- Department of Otolaryngology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Xinjie Yang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Delin Lei
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Kristine Bjørndal
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital Odense, Denmark
| | - Christian Godballe
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital Odense, Denmark
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - André M Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Chiara Copelli
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Frank Palmer
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal Patel
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel.,Department of Otolaryngology Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, The Technion, Israel Institute of Technology, Haifa, Israel
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35
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Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, Glick J, Yang X, Lei D, Bjørndal K, Godballe C, Mücke T, Wolff KD, Fliss D, Eckardt AM, Copelli C, Sesenna E, Palmer F, Ganly I, Patel S, Gil Z. Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma. An international collaborative study. Head Neck 2014; 37:1032-7. [PMID: 25060927 DOI: 10.1002/hed.23711] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 07/13/2013] [Revised: 01/19/2014] [Accepted: 04/04/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The patterns of regional metastasis in adenoid cystic carcinoma (ACC) of the head and neck and its association with outcome is not established. METHODS We conducted a retrospective multicentered multivariate analysis of 270 patients who underwent neck dissection. RESULTS The incidence rate of neck metastases was 29%. The rate observed in the oral cavity is 37%, and in the major salivary glands is 19% (p = .001). The rate of occult nodal metastases was 17%. Overall 5-year survival rates were 44% in patients undergoing therapeutic neck dissections, and 65% and 73% among those undergoing elective neck dissections, with and without nodal metastases, respectively (p = .017). Multivariate analysis revealed that the primary site, nodal classification, and margin status were independent predictors of survival. CONCLUSION Our findings support the consideration of elective neck treatment in patients with ACC of the oral cavity.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Yoav Binenbaum
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Kanika Sharma
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Naomi Ramer
- Department of Radiotherapy and Oncology, Max Cancer Center, New Delhi, India
| | - Ilana Ramer
- Department of Radiotherapy and Oncology, Max Cancer Center, New Delhi, India
| | - Abib Agbetoba
- Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Joelle Glick
- Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Xinjie Yang
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Delin Lei
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Kristine Bjørndal
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Christian Godballe
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Thomas Mücke
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Klaus-Dietrich Wolff
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Dan Fliss
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - André M Eckardt
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Chiara Copelli
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Enrico Sesenna
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Palmer
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Ian Ganly
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Snehal Patel
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel.,Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
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36
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Girardi A, Martinelli M, Cura F, Palmieri A, Carinci F, Sesenna E, Scapoli L. RFC1 and non-syndromic cleft lip with or without cleft palate: an association based study in Italy. J Craniomaxillofac Surg 2014; 42:1503-5. [PMID: 24942095 DOI: 10.1016/j.jcms.2014.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 12/02/2013] [Revised: 03/07/2014] [Accepted: 04/22/2014] [Indexed: 11/27/2022] Open
Abstract
The molecular basis of orofacial development is largely unknown and needs to be unravelled. Non-syndromic cleft lip with or without cleft palate (NSCL/P) is the most common craniofacial malformation, with an incidence of about 1/700 live births, although variable according to ethnicity. Being a multifactorial disease, it arises as a result of an interplay between genetic and environmental factors. Several approaches have been developed to identify susceptibility genes. Genes belonging to the folate/homocysteine pathway are attracting increasing interest because folate supplementation before and during early pregnancy can reduce the risk of NSCL/P. We performed a family based association study in order to assess if a genetic variant of RFC1 could be involved in NSCL/P onset. We genotyped 404 unrelated probands and their relatives for three biallelic polymorphic variants (rs1051266, rs4818789 and rs3788205), that were selected because they produced conflicting results on previous investigations. Evidence of association was found between the investigated polymorphisms and NSCL/P in our sample of the Italian population, albeit with weak significance levels. Results from this investigation provided a support of previous studies suggesting a role of RFC1 in NSCL/P aetiology, reinforcing the concept that genetic predisposition to NSCL/P varies enormously within different ethnic groups.
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Affiliation(s)
- Ambra Girardi
- Department of Experimental, Diagnostic and Specialty Medicine, University di Bologna, Via Belmeloro 8, 40126 Bologna, Italy
| | - Marcella Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University di Bologna, Via Belmeloro 8, 40126 Bologna, Italy.
| | - Francesca Cura
- Department of Experimental, Diagnostic and Specialty Medicine, University di Bologna, Via Belmeloro 8, 40126 Bologna, Italy
| | - Annalisa Palmieri
- Department of Experimental, Diagnostic and Specialty Medicine, University di Bologna, Via Belmeloro 8, 40126 Bologna, Italy
| | - Francesco Carinci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Enrico Sesenna
- Head and Neck Department, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Luca Scapoli
- Department of Experimental, Diagnostic and Specialty Medicine, University di Bologna, Via Belmeloro 8, 40126 Bologna, Italy
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Bianchi B, Ferri A, Ferrari S, Copelli C, Perlangeli G, Leporati M, Ferri T, Sesenna E. Reconstruction of mandibular defects using the scapular tip free flap. Microsurgery 2014; 35:101-6. [DOI: 10.1002/micr.22285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/23/2014] [Accepted: 05/28/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Bernardo Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Silvano Ferrari
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Chiara Copelli
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Giuseppe Perlangeli
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Massimiliano Leporati
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Teore Ferri
- Otolaryngology Head Neck Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department; University Hospital of Parma; Parma Italy
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38
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Ventura E, Ormitti F, Crisi G, Sesenna E. Goldenhar syndrome associated with contralateral agenesis of the internal carotid artery. Neuroradiol J 2014; 27:150-3. [PMID: 24750700 DOI: 10.15274/nrj-2014-10029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 07/25/2013] [Accepted: 02/24/2014] [Indexed: 11/12/2022] Open
Abstract
Congenital absence of the internal carotid artery (ICA) is an extremely rare vascular anomaly. Aplasia and displacement of the horizontal portion of the petrous carotid artery have been described in a patient with mandibulofacial dysostosis. To the best of our knowledge, the association between Goldenhar syndrome and ipsilateral ICA agenesis has emerged only in one case documented in the medical literature to date. We describe here a case that illustrates the association of Goldenhar syndrome with contralateral agenesis of the ICA incidentally detected on brain magnetic resonance imaging and subsequently confirmed on magnetic resonance angiography and high resolution computed tomography.
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Affiliation(s)
- Elisa Ventura
- Department of Neuroradiology, Parma University Hospital; Parma, Italy -
| | - Francesca Ormitti
- Department of Neuroradiology, Parma University Hospital; Parma, Italy
| | - Girolamo Crisi
- Department of Neuroradiology, Parma University Hospital; Parma, Italy
| | - Enrico Sesenna
- Department of Maxillo-Facial Surgery, University of Parma; Parma, Italy
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39
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Bianchi B, Ferri A, Ferrari S, Copelli C, Salvagni L, Sesenna E. The masseteric nerve: a versatile power source in facial animation techniques. Br J Oral Maxillofac Surg 2014; 52:264-9. [PMID: 24467945 DOI: 10.1016/j.bjoms.2013.12.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 08/20/2013] [Accepted: 12/30/2013] [Indexed: 11/25/2022]
Abstract
The masseteric nerve has many advantages including low morbidity, its proximity to the facial nerve, the strong motor impulse, its reliability, and the fast reinnervation that is achievable in most patients. Reinnervation of a neuromuscular transplant is the main indication for its use, but it has been used for the treatment of recent facial palsies with satisfactory results. We have retrospectively evaluated 60 patients who had facial animation procedures using the masseteric nerve during the last 10 years. The patients included those with recent, and established or congenital, unilateral and bilateral palsies. The masseteric nerve was used for coaptation of the facial nerve either alone or in association with crossfacial nerve grafting, or for the reinnervation of gracilis neuromuscular transplants. Reinnervation was successful in all cases, the mean (range) time being 4 (2-5) months for facial nerve coaptation and 4 (3-7) months for neuromuscular transplants. Cosmesis was evaluated (moderate, n=10, good, n=30, and excellent, n=20) as was functional outcome (no case of impairment of masticatory function, all patients able to smile, and achievement of a smile independent from biting). The masseteric nerve has many uses, including in both recent, and established or congenital, cases. In some conditions it is the first line of treatment. The combination of combined techniques gives excellent results in unilateral palsies and should therefore be considered a valid option.
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Affiliation(s)
- B Bianchi
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Italy
| | - A Ferri
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Italy.
| | - S Ferrari
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Italy
| | - C Copelli
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Italy
| | - L Salvagni
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Italy
| | - E Sesenna
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Italy
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40
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Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, Miles B, Yang X, Lei D, Bjøerndal K, Godballe C, Mücke T, Wolff KD, Fliss D, Eckardt AM, Copelli C, Sesenna E, Palmer F, Patel S, Gil Z. Analysis of failure in patients with adenoid cystic carcinoma of the head and neck. An international collaborative study. Head Neck 2013; 36:998-1004. [PMID: 23784851 DOI: 10.1002/hed.23405] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/09/2013] [Accepted: 06/03/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC) is a locally aggressive tumor with a high prevalence of distant metastases. The purpose of this study was to identify independent predictors of outcome and to characterize the patterns of failure. METHODS An international retrospective review was conducted of 489 patients with ACC treated between 1985 and 2011 in 9 cancer centers worldwide. RESULTS Five-year overall-survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 76%, 80%, and 68%, respectively. Independent predictors of OS and DSS were: age, site, N classification, and presence of distant metastases. N classification, age, and bone invasion were associated with DFS on multivariate analysis. Age, tumor site, orbital invasion, and N classification were independent predictors of distant metastases. CONCLUSION The clinical course of ACC is slow but persistent. Paranasal sinus origin is associated with the lowest distant metastases rate but with the poorest outcome. These prognostic estimates should be considered when tailoring treatment for patients with ACC.
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Affiliation(s)
- Moran Amit
- The Laboratory for Applied Cancer Research, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
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Ferrari S, Lanfranco D, Bianchi B, Copelli C, Ferri A, Leporati M, Sesenna E. Mandibular resection and reconstruction in the management of extensive ameloblastoma: our experience. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.388] [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: 10/26/2022]
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Bianchi B, Ferri A, Ferrari S, Copelli C, Sesenna E. Facelift approach for mandibular resection and reconstruction. Head Neck 2013; 36:1497-502. [PMID: 23996729 DOI: 10.1002/hed.23484] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/16/2013] [Accepted: 08/23/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Mandibular resection is the mainstay in the treatment of several pathologies involving the jaw. When benign lesions are approached, a limited exposure and less invasive access considering the cosmetic outcome is desirable to reduce morbidity and increase patient's quality of life after surgery. The facelift approach is widely used for rhytidectomy, parotidectomy, and facial animation procedures, whereas its use for mandibular resection and reconstruction is not described yet. METHODS Six patients underwent mandibular resection and reconstruction with free flaps or bone grafts via the facelift approach were retrospectively evaluated with regard to function and cosmesis. RESULTS No impairment of occlusion or facial nerve occurred; mouth opening was normal in 4 patient and partially limited in 2. Cosmesis was assessed as excellent by 3 patients and good in 3. CONCLUSION The facelift approach is a valid option for resecting and reconstructing benign lesions involving the mandibular ramus, angle, and posterior body.
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Affiliation(s)
- Bernardo Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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Amit M, Binenbaum Y, Sharma K, Naomi R, Ilana R, Abib A, Miles B, Yang X, Lei D, Kristine B, Christian G, Thomas M, Klaus-Dietrich W, Fliss D, Eckardt AM, Chiara C, Sesenna E, Frank P, Patel S, Gil Z. Adenoid cystic carcinoma of the nasal cavity and paranasal sinuses: a meta-analysis. J Neurol Surg B Skull Base 2013; 74:118-25. [PMID: 24436900 PMCID: PMC3709956 DOI: 10.1055/s-0033-1347358] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 11/21/2012] [Accepted: 03/10/2013] [Indexed: 10/26/2022] Open
Abstract
Objectives To identify independent predictors of outcome in patients with adenoid cystic carcinoma (ACC) of the paranasal sinuses and skull base. Design Meta-analysis of the literature and data from the International ACC Study Group. Setting University-affiliated medical center. Participants The study group consisted of 520 patients, 99 of them from the international cohort. The median follow-up period was 60 months (range, 32 to 100 months). Main Outcome Measures Overall survival (OS) and disease-specific survival (DSS). Results The 5-year OS and DSS of the entire cohort were 62% and 67%, respectively. The local recurrence rate was 36.6%, and the regional recurrence rate was 7%. Distant metastasis, most commonly present in the lung, was recorded in 106 patients (29.1%). In the international cohort, positive margins and ACC of the sphenoid or ethmoidal sinuses were significant predictors of outcome (p < 0.001). Perineural invasion and adjuvant treatment (radiotherapy or chemoradiation) were not associated with prognosis. Conclusion Tumor margin status and tumor site are associated with prognosis in ACC of the paranasal sinuses, whereas perineural invasion is not. Adjuvant treatment apparently has no impact on outcome.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
| | - Yoav Binenbaum
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
| | - Kanika Sharma
- Department of Radiotherapy & Oncology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Ramer Naomi
- Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
| | - Ramer Ilana
- Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
| | - Agbetoba Abib
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York, USA
| | - Brett Miles
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York, USA
| | - Xinjie Yang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Delin Lei
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Bjoerndal Kristine
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Godballe Christian
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Mücke Thomas
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Wolff Klaus-Dietrich
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Dan Fliss
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - André M. Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Copelli Chiara
- Maxillo-Facial Surgery, University-Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery, University-Hospital of Parma, Parma, Italy
| | - Palmer Frank
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ziv Gil
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
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Bianchi B, Ferri A, Ferrari S, Copelli C, Magri A, Ferri T, Sesenna E. Cross-facial nerve graft and masseteric nerve cooptation for one-stage facial reanimation: Principles, indications, and surgical procedure. Head Neck 2013; 36:235-40. [DOI: 10.1002/hed.23300] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bernardo Bianchi
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Andrea Ferri
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Silvano Ferrari
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Chiara Copelli
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Alice Magri
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Teore Ferri
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Enrico Sesenna
- Head and Neck Department; University Hospital of Parma; Parma Italy
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Sesenna E, Bianchi B, Ferrari S, Copelli C, Ferri T, Ferri A. Selective deep lobe parotidectomy for pleomorphic adenomas. Int J Oral Maxillofac Surg 2013; 42:1129-33. [PMID: 23702372 DOI: 10.1016/j.ijom.2013.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 02/19/2013] [Revised: 03/16/2013] [Accepted: 04/16/2013] [Indexed: 11/29/2022]
Abstract
The authors' experience of the selective deep lobe parotidectomy for the treatment of pleomorphic adenomas of the deep parotid lobe is presented. A retrospective analysis of 11 patients treated between 1997 and 2010 was performed; seven were males and four were females, ranging in age from 35 to 51 years. Parameters evaluated included facial nerve weakness, the occurrence of Frey's syndrome, cosmetic outcome, and recurrence. Follow-up ranged from 18 months to 11 years. No major complications, permanent facial nerve weakness, or Frey's syndrome occurred. Four patients developed temporary facial nerve impairments that lasted between 2 and 6 weeks, and two developed a sialocele that healed in 9 days in one case and 12 days in the other. The overall cosmetic assessment was excellent in eight patients, good in two, and satisfactory in the remaining one. No recurrences occurred. The selective deep lobe parotidectomy can be considered an effective technique for the management of deep parotid lobe pleomorphic adenomas. The major advantages of this procedure include a reduction in complications such as facial nerve impairments and Frey's syndrome, and an improved cosmetic outcome.
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Affiliation(s)
- E Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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Beltramini GA, Baj A, Massarelli O, Valentini V, Tullio A, Sesenna E, Gianni AB. PP123. Oral Oncol 2013. [DOI: 10.1016/j.oraloncology.2013.03.366] [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: 11/30/2022]
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Ferrari S, Copelli C, Bianchi B, Ferri A, Poli T, Ferri T, Gallesi P, Sesenna E, Brevi B. Rehabilitation with endosseous implants in fibula free-flap mandibular reconstruction: A case series of up to 10 years. J Craniomaxillofac Surg 2013; 41:172-8. [DOI: 10.1016/j.jcms.2012.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/29/2022] Open
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Abstract
The iliac crest free flap is one of the most reliable flaps for maxillary reconstruction because of the large amount of bone provided and the chance to harvest both muscle and skin. However, reconstruction of maxillary through-and-through defects requires special skills to be managed. Simultaneous replacement of oral lining and external tissue with the same features as the resected skin is difficult to achieve with conventional techniques and the use of flaps association is often necessary to ensure acceptable cosmetic and functional results. In the case presented the submental island flap was a good choice to overcome these difficulties.
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Foschini MP, Leonardi E, Eusebi LH, Farnedi A, Poli T, Tarsitano A, Cocchi R, Marchetti C, Gentile L, Sesenna E, Marucci G, Montebugnoli L. Podoplanin and E-cadherin Expression in Preoperative Incisional Biopsies of Oral Squamous Cell Carcinoma Is Related to Lymph Node Metastases. Int J Surg Pathol 2013; 21:133-41. [DOI: 10.1177/1066896912471851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metastases to cervical lymph nodes (LNs) are an important independent adverse indicator in the prognosis of oral squamous cell carcinoma (OSCC). An accurate evaluation of molecular patterns favoring the metastatic process can be helpful in predicting cases of OSCC with elevated probability of early or late metastases and, moreover, in planning the proper therapeutic procedures before surgery. To this end, immunohistochemical expressions of both E-cadherin and podoplanin were evaluated on preoperative incisional biopsies of OSCC from 102 patients. The probability to have or develop metastases was very low when high E-cadherin expression was found in a preoperative sample or when a low podoplanin expression was found. Therefore, because of the strong association with LN metastases, high E-cadherin/low podoplanin immunohistochemical expression should also be assessed on preoperative incisional biopsies as a useful tool for evaluating the probability of early or late LN metastases of OSCCs.
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Affiliation(s)
| | - Elisa Leonardi
- University of Bologna at Bellaria Hospital, Bologna, Italy
| | - Leonardo Henry Eusebi
- University of Bologna at Bellaria Hospital, Bologna, Italy
- University of Bologna, Bologna, Italy
| | - Anna Farnedi
- University of Bologna at Bellaria Hospital, Bologna, Italy
| | - Tito Poli
- University Hospital of Parma, Parma, Italy
| | | | - Roberto Cocchi
- “Casa sollievo della sofferenza” Hospital, San Giovanni Rotondo (FG), Italy
- Bellaria Hospital, Bologna, Italy
| | - Claudio Marchetti
- “Casa sollievo della sofferenza” Hospital, San Giovanni Rotondo (FG), Italy
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Ferri A, Leporati M, Corradi D, Ferri T, Sesenna E. Huge desmoplastic fibroma of the paediatric mandible: surgical considerations and follow-up in three cases. J Craniomaxillofac Surg 2012; 41:367-70. [PMID: 23218503 DOI: 10.1016/j.jcms.2012.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 11/16/2022] Open
Abstract
The desmoplastic fibroma is a rare locally aggressive spindle-cell proliferation made up of fibroblasts/myofibroblasts immersed in a dense collagenic stroma. Head and neck localisation of desmoplastic fibromas is even more rare and the literature is limited to small case series and reviews. A comprehensive review of the English literature from 1968 to 2011 revealed only 79 cases of mandibular desmoplastic fibromas and only 18 (22%) in patients under 4 years of age. Complete resection with clear margins is the surgical first option, but it can be difficult to achieve in the paediatric mandible, especially for giant tumours as the three reported here. Mandibular reconstruction in these cases is mandatory to ensure correct craniofacial development. The authors present three cases of huge mandibular desmoplastic fibromas in paediatric patients treated with mandibulectomy and immediate reconstruction using rib grafts. Indications, reconstructive options and results are discussed.
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Affiliation(s)
- Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100 Parma, Italy.
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