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Vaira LA, Lechien JR, Abbate V, Allevi F, Audino G, Beltramini GA, Bergonzani M, Boscolo-Rizzo P, Califano G, Cammaroto G, Chiesa-Estomba CM, Committeri U, Crimi S, Curran NR, di Bello F, di Stadio A, Frosolini A, Gabriele G, Gengler IM, Lonardi F, Maglitto F, Mayo-Yáñez M, Petrocelli M, Pucci R, Saibene AM, Saponaro G, Tel A, Trabalzini F, Trecca EMC, Vellone V, Salzano G, De Riu G. Validation of the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool: a new tool to assess the quality of health information provided by AI platforms. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08710-0. [PMID: 38703195 DOI: 10.1007/s00405-024-08710-0] [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: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The widespread diffusion of Artificial Intelligence (AI) platforms is revolutionizing how health-related information is disseminated, thereby highlighting the need for tools to evaluate the quality of such information. This study aimed to propose and validate the Quality Assessment of Medical Artificial Intelligence (QAMAI), a tool specifically designed to assess the quality of health information provided by AI platforms. METHODS The QAMAI tool has been developed by a panel of experts following guidelines for the development of new questionnaires. A total of 30 responses from ChatGPT4, addressing patient queries, theoretical questions, and clinical head and neck surgery scenarios were assessed by 27 reviewers from 25 academic centers worldwide. Construct validity, internal consistency, inter-rater and test-retest reliability were assessed to validate the tool. RESULTS The validation was conducted on the basis of 792 assessments for the 30 responses given by ChatGPT4. The results of the exploratory factor analysis revealed a unidimensional structure of the QAMAI with a single factor comprising all the items that explained 51.1% of the variance with factor loadings ranging from 0.449 to 0.856. Overall internal consistency was high (Cronbach's alpha = 0.837). The Interclass Correlation Coefficient was 0.983 (95% CI 0.973-0.991; F (29,542) = 68.3; p < 0.001), indicating excellent reliability. Test-retest reliability analysis revealed a moderate-to-strong correlation with a Pearson's coefficient of 0.876 (95% CI 0.859-0.891; p < 0.001). CONCLUSIONS The QAMAI tool demonstrated significant reliability and validity in assessing the quality of health information provided by AI platforms. Such a tool might become particularly important/useful for physicians as patients increasingly seek medical information on AI platforms.
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy.
- PhD School of Biomedical Science, Biomedical Sciences Department, University of Sassari, Sassari, Italy.
| | - Jerome R Lechien
- Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Mons School of Medicine, UMONS. Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology-Head Neck Surgery, Elsan Polyclinic of Poitiers, Poitiers, France
| | - Vincenzo Abbate
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Department, ASSt Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giovanni Audino
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Giada Anna Beltramini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Bergonzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, USA
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Giovanni Cammaroto
- ENT Department, Morgagni Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Umberto Committeri
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Salvatore Crimi
- Operative Unit of Maxillofacial Surgery, Policlinico San Marco, University of Catania, Catania, Italy
| | - Nicholas R Curran
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Francesco di Bello
- Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Arianna di Stadio
- Otolaryngology Unit, GF Ingrassia Department, University of Catania, Catania, Italy
| | - Andrea Frosolini
- Department of Maxillofacial Surgery, University of Siena, Siena, Italy
| | - Guido Gabriele
- Department of Maxillofacial Surgery, University of Siena, Siena, Italy
| | - Isabelle M Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Fabio Lonardi
- Department of Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Fabio Maglitto
- Maxillo-Facial Surgery Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology, Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Marzia Petrocelli
- Maxillofacial Surgery Operative Unit, Bellaria and Maggiore Hospital, Bologna, Italy
| | - Resi Pucci
- Maxillofacial Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianmarco Saponaro
- Maxillo-Facial Surgery Unit, IRCSS "A. Gemelli" Foundation-Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Department of Head and Neck Surgery and Neuroscience, University Hospital of Udine, Udine, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
| | - Eleonora M C Trecca
- Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Hospital Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
- Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy
| | | | - Giovanni Salzano
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy
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Allevi F, Borzi P, Valsecchi F, Cucurullo M, Bolognesi F, Rabbiosi D, Biglioli F. The extracapsular dissection technique in the management of benign tumours of the parotid gland: our experience in 194 patients. J Laryngol Otol 2024; 138:565-569. [PMID: 37807905 PMCID: PMC11063660 DOI: 10.1017/s0022215123001767] [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: 05/04/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The indications for and approaches to extracapsular dissection for parotid gland benign tumours are debated in the literature. This study retrospectively evaluates a single site's short- and long-term results with a standardised extracapsular dissection approach to benign parotid tumours. METHODS A retrospective review of a single institution's records identified cases with extracapsular dissection as the primary surgery for non-recurrent benign parotid tumours. A total of 194 eligible patients were identified (124 women and 70 men, age 47.75 ± 15.62 years). Pre-, intra- and post-surgical data were reviewed for complications and recurrences. RESULTS Histology reported pleomorphic adenoma in 165 patients, Warthin's tumour in 28 patients and both in one patient. Mean follow up was 36 ± 16 months (range, 12-84 months). The incidences of complications following extracapsular dissection were temporary (n = 13) and permanent (n = 0) facial nerve dysfunction, Frey's syndrome (n = 1)) and recurrences (n = 5). These rates align with prior literature. CONCLUSION This case series shows how a standardised approach to extracapsular dissection for benign parotid tumours yields favourable results, supporting a progressive change of strategy towards reduced invasiveness.
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Affiliation(s)
- Fabiana Allevi
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Patrizia Borzi
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Valsecchi
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Marco Cucurullo
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Bolognesi
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Dimitri Rabbiosi
- Maxillofacial Surgery Unit, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Federico Biglioli
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
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Allevi F, Abate N, Bolognesi F, Tarabbia F, Rabbiosi D, Bellasio MM, Lozza A, Biglioli F. Is pre-operative electromyography a reliable tool in differentiating acute and chronic facial palsy? A preliminary evaluation in patients treated with triple innervation facial reanimation. J Craniomaxillofac Surg 2024:S1010-5182(24)00139-2. [PMID: 38734508 DOI: 10.1016/j.jcms.2024.04.001] [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: 01/05/2024] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and further distinguishes acute palsies, still showing muscle fibrillations, from chronic cases. This article aims to show that EMG fibrillations might represent a better criterion to differentiate acute and chronic palsies than the standard 18-24 months' cut-off usually employed for classification and treatment purposes. We performed a cohort study using the eFACE tool for comparing triple innervation facial reanimation results in patients with EMG fibrillation treated <12 months, 12-18 months, and >18 months from paralysis onset. Patients showed a statistically significant post-operative improvement in all eFACE items, both in the whole sample and in the three groups. Only the deviation from the optimal score for the gentle eye closure item in group 2 didn't reach statistical significance (p = 0.173). The post-operative results were comparable in the three groups, as the Kruskal-Wallis test showed a difference only for the platysmal synkinesis item scores, which were significantly lower in group 3 (p = 0.025).
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Affiliation(s)
- Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Nicole Abate
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Tarabbia
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Dimitri Rabbiosi
- Department of Otorhinolaryngology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
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Saibene AM, Allevi F, Calvo-Henriquez C, Maniaci A, Mayo-Yáñez M, Paderno A, Vaira LA, Felisati G, Craig JR. Reliability of large language models in managing odontogenic sinusitis clinical scenarios: a preliminary multidisciplinary evaluation. Eur Arch Otorhinolaryngol 2024; 281:1835-1841. [PMID: 38189967 PMCID: PMC10943141 DOI: 10.1007/s00405-023-08372-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE This study aimed to evaluate the utility of large language model (LLM) artificial intelligence tools, Chat Generative Pre-Trained Transformer (ChatGPT) versions 3.5 and 4, in managing complex otolaryngological clinical scenarios, specifically for the multidisciplinary management of odontogenic sinusitis (ODS). METHODS A prospective, structured multidisciplinary specialist evaluation was conducted using five ad hoc designed ODS-related clinical scenarios. LLM responses to these scenarios were critically reviewed by a multidisciplinary panel of eight specialist evaluators (2 ODS experts, 2 rhinologists, 2 general otolaryngologists, and 2 maxillofacial surgeons). Based on the level of disagreement from panel members, a Total Disagreement Score (TDS) was calculated for each LLM response, and TDS comparisons were made between ChatGPT3.5 and ChatGPT4, as well as between different evaluators. RESULTS While disagreement to some degree was demonstrated in 73/80 evaluator reviews of LLMs' responses, TDSs were significantly lower for ChatGPT4 compared to ChatGPT3.5. Highest TDSs were found in the case of complicated ODS with orbital abscess, presumably due to increased case complexity with dental, rhinologic, and orbital factors affecting diagnostic and therapeutic options. There were no statistically significant differences in TDSs between evaluators' specialties, though ODS experts and maxillofacial surgeons tended to assign higher TDSs. CONCLUSIONS LLMs like ChatGPT, especially newer versions, showed potential for complimenting evidence-based clinical decision-making, but substantial disagreement was still demonstrated between LLMs and clinical specialists across most case examples, suggesting they are not yet optimal in aiding clinical management decisions. Future studies will be important to analyze LLMs' performance as they evolve over time.
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Affiliation(s)
- Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy.
| | - Fabiana Allevi
- Maxillofacial Surgery Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Rhinology Unit, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Antonino Maniaci
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology, Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Alberto Paderno
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
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Biglio A, Rossetti G, Gibelli DM, Dolci C, Cappella A, Allevi F, Vaira LA, De Riu G, Sforza C, Biglioli F. Three-dimensional evaluation of symmetry in facial palsy reanimation using stereophotogrammetric devices: A series of 15 cases. J Craniomaxillofac Surg 2023; 51:766-771. [PMID: 37858482 DOI: 10.1016/j.jcms.2023.09.011] [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: 02/03/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
Facial palsy can severely compromise quality of life, significantly altering the harmony and symmetry of the face, which can be restored by surgical rehabilitation. The aim of the study was the quantification of facial symmetry following facial reanimation. Fifteen consecutive adult patients were surgically treated through triple innervation for reanimation of flaccid unilateral facial paralysis (contralateral facial nerve, masseteric nerve, and hypoglossal nerve) and fascia lata graft for definition of the nasolabial sulcus. In the preoperative stage and at least 11 months after the surgical treatment, three-dimensional facial images were recorded through stereophotogrammetry in a neutral (rest) position, and with Mona Lisa and full-denture (maximum) smiles. Labial commissure inclination relative to the interpupillary axis, and a surface assessment of local facial asymmetry at rest and while smiling were obtained for the upper, middle, and lower facial thirds. The angle between the interpupillary axis and the labial commissure significantly improved in post-surgical acquisitions, regaining symmetry at rest (t-test; p < 0.001). Facial symmetry increased significantly when passing from pre-to postsurgical facial scans, from the lower to the upper facial third, and from the full smile to the rest position (ANOVA; p < 0.001). After treatment, the full smile recovered more symmetry than the other two expressions. In summary, surgical treatment significantly reduced facial asymmetry, but this reduction differed significantly among the various animations and facial thirds. The results of this study confirmed clinical findings of significant static and dynamic improvements in facial symmetry after triple innervation reanimation surgery.
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Affiliation(s)
- Andrea Biglio
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy; Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
| | - Giulia Rossetti
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Claudia Dolci
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Annalisa Cappella
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Operative Unit, Laboratorio di Morfologia Umana Applicata, IRCSS San Donato, San Donato Milanese, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy; School of Biomedical Sciences, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federico Biglioli
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
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González-Rodríguez H, Mayo-Yáñez M, Maria-Saibene A, Allevi F, Chiesa-Estomba CM, Vaira LA, Lechien JR. Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review. J Pers Med 2023; 13:1374. [PMID: 37763142 PMCID: PMC10533112 DOI: 10.3390/jpm13091374] [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: 08/16/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.
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Affiliation(s)
- Henar González-Rodríguez
- Otorhinolaryngology—Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology—Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
| | - Alberto Maria-Saibene
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
| | - Fabiana Allevi
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
| | - Carlos M. Chiesa-Estomba
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Otorhinolaryngology—Head and Neck Surgery Department, Hospital Universitario Donostia—Biodonostia Research Institute, 20014 Donostia, Spain
| | - Luigi A. Vaira
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Jerome R. Lechien
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Research Study Group, 75000 Paris, France; (A.M.-S.); (F.A.); (C.M.C.-E.); (L.A.V.); (J.R.L.)
- Department of Otolaryngology, Polyclinique de Poitiers, Elsan Hospital, 86000 Poitiers, France
- Department of Otolaryngology—Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France
- Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology—Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), 1000 Brussels, Belgium
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Abdelkarim A, Allevi F, Bolognesi F, Tarabbia F, Elyounsi M, Abdelrahim M, Abda EA, El-Shazly M, Biglioli F. Intra-surgical optimized identification of masseteric nerve for central facial nerve neurorrhaphy: A retrospective study. J Craniomaxillofac Surg 2023; 51:580-585. [PMID: 37598067 DOI: 10.1016/j.jcms.2023.08.010] [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: 02/09/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023] Open
Abstract
It is the aim of the study to provide a detailed intraoperative assessment of the masseteric nerve and the facial branch of the smiling muscles complex through the same superficial musculoaponeurotic system (SMAS) incision. This observational retrospective study aimed to define the straightest and safest surgical route to identify the facial nerve for the smiling muscles complex and the masseteric nerve, using distance from the tragus and zygomatic arch as anatomical landmarks. 30 patients were included in the study. The mean distance from the tragus to the masseteric nerve was 40.03 mm, the mean distance from the zygomatic arch was 12.24 mm, and the mean depth from the SMAS was 10.84 mm. Data were consistent, with little variation. The distance from the zygoma was found to be higher in male patients. There was a positive correlation between the depth to the nerve and the distance from the zygoma, but no correlation between body mass index and the other parameters studied. Within the limitations of the study it seems that the proposed standardized direct approach to the masseteric nerve is a reproducible technique that may be used to increase the safety of the procedure, reduce the operating time, and decrease the amount of dissection and related postoperative scarring, thereby fostering positive results.
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Affiliation(s)
- Ahmed Abdelkarim
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy; Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy.
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy.
| | - Filippo Tarabbia
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy.
| | - Mohamed Elyounsi
- Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Mohamed Abdelrahim
- Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Essam A Abda
- Rheumatology Rehabilitation and Physical Medication Department, Assiut University Hospital, Assiut, Egypt.
| | - Mohamed El-Shazly
- Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy.
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Vaira LA, Lechien JR, Abbate V, Allevi F, Audino G, Beltramini GA, Bergonzani M, Bolzoni A, Committeri U, Crimi S, Gabriele G, Lonardi F, Maglitto F, Petrocelli M, Pucci R, Saponaro G, Tel A, Vellone V, Chiesa-Estomba CM, Boscolo-Rizzo P, Salzano G, De Riu G. Accuracy of ChatGPT-Generated Information on Head and Neck and Oromaxillofacial Surgery: A Multicenter Collaborative Analysis. Otolaryngol Head Neck Surg 2023. [PMID: 37595113 DOI: 10.1002/ohn.489] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To investigate the accuracy of Chat-Based Generative Pre-trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery. STUDY DESIGN Observational and valuative study. SETTING Eighteen surgeons from 14 Italian head and neck surgery units. METHODS A total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1-6), completeness (range 1-3), and references' quality Likert scales. RESULTS The overall median score of open-ended questions was 6 (interquartile range[IQR]: 5-6) for accuracy and 3 (IQR: 2-3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial intelligence (AI) model achieved a correct response in 84.7% of the closed-ended questions (11 wrong answers). As for the clinical scenarios, ChatGPT provided a fully or nearly fully correct diagnosis in 81.7% of cases. The proposed diagnostic or therapeutic procedure was judged to be complete in 56.7% of cases. The overall quality of the bibliographic references was poor, and sources were nonexistent in 46.4% of the cases. CONCLUSION The results generally demonstrate a good level of accuracy in the AI's answers. The AI's ability to resolve complex clinical scenarios is promising, but it still falls short of being considered a reliable support for the decision-making process of specialists in head-neck surgery.
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Biomedical Sciences Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Jerome R Lechien
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS, Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology-Head Neck Surgery, Elsan Polyclinic of Poitiers, Poitiers, France
| | - Vincenzo Abbate
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Department, ASSt Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giovanni Audino
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Giada Anna Beltramini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Bergonzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Alessandro Bolzoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Umberto Committeri
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Salvatore Crimi
- Operative Unit of Maxillofacial Surgery, Policlinico San Marco, University of Catania, Catania, Italy
| | - Guido Gabriele
- Department of Maxillofacial Surgery, University of Siena, Siena, Italy
| | - Fabio Lonardi
- Department of Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Fabio Maglitto
- Maxillo-Facial Surgery Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Marzia Petrocelli
- Maxillofacial Surgery Operative Unit, Bellaria and Maggiore Hospital, Bologna, Italy
| | - Resi Pucci
- Maxillofacial Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Gianmarco Saponaro
- Maxillo-Facial Surgery Unit, IRCSS "A. Gemelli" Foundation-Catholic, University of the Sacred Heart, Rome, Italy
| | - Alessandro Tel
- Department of Head and Neck Surgery and Neuroscience, Clinic of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | | | | | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Giovanni Salzano
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, Naples, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
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9
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Atta MO, Allevi F, Bolognesi F, Abdelkarim A, Valsecchi F, Tarabbia F, Rabbiosi D, Ahmed A, Biglioli F. Periocular management in recent facial palsy patients treated with triple innervation technique: A retrospective case series. J Craniomaxillofac Surg 2023:S1010-5182(23)00068-9. [PMID: 37142529 DOI: 10.1016/j.jcms.2023.04.006] [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: 11/17/2022] [Revised: 03/02/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
Facial paralysis decreases eye protection mechanisms leading to ocular problems up to corneal ulceration, and blindness. This study aimed to evaluate the outcomes of periocular procedures for recent facial paralysis. Medical records of patients with unilateral recent complete facial palsy who did periocular procedures at the Maxillofacial Surgery Department of San Paolo Hospital (Milan, Italy) between April 2018 and November 2021 were retrospectively reviewed. 26 patients were included. All patients were evaluated 4 months after surgery. The first group included 9 patients who underwent upper eye lid lipofilling and midface suspension with fascia lata graft; they had no ocular dryness symptoms and no need for eye protection measures in 33.3% of cases, significant reduction of ocular symptoms and need for eye protection measures in 66.6% of patient, 0-2 mm lagophthalmos in 66.6% and 3-4 mm lagophthalmos in 33.3%. The second group of 17 patients who underwent upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy, had no ocular dryness symptoms and no need for eye protection measures in 17.6% of patient, significant reduction of ocular symptoms and need for eye protection measures in 76.4% of patient, 0-2 mm lagophthalmos in 70.5%, 3-4 mm lagophthalmos in 23.5% and one patient 5,8%had 8 mm lagophthalmos and persistent symptoms. No ocular complication, cosmetic complain or donner site morbidity were reported. Upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy decrease ocular dryness symptoms and need for eye protection measures and improve lagophthalmos: the association of the reinnervation with these complementary techniques is therefore highly recommended in order to immediately protect the eye.
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Affiliation(s)
- Mohamed O Atta
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy; Otorhinolaryngology, Head and Neck Surgery Department, Zagazig University, Sharkia, Egypt
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Ahmed Abdelkarim
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy; Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt
| | - Federico Valsecchi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Tarabbia
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Dimitri Rabbiosi
- Department of Otorhinolaryngology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Anany Ahmed
- Otorhinolaryngology, Head and Neck Surgery Department, Zagazig University, Sharkia, Egypt
| | - Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
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10
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Biglioli F, Allevi F. V to VII Nerve Transfer for Smile Reanimation. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:19-24. [PMID: 36754503 DOI: 10.1016/j.cxom.2022.09.002] [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] [Indexed: 02/09/2023]
Abstract
Using the wording "facial reanimation," surgeons mean restoring movements to the paralyzed face. According to the condition of mimic muscle, facial palsy can be classified as recent (mimic muscle still alive) and chronic (atrophy of mimic muscle) palsy. The treatment is quite different because in the former group the mimic muscles can be still used so long as a new motor source would be connected to the damaged facial nerve. In the latter group, muscular transplantation is needed to substitute the atrophied mimic muscles of the middle part of the face. In both cases, the neural impulse that makes the muscles (mimic muscle in the former, transplanted muscle in the latter) move come from a new motor nerve. Nowadays, the masseteric nerve is widely used as a new motor source in recent facial reanimation; the same nerve has also a main role in the treatment of both chronic facial palsy where it is used as the new nervous stimulus for the new transplanted muscle and facial paresis where the nervous stimulus coming from the masseteric nerve is used to empower the stimulus coming from the injured facial nerve. The masseteric nerve can be usually connected directly to the facial nerve without the interposition of a nerve graft, with a faster reinnervation. Moreover, the use of the masseteric nerve gives no morbidity to the masticatory functions.
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Affiliation(s)
- Federico Biglioli
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
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11
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Saibene AM, Allevi F, Calvo-Henriquez C, Dauby N, Dondossola D, Hervochon R, Lechien JR, Lobo-Duro D, Locatello LG, Maniaci A, Mannelli G, Mayo-Yáñez M, Maza-SolanoPhD J, Radulesco T, Tan N, Tincati C, Tucciarone M, Vaira LA, Sowerby L. Comprehensive management of paranasal sinus fungus balls: a Young-IFOS consensus statement. Int Forum Allergy Rhinol 2022; 13:877-885. [PMID: 36150088 DOI: 10.1002/alr.23093] [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: 06/21/2022] [Revised: 09/06/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paranasal sinus fungus balls (PSFB) are a common form of surgically treatable, non-invasive mycosis. To date, no guidelines have standardized PSFB treatment or the management of difficult cases (e.g., immunocompromised or fragile patients). The clinical consensus statement presented here aims to provide a comprehensive management guide to PSFB based on current evidence. METHODS A multidisciplinary, international panel of 19 specialists judged statements in three rounds of a modified Delphi-method survey. Statements encompassed the following PSFB management issues: definition, diagnostic workup, treatment indications and modalities, and follow-up. Otolaryngologists, maxillo-facial surgeons, infectious disease specialists, and transplant physicians were considered the target audience. RESULTS Among the 23 statements, 7 reached strong consensus, and 16 reached consensus. Consensus was reached on the definition, diagnosis, and treatment modalities for PSFB. Postoperative follow-up modalities and scenarios with bacterial superinfection were the most debated issues. CONCLUSIONS Until further data are available, these points provide a framework for the management of PSFB. Moreover, PSFB should be considered a non-invasive mycosis that is not necessarily symptomatic or related to odontogenic conditions. Although diagnosis may be incidental, endoscopy and single-imaging (CT or MRI, with distinctive features) are required for diagnosis, while contrast medium would allow for differential diagnosis. Although treatment of PSFB should be considered mandatory prior to sinus augmentation and is recommended for symptomatic patients, immunosuppressed patients, or patients with planned immunosuppression, watchful waiting could be considered for asymptomatic patients with chronic rhinosinusitis (CRS) who are provided with appropriate advice and assessment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alberto Maria Saibene
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Otolaryngology Unit, ASST Santi Paolo E Carlo, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Fabiana Allevi
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Maxillofacial Surgery Unit, ASST Santi Paolo E Carlo, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Christian Calvo-Henriquez
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Otolaryngology, Rhinology and sleep apnea unit, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), School of Public Health, Université Libre de Bruxelles (ULB) & Institute for Medical Immunology, Brussels, Belgium
| | - Daniele Dondossola
- Department of General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rémi Hervochon
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,ENT department, Pitié Salpêtrière Hospital, Paris, France
| | - Jérome R Lechien
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Foch Hospital, Paris Saclay University, France
| | - David Lobo-Duro
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Rhinology, Endoscopic Sinus & Skull Base Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Luca Giovanni Locatello
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Antonino Maniaci
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Department of Medical, Surgical Sciences and Advanced Technologies G.F Ingrassia, University of Catania, Catania, Italy
| | - Giuditta Mannelli
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Miguel Mayo-Yáñez
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Juan Maza-SolanoPhD
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Rhinology & Skull Base Surgery. ENT Department, University Hospital Virgen Macarena of Sevilla, Spain
| | - Thomas Radulesco
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Service ORL et Chirurgie Cervico-Faciale du Pr Michel, Hôpital de la Conception, Marseille, France
| | - Neil Tan
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Royal Cornwall Hospital, Truro, United Kingdom.,University of Exeter Medical School, Exeter, United Kingdom
| | - Camilla Tincati
- Infectious Diseases Clinic, Santi Paolo e Carlo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Manuel Tucciarone
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, Jerez University Hospital, Jerez de la Frontera, Spain
| | - Luigi Angelo Vaira
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Department of Medical, Surgical and Experimental Sciences, Maxillofacial Surgery Operative Unit, University of Sassari, Sassari, Italy
| | - Leigh Sowerby
- Young Otolaryngologists - International Federation of Otorhinolaryngological Societies (Yo-IFOS), Paris, France.,Department of Otolaryngology, Western University, London, Ontario, Canada
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12
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Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Treatment of Sinusitis Following Dental Implantation: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2022; 36:539-549. [PMID: 35244478 DOI: 10.1177/19458924221084484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Implantological procedures aimed at rehabilitating upper jaw edentulous patients (dental implant placement and/or maxillary sinus grafting) can sporadically result in sinusitis. In these patients, endoscopic sinus surgery is the most commonly employed treatment, but clinical scenarios and comprehensive management strategies are extremely heterogeneous across studies. OBJECTIVE We sought to systematically define treatment strategies and related success rates for sinusitis following dental implantation, detailing different current treatment choices and concepts. METHODS Adopting a PRISMA-compliant review framework, systematic searches were performed in multiple databases using criteria designed to include all studies published until November 2020 focusing on the treatment of human sinusitis following dental implantation. We selected all original studies, excluding case reports, specifying treatment modalities with objective treatment success definitions. Following duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates, which were pooled in a random-effects meta-analysis. RESULTS Among 581 unique citations, eight studies (181 patients) were selected. Seven studies were retrospective case series. All studies relied on endoscopic sinus surgery, often coupled with intraoral accesses, and assessed therapeutic success endoscopically. The pooled treatment success rate was 94.7% (95% confidence interval, 91.5%-98%). Failures were treated in seven of 15 cases with further antibiotic therapies and in another seven cases with surgical revision. A single patient was lost to follow-up. CONCLUSIONS Endoscopic sinus surgery appears to be the most frequent treatment of choice for sinusitis following dental implantation, with excellent success rates. The protean clinical picture drawn from the selected studies calls for the standardization of diagnostics and definitions in this field to enable direct comparisons between the results of different studies. The role of postoperative antibiotic therapies, which have been employed unevenly across studies, should also be prospectively investigated.
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Affiliation(s)
- Fabiana Allevi
- Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Cavallo
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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13
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Saibene AM, Allevi F, Ayad T, Lechien JR, Mayo-Yáñez M, Piersiala K, Chiesa-Estomba CM. Treatment for parotid abscess: a systematic review. Acta Otorhinolaryngol Ital 2022; 42:106-115. [PMID: 35612503 PMCID: PMC9132006 DOI: 10.14639/0392-100x-n1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/30/2022] [Indexed: 12/02/2022]
Abstract
A parotid abscess is a dangerous complication of parotitis. In this study, we aimed to define current treatment concepts for parotid abscess, focusing on different management options. The authors performed a PRISMA-compliant systematic review across multiple databases including all original studies published until January 2021 focusing on treatment of parotid abscess. Studies specifying treatment modalities and treatment success rates were included based on abstract and full-text selection. The authors assessed study quality, demographics, success rates, management modalities and adverse events. Among 1,318 citations, 18 studies met our inclusion criteria. Twelve studies relied only on incision and drainage with antibiotic therapy; the remaining 6 compared different treatment modalities (incision and drainage versus exclusive medical therapy or ultrasound-guided drainage). Heterogeneity between studies precluded meta-analysis of data. The review showed that antibiotics remain the mainstay of treatment for parotid abscess. Conversely, the role of incision and drainage, and aspiration should be studied further. The higher rate of complications following incision and drainage suggests a more conservative approach is needed. Incision and drainage remain the main salvage option for conservative treatment failures.
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14
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Nitro L, Pipolo C, Fadda GL, Allevi F, Borgione M, Cavallo G, Felisati G, Saibene AM. Distribution of cocaine-induced midline destructive lesions: systematic review and classification. Eur Arch Otorhinolaryngol 2022; 279:3257-3267. [PMID: 35138441 PMCID: PMC9130192 DOI: 10.1007/s00405-022-07290-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
Abstract
Purpose Intranasal cocaine is known to potentially lead to midline destructive lesions. The present systematic review was undertaken to systematically define the localization of cocaine-induced midline destructive lesions and their prevalence and to propose a practical classification of these lesions. Methods A PRISMA-compliant systematic review was performed in multiple databases with criteria designed to include all studies published until March 2021 providing a precise definition of cocaine-induced midline lesions in humans. We selected all original studies except case reports. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for lesion localization, patients’ demographics, exposure to cocaine, and relationship with external nose destruction. Results Among 2593 unique citations, 17 studies were deemed eligible (127 patients). All studies were retrospective case series. The destructive process determined a septal perforation in 99.2% of patients. The distribution prevalence decreased from the inferior third of the sinonasal complex (nasal floor and inferolateral nasal wall, respectively, 59% and 29.9% of patients) to the middle third (middle turbinate and ethmoid, 22.8% of patients), and ultimately to neurocranial structures (7.9% of patients). Nasal deformities were inconsistently reported across reviewed studies. Cocaine use duration, frequency, and status were reported only occasionally. Conclusion Based on the distribution prevalence observed, we propose a four-grade destruction location-based classification. Future prospective studies following the evolution of cocaine-induced lesions are needed to validate our classification, its relationship with lesion evolution, and whether it represents a reliable tool for homogeneous research results reporting.
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Affiliation(s)
- Letizia Nitro
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Fabiana Allevi
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mario Borgione
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy. .,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.
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15
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Molteni M, Bulfamante AM, Pipolo C, Lozza P, Allevi F, Pisani A, Chiapasco M, Portaleone SM, Scotti A, Maccari A, Borloni R, Felisati G, Saibene AM. Odontogenic sinusitis and sinonasal complications of dental treatments: a retrospective case series of 480 patients with critical assessment of the current classification. ACTA ACUST UNITED AC 2021; 40:282-289. [PMID: 33100340 PMCID: PMC7586196 DOI: 10.14639/0392-100x-n0457] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/24/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Marco Molteni
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Antonio Mario Bulfamante
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Paolo Lozza
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Antonia Pisani
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Matteo Chiapasco
- Oral Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Sara Maria Portaleone
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Alberto Scotti
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Alberto Maccari
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Roberto Borloni
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
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16
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Biglioli F, Guerra MB, Rabbiosi D, Ciardiello C, Allevi F. Comparison of results utilizing one-step and two-step triple innervation techniques. J Craniomaxillofac Surg 2021; 49:628-634. [PMID: 33994292 DOI: 10.1016/j.jcms.2021.03.006] [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: 08/14/2020] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
A retrospective comparison between two groups of patients who underwent one-step or two-step triple innervation was performed to reveal the role of scar tissue in axonal regeneration. The surgical technique used was the same in all cases, but the first group underwent a one-time triple innervation procedure, while patients in the second group underwent delayed performance of neurorrhaphies between the distal ends of the cross-face grafts and the terminal branches of the injured facial nerve. The Wilcoxon signed-rank test for paired groups showed a statistically significant improvement in both facial symmetry and voluntary movements in both groups of patients. Separately, the Mann-Whitney test confirmed no statistically significant difference between the two groups regarding the restoration of facial symmetry and voluntary movements, and the development of postoperative synkinesis. A comparison of median values for each spontaneous parameter between the groups revealed greater effectiveness of the two-step surgery, with both blinking and laughing demonstrating better results. The greater effectiveness of the double-step technique in restoring spontaneous movements strongly supports the use of a two-stage triple innervation technique in patients with facial palsy.
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Affiliation(s)
- Federico Biglioli
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Maria Beatrice Guerra
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Dimitri Rabbiosi
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Cristina Ciardiello
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
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17
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Fadda GL, Allevi F, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Treatment of Paranasal Sinus Fungus Ball: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2021; 130:1302-1310. [PMID: 33733891 DOI: 10.1177/00034894211002431] [Citation(s) in RCA: 2] [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] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Paranasal sinus fungus ball is a common non-invasive mycosis with excellent long-term surgical treatment results. The present systematic review and meta-analysis were undertaken to define current treatment concepts and success rates in paranasal sinus fungus ball treatment. METHODS Systematic searches were performed in multiple databases with criteria designed to include all studies published until May 2020 focusing on paranasal sinuses fungus ball treatment in humans. We selected studies including at least 10 patients, specifying treatment modalities, providing a minimum 6-month follow-up, and objectivating treatment success. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates. Success rates were pooled in a random effect meta-analysis and compared according to the use of intraoperative sinus lavages and postoperative antibiotics. RESULTS Among 740 unique citations, 14 studies were deemed eligible. Most (n = 11) were retrospective case series. All studies relied on endoscopic sinus surgery. Intraoperative lavages were proposed in 10 studies and postoperative antibiotics in 7 (for all patients in 5 studies and for selected patients in 2). No significant heterogeneity was observed between results (Cochran's Q P = .639, I2 test = 0). Treatment success rate was 98.4% (95% confidence interval 97.4%-99.3%). Intraoperative sinus toilette and postoperative antibiotics didn't significantly improve the success rate. CONCLUSION Endoscopic sinus surgery shows excellent results in fungus ball treatment. Further prospective studies might help further reducing antibiotics prescriptions in these patients and improve their management.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy.,ISGOS, The Italian Study Group on Odontogenic Sinusitis
| | - Fabiana Allevi
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Rosso
- Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Federica Martino
- Department of Clinical Sciences and Translational Medicine, Unit of Otorhinolaryngology, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
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18
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Giannaccare G, Pellegrini M, Bolognesi F, Fogagnolo P, Lupardi E, Allevi F, Bernabei F, Lozza A, Plazza C, Marchetti C, Scorcia V, Biglioli F. Spotlight on corneal neurotization. Expert Review of Ophthalmology 2021. [DOI: 10.1080/17469899.2021.1895751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Marco Pellegrini
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy
| | - Federico Bolognesi
- Division of Oral and Maxillofacial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Fogagnolo
- Eye Clinic, Head and Neck Department, ASST Santi Paolo E Carlo Hospital, University of Milan, Milan, Italy
| | - Enrico Lupardi
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy
| | - Fabiana Allevi
- Unit of Maxillofacial Surgery, Head and Neck Department, ASST Santi Paolo E Carlo Hospital, University of Milan, Milan, Italy
| | - Federico Bernabei
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy
| | | | - Christian Plazza
- Department of Aviation Medicine, Italian Air Force, Milan, Italy
| | - Claudio Marchetti
- Division of Oral and Maxillofacial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Federico Biglioli
- Unit of Maxillofacial Surgery, Head and Neck Department, ASST Santi Paolo E Carlo Hospital, University of Milan, Milan, Italy
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19
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Craig JR, Poetker DM, Aksoy U, Allevi F, Biglioli F, Cha BY, Chiapasco M, Lechien JR, Safadi A, Simuntis R, Tataryn R, Testori T, Troeltzsch M, Vaitkus S, Yokoi H, Felisati G, Saibene AM. Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement. Int Forum Allergy Rhinol 2021; 11:1235-1248. [PMID: 33583151 DOI: 10.1002/alr.22777] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/06/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental providers to make the diagnosis. The purpose of this study was to develop international multidisciplinary consensus on diagnosing ODS. METHODS A modified Delphi method was used to assess for expert consensus on diagnosing bacterial ODS. A multidisciplinary panel of 17 authors with ODS expertise from 8 countries (8 otolaryngologists, 9 dental specialists) was assembled. Each author completed 2 of 3 surveys (2 specialty-specific, and 1 for all authors). Thirty-seven clinical statements were created, focusing on 4 important diagnostic components: suspecting ODS; confirming sinusitis in ODS; confirming different dental pathologies causing ODS; and multidisciplinary collaborative aspects of diagnosing ODS. Target audiences were all otolaryngologists and dental providers. RESULTS Of the 37 clinical statements, 36 reached consensus or strong consensus, and 1 reached no consensus. Strong consensus was reached that certain clinical and microbiologic features should arouse suspicion for ODS, and that multidisciplinary collaboration between otolaryngologists and dental providers is generally required to diagnose ODS. To diagnose ODS, otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings of middle meatal purulence, edema, or polyps, and dental providers should confirm dental pathology based on clinical examination and dental imaging. CONCLUSION Based on multidisciplinary international consensus, diagnosing ODS generally requires otolaryngologists to confirm sinusitis, and dental providers to confirm maxillary odontogenic pathology. Importantly, both dental providers and otolaryngologists should suspect ODS based on certain clinical features, and refer patients to appropriate providers for disease confirmation.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI
| | - David M Poetker
- Department of Otolaryngology- Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, WI.,Division of Surgery, Zablocki VAMC, Milwaukee, WI
| | - Umut Aksoy
- Division of Surgery, Zablocki VAMC, Milwaukee, WI.,Department of Endodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Fabiana Allevi
- Department of Health Sciences, San Paolo and Carlo Hospital, Maxillofacial Surgery, University of Milan, Milan, Italy
| | - Federico Biglioli
- Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Bruce Y Cha
- Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Matteo Chiapasco
- Department of Biomedical, Surgical, and Dental Sciences, San Paolo and Carlo Hospital, Oral Surgery Unit, University of Milan, Milan, Italy
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Saint-Aubin, France
| | - Ahmad Safadi
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Regimantas Simuntis
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Roderick Tataryn
- Tataryn Endodontics, Spokane, WA.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Tiziano Testori
- Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Saulius Vaitkus
- Department of Otolaryngology-Head and Neck Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hidenori Yokoi
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University, Tokyo, Japan
| | - Giovanni Felisati
- Department of Health Sciences, San Paolo and Carlo Hospital, Otolaryngology Unit, University of Milan, Milan, Italy
| | - Alberto M Saibene
- Department of Health Sciences, San Paolo and Carlo Hospital, Otolaryngology Unit, University of Milan, Milan, Italy
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20
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Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review. Am J Rhinol Allergy 2020; 35:713-721. [PMID: 33236664 DOI: 10.1177/1945892420976766] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. OBJECTIVE The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. METHODS Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. RESULTS Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. CONCLUSIONS Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy
| | - Gian Luca Fadda
- Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Alberto Maria Saibene
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
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21
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Giannaccare G, Bolognesi F, Biglioli F, Marchetti C, Mariani S, Weiss JS, Allevi F, Cazzola FE, Ponzin D, Lozza A, Bovone C, Scorcia V, Busin M, Campos EC. In Vivo and Ex Vivo Comprehensive Evaluation of Corneal Reinnervation in Eyes Neurotized With Contralateral Supratrochlear and Supraorbital Nerves. Cornea 2020; 39:210-214. [PMID: 31335523 DOI: 10.1097/ico.0000000000002083] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To use an automated morphometric analysis system of in vivo confocal microscopy (IVCM) images for evaluating reinnervation occurring at the subbasal nerve plexus (SNP) after direct corneal neurotization (DCN) and to further report neurophysiological and histopathological findings. METHODS Prospective interventional case series including 3 eyes with neurotrophic keratitis that underwent DCN. Deep anterior lamellar keratoplasty was performed 18 months after DCN in patient 1. The following evaluations were performed before and at 3, 6, and 12 months after DCN: clinical evolution of keratitis; corneal sensitivity; IVCM images of the SNP analyzed with "ACCMetrics;" neurophysiological study of corneal reflex. Protein gene product 9.5 immunofluorescence staining assay and transmission electron microscopy were conducted on the neurotized button excised during deep anterior lamellar keratoplasty. RESULTS Complete healing was obtained in all patients by 3 months postoperatively. Corneal sensitivity was absent preoperatively in all eyes and improved after surgery, reaching an average value of 30 mm 1 year postoperatively. The corneal SNP was not visible at IVCM in any of the cases preoperatively and became visible by 3 months postoperatively, showing IVCM metrics comparable to normal contralateral eyes at 1 year. In all cases, neurophysiological evaluation showed a partial recovery of the electrical activity of the cornea. In patient 1, protein gene product (PGP) 9.5 staining of neurotized cornea showed nerve fascicles at the SNP, whereas transmission electron microscopy showed amyelinic nerve axons and nerve endings. CONCLUSIONS The corneal SNP exhibited IVCM metrics comparable to the normal contralateral eye 1 year after DCN. Ex vivo histopathological assessment of neurotized corneas confirmed the presence of nerves with normal ultrastructure.
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Affiliation(s)
- Giuseppe Giannaccare
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Ophthalmology, University "Magna Graecia," Catanzaro, Italy
| | - Federico Bolognesi
- Oral and Maxillofacial Surgery, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Biglioli
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Mariani
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Jayne S Weiss
- Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans, LA
| | - Fabiana Allevi
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federica E Cazzola
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, the Veneto Eye Bank Foundation, Venice, Italy
| | - Alessandro Lozza
- Service of Neurophysiopathology-National Neurological Institute "C. Mondino," Pavia, Italy
| | - Cristina Bovone
- Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and.,Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University "Magna Graecia," Catanzaro, Italy
| | - Massimo Busin
- Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and.,Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara, Italy
| | - Emilio C Campos
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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22
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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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23
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Saibene AM, Rosso C, Pipolo C, Lozza P, Scotti A, Ghelma F, Allevi F, Maccari A, Felisati G. Endoscopic adenoidectomy: a systematic analysis of outcomes and complications in 1006 patients. Acta Otorhinolaryngol Ital 2020; 40:79-86. [PMID: 32275649 PMCID: PMC7147541 DOI: 10.14639/0392-100x-n0150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022]
Abstract
Adenoid hypertrophy (AH) is an extremely common condition in the paediatric population, relating to different pathological scenarios. Failure in responding to medical therapy often leads to adenoidectomy. While traditional adenoidectomy is indeed a relatively “blind” procedure, endoscopic procedures allow more radical resections, bleeding monitoring and complete Eustachian tube sparing, making adenoidectomy a safer, more manageable and functional procedure. Though the literature widely describes endoscopic adenoidectomy, only small case series are available and the procedure itself has never really taken hold in routine otolaryngology practice. The aim of this article is to report data on endoscopic adenoidectomy in a large single centre patient population. We retrospectively evaluated the medical records of 1006 children who underwent endoscopic adenoidectomy with or without tonsillectomy (respectively 493 and 513 patients). Data on surgical time, blood loss, hospital stay, short and long-term complications, recurrences and post-operative pain were collected. Our analysis showed that the endoscopic approach requires a longer surgical time, but it is associated with less intraoperative blood loss, a lower complication rate and less treatment failures compared to large contemporary case series of either traditional or power-assisted approaches. The overall better outcomes are more noticeable when comparing our data with classic technique case series than with power-assisted case series. Endoscopic adenoidectomy should therefore be regarded as a valid technique, which, in expert hands, lowers the rates of complications and recurrences at the expense of a slightly increased surgical time.
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Affiliation(s)
| | - Cecilia Rosso
- Otolaryngology Department, San Paolo Hospital, University of Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Department, San Paolo Hospital, University of Milan, Italy
| | - Paolo Lozza
- Otolaryngology Department, San Paolo Hospital, University of Milan, Italy
| | - Alberto Scotti
- Otolaryngology Department, San Paolo Hospital, University of Milan, Italy
| | - Filippo Ghelma
- Disabled Advanced Medical Assistance Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Department, San Paolo Hospital, University of Milan, Italy
| | - Alberto Maccari
- Otolaryngology Department, San Paolo Hospital, University of Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Department, San Paolo Hospital, University of Milan, Italy
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Saibene AM, Allevi F, Biglioli F, Felisati G. Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy. Otolaryngol Head Neck Surg 2020; 162:795-796. [PMID: 32255735 DOI: 10.1177/0194599820917914] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck-otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues' burden. Specific issues and management decisions are discussed in detail in the article.
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Affiliation(s)
- Alberto Maria Saibene
- Otolaryngology Unit, Head and Neck Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Unit, Head and Neck Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Federico Biglioli
- Maxillofacial Surgery Unit, Head and Neck Department, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Head and Neck Department, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Gibelli D, Tarabbia F, Restelli S, Allevi F, Dolci C, Dell’Aversana Orabona G, Cappella A, Codari M, Sforza C, Biglioli F. Three-dimensional assessment of restored smiling mobility after reanimation of unilateral facial palsy by triple innervation technique. Int J Oral Maxillofac Surg 2020; 49:536-542. [DOI: 10.1016/j.ijom.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/24/2019] [Accepted: 07/19/2019] [Indexed: 01/22/2023]
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Saibene AM, Collurà F, Pipolo C, Bulfamante AM, Lozza P, Maccari A, Arnone F, Ghelma F, Allevi F, Biglioli F, Chiapasco M, Portaleone SM, Scotti A, Borloni R, Felisati G. Odontogenic rhinosinusitis and sinonasal complications of dental disease or treatment: prospective validation of a classification and treatment protocol. Eur Arch Otorhinolaryngol 2018; 276:401-406. [PMID: 30483941 PMCID: PMC6394426 DOI: 10.1007/s00405-018-5220-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 04/17/2018] [Accepted: 11/24/2018] [Indexed: 11/30/2022]
Abstract
Purpose Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients. Methods One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions. Results The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment. Conclusions The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%.
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Affiliation(s)
- Alberto Maria Saibene
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Fabio Collurà
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Antonio Mario Bulfamante
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy.
| | - Paolo Lozza
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Alberto Maccari
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Flavio Arnone
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Filippo Ghelma
- Disabled Advanced Medical Assistance Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Biglioli
- Maxillofacial Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Chiapasco
- Oral Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Sara Maria Portaleone
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Alberto Scotti
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Roberto Borloni
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
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Biglioli F, Soliman M, El-Shazly M, Saadeldeen W, Abda EA, Allevi F, Rabbiosi D, Tarabbia F, Lozza A, Cupello S, Privitera A, Dell'Aversana Orabona G, Califano L. Use of the masseteric nerve to treat segmental midface paresis. Br J Oral Maxillofac Surg 2018; 56:719-726. [PMID: 30122622 DOI: 10.1016/j.bjoms.2018.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/12/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
Segmental midface paresis with or without synkinesis reflects incomplete recovery from Bell's palsy, operations on the cranial base or parotid, or trauma, in 25%-30% of cases. To correct the deficit, the masseteric nerve was used to deliver a powerful stimulus to the zygomatic muscle complex, with the addition of a cross-face sural nerve graft to ensure more spontaneous smiling. By doing this, the orbicularis oculi muscle continues to have an appropriate stimulus from the facial nerve, and the zygomatic muscle complex is separately innervated, which considerably reduces synkinesis between the two muscle compartments. For those patients with muscular contractures of the midface, the new healthy neural stimulus relaxes muscles at rest. From January 2011 to March 2017, 20 patients presented with segmental facial paresis of the midface and were operated on using this new technique. All patients were evaluated before and after operation using Clinician-Graded Electronic Facial Paralysis Assessment (eFACE), and they showed considerable postoperative improvements in static, dynamic, and synkinetic variables. Our proposed use of the masseteric nerve to treat segmental facial paresis produces favourable results, but our initial data require confirmation by further studies.
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Affiliation(s)
- Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Mahmoud Soliman
- Plastic Surgery Department, Assiut University, Assiut, Egypt and Clinical Fellow at San Paolo Hospital, Milan University, Milan.
| | | | - Wael Saadeldeen
- Plastic Surgery Department, Assiut University, Assiut, Egypt.
| | - Essam A Abda
- Rheumatology and Rehabilitation Department, Assiut University, Assiut, Egypt.
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Dimitri Rabbiosi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Filippo Tarabbia
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Alessandro Lozza
- Service of Neurophysiopathology - National Neurological Institute C. Mondino, Pavia, Italy.
| | - Silvia Cupello
- Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Antonino Privitera
- Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - G Dell'Aversana Orabona
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - L Califano
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
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Biglioli F, Allevi F, Rabbiosi D, Cupello S, Battista VMA, Saibene AM, Colletti G. Triple innervation for re-animation of recent facial paralysis. J Craniomaxillofac Surg 2018; 46:851-857. [DOI: 10.1016/j.jcms.2018.02.014] [Citation(s) in RCA: 14] [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: 08/31/2017] [Revised: 02/10/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022] Open
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Biglioli F, Bolognesi F, Allevi F, Rabbiosi D, Cupello S, Previtera A, Lozza A, Battista VMA, Marchetti C. Mixed facial reanimation technique to treat paralysis in medium-term cases. J Craniomaxillofac Surg 2018; 46:868-874. [PMID: 29625866 DOI: 10.1016/j.jcms.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/05/2017] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022] Open
Abstract
Recent facial paralyses, in which fibrillations of the mimetic muscles are still detectable by electromyography (EMG), allow facial reanimation based on giving new neural stimuli to musculature. However, if more time has elapsed, mimetic muscles can undergo irreversible atrophy, and providing a new neural stimulus is simply not effective. In these cases function is provided by transferring free flaps into the face or transposing masticatory muscles to reinstitute major movements, such as eyelid closure and smiling. In a small number of cases, patients affected by paralysis are referred late - more than 18 months after onset. In these cases, reinnervating the musculature carries a high risk of failure because some or all of the mimetic muscles may atrophy irreversibly while axonal ingrowth is taking place. A mixed reanimation technique to address this involves a neurorrhaphy between the masseteric nerve and a facial nerve branch for the orbicularis oculi, to ensure a stronger innervation to that muscle, associated with the transposition of the temporalis muscle to the nasiolabial sulcus. This gives good symmetry in the rest of the midface, while smiling movement is achievable, but not guaranteed. This one-time facial reanimation is particularly indicated for those who refuse major free-flap surgery or when that may be risky, as in previously operated and irradiated fields. More extensive procedures based on utilizing a free flap to recover smiling, while adding a cross-face nerve graft to restore blinking, may be proposed for motivated patients. Between 2010 and 2015, five patients affected by complete unilateral facial palsy underwent this technique in the Maxillofacial Surgery Department, San Paolo Hospital (Milan, Italy). Symmetry of the middle-third of the face at rest and recovery of smiling was quite good. Complete voluntary eyelid closure was obtained in all cases. Combining temporalis flap rotation and a masseteric-to-orbicularis-oculi-facial-nerve branch neurorrhaphy seems to be a valid solution for those medium-term referred patients.
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Affiliation(s)
- Federico Biglioli
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department. (Head: Professor C. Marchetti), Sant'Orsola-Malpighi Hospital, University of Bologna, via Albertoni 15, Bologna, Italy
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy.
| | - Dimitri Rabbiosi
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Silvia Cupello
- Rehabilitation Medicine Department. (Head: Professor A. Privitera), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Antonino Previtera
- Rehabilitation Medicine Department. (Head: Professor A. Privitera), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Alessandro Lozza
- Service of Neurophysiopathology - National Neurological Institute C. Mondino. (Head: Dr R. Manni), via Mondino 2, Pavia, Italy
| | - Valeria M A Battista
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Claudio Marchetti
- Maxillo-Facial Surgery Department. (Head: Professor C. Marchetti), Sant'Orsola-Malpighi Hospital, University of Bologna, via Albertoni 15, Bologna, Italy
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Beltramini GA, Rabbiosi D, Allevi F, Giannì AB, Biglioli F. The use of fibrin glue to stabilize geometry of free-flaps vascular pedicle. Oral Maxillofac Surg 2018; 22:113-114. [PMID: 29147799 DOI: 10.1007/s10006-017-0663-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Giada A Beltramini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 35, via Francesco Sforza, 20122, Milan, Italy.
| | - Dimitri Rabbiosi
- Maxillofacial Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Aldo B Giannì
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 35, via Francesco Sforza, 20122, Milan, Italy
| | - Federico Biglioli
- Maxillofacial Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
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Sforza C, Ulaj E, Gibelli DM, Allevi F, Pucciarelli V, Tarabbia F, Ciprandi D, Dell'Aversana Orabona G, Dolci C, Biglioli F. Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures. Br J Oral Maxillofac Surg 2017; 56:3-7. [PMID: 29223635 DOI: 10.1016/j.bjoms.2017.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/21/2017] [Accepted: 11/25/2017] [Indexed: 11/17/2022]
Abstract
Facial palsy is a severe condition that may be ameliorated by facial reanimation, but there is no consensus about how to judge its success. In this study we aimed to test a new method for assessing facial movements based on 3-dimensional analysis of the facial surfaces. Eleven patients aged between 42 and 77 years who had recently been affected by facial palsy (onset between 6 and 18 months) were treated by an operation based on triple innervation: the masseteric to temporofacial nerve branch, 30% of the hypoglossal fibres to the cervicofacial nerve branch, and the contralateral facial nerve through two cross-face sural nerve grafts. Each patient had five stereophotogrammetric scans: at rest, smiling on the healthy side (facial stimulus), biting (masseteric stimulus), moving the tongue (hypoglossal stimulus), and corner-of-the-mouth smile (Mona Lisa). Each scan was superimposed onto the facial model of the "rest" position, and the point-to-point root mean square (RMS) value was automatically calculated on both the paralysed and the healthy side, together with an index of asymmetry. One-way and two-way ANOVA tests, respectively, were applied to verify the significance of possible differences in the RMS and asymmetry index according to the type of stimulus (p=0.0329) and side (p<0.0001). RMS differed significantly according to side between the facial stimulus and the masseteric one on the paralysed side (p=0.0316). Facial stimulus evoked the most asymmetrical movement, whereas the masseteric produced the most symmetrical expression. The method can be used for assessing facial movements after facial reanimation.
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Affiliation(s)
- C Sforza
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy.
| | - E Ulaj
- Maxillo-Facial Surgical Unit, Ospedale San Paolo, Dipartimento di Scienze della Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | - D M Gibelli
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - F Allevi
- Maxillo-Facial Surgical Unit, Ospedale San Paolo, Dipartimento di Scienze della Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | - V Pucciarelli
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - F Tarabbia
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - D Ciprandi
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - G Dell'Aversana Orabona
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - C Dolci
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - F Biglioli
- Maxillo-Facial Surgical Unit, Ospedale San Paolo, Dipartimento di Scienze della Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
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Biglioli F, Kutanovaite O, Autelitano L, Lozza A, Moneghini L, Bulfamante G, Allevi F. Surgical treatment of painful inferior alveolar nerve injuries following endodontic treatment: a consecutive case series of seven patients. Oral Maxillofac Surg 2017; 21:461-466. [PMID: 28932988 DOI: 10.1007/s10006-017-0656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Injuries of the inferior alveolar nerve (IAN) related to endodontic treatment are being increasingly reported. However, consensus on the preferred intervention and the timing of and indications for surgical treatment is lacking. Here, we describe our experience with painful IAN injuries arising from endodontic treatment and requiring prompt microsurgical treatment. METHODS Seven consecutive patients with painful IAN injuries were referred to the Maxillofacial Surgery Unit of San Paolo Hospital in Milan. All patients had undergone root canals endodontic treatment in the mandibular molar or premolar between 2007 and 2014. The time elapsed between injury and referral for surgical treatment ranged from 10 days to 20 months. Each patient was treated by one of several different microsurgical procedures, described herein. RESULTS Overall, neurosensory status and IAN-related pain improved in all seven patients. The best results were obtained by IAN replacement with a sural nerve graft. However, complete sensory recovery was not achieved in any of the patients. CONCLUSIONS Although our sample includes only seven patients, early surgical treatment with an interpositional sural nerve graft seems to allow neurosensory recovery. Less satisfactory results are achieved in patients with IAN injuries of > 12 months duration.
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Affiliation(s)
- Federico Biglioli
- Maxillofacial Surgical Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via di Rudini' 8, 20142, Milan, Italy
| | - Otilija Kutanovaite
- Maxillofacial Surgery Department, Vilnius University Hospital Zalgiris Clinics, Vilnius, Lithuania
| | - Luca Autelitano
- Maxillofacial Surgical Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via di Rudini' 8, 20142, Milan, Italy
| | - Alessandro Lozza
- Neurophysiopathology Service, C. Mondino National Neurological Institute, Pavia, Italy
| | - Laura Moneghini
- Unit of Pathology, Department of Health Sciences, San Paolo Hospital, Scienze della Salute Department, University of Milan, Milan, Italy
| | - Gaetano Bulfamante
- Unit of Pathology, Department of Health Sciences, San Paolo Hospital, Scienze della Salute Department, University of Milan, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgical Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via di Rudini' 8, 20142, Milan, Italy.
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Biglioli F, Kutanovaite O, Rabbiosi D, Colletti G, Mohammed MAS, Saibene AM, Cupello S, Privitera A, Battista VMA, Lozza A, Allevi F. Surgical treatment of synkinesis between smiling and eyelid closure. J Craniomaxillofac Surg 2017; 45:1996-2001. [PMID: 29033208 DOI: 10.1016/j.jcms.2017.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/04/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022] Open
Abstract
Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%. The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the masseteric nerve and a central branch of the facial nerve, as well as with the use of a cross-facial nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling. Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients. Neurorrhaphy of the masseteric nerve and the central branch of the facial nerve appears to produce favorable results. These initial data should be confirmed by further studies.
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Affiliation(s)
- Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Otilija Kutanovaite
- Maxillo-Facial Surgery Department, Vilnius University Hospital Zalgiris Clinics, Zalgirio, Vilnius, Lithuania
| | - Dimitri Rabbiosi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giacomo Colletti
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Alberto M Saibene
- Otolaryngology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Silvia Cupello
- Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonino Privitera
- Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Valeria M A Battista
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessandro Lozza
- Service of Neurophysiopathology - National Neurological Institute C. Mondino, Pavia, Italy
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
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Colletti G, Pipolo C, Lozza P, Felisati G, Allevi F, Biglioli F, Deganello A, Saibene A. Orbital medial wall fractures: purely endoscopic endonasal repair with polyethylene implants. Clin Otolaryngol 2016; 43:396-398. [DOI: 10.1111/coa.12675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Colletti
- Maxillofacial surgery department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - C. Pipolo
- Otolaryngology department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - P. Lozza
- Otolaryngology department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - G. Felisati
- Otolaryngology department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - F. Allevi
- Otolaryngology department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - F. Biglioli
- Otolaryngology department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - A. Deganello
- Otolaryngology department; Careggi Hospital; University of Florence; Florence Italy
| | - A.M. Saibene
- Otolaryngology department; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
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Biglioli F, Tarabbia F, Allevi F, Colombo V, Giovanditto F, Latiff M, Lozza A, Previtera A, Cupello S, Rabbiosi D. Immediate facial reanimation in oncological parotid surgery with neurorrhaphy of the masseteric-thoracodorsal-facial nerve branch. Br J Oral Maxillofac Surg 2016; 54:520-5. [DOI: 10.1016/j.bjoms.2016.02.014] [Citation(s) in RCA: 10] [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: 06/15/2015] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
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Colletti G, Dessy M, Allevi F, Dalmonte P, Bardazzi A, Deganello A, Biglioli F. Malformazione arterovenosa inizialmente diagnosticata come cisti follicolare. Dental Cadmos 2016. [DOI: 10.1016/s0011-8524(16)30068-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Biglioli F, Allevi F, Lozza A. Surgical treatment of painful lesions of the inferior alveolar nerve. J Craniomaxillofac Surg 2015; 43:1541-5. [DOI: 10.1016/j.jcms.2015.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/18/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022] Open
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Biglioli F, Allevi F, Colletti G, Lozza A. Cross-tongue procedure: a new treatment for long-standing numbness of the tongue. Br J Oral Maxillofac Surg 2015; 53:880-2. [PMID: 26403159 DOI: 10.1016/j.bjoms.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/18/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
The lingual nerve may be injured during oral procedures, usually during extraction of lower third molars. Patients often complain of numbness of the hemitongue postoperatively. If this persists for 3 months or more, microsurgical exploration and reconstruction of the lingual nerve is required, and better outcomes are achieved after early repair. After 18-24 months the production of axoplasmic fluid through the axons of the proximal stump is reduced, and neurorrhaphy between the proximal and distal stumps is not recommended. In such cases we suggest that a portion of the opposite lingual nerve should be used as an additional nerve source.
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Affiliation(s)
- Federico Biglioli
- University of Milan, Maxillo-facial Surgery Department, San Paolo Hospital, Milan, Italy.
| | - Fabiana Allevi
- University of Milan, Maxillo-facial Surgery Department, San Paolo Hospital, Milan, Italy.
| | - Giacomo Colletti
- University of Milan, Maxillo-facial Surgery Department, San Paolo Hospital, Milan, Italy.
| | - Alessandro Lozza
- Neurophysiopathology Service, C. Mondino National Neurological Institute, Pavia, Italy.
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Colletti G, Dalmonte P, Moneghini L, Ferrari D, Allevi F. Adjuvant role of anti-angiogenic drugs in the management of head and neck arteriovenous malformations. Med Hypotheses 2015; 85:298-302. [DOI: 10.1016/j.mehy.2015.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/28/2015] [Indexed: 01/06/2023]
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Allevi F, Battista V, Moneghini L, Biglioli F. Two typical cases of pseudoankylosis of the jaw: same treatment, different outcome. BMJ Case Rep 2015; 2015:bcr-2015-210099. [PMID: 26240098 DOI: 10.1136/bcr-2015-210099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudoankylosis of the temporomandibular joint is a rare, extra-articular form of ankylosis of the jaw. It is characterised by limited mandibular movement caused by an extrinsic condition of the joint leading to fusion between the coronoid process and temporal, zygomatic or maxillary bone. Pseudoankylosis is less frequent than the intracapsular form. Extracapsular ankylosis can be congenital or acquired; approximately 70% of cases are associated with trauma. A CT scan is usually requested to achieve a diagnosis. CT can detect bony fusion, thus differentiating pseudoankylosis from true ankylosis. Once symptomatic bone ankylosis is diagnosed, surgery with postoperative physiotherapy is the recommended treatment. The ankylotic bone is removed together with the coronoid process and the mouth is forced open under general anaesthesia. Two cases of post-traumatic pseudoankylosis of the jaw treated with bilateral coronoidectomy and postoperative physiotherapy are described.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxilllo Facial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Valeria Battista
- Department of Maxilllo Facial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Laura Moneghini
- Department of Surgical Pathology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Biglioli
- Department of Maxilllo Facial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
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Allevi F, Motta G, Colombo V, Biglioli F. Double-bellied latissimus dorsi free flap to correct full dental smile palsy. BMJ Case Rep 2015; 2015:bcr-2015-210436. [PMID: 26194415 DOI: 10.1136/bcr-2015-210436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old woman with left facial palsy presented to our department. She developed the condition after radical resection of a neurinoma of the homolateral VIII cranial nerve 2 years prior. On physical examination, a complete palsy of the lower third of the face was reported. Electromyographic examination showed no fibrillation potentials in mimic muscles. A latissimus dorsi muscle free flap (6 cm × 3 cm), split into two bellies linked by their own neurovascular pedicle, was used to restore full-mouth smile. Ten years after surgery, the patient showed a near-natural smile without need of any ancillary procedure.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gloria Motta
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Valeria Colombo
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Biglioli
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
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Colletti G, Tewfik K, Bardazzi A, Allevi F, Chiapasco M, Mandalà M, Rabbiosi D. Regional Flaps in Head and Neck Reconstruction: A Reappraisal. J Oral Maxillofac Surg 2015; 73:571.e1-571.e10. [DOI: 10.1016/j.joms.2014.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/07/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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Abstract
Warthin's tumour is the second most common benign neoplasm to affect the salivary glands. It virtually affects the sole parotid gland. A sudden increase in a tumour's size is usually due to a malignant transformation of the tumour. The transformation of the lymphoid stroma into malignant lymphoma is relatively common, while an epithelial malignancy is extremely rare. In this paper, the authors present a case of squamous cell carcinoma arising in Warthin's tumour. The patient underwent enucleoresection of the tumour. Intraoperative frozen section revealed the presence of a cystic component associated with the squamous cell carcinoma areas. In consideration of the result of the intraoperative consultation, the surgeons decided to enlarge the previous resection by removal of a 30×25 mm cuff from the surrounding parotid tissue. Close follow-up was carried out and 12 months after surgery there was no evidence of recurrence or metastatic neoplasm.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Federico Biglioli
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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Allevi F, Rabbiosi D, Mandalà M, Colletti G. Paradoxical embolism following intralesional sclerotherapy for cervical venous malformation. BMJ Case Rep 2014; 2014:bcr-2014-206781. [PMID: 25422340 DOI: 10.1136/bcr-2014-206781] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a rare case of a 47-year-old woman admitted to our maxillofacial surgery department for a large cervicofacial venous malformation. The patient underwent fluoroscopy-guided intralesional foam sclerotherapy with sodium tetradecyl sulfate and air under general anaesthesia. On awakening, after 48 h of endotracheal intubation, she displayed dysarthria and dysmetria. Her brain CT scan showed no haemorrhagic lesions. A chest CT scan ruled out a potential pulmonary embolism. Suspicion for a paradoxical embolism was high and echocardiography confirmed a patent foramen ovale, which acted as a passageway for the embolus. Transcranial ultrasound showed mild right-to-left heart shunting. The dysarthria and dysmetria disappeared gradually over 48 h, thus confirming a reversible ischaemic neurological deficit. A brain MRI performed 1 week later showed no ischaemic or haemorrhagic lesions. The patient recovered completely. She was advised cardiosurgical follow-up and discharged.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Dimitri Rabbiosi
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Mandalà
- Department of Otolaryngology, Borgo Roma Hospital, Verona, Italy
| | - Giacomo Colletti
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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Colletti G, Autelitano L, Rabbiosi D, Biglioli F, Chiapasco M, Mandalà M, Allevi F. Technical refinements in mandibular reconstruction with free fibula flaps: outcome-oriented retrospective review of 99 cases. Acta Otorhinolaryngol Ital 2014; 34:342-8. [PMID: 25709149 PMCID: PMC4299154] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 10/06/2014] [Indexed: 10/28/2022]
Abstract
Congenital disease, major trauma, tumour resection and biphosphonate-related osteonecrosis can lead to partial, subtotal, or total loss of the mandibular bone. Minor defects can be easily reconstructed using bone grafts, whereas microvascular free tissue transfer may be unavoidable in the case of major bone loss or poor quality of soft tissue. Simple bone or composite osteocutaneous fibula free flaps have proven invaluable and remain the workhorse for microvascular mandibular reconstruction in daily practice. Our experience with 99 consecutive fibular free flaps confirms the available data in terms of high success rate. In these cases, 90% had total success, while 7 had complete flap failures. Three of our patients showed skin paddle necrosis with bony conservation. This report focuses on the technical refinements used by the authors that can prove valuable in obtaining predictable and precise results: in particular, we discuss surgical techniques that avoid vascular pedicle ossification by removing the fibular periosteum from the vascular pedicle itself and reduce donor site morbidity and aid in management of the position in the new condylar fossa. Finally, new technologies such as intraoperative CT and custom premodelled fixation plates may also increase the predictability of morpho-functional results.
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Affiliation(s)
- G. Colletti
- Department of Maxillo Facial Surgery, "San Paolo" Hospital, University of Milano, Italy;,Address for correspondence: Giacomo Colletti, University of Milano, Department of Maxillo-Facial Surgery, "San Paolo" Hospital, via di Rudinì 8, 20140 Milano, Italy. Tel. +39 02 81844594. Fax +39 02 81844704. E-mail:
| | - L. Autelitano
- Department of Maxillo Facial Surgery, "San Paolo" Hospital, University of Milano, Italy
| | - D. Rabbiosi
- Department of Maxillo Facial Surgery, "San Paolo" Hospital, University of Milano, Italy
| | - F. Biglioli
- Department of Maxillo Facial Surgery, "San Paolo" Hospital, University of Milano, Italy
| | - M. Chiapasco
- Department of Oral Surgery, "San Paolo" Hospital, University of Milano, Italy
| | - M. Mandalà
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Italy
| | - F. Allevi
- Department of Maxillo Facial Surgery, "San Paolo" Hospital, University of Milano, Italy
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Allevi F, Fogagnolo P, Rossetti L, Biglioli F. Eyelid reanimation, neurotisation, and transplantation of the cornea in a patient with facial palsy. BMJ Case Rep 2014; 2014:bcr-2014-205372. [PMID: 25139921 DOI: 10.1136/bcr-2014-205372] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients affected by facial palsy suffer from failure to fully close the eyelids; the resulting eye exposure can lead to dry eye syndrome, loss of epithelial integrity, corneal ulceration and infections. Corneal anaesthesia exacerbates risk of corneal damage in these patients. Eyelid paralysis-associated corneal lesions may induce severe visual impairment, for which the ideal treatment is corneal transplantation, a procedure contraindicated in patients with corneal sensitivity and inadequate eyelid closure. We present the case of a patient affected by unilateral facial palsy associated with corneal anaesthesia, due to seventh and fifth cranial nerve damage following homolateral eighth cranial nerve surgery. The patient underwent surgery to re-establish eyelid and corneal competence, and then received a corneal graft with consequent amelioration of visual acuity. This is the first case of associated corneal anaesthesia and facial palsy that was comprehensively treated with a set of surgical procedures, including a corneal transplant.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Paolo Fogagnolo
- Department of Ophthalmology, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Luca Rossetti
- Department of Ophthalmology, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Federico Biglioli
- Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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Colletti G, Battista VMA, Allevi F, Giovanditto F, Rabbiosi D, Biglioli F. Extraoral approach to mandibular condylar fractures: Our experience with 100 cases. J Craniomaxillofac Surg 2014; 42:e186-94. [DOI: 10.1016/j.jcms.2013.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 07/09/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022] Open
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Abstract
The case of a recurrent phosphaturic mesenchymal tumour of the maxillary sinus 10 years after the first surgical excision is reported. The neoplasm first presented with paraneoplastic osteomalacia causing a pathological femur fracture. A right maxillary sinus tumour was identified and treated thereafter. The patient had no local symptoms and serum electrolytes returned to normal after surgical removal of the tumour. However, 10 years later, the patient's urine Ca and P levels increased and an octreoscan detected a new tumour in the right maxillary sinus. Early diagnosis prevented the effects of the paraneoplastic activity of the neoplasm. This case emphasises the importance of specific, close follow-up, because the neoplasm rarely produces local signs indicating its position. To our knowledge, this is the first reported case of a late relapse presenting without relevant symptoms (local pain or swelling or pathological fractures).
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillofacial Surgery, Università degli Studi di Milano, Milan, Italy
| | | | - Marco Mandalà
- Azienda Ospedaliera Universitaria Verona, Verona, Italy
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Biglioli F, Allevi F, Battista VM, Colombo V, Pedrazzoli M, Rabbiosi D. Lipofilling of the atrophied lip in facial palsy patients. Minerva Stomatol 2014; 63:69-75. [PMID: 24632798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Patients affected by unilateral facial palsy often show partial or complete atrophy of the orbicularis oris. The lower hemilip on the affected side may have partial functional recover due to direct reinnervation stemming from the unaffected side. This explains why atrophy of the paralysed side is sometimes limited. Negative esthetic and functional findings include partial invisibility of the vermillion border due to lip inversion resulting from muscle flaccidity, asymmetry of the lower lip, oral incompetence, and speech and nutrition impairments of variable degree. In this study, we used Coleman lipofilling as a secondary and ancillary procedure to consolidate the results already obtained with dynamic reanimation, specifically aiming to reduce the volumetric loss due to atrophy of the orbicularis oris muscle. METHODS Eight patients underwent lipofilling to restore volumetric loss due to muscular denervation atrophy. Six of our patients were affected by inveterate facial palsy and one by an acute form of facial palsy. The last patient presented with high-grade bilateral upper lip atrophy due to Moebius syndrome. Two patients underwent a second lipofilling intervention. RESULTS The esthetic volume increase and the ameliorated lip competence were immediately noticeable after the first lipofilling, to great patient satisfaction. As a result of the variable rate of resorption over time of the grafted fat, it may be advisable to repeat the procedure in some patients to maximize results. CONCLUSION Lipofilling represents a useful and safe ancillary technique for camouflage of lower lip atrophy in paralysed patients.
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Affiliation(s)
- F Biglioli
- Department of Maxillo‑Facial Surgery University of Milan San Paolo Hospital, Milan, Italy -
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Colletti G, Allevi F, Moneghini L, Palvarini M. Clown nose: a case of disfiguring nodular squamous cell carcinoma of the face. BMJ Case Rep 2014; 2014:bcr-2013-200471. [PMID: 24488659 DOI: 10.1136/bcr-2013-200471] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
'Clown nose' (CN) is the common medical term referring to a reddish-brown bulge involving the tip of the nose, reminding of a clown's fake red nose. Reports about these tumours are scarce. Most reports refer to metastatic skin manifestation of systemic malignancies: this condition has been rarely described as a primary skin neoplasm. We report a case of a 31-year-old patient with a giant cutaneous squamous cell carcinoma of the nose which evolved into a CN. After ruling out genetic or immune risk factors, the patient was treated with surgical excision of the lesion and local reconstruction with good aesthetic outcome and no recurrence over a 2-year follow-up.
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