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Troise S, Committeri U, Barone S, Palumbo D, D'Auria D, Arena A, Romano A, Salzano G, Abbate V, Raccampo L, Sembronio S, Vaira LA, Dell'Aversana Orabona G, Califano L, Piombino P. Submental intubation in complex maxillofacial trauma: Pilot balloon protection. J Craniomaxillofac Surg 2024; 52:212-221. [PMID: 38143159 DOI: 10.1016/j.jcms.2023.12.003] [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: 08/28/2023] [Revised: 10/02/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023] Open
Abstract
AIMS This study aims to describe our refined technique of submental intubation to avoid the recorded intraoperative complications related to tube passage and pilot balloon rupture. CASE SERIES This is a retrospective case series of 21 patients with complex maxillofacial trauma who underwent submental intubation from January 2019 to January 2023. All the patients underwent to the same procedure with a new technique of pilot balloon protection: the pilot balloon was not deflated because, once the connector was removed, only the tube was curved and passed through the incision extraorally while the cuff remained inflated. The wire of the pilot balloon was passed behind the last tooth so as not to interfere with the maxillary-mandibular fixation, remaining extraorally under the anesthetist's view. DISCUSSION Only 2 patients (9.5%) reported complications related to submental intubation: in particular a patient (4.8%) reported oral floor infection, and in another patient (4.8%) an unesthetic skin scar was observed. No patients reported intraoperative complications related to the procedure. CONCLUSION The technique of pilot balloon protection that we have proposed seems to be effective in reducing the intraoperative complications related to the passage of the pilot balloon, such as rupture, damage or early extubation.
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Affiliation(s)
- Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Umberto Committeri
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Simona Barone
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Daniela Palumbo
- Department of Surgical, Anesthesiological Intensive Care and Emergency Sciences, Federico II University of Naples, Naples, Italy
| | - David D'Auria
- Department of Surgical, Anesthesiological Intensive Care and Emergency Sciences, Federico II University of Naples, Naples, Italy
| | - Antonio Arena
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Antonio Romano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanni Salzano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luca Raccampo
- Maxillofacial Surgery Unit, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Unit, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Giovanni Dell'Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Abi Rached S, Chakar C, Samarani R, Menassa G, Sembronio S, Pucci R, Calabrese L, Cantore S, Malcangi A, Spirito F, DI Cosola M. Radiographic marginal bone level evaluation around two different tissue-level implant systems: a one-year prospective study. Minerva Dent Oral Sci 2023; 72:298-311. [PMID: 37326504 DOI: 10.23736/s2724-6329.23.04786-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Marginal bone loss, is a frequently reported variable in the evaluation of dental implants. The primary objective of this study was to evaluate radiographic marginal bone level changes around the two different tissue-level implant systems placed adjacently in the posterior maxilla or mandible. The influence of implant macro-geometry and vertical soft tissue thickness on marginal bone loss were also evaluated. METHODS Seven patients were included in the study and a total of 18 implants were analyzed. Each patient received two different implants placed adjacently in the maxilla or the mandible. The implants used in our study were either Straumann® SP cylindrical implants or JD Octa® tapered implants. During the surgery, vertical soft-tissue thickness was measured with a periodontal probe placed on the top of the bony crest and in the center of the future implant site. Healing abutments were then seated. Three months following implant placement, impressions were taken, and screw-retained metal ceramic prostheses were delivered. Standardized intraoral radiographs were taken immediately after implant placement and one year following implant loading in order to assess marginal bone level changes. RESULTS Results showed a mean marginal bone loss of 0.55±0.5 mm for Straumann® SP implants and 0.39±0.49 mm for JD Octa® implants after one year of loading and the difference was not statistically significant between the two systems. A statistically significant correlation was found between soft tissue thickness and marginal bone loss; in sites with thin mucosal tissues (≤2 mm), there was significantly greater bone loss compared to sites with thick, soft tissues (> 2 mm) in both implants. CONCLUSIONS Radiographic marginal bone loss was not statistically different between the two implant systems at the one-year examination period. Moreover, vertical soft tissue thickness influenced marginal bone loss regardless of the implant system used.
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Affiliation(s)
- Sandrine Abi Rached
- Department of Periodontology, Faculty of Dental Medicine, Cranio-Facial Research Laboratory, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Carole Chakar
- Department of Periodontology, Faculty of Dental Medicine, Cranio-Facial Research Laboratory, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Rawad Samarani
- Department of Periodontology, Faculty of Dental Medicine, Cranio-Facial Research Laboratory, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Gabriel Menassa
- Department of Periodontology, Faculty of Dental Medicine, Cranio-Facial Research Laboratory, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Salvatore Sembronio
- Department of Maxillofacial Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Leonardo Calabrese
- Department of Oral Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Stefania Cantore
- Regional Dental Community Service "Sorriso & Benessere - Ricerca e Clinica", Bari, Italy -
| | | | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele DI Cosola
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Michelutti L, Tel A, Zeppieri M, Ius T, Sembronio S, Robiony M. The Use of Artificial Intelligence Algorithms in the Prognosis and Detection of Lymph Node Involvement in Head and Neck Cancer and Possible Impact in the Development of Personalized Therapeutic Strategy: A Systematic Review. J Pers Med 2023; 13:1626. [PMID: 38138853 PMCID: PMC10745006 DOI: 10.3390/jpm13121626] [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: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023] Open
Abstract
Given the increasingly important role that the use of artificial intelligence algorithms is taking on in the medical field today (especially in oncology), the purpose of this systematic review is to analyze the main reports on such algorithms applied for the prognostic evaluation of patients with head and neck malignancies. The objective of this paper is to examine the currently available literature in the field of artificial intelligence applied to head and neck oncology, particularly in the prognostic evaluation of the patient with this kind of tumor, by means of a systematic review. The paper exposes an overview of the applications of artificial intelligence in deriving prognostic information related to the prediction of survival and recurrence and how these data may have a potential impact on the choice of therapeutic strategy, making it increasingly personalized. This systematic review was written following the PRISMA 2020 guidelines.
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Affiliation(s)
- Luca Michelutti
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Salvatore Sembronio
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
| | - Massimo Robiony
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
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Tel A, Zeppieri M, Robiony M, Sembronio S, Vinayahalingam S, Pontoriero A, Pergolizzi S, Angileri FF, Spadea L, Ius T. Exploring Deep Cervical Compartments in Head and Neck Surgical Oncology through Augmented Reality Vision: A Proof of Concept. J Clin Med 2023; 12:6650. [PMID: 37892787 PMCID: PMC10607265 DOI: 10.3390/jcm12206650] [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: 09/11/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Virtual surgical planning allows surgeons to meticulously define surgical procedures by creating a digital replica of patients' anatomy. This enables precise preoperative assessment, facilitating the selection of optimal surgical approaches and the customization of treatment plans. In neck surgery, virtual planning has been significantly underreported compared to craniofacial surgery, due to a multitude of factors, including the predominance of soft tissues, the unavailability of intraoperative navigation and the complexity of segmenting such areas. Augmented reality represents the most innovative approach to translate virtual planning for real patients, as it merges the digital world with the surgical field in real time. Surgeons can access patient-specific data directly within their field of view, through dedicated visors. In head and neck surgical oncology, augmented reality systems overlay critical anatomical information onto the surgeon's visual field. This aids in locating and preserving vital structures, such as nerves and blood vessels, during complex procedures. In this paper, the authors examine a series of patients undergoing complex neck surgical oncology procedures with prior virtual surgical planning analysis. For each patient, the surgical plan was imported in Hololens headset to allow for intraoperative augmented reality visualization. The authors discuss the results of this preliminary investigation, tracing the conceptual framework for an increasing AR implementation in complex head and neck surgical oncology procedures.
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Affiliation(s)
- Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy; (A.T.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Massimo Robiony
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy; (A.T.)
| | - Salvatore Sembronio
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy; (A.T.)
| | - Shankeeth Vinayahalingam
- Department of Maxillofacial Surgery, Radboud Medical University, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Filippo Flavio Angileri
- Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, 98125 Messina, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
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Sembronio S, Raccampo L, Tel A, Di Cosola M, Troise S, Dell’Aversana Orabona G, Robiony M. The Role of Temporomandibular Joint Arthroscopy for Diagnosis and Surgical Management of Synovial Chondromatosis. Diagnostics (Basel) 2023; 13:2837. [PMID: 37685375 PMCID: PMC10486883 DOI: 10.3390/diagnostics13172837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE We report the experience of our maxillo-facial surgery unit into the diagnostic and the therapeutic role of arthroscopy of temporomandibular joint (TMJ) synovial chondromatosis (SC). MATERIALS AND METHODS A series of sixteen patients with an imaging, arthroscopical, and histological diagnosis of SC treated with arthroscopy was selected. The surgeries were conducted in the Department of Maxillo-facial surgery, Academic hospital of Udine, from January 2016 to December 2022. Medical history, clinical examination, imaging, arthroscopical, and histological characteristics were recorded and then reviewed and discussed. RESULTS Clinical improvement, both in pain and in maximum incisal opening (MIO), were noticed in whole patients. Histologically, according to Milgram's classification, the sample was fairly homogeneous. Arthroscopic treatment was successful in 87.5% of the patients. Only two cases of SC relapse were registered and were then submitted to open surgery to perform a total sinovectomy. The data collected were used to develop an SC classification proposal based on clinical, radiological (magnetic resonance imaging), arthroscopical, and histopathological characteristics. CONCLUSIONS TMJ arthroscopy must be considered the first line of treatment for SC, leaving open surgery to relapses cases and those cases with extraarticular extension. A univocal classification is essential to best stage and prognostically characterise this pathology.
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Affiliation(s)
- Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
| | - Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Stefania Troise
- Maxillofacial Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Dell’Aversana Orabona
- Maxillofacial Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 1, 33100 Udine, Italy
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Raccampo L, Panozzo G, Tel A, Trevisiol L, D’agostino A, Sembronio S, Robiony M. Reply to Mattei et al. Jacob Disease, Osteochondroma of the Coronoid Process, Coronoid Process Hyperplasia or Langenbeck Disease: The Big Jumble. Comment on "Raccampo et al. Jacob's Disease: Case Series, Extensive Literature Review and Classification Proposal. J. Clin. Med. 2023, 12, 938". J Clin Med 2023; 12:5118. [PMID: 37568520 PMCID: PMC10420236 DOI: 10.3390/jcm12155118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
As authors of the text, we can only thank Mattei et al. [...].
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Affiliation(s)
- Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Giorgio Panozzo
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, 37129 Verona, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Lorenzo Trevisiol
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, 37129 Verona, Italy
| | - Antonio D’agostino
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, 37129 Verona, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100 Udine, Italy
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Colapinto G, Goker F, Nocini R, Albanese M, Nocini PF, Sembronio S, Argenta F, Robiony M, Del Fabbro M. Outcomes of a Pharmacological Protocol with Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Randomized Study on 202 Osteoporosis Patients. J Clin Med 2023; 12:4662. [PMID: 37510777 PMCID: PMC10380687 DOI: 10.3390/jcm12144662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a challenging situation in clinics. Previous studies have shown that pentoxifylline combined with tocopherol proved to be beneficial in patients with osteoradionecrosis, due to their antioxidant and antifibrotic properties. The aim of this randomized study was to evaluate the effect of pentoxifylline and tocopherol in patients that had developed MRONJ after tooth extractions. The study population consisted of 202 Stage I MRONJ female patients with an average age of 66.4 ± 8.3 years, who were divided into two groups. The test group (n = 108) received a pharmacological protocol with pentoxifylline and tocopherol (2 months pre-operatively and 6 months post-operatively). The control group (n = 94) had sequestrectomy operations without any pharmacological preparation. The main outcomes were clinical healing of the mucosa after 1 month, and clinical and radiographic healing of the bone lesion at 6 months. In the test group all patients had mucosal healing and there was only one relapse within 6 months. In the control group, in 17% of the patients the mucosa did not heal, 71% of the patients relapsed within two months, and 7% developed infectious complications (such as abscess or phlegmon). After 6 months, the control group patients with persisting issues were prescribed pentoxifylline and tocopherol, as in the test group. At a subsequent follow-up, all those patients healed completely. Patients were monitored for a period of 7.8 ± 0.3 years, during which no relapse or additional problems were reported. As a conclusion, pentoxifylline and tocopherol protocol seems to be beneficial in the management of MRONJ patients.
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Affiliation(s)
- Gianluca Colapinto
- Indipendent Researcher, Chief Medical Officer, Oral Med Care srl, 70032 Bitonto, BA, Italy
| | - Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Riccardo Nocini
- Dipartimento Scienze Chirurgiche Odontostomatologiche e Materno-Infantili, Università degli Studi di Verona, 37134 Verona, Italy
| | - Massimo Albanese
- Dipartimento Scienze Chirurgiche Odontostomatologiche e Materno-Infantili, Università degli Studi di Verona, 37134 Verona, Italy
| | | | | | - Francesca Argenta
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
| | - Massimo Robiony
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
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Raccampo L, Sembronio S, Tel A, Cosola MD, D'Alì L, Loreto CD, Robiony M. An unusual cause of jaw pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:3-9. [PMID: 36804837 DOI: 10.1016/j.oooo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | | | - Lorenzo D'Alì
- Institute of Pathology, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Carla Di Loreto
- Institute of Pathology, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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Raccampo L, Sembronio S, Tel A, Robiony M. Extended Complex Temporomandibular Joint Reconstructions Exploiting Virtual Surgical Planning, Navigation Assistance, and Custom-Made Prosthesis: A Comprehensive Protocol and Workflow. J Pers Med 2023; 13:931. [PMID: 37373920 DOI: 10.3390/jpm13060931] [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: 04/30/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Alloplastic temporomandibular joint (TMJ) replacement is a well-established procedure in maxillo-facial surgery. However, the surgical management of large excision in this area requires complex reconstruction beyond the standard TMJ prosthesis. OBJECTIVE This study aims to describe the design and the consequential application of a protocol which involves the use of computer-assisted surgery tools to best face complex TMJ reconstruction (TMJR). Preoperative accurate study of every single case and intraoperative check of the surgical act are nowadays essential to perform such delicate surgical procedures. MATERIALS AND METHODS The study is a retrospective and single institution case series. The various processes of the management and planning of extended TMJ reconstruction (eTMJR) are extensively described, from the preoperative clinical evaluation, imaging acquisition protocols and virtual surgical planning (VSP), focusing also on the intraoperative transfer of VSP using navigation and surgical guides. RESULTS We included nine patients with different pathologies which were candidates for eTMJR. Overall, the application of our protocol and workflow permitted the reduction of complications and pain, and the improvement of the maximum interincisal opening (MIO) of the patients, restoring patients' masticatory function and esthetics. CONCLUSIONS The eTMJR should be considered as a safe and reliable surgical management modality in selected patients with large temporomandibular joint and skull base (TMJ-SB) lesions. An accurate preoperative protocol and workflow is essential to perform such insidious and complex reconstruction. However, more extensive studies on this type of device have to be conducted in order to validate its real usefulness and indications.
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Affiliation(s)
- Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
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Tel A, Bagatto D, Sembronio S, Ferrari S, Robiony M. Double osseous flaps for simultaneous midfacial and mandible reconstruction: Automation in surgical complexity within an entirely computerized workflow. Front Oncol 2023; 13:1103104. [PMID: 36816944 PMCID: PMC9935681 DOI: 10.3389/fonc.2023.1103104] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Broad maxillofacial surgical resections involving both the midface and the mandible represent a challenge in terms of reconstruction. Although several papers have explored the possibility of simultaneously using two microsurgical flaps, reports on the implementation of a dual osseous flap strategy are limited, and mainly addressed to static anatomical reconstruction, regardless of functional implications. In particular, there is a lack in the literature of a unifying protocol which illustrates how technology including virtual planning, statistical shape modeling, virtual occlusion, 3D-printing and patient-specific implants can address the functional and accuracy needs required for an optimal reconstruction. Materials and methods In this paper, the Authors present their preliminary experience in a two-center study, showing how broad maxillofacial defects, requiring a simultaneous reconstruction in both the mandible and the midface, can be successfully reconstructed using the combination of two osseous flaps in an automated sequence in which all steps are anticipately defined in a virtual plan, accounting for the optimal alignment of temporomandibular joint, predicting the final occlusion and defining a mandibular shape according to a statistical shape model. Results Average RMSE for the iliac bone crest flap was of 3.2 ± 0.36 mm; for the fibula flap, RMSE value was of 2.3 ± 0.65 mm, for patient-specific implants, for mandibular prostheses the average RMSE was 2.46 mm with 0.76 mm standard deviation. Temporomandibular joint function increased when a TMJ prosthesis was placed. Conclusions Double bone free flap is a valuable resource to reconstruct wide defects that simultaneously involve two thirds of the cranio-maxillo-facial skeleton, but a careful virtual planning study should be always performed before approaching this surgical option.
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Affiliation(s)
- Alessandro Tel
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, University Hospital of Udine, Udine, Italy
| | - Salvatore Sembronio
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Silvano Ferrari
- Department of Maxillofacial Surgery, University Hospital of Parma, Parma, Italy
| | - Massimo Robiony
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy,*Correspondence: Massimo Robiony,
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Di Cosola M, Spirito F, Zhurakivska K, Nocini R, Lovero R, Sembronio S, Santacroce L, Brauner E, Storto G, Lo Muzio L, Cazzolla AP. Congenital adrenal hyperplasia. Role of dentist in early diagnosis. Open Med (Wars) 2022; 17:1699-1704. [PMID: 36382053 PMCID: PMC9616050 DOI: 10.1515/med-2022-0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is a genetic disorder characterized by an impairment of steroid synthesis due to an altered production of 21-hydroxylase enzyme. Corticoid hormones are involved in the development and functioning of many organs. The aim of the present study was to review the international literature to collect data regarding oral manifestations of CAH. A review of the literature describing oral features of patients affected by CAH was performed using electronic databases (PubMed and Scopus). The data about number of patients, form of CAH, and oral findings were extracted and analyzed. Seven studies were included in the final analysis. The principal findings reported regarded an advanced dental development observed in patients with CAH. One paper reported amelogenesis imperfecta and periodontal issues. The dentist could be the first specialist involved in the CAH syndrome diagnosis, identifying the characteristic features described above, especially for the classical simple virilizing and non-classical form.
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Affiliation(s)
- Michele Di Cosola
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana,” University of Salerno , Via Allende, 84081 , Baronissi (SA) , Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Riccardo Nocini
- ENT Department, University of Verona , 37100 , Verona , Italy
| | - Roberto Lovero
- Clinical Pathology Unit, AOU Policlinico Consorziale di Bari - Ospedale Giovanni XXIII , 70124 , Bari , Italy
| | - Salvatore Sembronio
- Department of Maxillofacial Surgery, University of Udine, Academic Hospital “Santa Maria della Misericordia,” , 33100 , Udine , Italy
| | - Luigi Santacroce
- Department of Interdisciplinary Medicine, Microbiology and Virology Laboratory, University Hospital of Bari, Università degli Studi di Bari , 70124 , Bari , Italy
| | - Edoardo Brauner
- Department of Dental and Maxillary Facial Sciences, “Sapienza” University of Rome , 00185 , Rome , Italy
| | - Giovanni Storto
- Nuclear Medicine Unit, IRCCS Regional Cancer Hospital CROB, Referral Cancer Center of Basilicata , 85028 , Potenza , Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Angela Pia Cazzolla
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
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Tel A, Bagatto D, Costa F, Sembronio S, Robiony M. Anatomical Computerized Exploration to Excise Malignancies in Deep Facial Compartments: An Advanced Virtual Reality Protocol for a Tailored Surgical Approach. Front Oncol 2022; 12:875990. [PMID: 35646710 PMCID: PMC9137398 DOI: 10.3389/fonc.2022.875990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objective/Hypothesis This study describes the design and application of a novel advanced protocol for virtual three-dimensional anatomical reconstruction of the deep facial compartments, aiming to improve the preoperative understanding and the intraoperative assistance in complex resective surgeries performed for malignant diseases which extend in complex spaces, including the pterygomaxillopalatine fossa, the masticator space, and the infratemporal fossa. Methods This study is a non-profit, retrospective, and single-institution case series. The authors clearly describe in detail imaging acquisition protocols which are suitable to segment each target, and a multilayer reconstruction technique is presented to simulate anatomical structures, with particular focus on vascular networks. Virtual surgical planning techniques are individually designed for each case to provide the most effective access to the deep facial compartments. Intraoperative guidance systems, including navigation and virtual endoscopy, are presented, and their role is analyzed. Results The study included seven patients with malignant disease located in the deep facial compartments requiring radical resection, and all patients underwent successful application of the protocol. All lesions, except one, were subject to macroscopically radical resection. Vascular structures were identified with overall reconstruction rates superior to 90% for major caliber vessels. Prominent landmarks for virtual endoscopy were identified for each case. Conclusions Virtual surgical planning and multilayer anatomical reconstruction are valuable methods to implement for surgeries in deep facial compartments, providing the surgeon with improved understanding of the preoperative condition and intraoperative guidance in critical phases for both open and endoscopic phases. Such techniques allow to tailor each surgical access, limiting morbidity to strictly necessary approaches to reach the disease target.
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Affiliation(s)
- Alessandro Tel
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, University Hospital of Udine, Udine, Italy
| | - Fabio Costa
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Salvatore Sembronio
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
- *Correspondence: Massimo Robiony,
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Raccampo L, Sembronio S, Tel A, Cacitti V, Robiony M. Oral Lichen Planus arising after BNT162b2 mRNA COVID-19 Vaccine: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e54-e57. [PMID: 35851250 PMCID: PMC8995197 DOI: 10.1016/j.oooo.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Veronica Cacitti
- Department of Pathology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Robiony M, Sembronio S, Tel A, Ocello E, Antonio JK, Graziadio M, Miani C. Clinical signs, telemedicine and online consultations in head and neck diseases during the SARS CoV-2 pandemic: an Italian experience. Acta Otorhinolaryngol Ital 2022; 42:S36-S45. [PMID: 35763273 PMCID: PMC9137386 DOI: 10.14639/0392-100x-suppl.1-42-2022-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
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Lazzarotto A, Tel A, Vetrugno L, Cereser L, Sembronio S, Di Cosola M, Bove T, Robiony M. Pneumomediastinum, pneumothorax and subcutaneous emphysema after tracheostomy closure. When less is more. Acta Biomed 2022; 92:e2021368. [PMID: 35045064 PMCID: PMC10523032 DOI: 10.23750/abm.v92is1.11551] [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] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/28/2021] [Indexed: 06/14/2023]
Abstract
Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on several factors, including direct trauma to the tracheal wall caused by surgical maneuvers or insufficient closure of soft tissue layers which do not seal air leakage. In this paper we explore this phenomenon by reporting the case of one patient undergoing surgical closure of tracheostomy after two weeks, who later developed subcutaneous emphysema followed by pneumomediastinum. Physiopatology is analyzed and management strategies for this condition are suggested based on our experience.
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Affiliation(s)
- Andrea Lazzarotto
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy..
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy..
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.
| | - Michele Di Cosola
- 4. Department of Clinical and Experimental Medicine, Riuniti University Hospital of Foggia, Viale Luigi Pinto 1, 71122, Foggia, Italy.
| | - Tiziana Bove
- 2. Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Massimo Robiony
- a:1:{s:5:"en_US";s:114:"Chief of Maxillofacial Surgery Unit, Academic Hospital of Udine Department of Medical Sciences University of Udine";}.
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Tel A, Arboit L, Sembronio S, Costa F, Nocini R, Robiony M. The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit-Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality. Front Surg 2021; 8:715262. [PMID: 34497829 PMCID: PMC8419325 DOI: 10.3389/fsurg.2021.715262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/27/2021] [Indexed: 01/17/2023] Open
Abstract
In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.
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Affiliation(s)
- Alessandro Tel
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Lorenzo Arboit
- Faculty of Medicine and Surgery, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Salvatore Sembronio
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Fabio Costa
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Riccardo Nocini
- Department of Otorhinolaryngology, University Hospital of Verona, Verona, Italy
| | - Massimo Robiony
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
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Tel A, Murta F, Sembronio S, Costa F, Robiony M. Virtual planning and navigation for targeted excision of intraorbital space-occupying lesions: proposal of a computer-guided protocol. Int J Oral Maxillofac Surg 2021; 51:269-278. [PMID: 34373183 DOI: 10.1016/j.ijom.2021.07.013] [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: 02/11/2021] [Revised: 04/03/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to present an innovative approach for the preoperative assessment and intraoperative targeted excision of masses occupying the intraorbital space based on multimodal image fusion, segmentation, virtual models, digital planning, and navigation. Nineteen patients were studied and underwent surgery using the presented workflow, in both open and endoscopic procedures. Three main scenarios were standardized for the application of computer-guided surgery: single masses of the superior-lateral compartment, single masses of the inferior-medial compartment, and multifocal masses. An operative protocol was devised, and the accuracy of the osteotomies was analysed. All patients were managed successfully by applying the same protocol. No intraoperative complications were reported. The accuracy of the osteotomies was evaluated as a surrogate endpoint for the overall precision of surgery, showing average discrepancies of <1 mm for lateral marginotomies and <0.5 mm for endoscopic osteotomies. This study outlines an operative workflow for the implementation of virtual models to excise orbital masses, enhancing in-depth preoperative understanding of the anatomical relationships within the orbital space and increasing precision in both open and endoscopic approaches.
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Affiliation(s)
- Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Fabiola Murta
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Fabio Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Tel A, Tuniz F, Sembronio S, Costa F, Bresadola V, Robiony M. Cubik system: maximizing possibilities of in-house computer-guided surgery for complex craniofacial reconstruction. Int J Oral Maxillofac Surg 2021; 50:1554-1562. [PMID: 34312041 DOI: 10.1016/j.ijom.2021.07.008] [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: 12/24/2020] [Revised: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022]
Abstract
Craniofacial reconstruction represents a major challenge due to the complex anatomical morphology. Although implant production has often been outsourced to external companies, in-house planning and manufacturing has developed in many centres. This note introduces a conceptualized modular mould system to perform any desired craniofacial reconstruction, named 'Cubik', inspired by the famous Rubik's cube. A sophisticated virtual process is described that simulates realistic cranio-orbital resections, and the workflow to create multi-component moulds in order to achieve intraoperatively moulded implants is presented. The description focuses on the appropriate definition of interfaces between the subdivision surfaces of the planned implant, which is the key element to successful design and function of the moulds during surgery and is the peculiarity of the Cubik system. The use of Cubik does not prolong the overall duration of surgery, and it appears to be a very versatile tool, allowing personalized implants with different morphology to be created, which are suitable to cover every potential defect of the skull and the orbital region. This study extends the potential of in-house production, allowing highly accurate implantable craniofacial implants to be fabricated, and in the future this might represent a solution to achieve in-house replacement of other segments of the facial skeleton.
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Affiliation(s)
- A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - F Tuniz
- Neurosurgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - F Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - V Bresadola
- Simulation Centre, General Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Tel A, Sembronio S, Costa F, Robiony M. Scoping Zygomaticomaxillary Complex Fractures With the Eyes of Virtual Reality: Operative Protocol and Proposal of a Modernized Classification. J Craniofac Surg 2021; 32:552-558. [PMID: 33704979 DOI: 10.1097/scs.0000000000006941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/26/2022] Open
Abstract
INTRODUCTION Fractures of the zygomaticomaxillary complex (ZMC) represent an extremely heterogeneous group of injuries to the midfacial skeleton. Traditionally, the diagnosis of such fractures was based on 2-dimensional radiograms and, more recently, on volumetric computed tomography (CT) scans, while the treatment was exclusively based on the surgeon's experience. Many classification attempts have been made in the past, but no paper has taken into account the importance of virtual surgical planning (VSP) in proving a modernized classification. The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation. METHODS Patients with ZMC fractures were collected to create a study model. The VSP was used to generate 3-dimensional models of fractures. Fractured segments were duplicated and digitally put in the optimal reduction position. Repositioned fragments were overlapped to their original preoperative counterparts and exported to the surgical navigator to be navigated. Planned virtual reduction was overlaid to postoperative CT scan to assess the accuracy of reduction, explored using color maps and the calculation of root mean square error. RESULTS For all patients, the application of VSP was successfully accomplished. High accuracy was confirmed between the planned virtual reduction and the postoperative CT scan. A 5-item classification based on VSP is proposed. All patients were included in the presented subclasses. CONCLUSIONS The adoption of virtual planning in ZMC fractures allows for an improved study of the displacement of the fracture and might indicate to the surgeons the required maneuvers to achieve optimal reduction. The presented proposal of classification might be an aid to simplify the choice of the most appropriate reduction method and might provide a deeper insight into the morphologic characteristics of fractures.
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Affiliation(s)
- Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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Sembronio S, Tel A, Tremolada C, Lazzarotto A, Isola M, Robiony M. Temporomandibular Joint Arthrocentesis and Microfragmented Adipose Tissue Injection for the Treatment of Internal Derangement and Osteoarthritis: A Randomized Clinical Trial. J Oral Maxillofac Surg 2021; 79:1447-1456. [PMID: 33675704 DOI: 10.1016/j.joms.2021.01.038] [Citation(s) in RCA: 8] [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] [Received: 11/14/2020] [Revised: 01/07/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Internal derangement and osteoarthritis are the most common degenerative temporomandibular joint diseases and initial treatment for such conditions relies on arthrocentesis. Microfragmentation of adipose tissue has been proven in orthopedic literature to represent a more effective method to preserve stem cells, but no application has ever been reported in the temporomandibular joint. The purpose of this randomized clinical trial is to compare standard treatment conducted by injecting hyaluronic acid after the procedure to the new treatment relying upon microfragmented adipose tissue injection using the Lipogems technology. MATERIALS AND METHODS A randomized clinical trial was designed enrolling 20 patients in the control group receiving the standard treatment and 20 patients in the experimental group receiving microfragmented adipose tissue obtained through the Lipogems technology after arthrocentesis. Two main outcomes were defined, pain (visual analogic scale) and function (maximum interincisal opening). Both were measured in the immediate preoperative time, and 10 days, 1 month, and 6 months after the procedure. RESULTS In both groups, pain reduction and mouth opening significantly improved compared with the preoperative situation (P = .001). At 6-month follow-up, there was an almost statistically significant reduction of pain compared with preoperative visual analogic scale (P = .0546) and a statistically significant improvement of mouth opening (P = .0327). Overall, statistical analyses showed that the experimental group had a statistically significant superiority in the success rate of the procedure compared with the control group (P = .018). CONCLUSIONS Preliminary results of this clinical trial show that the injection of microfragmented adipose tissue can significantly improve outcomes of pain and function compared with the standard treatment and encourage to pursue research on this topic. Further studies with a longer follow-up time are needed to evaluate the clinical stability of the achieved improvement in pain and function.
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Affiliation(s)
- Salvatore Sembronio
- Consultant, Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Tel
- Resident, Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Carlo Tremolada
- Professor, Manchester Metropolitan University (UK), Founder of Lipogems, Scientific Director of Image Regenerative Clinic, Udine, Italy
| | - Andrea Lazzarotto
- Resident, Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Miriam Isola
- Assistant Professor, Statistics Institute, University of Udine, Udine, Italy
| | - Massimo Robiony
- Department Head and Full Professor, Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Robiony M, Bocin E, Sembronio S, Costa F, Arboit L, Tel A. Working in the era of COVID-19: An organization model for maxillofacial surgery based on telemedicine and video consultation. J Craniomaxillofac Surg 2021; 49:323-328. [PMID: 33581957 PMCID: PMC7862884 DOI: 10.1016/j.jcms.2021.01.027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/28/2020] [Accepted: 01/31/2021] [Indexed: 11/01/2022] Open
Abstract
The worldwide pandemic caused by the COVID-19 outbreak has led to an unprecedented burden on hospital structures, posing new challenges in terms of reshaping healthcare services. At the same time, the so-called 'lockdown' restrictions have decreased overall mobility, thereby challenging the traditional concept of clinical examination. Moreover, the need for security for both patients and healthcare personnel has posed a further limitation to face-to-face meeting. Telemedicine has provided a valuable solution for such issues, allowing the evaluation of oral and maxillofacial surgery patients through technological interfaces, restricting physical consultations to cases with high clinical priority, intercepting suspects, and maintaining contact with discharged patients. Thanks to the experience gained during the previous wave of infections, the purpose of this study was to present a reorganization of clinical services for oral and maxillofacial surgery in order to help cope with the latest COVID-19 resurgence. Using commonly available software for telecommunications and online meetings, the Oral and Maxillofacial Surgery Department of the University Hospital of Udine has reshaped the organization of healthcare services, with telemedicine central to the continuity of assistance, while at the same time minimizing the risk of exposure for both patients and operators. Additionally, the high number of patients evaluated through telemedicine improved our ability to define signs and symptoms of diseases using informatic tools, thus allowing the introduction of the concept of 'telesemiology'. During our previous lockdown experience, between March and April 2020, 78 patients were evaluated using teleconsultation. All outpatient examinations were rescheduled and translated into a virtual platform, allowing each patient to undergo evaluation in the most appropriate setting. Special attention was paid to the follow-up of oncological patients. The rehabilitation team represented a crucial element in maintaining contact with more complex patients in this crucial time. This study was based on our previous lockdown experience - a situation that many will be facing again over the coming months. Our hope is that the organizational structure that our department applied during the previous wave of infections may offer other colleagues a solution to facing the current COVID-19 recrudescence.
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Affiliation(s)
- Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Italy.
| | - Elena Bocin
- Rehabilitation Unit, Academic Hospital of Udine, Department of Medicine, University of Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Italy
| | - Fabio Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Italy
| | - Lorenzo Arboit
- Faculty of Medicine and Surgery, University of Pisa, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Italy
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Sembronio S, Tel A, Robiony M. Comment on "Computer-assisted surgery for replacement of the temporomandibular joint with customized prostheses: can we validate the results?". Oral Maxillofac Surg 2021; 25:569-570. [PMID: 33527259 DOI: 10.1007/s10006-021-00942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy. .,Maxillofacial Surgery Unit, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 1, 33100, Udine, Italy.
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Tel A, Tuniz F, Fabbro S, Sembronio S, Costa F, Robiony M. Computer-Guided In-House Cranioplasty: Establishing a Novel Standard for Cranial Reconstruction and Proposal of an Updated Protocol. J Oral Maxillofac Surg 2020; 78:2297.e1-2297.e16. [DOI: 10.1016/j.joms.2020.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022]
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Sembronio S, Tel A, Robiony M. The use of cutting/positioning devices for custom-fitted temporomandibular joint alloplastic reconstruction: current knowledge and development of a new system. Int J Oral Maxillofac Surg 2020; 50:530-537. [PMID: 33097370 DOI: 10.1016/j.ijom.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/17/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Alloplastic replacement of the temporomandibular joint (TMJ) is the treatment of choice in cases of TMJ end-stage disease. Improvements in computer-aided design/computer-aided manufacturing (CAD/CAM) translated into the possibility ongf designi very precise TMJ prostheses based on the anatomy of each single patient. Custom-made TMJ prostheses are described in the most recent literature and provide facilitations in terms of ease of placement and accuracy. Although before the era of custom-made surgical guides, they did not play a prominent role in the field of TMJ surgery, their use has become mandatory when custom-made prostheses are used. Surgical guides, generally known also as cutting guides, allow the subcondylar bone cut to be performed according to the exact shape and size of the planned prostheses. Additionally, they allow the predrilling of fixation holes in the mandible to minimize errors in prostheses positioning. However, the design of surgical guides did not evolve over time as much as prostheses did. In this paper the authors critically analysed literature on this topic and described the improvements of surgical guides over time. Moreover, based on the findings of literature research, a new cutting guide system was developed and is proposed in this article.
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Affiliation(s)
- S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Robiony M, Bocin E, Sembronio S, Costa F, Bresadola V, Tel A. Redesigning the Paradigms of Clinical Practice for Oral and Maxillofacial Surgery in the Era of Lockdown for COVID-19: From Tradition to Telesemeiology. Int J Environ Res Public Health 2020; 17:E6622. [PMID: 32932911 PMCID: PMC7557395 DOI: 10.3390/ijerph17186622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 01/31/2023]
Abstract
The rise of the COVID-19 pandemic has posed new challenges for health care institutions. Restrictions imposed by local governments worldwide have compromised the mobility of patients and decreased the number of physicians in hospitals. Additional requirements in terms of medical staff security further limited the physical contact of doctors with their patients, thereby questioning the traditional methods of clinical examination. Our institution has developed an organization model to translate the essential clinical services into virtual consultation rooms using a telemedicine interface which is commonly available to patients. We provide examples of clinical activity for a maxillofacial surgery department based on teleconsultation. Our experience is summarized and an organization model is drafted in which outpatient consultation offices are translated into virtual room environments. Clinical examples are provided, demonstrating how each subspecialty of oral and maxillofacial surgery can benefit from virtual examinations. The concept of "telesemeiology" is introduced and a checklist is presented to guide clinicians to perform teleconsultations. This paper is intended to provide an organization model based on telemedicine for maxillofacial surgeons and aims to represent an aid for colleagues who are facing the pandemic in areas where lockdown limits the possibility of a physical examination.
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Affiliation(s)
- Massimo Robiony
- Department of Medicine, University of Udine, 33100 Udine, Italy; (E.B.); (S.S.); (F.C.); (V.B.); (A.T.)
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
| | - Elena Bocin
- Department of Medicine, University of Udine, 33100 Udine, Italy; (E.B.); (S.S.); (F.C.); (V.B.); (A.T.)
- Rehabilitation Unit, Academic Hospital of Udine, 33100 Udine, Italy
| | - Salvatore Sembronio
- Department of Medicine, University of Udine, 33100 Udine, Italy; (E.B.); (S.S.); (F.C.); (V.B.); (A.T.)
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
| | - Fabio Costa
- Department of Medicine, University of Udine, 33100 Udine, Italy; (E.B.); (S.S.); (F.C.); (V.B.); (A.T.)
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
| | - Vittorio Bresadola
- Department of Medicine, University of Udine, 33100 Udine, Italy; (E.B.); (S.S.); (F.C.); (V.B.); (A.T.)
- Department and Simulation Center, Academic Hospital of Udine, 33100 Udine, Italy
| | - Alessandro Tel
- Department of Medicine, University of Udine, 33100 Udine, Italy; (E.B.); (S.S.); (F.C.); (V.B.); (A.T.)
- Maxillofacial Surgery Department, Academic Hospital of Udine, 33100 Udine, Italy
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Tel A, Bortuzzo F, Pascolo P, Costa F, Sembronio S, Bresadola V, Baldi D, Robiony M. Maxillofacial Surgery 5.0: a new paradigm in telemedicine for distance surgery, remote assistance, and webinars. ACTA ACUST UNITED AC 2020; 69:191-202. [DOI: 10.23736/s0026-4970.20.04274-0] [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] [Indexed: 11/08/2022]
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Tel A, Sembronio S, Costa F, Robiony M. Comment on "In-House Surgeon-Led Virtual Surgical Planning for Maxillofacial Reconstruction". J Oral Maxillofac Surg 2020; 78:1443-1445. [PMID: 32579885 DOI: 10.1016/j.joms.2020.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
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Sembronio S, Tel A, Robiony M. Protocol for fully digital and customized management of concomitant temporomandibular joint replacement and orthognathic surgery. Int J Oral Maxillofac Surg 2020; 50:212-219. [PMID: 32527566 DOI: 10.1016/j.ijom.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/06/2019] [Revised: 02/08/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Abstract
End-stage temporomandibular joint (TMJ) disease is caused by a multitude of pathological processes that impair TMJ anatomy and function. In many cases, end-stage TMJ disease and dentofacial skeletal deformities coexist. The optimal treatment for such conditions is total alloplastic joint replacement and orthognathic surgery. Such procedures have historically been conducted in two separate stages. Furthermore, while technological improvements resulting from the widespread adoption of virtual reality initially led to significant improvements in the field of orthognathic planning, the adoption of virtual design techniques to optimize TMJ reconstruction was a later achievement. Therefore, planning for TMJ replacement and orthognathic surgery did not develop in parallel, leading to various combinations of planning for orthognathic surgery and TMJ replacement with the aim of performing both procedures simultaneously in one stage. Nowadays, improvements in virtual planning and three-dimensional printing have allowed these procedures to be conducted in the same surgical step based on fully digital planning and entirely customized surgery. This paper introduces a fully digital protocol for the treatment of end-stage TMJ disease and associated acquired dentofacial deformities, in which all surgical steps are customized and the whole surgery is performed in succession using automated procedures, thanks to the combined use of virtual surgical planning, surgical guides, custom-designed TMJ prostheses, and patient-fitted osteosynthesis devices.
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Affiliation(s)
- S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Sembronio S, Tel A, Perrotti G, Robiony M. One-Stage Computer-Guided Customized Management of Skeletal Asymmetry by Concomitant Proportional Condylectomy and Orthognathic Surgery in Patients With Unilateral Condylar Hyperplasia. J Oral Maxillofac Surg 2020; 78:2072.e1-2072.e12. [PMID: 32621806 DOI: 10.1016/j.joms.2020.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Facial asymmetry associated with unilateral condylar hyperplasia can benefit from condylectomy, which aims to arrest the pathologic condylar growth and restore an appropriate posterior height. However, there are several cases in which condylar hyperplasia is combined with various dentofacial deformities, for which joint surgery has to be accompanied by concomitant orthognathic surgery. The literature is relatively poor of examples in which virtual planning for orthognathic surgery includes the evaluation of condylectomy, which is often manually performed. The aim of this study was to present and discuss a workflow for 1-stage computer-guided customized management of skeletal asymmetry by simultaneous condylectomy and orthognathic surgery. MATERIALS AND METHODS Five patients were enrolled in this study from 2018 to 2019. All patients underwent combined virtual planning of orthognathic surgery and condylectomy. Virtual surgery was translated into real surgical coordinates using patient-specific surgical guides and custom-designed osteosynthesis plates. RESULTS All surgical procedures were uneventful, and in all patients, virtual planning was successfully brought into the operating room with high accuracy, as confirmed by superimposition analyses. Symmetrization of the face and achievement of correct occlusion were observed in all cases. CONCLUSIONS The presented protocol is a reliable solution for the combined planning of orthognathic surgery and condylectomy. Virtual planning, surgical guides, and custom-designed plates allow computerized simulations to be replicated in the real patient.
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Affiliation(s)
- Salvatore Sembronio
- Assistant Professor, Maxillofacial Surgery Department, Academic Hospital of Udine, and Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Tel
- Resident, Maxillofacial Surgery Department, Academic Hospital of Udine, and Department of Medicine, University of Udine, Udine, Italy
| | - Giovanna Perrotti
- Private Practitioner in Orthodontics, Lake Como Institute, Como, Italy
| | - Massimo Robiony
- Full Professor, Department Head, Maxillofacial Surgery Department, Academic Hospital of Udine, and Department of Medicine, University of Udine, Udine, Italy.
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Sembronio S, Tel A, Robiony M. Comment on "Computer-Guided Arthrocentesis Using Patient-Specific Guides: A Novel Protocol for Treatment of Internal Derangement of the Temporomandibular Joint". J Oral Maxillofac Surg 2020; 78:1219. [PMID: 32461064 DOI: 10.1016/j.joms.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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Tel A, Sembronio S, Costa F, Stenico AS, Bagatto D, D'Agostini S, Robiony M. Endoscopically assisted computer-guided repair of internal orbital floor fractures: an updated protocol for minimally invasive management. J Craniomaxillofac Surg 2019; 47:1943-1951. [DOI: 10.1016/j.jcms.2019.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/23/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
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De Riu G, Vaira LA, Carta E, Meloni SM, Sembronio S, Robiony M. Bone marrow nucleated cell concentrate autograft in temporomandibular joint degenerative disorders: 1-year results of a randomized clinical trial. J Craniomaxillofac Surg 2019; 47:1728-1738. [DOI: 10.1016/j.jcms.2018.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022] Open
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Costa F, Emanuelli E, Franz L, Tel A, Sembronio S, Robiony M. Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature. Am J Otolaryngol 2019; 40:700-704. [PMID: 31239183 DOI: 10.1016/j.amjoto.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/04/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maxillary fungus ball (FB) is the most frequent paranasal localization. OBJECTIVE To review clinical presentation, surgery and results of treatment in our series of patients with maxillary FB. To review the literature concerning treatment of maxillary FB. PATIENTS AND METHODS 48 patients with a diagnosis of maxillary FB were treated with endoscopic sinus surgery (ESS) alone or in association with external approaches. Before surgery all patients received computed tomography (CT), nasal endoscopy and dental examination. All the patients were followed for 1 year after surgery. Studies concerning surgical treatment of maxillary FB from 2006 were reviewed. RESULTS The mean age of patients was 53.6 ± 11.9 years. 20 patients (41.6%) did not present any symptom, 19 patients (39.7%) had nasal symptoms, 3 patients (6.2%) had facial pain, 6 patients (12.5%) had a combination of both. Endoscopic examination was positive in 31 patients (64.6%), 17 patients (35.4%) showed negative findings. Logit regression model demonstrated that clinical symptoms contribute to the prediction of a positive endoscopic examination. 25 patients (52.1%) presented odontogenic factors. Complete clinical and radiological resolution of FB was observed in 46 patients (95.8%). CONCLUSIONS Comparing our sample to the studies reviewed we may concluded that odontogenic factors were frequently reported and should be treated at the same time of maxillary FB. ESS alone or in association with external approaches is an effective treatment for patients with maxillary FB.
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Affiliation(s)
- Fabio Costa
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy.
| | - Enzo Emanuelli
- Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Leonardo Franz
- Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Alessandro Tel
- Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Massimo Robiony
- Azienda Ospedaliero Universitaria of Udine, Department of Medical and Biological Science, University of Udine, Udine, Italy
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Tel A, Bagatto D, Tuniz F, Sembronio S, Costa F, D'Agostini S, Robiony M. The evolution of craniofacial resection: A new workflow for virtual planning in complex craniofacial procedures. J Craniomaxillofac Surg 2019; 47:1475-1483. [DOI: 10.1016/j.jcms.2019.06.016] [Citation(s) in RCA: 9] [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: 02/02/2019] [Revised: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 02/03/2023] Open
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Sembronio S, Tel A, Robiony M. Comment on: “Does Accurate Positioning of the Temporomandibular Joint Titanium Condylar Prosthesis Prevent Complications?”. J Oral Maxillofac Surg 2019; 77:888-889. [DOI: 10.1016/j.joms.2018.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
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Sembronio S, Tel A, Robiony M. Re: Condylectomy: treatment of recurrent unilateral dislocation of the temporomandibular joint in a patient with Ehlers-Danlos syndrome. Br J Oral Maxillofac Surg 2019; 57:482-484. [PMID: 30992226 DOI: 10.1016/j.bjoms.2019.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/21/2019] [Indexed: 11/17/2022]
Affiliation(s)
- S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine.
| | - A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine
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Tel A, Costa F, Sembronio S, Lazzarotto A, Robiony M. All-in-one surgical guide: A new method for cranial vault resection and reconstruction. J Craniomaxillofac Surg 2018; 46:967-973. [PMID: 29716817 DOI: 10.1016/j.jcms.2018.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/05/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Great precision is required for craniofacial surgery, and computer-aided design (CAD) methods may be used to plan surgery before it is performed. In this study, three-dimensional (3D)-printed cutting guides are used to match computer models with surgical procedures. We describe a novel method of computer-aided surgery for autologous cranioplasty that includes a new strategy for generating and using cutting guides. These guides may be used not only for osteotomies, but also for many other steps in the surgical procedure. MATERIALS AND METHODS Preoperatively, anatomical data were imported into a CAD package and used for virtual surgical planning (VSP). Cutting guides were designed after considering how to integrate all the surgical steps. Models of the microplates and micro-screws were also made. Surgical guides were exported and printed, and preoperative simulations using a replica of the patient's skull established the sequence of steps. The accuracy of the procedure was evaluated postoperatively using computed tomography (CT) scans. RESULTS In every patient examined, the all-in-one surgical-guide system was able to automate the many steps in the procedure and dramatically decreased the duration of surgery. The experimental guide enhanced every phase of surgery, including excising the lesion, and harvesting, positioning, and fixing the graft. In each step, precision was enhanced and the outcome corresponded with the VSP. CONCLUSIONS The few previous reports on cutting guides used in cranioplasty generally describe the use of separate guides for dismantling and reconstruction. The ability to perform more surgical sequences using a single tool can improve surgical accuracy. Clearly there is no single perfect surgical guide; however, effective surgical-design strategies should be used to build the best approach to each procedure.
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Affiliation(s)
- Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Fabio Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Andrea Lazzarotto
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.
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Robiony M, Sembronio S. Comment on "A Modified Preauricular Approach for Treating Intracapsular Condylar Fractures to Prevent Facial Nerve Injury: The Supratemporalis Approach". J Oral Maxillofac Surg 2016; 74:2114-2115. [PMID: 27575860 DOI: 10.1016/j.joms.2016.06.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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Robiony M, Costa F, Sembronio S. Comments on "The Role of Piezoelectric Instrumentation in Rhinoplasty Surgery". Aesthet Surg J 2016; 36:NP187-8. [PMID: 27069244 DOI: 10.1093/asj/sjw007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Massimo Robiony
- Dr Robiony is an Associate Professor and Department Head, and Dr Costa is an Assistant Professor, Department of Maxillofacial Surgery, University of Udine, Udine, Italy. Dr Sembronio is an Assistant Professor of Maxillofacial Surgery, Hospital of Pordenone, Pordenone, Italy
| | - Fabio Costa
- Dr Robiony is an Associate Professor and Department Head, and Dr Costa is an Assistant Professor, Department of Maxillofacial Surgery, University of Udine, Udine, Italy. Dr Sembronio is an Assistant Professor of Maxillofacial Surgery, Hospital of Pordenone, Pordenone, Italy
| | - Salvatore Sembronio
- Dr Robiony is an Associate Professor and Department Head, and Dr Costa is an Assistant Professor, Department of Maxillofacial Surgery, University of Udine, Udine, Italy. Dr Sembronio is an Assistant Professor of Maxillofacial Surgery, Hospital of Pordenone, Pordenone, Italy
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Robiony M, Zorzan E, Polini F, Sembronio S, Toro C, Politi M. Osteogenesis distraction and platelet-rich plasma: combined use in restoration of severe atrophic mandible. Long-term results. Clin Oral Implants Res 2009; 19:1202-10. [PMID: 18983325 DOI: 10.1111/j.1600-0501.2008.01568.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this paper is to report long-term results on the use of autologous bone graft and platelet-rich plasma in alveolar distraction osteogenesis (DO) for restoration of severe atrophic mandible. We tested the efficacy as to reabsorption of bone volume, peri-implant reabsorption, implant survival and success rate. MATERIALS AND METHODS Twelve patients were treated. The surgical procedure consisted in mixing autologous bone, harvested from the iliac crest, with autologous platelet concentrate (APC) and in filling the distraction gap with this graft. After a latency of 15 days, a distraction rate of 0.5 mm/day was followed. After a 60-day period of consolidation, the distraction device was removed and implants were placed simultaneously. The abutment connection was accomplished after 6 months. In addition, every patient was evaluated clinically and radiographically annually for 5 years. RESULTS Planned alveolar height was reached in 11 out of 12 patients. The total number of implants positioned was 47. At the time of implant positioning, the mean decrease of total bone volume was 2.3%. The mean peri-implant resorption was 0.40 mm at the time of abutment connection, 0.61 mm 1 year after implant loading and 1.51 mm after 5 years. After 5 years of follow-up, the mean rate of vertical bone loss was 18.7%. Instead, the implant survival and success rates were 97.9% and 91.5%, respectively. CONCLUSIONS Long-term results allow us to confirm the combination of autologous bone-platelet gel with alveolar DO as an effective and predictable procedure in restoration of severe atrophic mandible.
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Affiliation(s)
- M Robiony
- Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, P.le Santa Maria della Misericordia, 33100 Udine, Italy.
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Sembronio S, Albiero AM, Zerman N, Costa F, Politi M. Endoscopically assisted enucleation and curettage of large mandibular odontogenic keratocyst. ACTA ACUST UNITED AC 2008; 107:193-6. [PMID: 18801672 DOI: 10.1016/j.tripleo.2008.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 06/28/2008] [Accepted: 07/25/2008] [Indexed: 11/30/2022]
Abstract
This article reports a case of a mandibular multilocular keratocyst treated with endoscopically assisted enucleation and curettage. An ectopic third molar displaced in the coronoid process area was also removed.Odontogenic keratocysts (OKCs) are known for their propensity to recur. The incomplete removal of the cyst is one of the mechanisms for which it is thought that the keratocyst recurs. The endoscopic assistance allowed us to explore accurately the operative field and the areas of difficult access, improving the complete removal of the cystic lesion. Moreover, it allowed us to monitor closely the separation of the cyst lining from the inferior alveolar nerve and limit the extension of the surgical approach. At 3-year follow-up no evidence of recurrence was evidenced by radiological and clinical controls.
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Affiliation(s)
- Salvatore Sembronio
- Department of Maxillofacial Surgery, Faculty of Medicine, University of Udine, Padigline Petracco, Piazzale S. Maria della Misericordia, Udine, Italy.
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Sembronio S, Toro C, Maria Albiero A, Politi M. O.662 TMJ laser arthroscopy for posterior disc displacement. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71786-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Toro C, Robiony M, Sembronio S, Politi M. O.254 Prefabrication of head & neck subunits: a new concept. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Costa F, Robiony M, Salvo I, Toro C, Sembronio S, Politi M. Simultaneous functional endoscopic sinus surgery and esthetic rhinoplasty in orthognathic patients. J Oral Maxillofac Surg 2008; 66:1370-7. [PMID: 18571019 DOI: 10.1016/j.joms.2008.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 12/06/2007] [Accepted: 01/03/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Patients treated for dentofacial deformities may be predisposed to aggravated sinonasal disease postoperatively, particularly if concurrent rhinoplasty is performed. The authors present their experience with simultaneous rhinoplasty, maxillary/mandibular osteotomies, and functional endoscopic sinus surgery (FESS). PATIENTS AND METHODS Thirteen patients were treated with simultaneous rhinoplasty, maxillary/mandibular osteotomies, and FESS from January 2002 to December 2005. An operative algorithm for patients with dentofacial deformities requiring rhinoplasty was developed. The surgical procedure was performed under general anesthesia with nasotracheal intubation and maxillary/mandibular osteotomies first. Nasotracheal intubation was then converted to orotracheal intubation and FESS was performed. The third step was correction of the esthetic deformities of the nose through an open approach. RESULTS In all cases, it was possible to successfully complete the combined operation. Median operation time was: 2 hours and 18 minutes for orthognathic bimaxillary surgery, 54 minutes for rhinoplastic surgery; and 23 minutes for FESS. All the patients had good esthetic and functional results and were free from symptoms consistent with previous rhinosinusitis. CONCLUSION The combination of orthognathic surgery, rhinoplasty, and FESS in selected cases is safe and effective.
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Affiliation(s)
- Fabio Costa
- Department of Maxillofacial Surgery, University of Udine, Udine, Italy.
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Sembronio S, Albiero AM, Toro C, Robiony M, Politi M. Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint? ACTA ACUST UNITED AC 2008; 105:274-80; discussion 281. [DOI: 10.1016/j.tripleo.2007.07.003] [Citation(s) in RCA: 31] [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: 02/08/2007] [Revised: 06/07/2007] [Accepted: 07/02/2007] [Indexed: 11/16/2022]
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Costa F, Polini F, Zerman N, Sembronio S, Toro C, Politi M. Functional endoscopic sinus surgery for the treatment of Aspergillus mycetomas of the maxillary sinus. Minerva Stomatol 2008; 57:117-125. [PMID: 18427380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The proper treatment for Aspergillus mycetoma (AM) of the maxillary sinus is a complete removal of the sinus fungal masses and improvement of aeration for the involved sinuses. We report our experience in the treatment of AM of the maxillary sinus by functional endoscopic sinus surgery (FESS). METHODS Thirteen immunocompetent patients with AM underwent FESS under general anesthesia. Mycotic concretions were endonasally removed through the enlarged maxillary natural ostium. Care was taken to avoid any removal of the maxillary sinus mucosa. Only in one case complete removal could not be achieved and therefore we opened the maxillary sinus via the canine fossa and cleared it of fungal masses. Follow-up has ranged from 6 months to 4 years after surgery. Patients were all closely followed postoperatively with serial endoscopic examinations in order to verify the maintenance of opening of the maxillary natural ostium. RESULTS Histological examination was positive for Aspergillus in all the patients. Postoperative radiographs and endoscopic examinations revealed maintenance of the antrostomy performed during FESS without mucosal degeneration and no evidence of recurrence. All patients were free of symptoms after a mean follow-up of 31 months. None of the patients required a second procedure. CONCLUSION Surgical treatment of AM with FESS appears a reliable and safe surgical treatment. Sinus physiology is preserved in the event of a future bone reconstruction for prosthetic purposes.
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Affiliation(s)
- F Costa
- Department of Maxillofacial Surgery, Faculty of Medicine, University of Udine, Udine, Italy.
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Abstract
Two basic techniques for lateral osteotomy have been developed to date; the internal (endonasal) continuous technique and the external (percutaneous) perforating method. Numerous investigators have subjectively reported that the application of the two techniques results in less postoperative ecchymosis and edema compared to the use of other techniques, but an alternative and gentle method for performing lateral osteotomy or bony hump removal has not been proposed yet. The authors present a new soft technique to perform nasal osteotomy in rhinoplasty using piezoelectric ultrasonic vibrations, and emphasize the advantages of this method.
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Affiliation(s)
- Massimo Robiony
- Department of Maxillo-Facial Surgery, University of Udine, Udine, Italy.
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Robiony M, Polini F, Costa F, Sembronio S, Zerman N, Politi M. Endoscopically assisted intraoral vertical ramus osteotomy and piezoelectric surgery in mandibular prognathism. J Oral Maxillofac Surg 2007; 65:2119-24. [PMID: 17884552 DOI: 10.1016/j.joms.2006.03.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 03/03/2006] [Accepted: 03/29/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Massimo Robiony
- Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, Udine, Italy
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Polini F, Robiony M, Toro C, Costa F, Sembronio S, Politi M. Penetrating injury of the facial skeleton through the orbit, by a massive metallic shotgun block: A case report. Br J Oral Maxillofac Surg 2007; 45:586-7. [PMID: 17027129 DOI: 10.1016/j.bjoms.2006.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2006] [Indexed: 10/24/2022]
Abstract
We present a case of invasion of the orbit and the infra-temporal fossa by a massive breechblock from a shotgun. The block was removed and two months later the orbit was reconstructed with iliac crest. Six months after that the patient had plastic surgery and insertion of ocular prosthesis.
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Affiliation(s)
- F Polini
- Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, P.le Santa Maria della Misericordia, 33100 Udine, Italy.
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Sembronio S, Albiero AM, Polini F, Robiony M, Politi M. Intraoral endoscopically assisted treatment of temporomandibular joint ankylosis: preliminary report. ACTA ACUST UNITED AC 2007; 104:e7-10. [DOI: 10.1016/j.tripleo.2007.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 12/29/2006] [Accepted: 01/11/2007] [Indexed: 10/23/2022]
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