The combination of laser-assisted surgery with PRP for the treatment of BRONJ in cancer patient. A pilot study

Aim. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known potential complication of bisphosphonates (BPs) therapy and its treatment could reckon on different approaches. Recently, encouraging results for BRONJ were showed from some clinical studies using Er, Cr: YSGG laser-assisted surgery. Platelet-Rich Plasma (PRP), a new approach to promote tissue regeneration and healing, may be a promising complementary therapy. The aim of this pilot study is to study the effectiveness, in terms of clinical healing, of a combined treatment (laserassisted surgery and topical PRP) for BRONJ in a group of cancer patients. Methods. Ten oncological patients (3 males, 7 females; aged 69-89 years, mean age 76.2±5.8) with BRONJ were consecutively recruited. BRONJ was classified (T0) according to. All patients underwent pre- and peri-operatory antibiotic prophylaxis, and preparation of autologous PRP; the following combined surgical protocol was applied: i) exposure of the surgical area, through the creation of surgical edges; ii) courettage of the necrotic bone and, if present, sequestrectomy, by using a Er, Cr: YSGG laser; iii) application of autologous PRP over the entire bone cavity; iiii) suture of surgical flaps. All patients performed a CT after 3 months from surgery (T1) in order to re-stage of the disease. Successful treatments were considered the complete healing and the radiological improvement (transition from a higher stage to a lower one). Results. At T0 6/10 patients were stage IB, 2/10 were stage IIA and 2/10 were stage IIB. At T1, 3/10 (30%) cases (2 cases IB and 1 case IIB) showed no clinical and radiological signs of BRONJ relapse; 5/10 (50%) cases (4 cases IB and 1 case IIB) showed clinical improvement, whereas 2/10 (20%) (both IIA) showed no-improvement. Conclusion. The association of laser-assisted surgery and topical PRP, firstly investigated in this study, seems useful in BRONJ healing among cancer patients. Further investigation is necessary in order to validate these preliminary result

Persistent post-traumatic headache: A migrainous loop or not? The clinical evidence

Background: Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. Main body: The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. Conclusion: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability