Basic and advanced endoscopic sinus surgery course: open and endoscopic cadaver dissection techniques and live surgery.

This course originates from the close collaboration experienced and established over many years between the three professionals most involved in the surgical treatment of lesions of the anterior skull base. We believe, and the results have proved us right, that the achievement of the best treatment in such complex anatomical regions can be born only from an accurate preoperative study, the realization of several surgical procedures and the care of every detail during the post-operative period carried out in a close collaboration among Otolaryngologists, Maxilo-Facial surgeons and Neurosurgeons. The relatively recent introduction of endoscopic surgery and the huge expansion of the latter has further expanded the possibilities of collaboration. On the other hand those who want to approach to this type of pathologies necessarily have to know not only the techniques and possibilities of endoscopy but also the open techniques which are essential to face certain situations or clinical manifestations. The experience of many years of shared work between two surgical university schools with great traditions such as Modena and Verona besides a personal friendship established over time has enabled us both to joint the three specialties and to create a group that is inspired by the same principles

Combined effect of vestibular and craniomandibular disorders on postural behaviour.

Sebbene l’esistenza di una correlazione tra i disordini dell’articolazione temporo-mandibolare e le alterazioni dell’apparato muscolo-scheletrico sia stata più volte riportata in Letteratura in campo odontostomatologico, la questione se esista una correlazione tra questi disordini e le modificazioni della postura è ancora da definire. In questo studio il Cranio Mandibular Index è stato utilizzato per valutare il grado di disfunzione temporo-mandibolare ed i problemi ed essa corrrelati in 40 pazienti con funzionalità vestibolare nella norma, ed in 42 pazienti affetti da disordini vestibolari periferici. La valutazione dell’equilibrio è stata eseguita utilizzando la posturografia statica e la “body sway area” misurata in due condizioni: ad occhi aperti e ad occhi chiusi. Questi dati sono stati successivamente confrontati con quelli ottenuti nei 40 soggetti sani. Il controllo posturale ha evidenziato un comportamento significativamente differente tra i due gruppi con un aumento del “body sway” medio nei pazienti con disordini cranio-mandibolari rispetto ai controlli (p<0,005). Sebbene il coinvolgimento dell’apparato stomatognatico non risulti quantitativamente differente nei due campioni patologici, i pazienti affetti anche da sofferenza vestibolare periferica hanno presentato un “body sway” medio maggiore rispetto ai pazienti affetti solo da disordini craniomandibolari (p<0,005). Questi ultimi hanno presentato un “body sway” medio maggiore dei controlli solo nelle prove ad occhi chiusi (p<0,05). I risultati di questo studio hanno dimostrato che le alterazioni craniomandibolari possono essere alla base di una moderata instabilità posturale nei pazienti con funzionalità vestibolare nella norma. Al contrario tali alterazioni, se associate a disordini vestibolari periferici, possono determinare problemi nel mantenimento della stazione eretta, probabilmente a causa dell’effetto negativo di origine somatosensoriale sui riflessi vestibolo-spinali.A correlation has been reported in the dental literature between temporomandibular disorders and musculoskeletal abnormalities, however, the question whether they modify body postural sway remains controversial. In the present investigation, the Craniomandibular Index was used to evaluate the clinical extension of temporomandibular joint dysfunction and related problems in 40 patients with normal vestibular function and in 42 patients with peripheral vestibular disorders. Balance function was assessed by static posturography and body sway area was measured in two conditions: i) eye open, and g) eye closed. Data were compared to those of 40 healthy subjects. Postural control showed a significantly different behaviour between groups with an increase in average body sway in patients with craniomandibular disorders as opposed to controls (p < 0.005). Although the involvement of the stomatognathic apparatus was not quantitatively different in the two groups of patients, those also presenting a peripheral vestibular disorder exhibited greater average body sway than patients with only craniomandibular disorders (p < 0.005). The latter showed a greater average body sway than controls only in the trial with eyes closed (p < 0.05). The results demonstrated that craniomandibular alterations could produce moderate postural instability in patients with a normal vestibular function. Conversely, their association with peripheral vestibular disorders becomes a real challenge to the upright quiet stance probably due to a negative effect of somatosensory origin on the vestibulo-spinal reflex impairment

Bilateral reconstruction of the mandibular body with symphyseal preservation using a single fibula free flap: operative technique

Mandibular osteonecrosis may occur in 5% of the patients who undergo radiotherapy for the treatment of head and neck malignancies. Resection and microvascular reconstruction is the treatment of choice in complicated osteoradionecrosis, however multifocal presentation may complicate the management of the disease given the poor quality and limited availability of adequate recipient vessels

A multi-range approach for Cultural Heritage survey: a case study in Mantua Unesco site

In this paper, a Cultural Heritage survey, performed by employing and integrating different type of acquisition technologies (imagebased and active sensor based) is presented. The aim of the survey is to create a 3D multiscale database, therefore, different restitution scales, from the architectural-urban one to a detail one are taken in consideration. This research is part of a project financed by the Unesco for the study of historical gardens located in Mantua and Sabbioneta, and in particular for the Palazzo Te renaissance gardens in Mantua, which are reported in this paper. First of all, a general survey of the area has been realized by employing the classical aerial photogrammetry in order to provide the actual arboreal and urban furniture conditions of the gardens (1:500 scale). Next, a detailed photogrammetric survey of the Esedra courtyard in Palazzo Te has been performed by using a UAV system. At the end, laser scanning and traditional topography have been used for the terrestrial detailed acquisition of gardens and architectural façades (1:50???1:20 scale). The aim of this research is to create a suitable graphical documentation support for the study of the structure of the gardens, to analyze how they have been modified over the years and as an effective support for eventual future re-design. Moreover, the research has involved a certain number of botanic and archeological investigations, which have been duly acquired and modeled with image based systems. Starting from the acquired datasets with their acquisition scales, a series of comparative analysis have been performed, especially for those areas in which all the systems have been employed. The comparisons have been extracted by analyzing point cloud models obtained by using a topographical network. As a result, the multi-range approach efficiency, obtained by employing the actual available technologies have been illustrated in the present work

A comparative in vivo evaluation of bioactive glasses and bioactive glass-based composites for bone tissue repair

In this work a set of novel materials for bone tissue regeneration have been tested in vivo in an animal model. In fact, despite many studies have been devoted to amorphous 45S5 Bioglass®, there is lack in the literature of works aimed to study the in vivo performance of heat-treated – and thus partially crystallized – 45S5. As widely reported, crystallization limits the bioactivity of 45S5 and is the main reason that prevents a broader use of this material. Thus, in the present work, a recently developed bioactive glass (BG_Ca/Mix) is tested, since previous investigations demonstrated that BG_Ca/Mix is particularly promising by virtue of both its high bioactivity and lower tendency to crystallize with respect to 45S5. BG_Ca/Mix sintered powders and two composites, which contain BG_Ca/Mix and an increasing percentage (20&nbsp;wt% or 70&nbsp;wt%) of hydroxyapatite (HA), were considered. As a term of comparison, 45S5 sintered powders were also studied. The samples were implanted in rabbits' femurs and harvested after 8&nbsp;weeks. The histological analysis demonstrated that BG_Ca/Mix has an osteoconductive ability slightly higher than that of 45S5 glass-ceramics, followed by that of the composites, which may represent the starting point for obtaining systems with degradation rate tailored for a given clinical application. Moreover, the 45S5 samples were locally cracked, probably because of a non-uniform dissolution in the physiological environment. On the contrary such cracks, which could lead to implant instability and unsuitable mechanical performance, were not observed in BG_Ca/Mix

Cell Proliferation to Evaluate Preliminarily the Presence of Enduring Self-Regenerative Antioxidant Activity in Cerium Doped Bioactive Glasses

(1) Background: a cell evaluation focused to verify the self-regenerative antioxidant activity is performed on cerium doped bioactive glasses. (2) Methods: the glasses based on 45S5 Bioglass®, are doped with 1.2 mol%, 3.6 mol% and 5.3 mol% of CeO2 and possess a polyhedral shape (~500 µm2). Glasses with this composition inhibit oxidative stress by mimicking catalase enzyme (CAT) and superoxide dismutase (SOD) activities; moreover, our previous cytocompatibility tests (neutral red (NR), 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and Bromo-2-deoxyUridine (BrdU)) reveal that the presence of cerium promotes the absorption and vitality of the cells. The same cytocompatibility tests were performed and repeated, in two different periods (named first and second use), separated from each other by four months. (3) Results: in the first and second use, NR tests indicate that the presence of cerium promotes once again cell uptake and viability, especially after 72 h. A decrease in cell proliferation it is observed after MTT and BrdU tests only in the second use. These findings are supported by statistically significant results (4) Conclusions: these glasses show enhanced proliferation, both in the short and in the long term, and for the first time such large dimensions are studied for this kind of study. A future prospective is the implantation of these bioactive glasses as bone substitute in animal models

Efficacy of species-specific recA PCR tests in the identification of Burkholderia cepacia complex environmental isolates

In this study, we evaluated if recA species-specific PCR assays could be successfully applied to identify environmental isolates of the widespread Burkholderia cepacia complex (Bcc) species. A total of 729 Bcc rhizosphere isolates collected in different samplings were assigned to the species B. cepacia genomovar I (61), B. cenocepacia recA lineage IIIB (514), B. ambifaria (124) and B. pyrrocinia (30), by means of recA (RFLP) analysis, and PCR tests were performed to assess sensitivity and specificity of recA species-specific primers pairs. B. cepacia genomovar I specific primers produced the expected amplicon with all isolates of the corresponding species (sensitivity, 100%), and cross-reacted with all B. pyrrocinia isolates. On the contrary, B. cenocepacia IIIB primers did not give the expected amplicon in 164 B. cenocepacia IIIB isolates (sensitivity, 68.1%), and isolates of distinct populations showed different sensitivity. B. ambifaria primers failed to amplify a recA-specific fragment only in a few isolates of this species (sensitivity, 93.5%). The absence of specific amplification in a high number of B. cenocepacia rhizosphere isolates indicates that recA specific PCR assays can lead to an underestimation of environmental microorganisms belonging to this bacterial species

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Sol-gel derived bioactive glasses with low tendency to crystallize: synthesis, post-sintering bioactivity and possible application for the production of porous scaffolds.

A new sol-gel (SG) method is proposed to produce special bioactive glasses (BG_Ca family) characterized by a low tendency to devitrify. These formulations, derived from 45S5 Bioglass®, are characterized by a high content of CaO (45.6 mol%) and by a partial or complete substitution of sodium oxide with potassium oxide (total amount of alkaline oxides: 4.6 mol%), which increases the crystallization temperature up to 900°C. In this way, it is possible to produce them by SG preserving their amorphous nature, in spite of the calcination at 850°C. The sintering behavior of the obtained SG powders is thoroughly investigated and the properties of the sintered bodies are compared to those of the melt-derived (M) counterparts. Furthermore, the SG glass powders are successfully used to produce scaffolds by means of a modified replication technique based on the combined use of polyurethane sponges and polyethylene particles. Finally, in the view of a potential application for bone tissue engineering, the cytotoxicity of the produced materials is evaluated in vitro

Linfadenectomia sovraomoioidea.

Lo svuotamento linfonodale sovra-omoioideo è la dissezione laterocervicale selettiva più frequentemente eseguita in caso di carcinoma del cavo orale. Con il termine “svuotamento linfonodale selettivo” si intende l’asportazione dei pacchetti linfonodali a maggior rischio di metastasi, con la preservazione di uno o più livelli linfonodali di solito rimossi durante uno svuotamento radicale. In particolar modo lo svuotamento sovraomoioideo prevede la dissezione del I-II-III livello linfonodale (ovvero al di sopra, cranialmente, rispetto al muscolo omoioideo). La possibilità di eseguire dissezioni selettive del collo si basa sul fatto che il drenaggio linfatico delle mucose del cavo orale, in pazienti con carcinoma a cellule squamose precedentemente non trattati, segue percorsi relativamente costanti e di conseguenza le metastasi linfonodali presentano un pattern di diffusione relativamente prevedibile in base alla localizzazione del tumore primitivo. Gli studi anatomici di Rouvière, Fish e Sigel (e successivamente Shah) hanno concluso che i tumori della cavità orale metastatizzano più frequentemente ai linfonodi del collo del I, II, e III livello, mentre i tumori dell’orofaringe, ipofaringe, laringe metastatizzano più frequentemente al II, III, e IV livello. Il trattamento chirurgico delle metastasi linfonodali è stato proposto ed eseguito in origine da Von Albrecht nel 1875, ai primordi della chirurgia laringea, con la sola asportazione dei linfonodi metastatici; Gluck e Sorensen asportavano anche il muscolo sternocleidomastoideo, la giugulare interna e, talvolta, la carotide. Crile nel 1898 introdusse lo svuotamento linfonodale sistematico in monoblocco con la laringectomia, dimostrando che nella sua casistica i malati così trattati sopravvivevano mediamente quattro volte di più di quelli trattati con semplice laringectomia. In seguito, circa 70 anni dopo, Suarez e Bocca iniziarono a conservare il nervo spinale accessorio, la vena giugulare interna e il muscolo sternocleidomastoideo in caso di tumori della laringe e ipofaringee con collo clinicamente negativo per localizzazioni metastatiche linfonodali. L’origine dello svuotamento selettivo, invece, non è del tutto chiara. Molti chirurghi hanno usato questo tipo di procedura per decadi senza descriverla formalmente. Per esempio, Kocher eseguiva un’asportazione parziale dei linfonodi nei pazienti con carcinoma del cavo orale e collo N0 già alla fine del diciannovesimo secolo. Con il tempo si diffuse una procedura detta “svuotamento sovraioideo” (cioè del I livello) nei casi di linfoadenopatie occulte associate ai carcinomi soprattutto del labbro. In seguito, nel 1972, Lindberg ha dimostrato che i livelli più frequentemente coinvolti in pazienti con carcinoma del cavo orale sono in genere il II e il III; nei carcinomi del pavimento della bocca e della lingua mobile il livello più frequentemente coinvolto è, invece, il I. Più tardi Byers propose i termini “anteriore” e “sovraomoioideo” per indicare le dissezioni parziali, ma solo nel 1991 si iniziò ad usare il termine selettivo per descrivere le resezioni linfonodali limitate (Academy’s Committee for Head and Neck Surgery and Oncology). In generale lo svuotamento linfonodale laterocervicale del collo può essere eseguito secondo due diversi tempi rispetto al momento dell’asportazione del tumore primario: 1) in contemporanea all’asportazione del tumore primario ed in assenza di evidenza clinica e radiologica di metastasi linfonodali laterocervicali, ovvero in stadio cN0, al fine di eradicare eventuali metastasi occulte: viene definito svuotamento elettivo o elective neck dissection. 2) successivamente all‘intervento sul tumore primario, al manifestarsi clinico o radiologico delle metastasi linfonodali laterocervicali: viene definito svuotamento terapeutico o therapeutic neck dissection. Lo svuotamento linfonodale elettivo (cN0) è abitualmente di tipo selettivo. Lo svuotamento selettivo del collo per il carcinoma del cavo orale comprende i livelli I-III ed è altrimenti denominato svuotamento linfonodale laterocervicale sovra-omoioideo. La “depth of invasion” (DOI) è ad oggi il miglior fattore per ipotizzare la presenza di metastasi linfonodali occulte laterocervicali e quindi decidere se attuare uno svuotamento linfonodale laterocervicale elettivo (cN0) o terapeutico (al manifestarsi delle metastasi linfonodali cN+). Per carcinomi con una DOI maggiore ai 4mm, si deve programmare uno svuotamento linfonodale elettivo (NCCN Guidelines, 2018). Studi randomizzati hanno dimostrato la superiore efficacia in termini di sopravvivenza dello svuotamento linfonodale elettivo in pazienti affetti da carcinomi del cavo orale cN0, quando la profondità d’infiltrazione (DOI) è superiore ai 3 mm. Quando la DOI è compresa tra 2 e 4mm si deve valutare e soppesare quando sia attuabile l’alternativa di un follow-up stringente ed accurato, secondo le specifiche condizioni socio-sanitarie del paziente in esame. In caso di dubbia aderenza al follow-up clinico-strumentale, consigliamo di effettuare uno svuotamento elettivo sovraomoioideo. In conclusione, lo svuotamento selettivo sovra-omoioideo del collo è attualmente indicato nei pazienti con carcinoma squamoso del cavo orale senza evidenza clinica o radiologica di coinvolgimento linfonodale(cN0), da attuarsi in unico tempo con l’asportazione radicale del tumore primario