OXIDIZED CELLULOSE WRAP IN SECONDARY INTENTION HEALING OF THE ORAL MUCOSA IN THE TREATMENT OF ONJ

Osteonecrosis of the jaws (ONJ) due to the use of bisphosphonate drugs is a particularly complex condition. The mechanisms through which this pathology develops are manifold. To date, the management of ONJ is controversial.This study analyzed out-patients with documented ONJ treated in Oral and maxillofacial surgery Unit of University "Magna Graecia" of Catanzaro.A total of 11 patients, 8 women and 3 men, were enrolled. The inclusion criteria were: (1) refusal to surgical treatment with flaps; (2) absence of antiplatelet therapy which would also make it impossible to prepare gel from platelet-rich plasma (PRP) or similar; (3) absence of antiblastic therapy in the healing phase. Each case was staged according to the classification of the Italian Societies of Oral Medicine and Maxillofacial Surgery (SICMF-SIPMO classification): a clinical-radiological bone involvement.The following data were recorded: clinical data, comorbidities and concomitant drugs, antibiotic drugs used, type of treatment adopted, clinical mucosal healing time.Each patient underwent antibiotic protocol prior to surgery. Endpoint with surgery was: complete removal of necrotic tissues, packaging of a "re-epithelialization trench" (RET) and apposition of a compress of oxidized cellulose inside this RET. 100% of the patients endured the post-surgery very well, 10 out of 11 (90,91%) patients had excellent healing by secondary intention of the surgical wound. Only one patient (9.09%) had prolonged bone exposure; he subsequently resumed antiblastic therapy and was therefore excluded from work.The results indicate how the use of an oxidized cellulose pack associated with the correct packaging of a re-epithelialization site can guarantee satisfactory post-operative comfort and rapid wound healing. Radiological follow-up was performed at one year. It confirmed the correct healing of the site (clinical and radiological healing)

Classical Orbital Floor Post-Traumatic Reconstruction vs. Customized Reconstruction with the Support of “In-House” 3D-Printed Models: A Retrospective Study with an Analysis of Volumetric Measurement

Background: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. Objective: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers (“In-House” reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. Materials and Methods: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais–Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. Results: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the “Magna Graecia” University Hospital of Catanzaro 10 fulfilled the study’s inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. Conclusion: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient’s anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing

Effect of COVID-19 Italian Lockdown on Maxillofacial Trauma Related to Domestic Violence: A Retrospective Cohort Study

Background: This retrospective study aims to identify the potential reasons for the increase in maxillofacial trauma from domestic violence in the first COVID-19 lockdown and propose some strategies that could be effective in fighting it during any future pandemic events. Materials and Methods: The study was conducted on patients with maxillofacial trauma who arrived at the Maxillofacial Unit of the Magna Graecia University of Catanzaro from 9 March to 3 May 2020, who were compared with those registered in the same period in 2019. Inclusion criteria were: patients of both sexes and admission diagnosed with maxillofacial trauma with or without bone fracture. Exclusion criteria were: patients less than 7 years of age, maxillofacial trauma that occurred outside the established period, and patients unconscious or with unclear clinical history. Patients were divided into two groups according to the mechanism of injury (MOI): “domestic” and “non-domestic” trauma. Both descriptive and regressive statistical analysis was conducted using a Student’s t-test with a significance level set at p < 0.05. Results: The total number of maxillofacial fractures in 2020 was similar to 2019 (31 pcs in 2020 vs. 38 pcs in 2019). Before the lockdown, most of the trauma occurred in non-domestic settings (25% in 2020 vs. 76.67% in 2019), especially in road accidents (4.17% in 2020 vs. 20% in 2019). During the lockdown, most of the trauma occurred in a domestic setting (75% in 2020 vs. 23.33% in 2019), especially interpersonal violence (31.58% in 2020 vs. 14.28% in 2019). There were 7 cases of interpersonal violence recorded in 2020 (1 male and 6 female), compared to only one case (female) recorded in 2019, with a statistically significant p-Value (0.0475). Conclusions: The first COVID-19 lockdown has provided the opportunity to study the aetiology of domestic trauma due to interpersonal violence attributable to economic and social problems, all of which were aggravated by the impediment to requesting help due to the difficulty of contacting the services and the general slowdown in the ways out of violence. The analysis conducted and compared with data in the literature suggests the adoption of a proactive (and non-reactive) approach to combat domestic violence during pandemic events