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Research Interests: Dentistry, Temporomandibular Joint, Macrophages, Medicine, Oral and Maxillofacial Surgery, and 14 moreHead and Neck, Humans, Male, Follow-up studies, Differential Diagnosis, Cell nucleus, Adult, Lymphocytes, Cytoplasm, Temporomandibular Joint Disorders, fibroblasts, Joint Capsule, Synovial membrane, and Soft Tissue Neoplasms
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The invasive nature of glioblastoma is problematic in a radical surgery approach and can be responsible for tumor recurrence. In order to create new therapeutic strategies, it is imperative to have a better understanding of the mechanisms... more
The invasive nature of glioblastoma is problematic in a radical surgery approach and can be responsible for tumor recurrence. In order to create new therapeutic strategies, it is imperative to have a better understanding of the mechanisms behind tumor growth and invasion. The continuous cross-talk between glioma stem cells (GSCs) and the tumor microenvironment (TME) contributes to disease progression, which renders research in this field difficult and challenging. The main aim of the review was to assess the different possible mechanisms that could explain resistance to treatment promoted by TME and GSCs in glioblastoma, including the role of M2 macrophages, micro RNAs (miRNAs), and long non-coding RNAs (lncRNAs) from exosomes from the TME. A systematic review of the literature on the role of the TME in developing and promoting radioresistance and chemoresistance of GBM was performed according to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) ...
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ObjectiveTo investigate the accuracy of Chat‐Based Generative Pre‐trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery.Study DesignObservational and valuative study.SettingEighteen... more
ObjectiveTo investigate the accuracy of Chat‐Based Generative Pre‐trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery.Study DesignObservational and valuative study.SettingEighteen surgeons from 14 Italian head and neck surgery units.MethodsA total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1‐6), completeness (range 1‐3), and references' quality Likert scales.ResultsThe overall median score of open‐ended questions was 6 (interquartile range[IQR]: 5‐6) for accuracy and 3 (IQR: 2‐3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial inte...
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The ongoing COVID-19 pandemic required a firm and prompt effort in the development of an effective vaccine. Reports of adverse reactions are increasing. Lichen planus, as well as its oral variant, is a condition that has previously been... more
The ongoing COVID-19 pandemic required a firm and prompt effort in the development of an effective vaccine. Reports of adverse reactions are increasing. Lichen planus, as well as its oral variant, is a condition that has previously been reported to be associated with vaccines. This is one of the first reports of oral lichen planus (OLP) arising after any COVID-19 vaccine. Here the authors present 2 cases of OLP that occurred after BNT162b2 mRNA COVID-19 vaccination (Comirnaty, Pfizer, New York, NY, USA; BioNTech, Mainz, Germany).
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Purpose. 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’... more
Purpose. 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. Materials and methods. 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’. Results. 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. Conclusions. 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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Complex craniofacial surgery has been later to take advantage of computerized planning than traditional maxillofacial procedures. Virtual reality, 3D model navigation, and bioengineering analyses have changed our approach to the surgical... more
Complex craniofacial surgery has been later to take advantage of computerized planning than traditional maxillofacial procedures. Virtual reality, 3D model navigation, and bioengineering analyses have changed our approach to the surgical planning of craniofacial resection, increasing the benefits of surgery in terms of accuracy while decreasing complication rate. This study introduces a new workflow for 3D reconstruction, virtual model navigation, and alignment analyses, and demonstrates its successful application in a sample of four patients. A case of squamous cell carcinoma of the maxillary and ethmoid sinus in a 62-year-old patient is presented to evaluate the application of the workflow for a combined transfacial and transcranial resection. Results demonstrate that virtual surgical planning was successfully translated into navigational coordinates and reproduced in the operating room. While the literature provides a wide range of applications of virtual planning for traditional maxillofacial procedures, its introduction for complex craniofacial procedures remains difficult. The presented case shows that it is worth investigating the correlation between virtual reality planning and surgical accuracy for craniofacial resection, and related advantages in terms of surgical safety and improved prognosis.
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Jacob’s disease is a rare entity consisting of the formation of a pseudojoint between an abnormal coronoid process of the mandible and the inner surface of the zygomatic bone. First described by Jacob in 1899, its diagnosis and definition... more
Jacob’s disease is a rare entity consisting of the formation of a pseudojoint between an abnormal coronoid process of the mandible and the inner surface of the zygomatic bone. First described by Jacob in 1899, its diagnosis and definition have never been entirely univocal. In this paper, we present three emblematic cases and an extensive review of the literature on Jacob’s disease. Given the variability observed in the presentation of the disease, we have developed a proposal for the classification, here reported.
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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... more
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 usin...
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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... more
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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The maxillary sinus floor augmentation technique requires lifting of the sinus membrane with a series of curved elevators. Lifting of the sinus membrane can be difficult due to the presence of bleeding, requiring the alternate use of... more
The maxillary sinus floor augmentation technique requires lifting of the sinus membrane with a series of curved elevators. Lifting of the sinus membrane can be difficult due to the presence of bleeding, requiring the alternate use of curved elevators and the aspirator. This technical note presents a new surgical device, a suction dissector specifically designed for sinus membrane elevation. The suction dissector has a curvature similar to that of the curved dissector commonly used for lifting of the sinus membrane and contains an internal channel that allows the aspiration of liquid.
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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... more
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 ...
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IntroductionBroad 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... more
IntroductionBroad 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 methodsIn 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 th...
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Introduction: The Covid-19 global pandemic has suspended thousands of clinical education programs around the world. Also in Italy, as in the rest of the world, frontal teaching activities and internships in the medical field have been... more
Introduction: The Covid-19 global pandemic has suspended thousands of clinical education programs around the world. Also in Italy, as in the rest of the world, frontal teaching activities and internships in the medical field have been suspended. At the university hospital of Udine (North-Eastern Italy) it was decided to strengthen the use of simulation in all training stages to get over the block of training activities. Methods: A protocol has been drawn up with the aim of providing training in safety for every student of the degree courses in medicine and health area and for doctors in residency training. In this way it was possible to carry out training sessions with a maximum of 6 students engaged in the simulation activities offered by the Center (3D) virtual cadaver, laparoscopic pelvic trainer stations, ultrasound laboratory, microsurgery, etc.). The key points of the protocol were represented by i) internet booking of the training activity; ii) respect of safety measures (han...
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Objective/HypothesisThis 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... more
Objective/HypothesisThis 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.MethodsThis 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 v...
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The ongoing pandemic of Coronavirus disease 2019 (COVID-19) required a firm and prompt effort into the development of an effective vaccine. Reports of adverse reactions are increasing. Lichen planus, and its oral variant, is a condition... more
The ongoing pandemic of Coronavirus disease 2019 (COVID-19) required a firm and prompt effort into the development of an effective vaccine. Reports of adverse reactions are increasing. Lichen planus, and its oral variant, is a condition that has been previously reported associated with vaccines. This is one of the first report of oral lichenplanus(OLP) arising after any COVID-19 vaccine. Here we present two cases of OLP occurred after BNT162b2 mRNA COVID-19 vaccination (Comirnaty, Pfizer, New York, NY, USA; BioNTech, Mainz, Germany).
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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... more
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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Background: Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking... more
Background: Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking complications. Three-dimensional printing technology has enabled health care facilities to generate custom anatomical models to which implants can be molded to precisely match orbital anatomy. The authors present their early experience with these models and their use in optimizing orbital fracture fixation. Methods: Maxillofacial computed tomographic scans from patients with orbital floor or wall fractures were prospectively obtained and digitally reconstructed. Both injured-side and mirrored unaffected-side models were produced in-house by stereolithography printing technique. Models were used as templates for molding titanium reconstruction plates, and plates were implanted to reconstruct the patients’ orbital walls. Results: Nine patients (mean age, 15.5 years) were included. Enophthalmos was present in seven patients preoperatively and resolved in six patients with surgery. All patients had excellent conformation of the implant to the fracture site on postoperative computed tomographic scan. Postoperative fracture-side orbital volumes were significantly less than preoperative, and not significantly different from unfractured-side orbital volumes. Total model preparation time was approximately 10 hours. Materials cost was at most $21. Plate bending time was approximately 60 seconds. Conclusions: Patient-specific orbital models can speed the shaping of orbital reconstruction implants and potentially improve surgical correction of orbital fractures. Production of these models with consumer-grade technology confers the same advantages as commercial production at a fraction of the cost and time. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.