Achille Tarsitano

Accuracy of fibular sectioning and insertion into a rapid-prototyped bone plate, for mandibular reconstruction using CAD-CAM technology.

Modern techniques of mandibular reconstruction, such as CAD-CAM technology and rapid prototyping, offer new means by which reconstructive surgery can be planned to optimise aesthetic outcomes and prosthetic rehabilitation. The high degree of accuracy afforded by these approaches is principally attributable to high-precision fibular sectioning and insertion of the bone into a customised bone plate. CAD-CAM mandibular reconstruction procedures using vascularised bone free-flap transfers were performed on 10 patients with benign or malignant neoplasms. Five were not treated with the aid of CAD-CAM technology, and served as the control group. Five were scheduled for maxillofacial surgery using surgical cutting guides and customised bone plates. A generalised linear model for linear measures was used to compare the accuracy of reconstruction between the two groups. A difference, even though not significant, in the lateral shift of the mesial and distal positions of the fibular units was evident between groups. CAD-CAM-generated fibular surgical guides afford improved accuracy when used to restore native anatomy, especially in the context of mandibular arch restoration, and both operating room time and related costs are reduced during fibular sectioning.

Health-related quality of life as a survival predictor for patients with oral cancer: is quality of life associated with long-term overall survival?

OBJECTIVE The aim of the present prospective study was to obtain further insight into health-related quality of life (HR-QoL) as a predictor of survival in a selected cohort of patients with oral cancer. STUDY DESIGN A total of 124 patients were treated with surgery or combined therapy. All of the recruited patients completed the European Organization for Research and Treatment of Cancer questionnaires QLQC30 and H&N35 on 4 occasions. Overall survival was assessed. Univariate and multivariate Cox proportional hazards regression models were conducted. RESULTS High baseline HR-QoL score and high pain symptom score were significantly associated with a better survival (HR 0.86 and 0.92 respectively). Swallowing (HR 0.94), and speech (HR 0.92) high baseline scores were also significantly associated with a better survival in the adjusted analyses. CONCLUSIONS Patients who reported a better HR-QoL at tumor diagnosis had a better survival than patients with a lower HR-QoL baseline score.

Mandibular reconstructions using computer-aided design/computer-aided manufacturing: A systematic review of a defect-based reconstructive algorithm

Modern planning techniques, including computer-aided design/computer-aided manufacturing (CAD-CAM) can be used to plan reconstructive surgery, optimising aesthetic outcomes and functional rehabilitation. However, although many such applications are available, no systematic protocol yet describes the entire reconstructive procedure, which must include virtual planning, custom manufacture, and a reconstructive algorithm. We reviewed current practices in this novel field, analysed case series described in the literature, and developed a new, defect-based reconstructive algorithm. We also evaluated methods of mandibular reconstruction featuring virtual planning, the use of surgical guides, and laser printing of custom titanium bony plates to support composite free flaps, and evaluated their utility.

Impact of perineural invasion as independent prognostic factor for local and regional failure in oral squamous cell carcinoma

OBJECTIVE Perineural invasion (PNI) is frequent in oral squamous cell carcinoma (OSCC) and could play an important role in treatment decisions. STUDY DESIGN This retrospective study used multivariate analysis to evaluate the impact of PNI on locoregional recurrence, neck metastases, and survival in 236 consecutive patients with oral cancer. RESULTS There were significant differences in the local (P = .007) and regional (P = .041) failure rates in the PNI-positive group compared with the PNI-negative group. Univariate analysis demonstrated that PNI-positive patients had significantly worse locoregional control (P = .011), disease-specific survival (P = .023), and overall survival (P = .046) compared with PNI-negative patients. CONCLUSION PNI was an independent predictor of local and regional failure in a well-defined, homogeneous population with OSCC.

DNA methylation analysis by bisulfite next-generation sequencing for early detection of oral squamous cell carcinoma and high-grade squamous intraepithelial lesion from oral brushing.

PURPOSE Oral squamous cell carcinoma (OSCC) is commonly preceded by oral potentially malignant lesions (OPML). The aim of the present study was to assess, by bisulfite next-generation sequencing (NGS), the methylation status of a list of candidate genes obtained from oral brushings to early detect OPML and OSCC. MATERIAL AND METHODS Oral brushing specimens from 11 OSCC, 11 high-grade squamous intraepithelial lesions (HG-SIL), 9 low-grade SIL (LG-SIL), 9 oral lichen planus (OLP), and 8 healthy donors were included in this study. We investigated, by means of bisulfite NGS, the promoter of GP1BB, ZAP70, KIF1A, p16[CDKN2A], CDH1, miR137, and miR375. Statistical significance between lesions and a pool of healthy donors were evaluated with the Mann-Whitney U test. RESULTS ZAP70 was found to be hypermethylated in 100% of OSCC and HG-SIL and in 28.6% of LG-SIL. GP1BB hypomethylation was detected in 90.9% OSCC and HG-SIL and in 37.5% of LG-SIL. MiR137 was hypermethylated in 100% of OLP, 44.4% of OSCC, 40% HG-SIL, and 25% LG-SIL. KIF1A hypermethylation was found to be associated with TP53 mutations (p < 0.0001). CONCLUSION In the present preliminary cohort of patients, DNA methylation analysis of GP1BB and ZAP70 seems to be a promising noninvasive tool for early detection of OSCC and HG SIL from oral brushing specimens.

Clonality analysis in primary oral squamous cell carcinoma and related lymph-node metastasis revealed by TP53 and mitochondrial DNA next generation sequencing analysis.

The chance of developing a neck nodal metastasis after initial treatment of oral squamous cell carcinoma varies from 12.4% to 62%. Despite being the main reason for cancer-related mortality, nodal metastases are still rarely subjected to molecular analyses, and our knowledge of the clonal heterogeneity of multiple lesions within the same patient is limited. The aim of the present study was to evaluate the relationship between primary oral cancer and lymph node metastasis in a series of patients with synchronous and metachronous metastases by 2 clonality tests: mt-DNA and TP53 sequence analysis. The study population consisted of 10 consecutive patients. Data identified in this study demonstrate that our assay based on next-generation analysis of TP53 and mt-DNA is simple, is reliable, allows high throughput, and may be applied to retrospective cases. The combination of mt-DNA and TP53 data analysis helped us to evaluate more precisely and consistently the genetic relationship among different tumor clones.

Computer-Aided Rehabilitation of Maxillary Oncological Defects Using Zygomatic Implants: A Defect-Based Classification

PURPOSE A complete maxillectomy for neoplastic lesions leads to serious oral dysfunction. Zygomatic implants for fixed bridge support are considered beneficial for maxillary defects after tumor resection. MATERIALS AND METHODS This clinical study examined the management of patients with different maxillary defect types who underwent delayed rehabilitation using zygomatic implants and immediate prosthetic loading. Virtual preoperative planning and intraoperative navigation were performed in all cases. RESULTS Five patients were treated with this new method. The total number of zygomatic implants positioned was 17. Four patients had immediate loading of a fixed prosthesis and 1 had delayed loading. One patient had 1 failed implant. CONCLUSION The use of preoperative virtual surgical planning and an intraoperative navigation system allows the surgeon to achieve safer implant positioning in a complex anatomic site. A systematic bone defect classification was created and a specific treatment protocol is proposed for each type of defect.

The diagnostic and surgical management of a multifocal calcifiyng epithelial odontogenic tumor in the mandible and maxilla associated with a squamous odontogenic tumor: first reported case in the literature

The calcifiyng epithelial odontogenic tumor (CEOT) and the squamous odontogenic tumor (SOT) are rare and benign odontogenic tumors that affect the jaw. This article describes the diagnostic and surgical management of a multifocal CEOT in the mandible and maxilla associated with an SOT. This case is the first to demonstrate that there may be a multifocal variant of CEOT associated with an SOT that has not been previously recognized. Clinical, radiographic, and histologic signs are reported. Treatment modality, oral rehabilitation, and long-term follow-up are shown. Because of the rarity of this kind of simultaneous pathologic association, it is of paramount, and indeed obvious, importance to prospective reviewers that published reports are produced meticulously, including all clinically, radiographically, and histologically relevant data.

Laser evaporation versus laser excision of oral leukoplakia: A retrospective study with long-term follow-up

OBJECTIVES The study makes a comparison between two surgical approaches for the treatment of oral leukoplakia (OL) in terms of recurrence in a well-defined cohort of patients with a long-term follow-up period. METHODS The cohort consisted of 77 OL patients divided into 2 groups. Group 1: 47 patients treated with laser evaporation using a Nd:YAG laser. Group 2: 30 patients treated with a CO2 laser for excision. Clinical and histological examinations were performed for the diagnosis of OL before treatment. We included OLs with or without dysplasia. The mean follow-up period was 60 ± 32.49 months. RESULTS Of the 77 patients, 22 (28.5%) showed recurrence during the follow-up period. No significant difference was found between the two treatments (χ(2) = 2.6; p = 0.2). However, CO2 laser excision resulted in better results than the Nd:YAG laser evaporation, considering the non-homogeneous OLs (χ(2) = 3.9; p = 0.04) and OLs with mild dysplasia (χ(2) = 4.6; p = 0.03). DISCUSSION The study makes a comparison between our results and articles from the literature, and suggests when each of the two surgical approaches is most appropriate.

Intraoperative biopsy of the major cranial nerves in the surgical strategy for adenoid cystic carcinoma close to the skull base

OBJECTIVE Adenoid cystic carcinoma of the salivary glands has a propensity for perineural invasion, which could favor spread along the major cranial nerves, sometimes to the skull base and through the foramina to the brain parenchyma. This study evaluated the relationship between neural spread and relapse in the skull base. STUDY DESIGN During surgery, we performed multiple biopsies with extemporaneous examination of the major nerves close to the tumor to guide the surgical resection. RESULTS The percentage of actuarial local control at 5 years for patients with a positive named nerve and skull base infiltration was 12.5%, compared with 90.0% in patients who were named nerve-negative and without infiltration of the skull base (P = .001). CONCLUSIONS Our study shows that local control of disease for patients who are named nerve-positive with skull base infiltration is significantly more complex compared with patients who are named nerve-negative without infiltration of the skull base.