Unit of Oral and Maxillofacial Surgery

Verona, Italy

Unit of Oral and Maxillofacial Surgery

Verona, Italy
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Bedogni A.,Unit of Oral and Maxillofacial Surgery | Saia G.,Unit of Maxillofacial Surgery | Bettini G.,Unit of Maxillofacial Surgery | Tronchet A.,Unit of Maxillofacial Surgery | And 10 more authors.
Oncologist | Year: 2012

Background. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented adverse event from treatment with nitrogen-containing bisphosphonates (NBPs). During a preliminary histomorphometric study aimed at assessing the rate of bone remodeling in the jaws of patients with surgically resected BRONJ, we found a defect of bone mineralization (unpublished data). We hypothesized that osteomalacia could be a risk factor for BRONJ in patients taking NBPs. Therefore, we looked for static and dynamic histomorphometric evidence of osteomalacia in biopsies from subjects with and without BRONJ. Methods. This case-control study used histomorphometric analysis of bone specimens of patients using NBPs (22 patients with BRONJ and 21 patients without BRONJ) who required oral surgical interventions for the treatment/ prevention of osteonecrosis. Patients were given tetracycline hydrochloride according to a standardized protocol before taking bone biopsies from their jaws. Biopsies with evidence of osteomyelitis or necrosis at histology were excluded from the study. Osteomalacia was defined as a mineralization lag time >100 days, a corrected mean osteoid thickness >12.5 mm, and an osteoid volume >10%. Results. In all, 77% of patients with BRONJ were osteomalacic compared with 5% of patients without BRONJ, according to histomorphometry. Because osteomalacia was found almost exclusively in NBP users with BRONJ, this is likely to be a generalized process in which the use of NBPs further deteriorates mechanisms of bone repair. Conclusions. Osteomalacia represents a new and previously unreported risk factor for disease development. This finding may contribute to a better understanding of the pathogenesis of this disease and help with the development of strategies to increase the safety of NBP administration. © AlphaMed Press.

Bettini G.,University of Padua | Blandamura S.,Institute of Pathology | Saia G.,University of Padua | Bedogni A.,Unit of Oral and Maxillofacial Surgery
BMJ Case Reports | Year: 2012

A female patient with non-small-cell lung cancer presented with a huge area of exposed bone in the mandible following spontaneous teeth loss. She was receiving multimodal chemotherapy containing bevacizumab. No previous treatment with bisphosphonates or comorbid conditions was reported. Pain medications and infection control were offered to the patient who was closely followed up. Initial imaging and histology of bone and surrounding mucosa (8 weeks after bevacizumab cessation) confirmed the clinical suspicion of avascular osteonecrosis of the mandible. Subsequent imaging and histology of bone and gingiva (12 weeks after bevacizumab cessation) revealed the initial sequestration of the mandible with a marked expansion of the mucosal vascular network. Spontaneous bone sequestration eventually occurred few months later, followed by stable and painless mucosal coverage of the mandibular bone. The patient remained disease-free up to 3 years of follow-up. Copyright 2012 BMJ Publishing Group. All rights reserved.

Bedogni A.,Unit of Oral and Maxillofacial Surgery | Anesi A.,University of Modena and Reggio Emilia | Fior A.,Unit of Oral and Maxillofacial Surgery | Bettini G.,University of Padua | Nocini P.,Unit of Oral and Maxillofacial Surgery
Journal of Reconstructive Microsurgery | Year: 2013

In this report, we describe the first successful case of microvascular free tissue transfer in a patient with Evans Syndrome (ES), a rare form of idiopathic thrombocytopenic purpura (ITP) and associated autoimmune hemolytic anemia (AIHA). Microvascular surgery in the setting of ES is likely to have higher complication rates because of the increased risk of postoperative bleeding and free flap thrombosis. The case presented here opens up to the feasibility of microvascular reconstruction of patients with coagulation disorders like ES. Every effort should be made to control for hemolytic, thrombocytopenic, and thrombophilic states associated with ES. In the absence of evidence-based treatment guidelines for ES, personalized treatment protocols with high-dose corticosteroids, immunoglobulin, and postoperative anticoagulation regimen are highly recommended. © 2013 by Thieme Medical Publishers, Inc.

Campisi G.,University of Palermo | Fedele S.,University College London | Fusco V.,Azienda Ospedaliera Of Alessandria City Hospital | Pizzo G.,University of Palermo | And 2 more authors.
Future Oncology | Year: 2014

Osteonecrosis of the jaws (ONJ) is an adverse side event of bisphosphonates and denosumab, antiresorptive agents that effectively reduce the incidence of skeletal-related events in patients with metastatic bone cancer and multiple myeloma. Available data suggest that 0-27.5% of individuals exposed to antiresorptive agents can develop ONJ. There is increasing evidence that avoidance of surgical trauma and infection to the jawbones can minimize the risk of ONJ, but there are still a significant number of individuals who develop ONJ in the absence of these risk factors. Bone necrosis is almost irreversible and there is no definitive cure for ONJ with the exclusion, in certain cases, of surgical resection. However, most ONJ individuals are affected by advanced incurable cancer and are often managed with minimally invasive nonsurgical interventions in order to control jawbone infections and painful symptoms. This article summarizes current knowledge of ONJ epidemiology, manifestations, risk-reduction and therapeutic strategies. Further research is needed in order to determine individual predisposition to ONJ and clarify the effectiveness of available treatments. © 2014 Future Medicine Ltd.

Brisco J.,Weston Park Hospital | Brisco J.,Royal Marsden Hospital NHS Foundation Trust | Fuller K.,Weston Park Hospital | Lee N.,Charles Clifford Dental Hospital | Andrew D.,Unit of Oral and Maxillofacial Surgery
British Journal of Oral and Maxillofacial Surgery | Year: 2014

We compared the image quality and radiation dose to the lens of the eye in patients with suspected orbital fractures who were imaged using cone beam computed tomography (CBCT) or conventional multislice computed tomography (CT). Although CBCT has a lower radiation dose than conventional CT, it is not known whether the image quality is comparable for diagnostic purposes. We identified fractures of the orbit (floor or roof, or both) in 6/10 patients who were scanned using CBCT and in 5/10 patients who were scanned using multislice CT (orbital floor and medial wall). Impingement of the rectus muscle on fracture lines was identified with both techniques, but retro-orbital haemorrhage was detected only on multislice CT. The mean radiation dose to the lens of the eye was 42% lower (range 23-53, SD 10) for CBCT than for multislice CT (p < 0.001), and the effective dose (a measure of the risk of developing a radiation-induced cancer) was also significantly lower. CBCT can therefore be used to diagnose orbital fractures, and is associated with a significantly lower radiation dose than multislice CT. © 2013 The British Association of Oral and Maxillofacial Surgeons.

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