Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred ...technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.
The aim of oral cancer surgery is tumor removal within clear margins of healthy tissue: the latter definition in the literature, however, may vary between 1 and 2 cm, and should be intended in the ...three dimensions, which further complicates its precise measurement. Moreover, the biological behavior of tongue and floor of mouth cancer can be unpredictable and often eludes the previously mentioned safe surgical margins concept due to the complexity of tongue anatomy, the intricated arrangements of its intrinsic and extrinsic muscle fibers, and the presence of rich neurovascular and lymphatic networks within it. These structures may act as specific pathways of loco-regional tumor spread, allowing the neoplasm to escape beyond its visible macroscopic boundaries. Based on this concept, in the past two decades, compartmental surgery (CS) for treatment of oral tongue and floor of mouth cancer was proposed as an alternative to more traditional transoral resections.
The authors performed three anatomical dissections on fresh-frozen cadaver heads that were injected with red and blue-stained silicon. All procedures were documented by photographs taken with a professional reflex digital camera.
One of these step-by-step cadaver dissections is herein reported, detailing the pivotal points of CS with the aim to share this procedure at benefit of the youngest surgeons.
We herein present the CS step-by-step technique to highlight its potential in improving loco-regional control by checking all possible routes of tumor spread. Correct identification of the anatomical space between tumor and nodes (T-N tract), spatial relationships of extrinsic tongue muscles, as well as neurovascular bundles of the floor of mouth, are depicted to improve knowledge of this complex anatomical area.
Reconstruction of oral cavity and oropharyngeal defects following radical surgery for squamous cell carcinoma (SCC) can be achieved by a variety of options. In selected cases myocutaneous platysma ...flap (MPF) may be a valid choice. However, several anatomical and oncological controversies on the use of this flap are debated. A retrospective study on 61 patients treated between January 2005 and December 2017 in two referral centres in which MPF was used for the reconstruction of defects following surgical resection of SCC of the oral cavity and oropharynx was conducted. The technique of flap harvesting with anatomic details is described. In all cases the submental artery was sacrificed preserving the facial artery. All clinical data were collected. Tumours involved the oral cavity in 95.1% of cases, and the oropharynx in 4.9%. Pathological staging (TNM 7
th
edition) of tumours was: pT1 (42.6%), pT2 (39.3%), pT3 (4.9%) and pT4a (13.1%). Success rate of the flap was 93.4%. Four (6.5%) patients developed a partial necrosis of the skin paddle without platysma muscle involvement; none required surgical revision. The mean follow-up was 69 months (5-153 months). Thirteen patients (21.3%) developed a local recurrence, and in 1 patient was associated with contralateral neck metastasis. The MPF can be a suitable option in head and neck reconstruction of small or medium-sized defects in selected cases. The vascular pedicle can be provided by branches of the facial artery achieving both oncological radicality and optimal flap vascular supply.
Introduction
In the last decade, compartmental surgery (CTS) has been the surgical approach of choice for advanced tumors of the tongue and oral floor.
Methods
Advanced tumors (cT3–T4) oral tongue ...squamous cell carcinoma (OTSCC) may extend beyond the lingual septum and involve the contralateral hemitongue, developing along the intrinsic transverse muscle. The disease may then involve the genioglossus muscle and, more laterally, the hyoglossus muscle.
Results
The surgical approach to the contralateral tongue must be guided by anatomic and anatomopathological principles to achieve a safe oncological resection based on the principles of CTS.
Conclusion
We propose a schematic classification of glossectomies that extend to the contralateral hemitongue based on the anatomy and pathways of tumor spread.
Objective
The aim of the study was to evaluate the impact of the COVID-19 pandemic on new diagnoses of head and neck cancer (HNC) in South Tyrol, northern Italy in terms of the number of new ...diagnoses and worsening disease stage due to diagnostic delay.
Methods
Patients were divided into two groups: the control group with a first diagnosis of HNC in 10 months before the national lockdown (March 9th, 2020) and the study group with a first diagnosis of HNC in 10 months after lockdown.
Results
A total of 124 patients were included in the study. Before the spread of COVID-19, 79 new diagnoses of HNCs were registered, while in the period after the lockdown, 45 new cancers cases were diagnosed and the difference was statistically significant (
p
= 0.01278). Early clinical T-stage results showed 52 cases in the control group and 21 in the study group, again with a significant difference (
p
= 0.03711). Advanced T-stage results showed 27 cases in the control group and 24 in the study group.
Conclusions
This study highlights the impact of the COVID-19 pandemic on HNCs, showing a statistically significant difference in the number of diagnoses before and after the lockdown which was related to the spread of the SARS-CoV-2 virus, and with a relevant decrease in early cT-staged HNCs.
The aim of this study was to assess fecal microbiota and metabolome in a population with symptomatic uncomplicated diverticular disease (SUDD).
Whether intestinal microbiota and metabolic profiling ...may be altered in patients with SUDD is unknown.
Stool samples from 44 consecutive women 15 patients with SUDD, 13 with asymptomatic diverticulosis (AD), and 16 healthy controls (HCs) were analyzed. Real-time polymerase chain reaction was used to quantify targeted microorganisms. High-resolution proton nuclear magnetic resonance spectroscopy associated with multivariate analysis with partial least-square discriminant analysis (PLS-DA) was applied on the metabolite data set.
The overall bacterial quantity did not differ among the 3 groups (P=0.449), with no difference in Bacteroides/Prevotella, Clostridium coccoides, Bifidobacterium, Lactobacillus, and Escherichia coli subgroups. The amount of Akkermansia muciniphila species was significantly different between HC, AD, and SUDD subjects (P=0.017). PLS-DA analysis of nuclear magnetic resonance -based metabolomics associated with microbiological data showed significant discrimination between HCs and AD patients (R=0.733; Q=0.383; P<0.05, LV=2). PLS analysis showed lower N-acetyl compound and isovalerate levels in AD, associated with higher levels of A. municiphila, as compared with the HC group. PLS-DA applied on AD and SUDD samples showed a good discrimination between these 2 groups (R=0.69; Q=0.35; LV=2). SUDD patients were characterized by low levels of valerate, butyrate, and choline and by high levels of N-acetyl derivatives and U1.
SUDD and AD do not show colonic bacterial overgrowth, but a significant difference in the levels of fecal A. muciniphila was observed. Moreover, increasing expression of some metabolites as expression of different AD and SUDD metabolic activity was found.
Introduction
The concealment of the body following a homicide undermines different moments of the forensic and medico-legal investigations. The aim of the present study is to provide an overview of ...the literature and the forensic casuistry of the Institute of Legal Medicine of Padova for analyzing and discussing diverse methodological approaches for the forensic pathologist dealing with covered-up homicides.
Material and methods
A literature review, updated until September 2019, was performed, and a literature pool of forensic cases was built. In-house cases were included by conducting a retrospective analysis of the forensic caseworks of Padova of the last 20 years. Data regarding epidemiology, methodology of assessment, methods of concealment, and answers to medico-legal issues were extracted for both data sets.
Results and discussion
Seventy-eight papers were included in the literature review (78.2% being case reports or case series, 17% retrospective studies, and 6% experimental studies or reviews). Literature and in-house data sets consisted of 145 and 13 cases, respectively. Death scene investigation, radiology, toxicology, and additional analyses were performed in 20–54% of literature and 62–77% of in-house cases. Cover-up by multiple methods prevailed. Death was caused by head trauma in about 40% of cases (both data sets), strangulation in 21% of literature, and 7% of in-house cases, and was undetermined in 17% of literature and 7% of in-house cases.
Conclusions
The methodology of ascertainment should be case-specific and based on a multidisciplinary and multimodal evaluation of all data, including those gained through novel radiological and/or analytical techniques.
Left lower-abdominal pain is considered the best symptom to differentiate between symptomatic uncomplicated diverticular disease (SUDD) and irritable bowel syndrome (IBS). However, this statement has ...not been validated yet.
The aim of this study was to assess whether prolonged left lower-quadrant pain is the best symptom characterizing SUDD and be able to differentiate SUDD from IBS-like symptoms in diverticulosis, and to compare the location of abdominal pain with fecal calprotectin (FC) expression.
Seventy-two patients suffering from abdominal pain and having diverticula at colonoscopy were enrolled. Patients were classified according to SUDD definition (abdominal pain for at least 24 consecutive hours in left lower abdomen) (42 patients) and IBS-like symptoms fulfilling Rome III criteria (30 patients). Abdominal pain was assessed using a 10-point visual scale, assigning numerical values from 0 (absence of pain) to 10 (severe pain). FC expression was assessed by a rapid test in all patients enrolled.
FC test was positive in 27 (64.3%) patients in the SUDD group and in no patient in the IBS-like group (P<0.0001). In patients with SUDD, there was a significant correlation between the severity of the abdominal pain and the FC score (P=0.0015). Extension of diverticulosis correlated with FC score (P=0.022) and the severity of diverticulosis (P=0.005).
Severe and prolonged left lower-abdominal pain seems to be the best symptom characterizing SUDD, and it can differentiate these patients from those harboring diverticula but suffering from IBS-like according to Rome III criteria.
Anthropometric measurements play a crucial role in medico-legal practices. Actually, several scanning technologies are employed in post-mortem investigations for forensic anthropological ...measurements. This study aims to evaluate the precision, inter-rater reliability, and accuracy of a handheld scanner in measuring various body parts.
Three independent raters measured seven longitudinal distances using an iPad Pro equipped with a LiDAR sensor and specific software. These measurements were statistically compared to manual measurements conducted by an operator using a laser level and a meterstick (considered the gold standard).
The Friedman test revealed minimal intra-rater variability in digital measurements. Inter-rater variability analysis yielded an ICC = 1, signifying high agreement among the three independent raters. Additionally, the accuracy of digital measurements displayed errors below 1.5%.
Preliminary findings demonstrate that the pairing of LiDAR technology with the Polycam app (ver. 3.2.11) and subsequent digital measurements with the MeshLab software (ver. 2022.02) exhibits high precision, inter-rater agreement, and accuracy. Handheld scanners show potential in forensic anthropology due to their simplicity, affordability, and portability. However, further validation studies under real-world conditions are essential to establish the reliability and effectiveness of handheld scanners in medico-legal settings.
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