Giuliano Ascani

Objective: To evaluate the dento‐skeletal and upper airway effects of a fully intraoral fixed appliance activated with Class III intermaxillary elastics in growing patients with skeletal Class III malocclusion, compared with an untreated matched control group. Materials and Methods: This retrospective controlled study included 18 growing patients treated with an intraoral appliance anchored to molar bands in both arches activated with intermaxillary elastics. An untreated control group of 18 subjects matched for skeletal disharmony, sex, chronological age, and observation interval was selected from the Burlington Growth Study (AAOF) database. Lateral cephalograms were obtained before (T0) and at the end of treatment (T1) and analyzed using the Steiner and Kirjavainen analyses. ANB and Wits appraisal were defined as primary outcomes. Results: No statistically significant baseline differences were found between groups. The study group showed a statistically significant improvement of the sagittal intermaxillary relationship as measured by the Wits appraisal (Δ = +4.60 mm), whereas the between‐group difference in the ANB angle did not reach statistical significance (Δ = +0.59°). SNB remained essentially stable in the treated group (Δ = +0.01°) compared with a slight forward repositioning in controls (Δ = +0.78°). All vertical parameters showed no significant between‐group differences. A non‐significant trend toward upper incisor proclination was observed, while IMPA remained essentially stable (Δ = +1.58°). Airway changes were limited and topographically selective: significant increases were observed at the nasopharyngeal level and in soft palate length, with no significant changes at the velopharyngeal or oropharyngeal levels. Conclusions: The present study suggests that a fully intraoral fixed appliance activated with Class III intermaxillary elastics may represent a possible early treatment option in growing Class III patients. These preliminary findings should be confirmed by prospective controlled studies with larger samples, three‐dimensional airway assessment and long‐term follow‐up.

Pilomatricomas are benign tumors originating from hair follicle matrix cells and represent the most common skin tumors in pediatric patients. Pilomatricomas may be associated with genetic syndromes such as myotonic dystrophy, familial adenomatous polyposis (FAP), Turner syndrome, Rubinstein–Taybi syndrome, Kabuki syndrome, and Sotos syndrome. This study reviews the literature on pilomatricomas occurring in syndromic contexts and presents a novel case linked to Apert syndrome. A systematic review was conducted using PubMed and Cochrane databases, focusing on case reports, case series, and reviews describing pilomatricomas associated with syndromes. A total of 1272 articles were initially screened; after removing duplicates and excluding articles without syndromic diagnoses or lacking sufficient data, 81 full-text articles were reviewed. Overall, 96 cases of pilomatricomas associated with genetic syndromes were identified. Reports of patients with Apert syndrome who do not develop pilomatricomas are absent in the literature. Pilomatricomas predominantly affect pediatric patients, with a slight female predominance, and are often the first manifestation of underlying genetic syndromes. Our study highlights previously unreported associations of pilomatricoma with Apert syndrome, providing molecular insights. This study contributes to understanding the clinical and molecular features of pilomatricomas in syndromic contexts and underscores the importance of genetic analysis for accurate diagnosis and management.

Von Willebrand disease is a rare inherited bleeding disorder characterized by deficient or defective von Willebrand factor, crucial for platelet adhesion and aggregation. This case report aims to highlight the challenges of diagnosing undiagnosed von Willebrand disease in dental practice and to describe a multidisciplinary management approach to prevent life-threatening complications during oral surgery. A 32-year-old male with no significant medical history underwent surgical extraction of an impacted third molar. The patient experienced severe intraoperative bleeding unresponsive to standard local hemostatic measures. Subsequent hematological evaluation confirmed Type I von Willebrand disease. For the extraction of the remaining impacted molars, a tailored protocol was implemented, including preoperative administration of von Willebrand factor-containing factor VIII concentrates, tranexamic acid therapy, local hemostatic agents, and close perioperative monitoring in collaboration with hematology specialists. The initial procedure resulted in excessive bleeding, leading to the diagnosis of von Willebrand disease. Following the implementation of the multidisciplinary protocol, the patient underwent multiple extractions without immediate or delayed bleeding complications. Hemoglobin levels remained stable postoperatively, and the patient reported satisfactory pain control. Early identification and tailored management of bleeding disorders are critical in oral surgery to prevent severe hemorrhagic complications. A multidisciplinary approach involving dentists, oral surgeons, and hematologists ensures safe and effective care for patients with von Willebrand disease, emphasizing the importance of comprehensive preoperative assessments and structured treatment protocols.

Accuracy in the evaluation of death-induced tissue degradation for thanato-chronological purposes is strictly dependent on the condition of the biological source as well as on the precision of post-mortem interval (PMI) estimation. Thus, the optimization of tissue handling and identification of sensitive post-mortem biomarkers could help establish a timeline for post-mortem events. To this aim, we investigated the proteome changes in cortex samples of 6-week-old female SAMR1 mice over a post-mortem time course. After death, brain tissue was removed immediately (T0), and after 4, 8, 12, 24, and 32 h, four mice were used for each time period, and animals were maintained at 4 °C until brain removal. Dissected tissues were frozen at −80 °C until processed. Proteomic analysis, performed on samples related to early and late PMIs (24 h post-mortem, respectively) showed protein level changes as compared to T0 samples, with a remarkable increase in Calpain11 in the early PMI, as well as in Caspases 7 and 8 together with Gasdermin 3 in late PMI. These findings were confirmed by LIFT mass spectrometry technology and western blot analysis and, although requiring further investigation in other biological samples, suggest that these proteins could be considered as putative biomarkers of different PMIs.

Extracellular vesicles (EVs) are secreted from many tumors, including glioblastoma multiforme (GBM), the most common and lethal brain tumor in adults, which shows high resistance to current therapies and poor patient prognosis. Given the high relevance of the information provided by cancer cell secretome, we performed a proteomic analysis of microvesicles (MVs) and exosomes (EXOs) released from GBM-derived stem cells (GSCs). The latter, obtained from the brain of GBM patients, expressed P2X7 receptors (P2X7Rs), which positively correlate with GBM growth and invasiveness. P2X7R stimulation of GSCs caused significant changes in the EV content, mostly ex novo inducing or upregulating the expression of proteins related to cytoskeleton reorganization, cell motility/spreading, energy supply, protection against oxidative stress, chromatin remodeling, and transcriptional regulation. Most of the induced/upregulated proteins have already been identified as GBM diagnostic/prognostic factors, while others have only been reported in peripheral tumors. Our findings indicate that P2X7R stimulation enhances the transport and, therefore, possible intercellular exchange of GBM aggressiveness-increasing proteins by GSC-derived EVs. Thus, P2X7Rs could be considered a new druggable target of human GBM, although these data need to be confirmed in larger experimental sets.

Background: Facial gunshot wounds present a complex challenge to both medical professionals and victims with significant physical, psychological, and economic implications for those who suffer these types of injuries. Reconstructive surgery offers satisfactory aesthetic and functional outcomes, improving a patient’s quality of life. In these cases, the surgical procedure may encompass additional phases beyond those initially identified based on the type of wound and the extent of tissue destruction. As a result, each case necessitates thorough evaluation to determine an appropriate strategy. Nonetheless, it is worth noting that the outcomes achieved in terms of both aesthetics and functionality in this domain have the potential to be excellent. Case presentation: A 66-year-old man attempted suicide with a shotgun, causing severe facial injuries and fractures. He had a history of depression and was taken to the emergency department promptly. CT scans revealed brain and facial bone injuries, and he underwent surgery to control bleeding and tracheostomy. Postoperative recovery was successful. The patient’s condition stabilized, and he was discharged after 10 days. Follow-up visits showed gradual healing. Despite an offer for further facial reconstruction, he declined, satisfied with the achieved results. Conclusions: The present case report is intended to support the argument that effective facial reconstruction should be considered in the medico-legal assessment. It could be beneficial to introduce a new classification system and personalized evaluation methods with careful consideration given to treatment costs (which can be very high) and expected results. Since reconstructive surgery modifies damage and impacts the long-term costs of permanent impairments, its inclusion in the decision-making process would promote improved personalized care.

Purpose The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic. Methods This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed. Results The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration Conclusions The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic’s conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Purpose: the purpose of this study was to retrospectively analyze the clinical records of patients admitted for maxillo-facial fracture to 18 Italian center, evaluating the epidemiological differences between the different phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery deparments in Italy, from February 23, 2020 to February 23, 2022. According to the date of admission, all the data were stratified in four chronological periods encompassing the four different moments in terms of restriction in Italy: pre-pandemic, first wave, partial restrictions and post-pandemic groups. Differences in epidemiological data between the groups were analysed. Results: 2,938 patients were included. There was a statistically significant difference in the cause of hospitalization between pre-pandemic and first wave groups (p=0.005) and between pre-pandemic and partial restriction groups (p=0.002). The differences between the pre- and post-pandemic groups where instead not significant (p=0.106). Compared to the pre-pandemic period, the number of Black patients was significantly higher during the first wave and the post-pandemic period. Differences between the periods in terms of gender, age, type of fracture, treatment modality, and length of hospital stay were not found to be statistically significant. Conclusions: during the COVID-19 pandemic there have been profound changes in the epidemiology of fractures influenced by the restrictive measures implemented by the government. At the end of the pandemic, the epidemiology of fractures returned to being the same as in the pre-pandemic period.Purpose: the purpose of this study was to retrospectively analyze the clinical records of patients admitted for maxillo-facial fracture to 18 Italian center, evaluating the epidemiological differences between the different phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery deparments in Italy, from February 23, 2020 to February 23, 2022. According to the date of admission, all the data were stratified in four chronological periods encompassing the four different moments in terms of restriction in Italy: pre-pandemic, first wave, partial restrictions and post-pandemic groups. Differences in epidemiological data between the groups were analysed. Results: 2,938 patients were included. There was a statistically significant difference in the cause of hospitalization between pre-pandemic and first wave groups (p=0.005) and between pre-pandemic and partial restriction groups (p=0.002). The differences between the pre- and post-pandemic groups where instead not significant (p=0.106). Compared to the pre-pandemic period, the number of Black patients was significantly higher during the first wave and the post-pandemic period. Differences between the periods in terms of gender, age, type of fracture, treatment modality, and length of hospital stay were not found to be statistically significant. Conclusions: during the COVID-19 pandemic there have been profound changes in the epidemiology of fractures influenced by the restrictive measures implemented by the government. At the end of the pandemic, the epidemiology of fractures returned to being the same as in the pre-pandemic period.

Article: Giant mass obstructing oral cavity in a newborn - Minerva Pediatrics 2023 April;75(2):318-20 - Minerva Medica - Journals