breast reduction

Transcription

breast reduction

EUROPEAN JOURNAL OF INFLAMMATION
Vol. 10, no. 1 (S3), 1-4 (2012)
BREAST REDUCTION:
A RETROSPECTIVE ANALYSIS ON 139 PATIENTS
C. RIBERTI1, I. PEZZINI1, P. CARCOFORO2, F. CARINCI3, I. ZOLLINO3,
V. CANDOTTO3, V. PINTO4, G.P. MORSELLI4
Department of Plastic Surgery, University of Ferrara, Ferrara, Italy
Department of General Surgery, University of Ferrara, Ferrara, Italy
3
Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy
4
University of Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy
1
2
Gigantomastia represents a disabling condition characterized by excessive breast growth. Breast reduction
can be performed with some techniques such as inferior pedicle reduction and superior pedicle reduction. Aim of
this retrospective study is to assess the clinical outcome of a series of 139 patients underwent to breast reduction
and discuss the pertinent literature. One hundred and thirty nine patients underwent to breast reduction during
the period between September 2005 and December 2010. Treatments were grouped into three classes: 1 - inferior
pedicle breast reduction, 2 - superior pedicle breast reduction and 3 - scars corrections. Eight out of 139 cases
had failures such as keloids and poor aesthetics results. Chi square text was used to detect those variables (i.e.
surgeon, type of surgery) potentially associated with failures. None of studied variables correlated with failures.
Breast reduction is a worldwide use to correct gigantomastia and several surgical techniques are available. Proper
diagnosis is of paramount importance to avoid potential complications such as hematomas or sieromas. In addition
the patient’ psychological habitus has to be evaluated at admission. Since very few cases failed in our series, breast
reductions are considered reliable surgical techniques to cure gigantomastia.
determinate the shape of the new breast depends on the
In breast hypertrophy (also named macromastia or
type of pedicle that is going to be used. At present time to
gigantomastia) volume and weight of breast cone are
elevate the nipple-areola complex four
appear
increased. JOURNAL
Evaluation
of breast composition at admission
EUROPEAN
OF INFLAMMATION
Vol. techniques
10, no. 1 (S3), 5-9
(2012)
to be used more often: 1- the superiorly based dermal
is of paramount importance since the surgeon has to know
pedicle, 2- the vertical bipedicle dermal flap, 3- the free
the correct amount of tissue to resect to avoid alteration
nipple
graft, 4- the inferior pyramidal dermal flap. Monoof shape (1).
ABDOMINOPLASTY
SURGERY:
Breast surgery aims not only
to
reduce
the
dimension
pedicle
techniques
consider the classic circumferential
A RETROSPECTIVE ANALYSIS ON
186 PATIENTS
but also to redistribute volume among the four quadrants
gland excision that can be adjusted to leave an inferior,
superior,
lateral or medial
pedicle (Fig.
1) (4). Bi-pedicle
and the repositioning of nipple-areola
complex
(2). The
1
1
2
3
3
C. surgical
RIBERTI
, I. PEZZINI
P. CARCOFORO
, F. CARINCI
, I. ZOLLINO
,
techniques
include
another
type
of
glandular
excision,
basic principles of
reduction
are to, decrease
3
4
4
, V. PINTO
, G.P.
such
as MORSELLI
the base, wedge or combined resection, to
breast volume while maintainingV.
a CANDOTTO
physiologic function
create pedicles with two vascular bases: for instance, the
and a normal sensibility (3). Many techniques have
1
Department
Plastic
Surgery,
of Ferrara,
horizontal
bi-pedicleFerrara,
techniqueItaly
employs a combination of
been described but all
follow few of
main
concepts:
1 - University
2
Department
of General
of Ferrara,
Ferrara,
Italythe combined pedicle
joined lateral
and medial
pedicle,
modeling and repositioning
the parenchyma;
2 - Surgery,
skin and University
3
appliesUniversity
two separate
for theItaly
nipple
parenchyma
are of
independent
variables
thus they can and procedure
Department
D.M.C.C.C.,
Sectionand
of Maxillofacial
Plastic Surgery,
of pedicles,
Ferrara,one
Ferrara,
areola
and
the
other
to
improve
the
shape
and
projection
be4University
managed separately;
3
skin
excess
is
secondary
to
of Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy
cone hypertrophy and can be corrected by redraping over
of the breast (5). Goal of mono or bi-pedicle surgery is
the molded structure. Parenchyma modification which will
to provide sufficient blood supply to the nipple areola
Massive weight loss for high percentage of patients means cutaneous skin folds that cause important functional
words: body
Breast,contouring
gigantomastia,
reduction,
surgery
and hygienic problems. In these Key
patients
with
removal
of the excessive skin fold becomes
necessary to improve their new quality of life. One hundred and eighty six patients during the period between
September
Corresponding 2005
author:and December 2010 underwent to abdominoplasty surgery at the Plastic Surgery Unit, S. Anna
Hospital,
Ferrara.
Surgery performed was lipectomy for 99 patients, fascial plastic in 75 cases, scars review for 5
Prof. Francesco
Carinci, M.D
Departmentand
of D.M.C.C.C.
patients
lipectomy with fascial plastic in 7 cases. There had been 3 cases of bleeding and 18 cases of keloids.
Section of Maxillofacial and Plastic Surgery
0393-974X
(2012)
Chi
square text was used to detect the variables (i.e. surgeon, type of surgery and diagnosis) potentially
associated
University of Ferrara
Copyright © by BIOLIFE, s.a.s.
with
failures.
However,
despite
of
possible
methodological
difficulties
and
the
limited
complications
in
our
series,
This publication and/or article is for individual use only and may not be further
Corso Giovecca 203 44100 Ferrara Italy
reproducedand
without
written
from the copyright
holder.
abdominoplasty
can www.carinci.org
be considered essential option for post-bariatric patients
for
all permission
those patients
that have
E-mail: [email protected] Web:
1 (S3)
Unauthorized reproduction may result in financial and other penalties
Phone:
+39.0532.455874
+39.0532.455582
loss
massive
weight,Fax:
because
it can improve lifestyle and even psychological status.
Alteration in volume and in shape dimension of
soft tissues of pubic area can bring psychological
discomfort and embarrassment to patients. In some cases
the deformity can be even seen under the clothing (1).
However, cutaneous deformities enlarged by massive
weight lose are constant remainders to the patients of
physical and psychological difficulties (2).
Abdominoplasty is the most recommended treatment
for abdominal skin laxity. It is a form of cosmetic surgery
used to make abdomen tighter, and it is defined as surgical
and suturing in at the midline with an on lay polypropilene
prosthetic mesh apposed over the muscle and sutured to
the fascia overlapping the fascial defect (4).
Several abdominoplasty methods have been described
in literature: 1- limited abdominoplasty of lower abdomen,
2- skin resection in the upper and lower abdomen in which
blood supply is ensured by peri-umbilical perforants,
3- perforator-sparing abdominoplasty with selective
dissection of peri-umbilical perforants to ensure flap
blood supply, 4- Fleur-de-Lys abdominoplasty for patients
Vol. 10, no. 1 (S3), 11-15 (2012)
EVALUATION OF PULSED LIGHT FOR HAIR REMOVAL: CLINICAL STUDY IN MICE
A. SCARANO1, B. PALMIERI2, A. DI CRISTINZI1,
F. CARINCI3, A. LUCCHESE4
Department of Oral Science, Nano and Biotechnology, University of Chieti-Pescara, Italy
2
Medical School, University of Reggio-Emila
3
4
Department of D.M.C.C.C., School of Dental Hygiene, University of Ferrara, Ferrara Italy
1
The presence of excessive perioral hair in women is associated with psychological and emotional distress, and
causes significant impairment of their quality of life. The aim of the present study is to show the efficacy of intense
pulsed light (IPL) device in a mouse model. Thirty female, 6-8 weeks-old black-haired mice were selected. Mices
were divided into five groups, each of six subjects, and were anaesthetized; the first five groups were only shaved
with electric razor and waxing, while the other groups, after shaving of back, they were treated with the light of
an intense pulsed light source device (590-1200 nm, spot size 20x50 mm-pulse duration 5-105 msec) (MED-LITE
device, Dermal Medical, Bologna-Italy). All mices (Test group) received 12 sessions of treatment at 1 week interval.
Hair counts and photographic evaluation of skin sites were made at baseline and at the last follow-up after the
following time intervals: 4, 8, 12 weeks. All mices were evaluated after the following time intervals: 4, 8, 12 weeks.
A statistically significant difference was present between hair reduction after treatment in control group vs. test
(control vs. test) p-value = 0.08 after 4-8 and 12 weeks. We suggest that both intense pulsed light sources could
reduce the hair even.
by inadequate light penetration into the skin. Multiple
Pulsed Light hair removal is a well standardized
treatments are also required in order
match
improving
Vol.to
10,effectively
no. 1 (S3), 17-21
(2012)
with the vulnerable hair growth cycle (7). The aim of this
their life quality (1). The exceeding facial hair overgrowth
study is to show the efficacy of intense pulsed light (IPL)
especially around the lips and chin in otherwise healthy
device in PALPEBRARUM
a mouse model.
women is associated with TREATMENT
psychological andOF
emotional
XANTHELASMA
distress (2), and causes significant
loss
of
self-image
WITH VOLTAIC ARC DERMOABRASION
MATERIALS AND METHODS
satisfaction (3). Polycystic ovary syndrome (PCOS) is
estimated to affect between 4% and 6% of1 the female
2
, B.animal
BRANDIMARTE2,
A. SCARANO , G.L. BERTUZZI
Subject
population, whose up to 80% develop hirsutism, being3
4
F. CARINCI
The black-haired mice used in this study were obtained
one of the most common background to seek
permanent , A. LUCCHESE
from the laboratory of University of Chieti-Pescara, Italy. Thirty
removal of the facial hair (4). The principle behind long1
female, 6-8
weeks-old black-haired
mice wereItaly
selected.
Department
of
Oral
Science,
Nano
and
Biotechnology,
University
of Chieti-Pescara,
term epilation with high intensity pulsed light (IPL) is
2
School, University
of Tor Vergata, Rome
based on the concept of selectiveMedical
photothermolysis
(5).
Test procedure
3
According
to thisofprinciple,
radiant
energyofemitted
by IPL and Plastic
Department
D.M.C.C.C.,
Section
Maxillofacial
University
of Ferrara,
The Surgery,
hair on the
back of the
mice was Ferrara,
carefully Italy
shaved
4
is preferentially
absorbed
an energy-absorbing
Department
of by
D.M.C.C.C.,
School of target
Dental Hygiene,
Ferrara,
Ferrara
using an University
electric razorof(Fig.
1) before
waxingItaly
or exposing to
structure, the hair chromophore. Several clinical studies
the light sources. Mices were divided into five groups, each
on the efficacy of photo-assisted hair destruction have
of six subjects, and were anaesthetized; the first five groups
Xanthelasma
palpebrarum
is atreatment
benign condition
never with
limitselectric
functioning;
appearance
is often
were shaved
razor anditswaxing,
while the
other
reported
that re-growth
of hair after
is commonand almost
seen
as
cosmetically
disturbing.
Surgical
excision
has
been
the
treatment
of
choice
for
decades.
However,
this
groups,
after
shaving
of
back,
they
were
treated
with
the
light
(6). Due to incomplete destruction of progenitor hair cells,
normally effective measure bears a considerable risk of side effects, especially an ectropion, which could lead to
additional procedures, e.g., full thickness skin graft. 13 patients with bilateral 26 xanthelasma with an voltaic
words: photothermolysis, peri-oral hair, pulsed light, hair removal
arc dermoabrasion device Key
(EL-Abras,
TECNOSER s.r.l., Roma, Italy). Photographs were taken before and after
treatment
and
were
then
evaluated
by
an
independent observer. The evaluation of the results was made 2 months
Corresponding author: Prof. Francesco Carinci, M.D
after thisofsingle
treatment. The final evaluation assessed the presence or absence of hypochromic or achromic
Department
D.M.C.C.C.
Section
Maxillofacial
Plastic
Surgery
scars. ofThe
patientsand
were
given
a single sessions to remove the lesions. Two months after treatment,
the result
0393-974X
(2012)
University
of Ferrara
was scored
as 4 (i.e. with a clearing of lesions evaluated as being > 75% and in fact assessedCopyright
by the©independent
by BIOLIFE, s.a.s.
publication and/or article is for individual use only and may not be further
observer as complete resolution) in six patients for a total of 12Thislesions;
scored as 3 in four patients for a total of
reproduced without written permission from the copyright holder.
E-mail: [email protected] Web: www.carinci.org
11 (S3)
8 lesions,
and as 2 in
three
patients for a total of 6 lesions.
No patientUnauthorized
presented
a result
scored
as 0, 1andorother
2. penalties
Eight
reproduction
may
result in financial
Phone:
+39.0532.455874
Fax:
+39.0532.455582
lesions showed slight erythema in the treated areas and this persisted for 1 month. The visible and unsightly
nature of xanthelasma has led to the proposal of numerous treatments. Reconstruction by a flap or full-thickness
skin graft may be necessary in the presence of excessively large lesions or lesions involving the medial canthus.
The possibilities of surgical resection appear to be more limited in the lower eyelid, as the more limited skin laxity
rapidly induces a risk of ectropion. On the basis of our results, we would like to recommend xanthelasma treatment
with the voltaic arc dermoabrasion as an excellent therapeutic alternative to the hitherto described approaches.
treatment JOURNAL
of hirsutism
in adults significantly
EUROPEAN
OF INFLAMMATION
Xanthelasma palpebrarum is the most common form
of xanthoma. The lesions appear as yellowish, flat, and
soft and are located mostly at the medial angle of the
eyelid (1). It is usually bilateral and is characterized by the
seen as cosmetically disturbing. Surgical excision has
been the treatment of choice for decades. However, this
normally effective measure bears a considerable risk of
side effects, especially an ectropion, which could lead
Vol. 10, no. 1 (S3), 23-25 (2012)
LOP EARS:
A RETROSPECTIVE STUDY
A. FRANCHELLA1, S. PELLEGRINELLI1, F. CARINCI2,
I. ZOLLINO2, G. CARNEVALI2, V. CANDOTTO2,
S. FRANCHELLA2, V. PINTO3, G.P MORSELLI3
Department of Pediatric Surgery, University of Ferrara, Ferrara, Italy
3
1
2
Congenital “lop ears” are a deformity include varying degrees of turning down (lidding) of the helix, reduction
in the fossa triangularis, scapha compression, reduction of the superior crus of the antihelix and an associated
reduction in vertical height of the external ear. Aim of this retrospective study is to assess the clinical outcome
in a series of patients affected lop ears and discuss the pertinent literature. In the period between January 2003
and December 2009, 32 patients underwent to lop ears correction at the Pediatric Surgery Unit, S Anna Hospital,
Ferrara, Italy. Patients included 4 (33.3%) females and 8 (66.6%) males. Age ranged from 5.6 to 18 years with a
mean value of 11 at the time of admission. Lop ears were treated with Mustarde’ surgical technique under general
anesthesia. No complications were detected in the follow-up period. The goal standard of surgery treatment for
prominent ears is to obtain symmetrical and natural ears with not sign of being operated. More than 200 surgical
techniques have been described for its correction indicating the lack of an ideal technique. These techniques can be
classified into two categories: with conservation of cartilage and with cartilage section. Section methods attend to
eliminate the inherent memory of the cartilage so that the shape of the ear can be modified. These techniques may
leave significant asymmetries. In contrast, methods which shape the cartilage are based on the Mustardé technique,
which consists of placing 3 or 4 horizontal mattress sutures with permanent suture material along the ridge of the
helix, to create an antihelix fold. Our clinical results are similar to those reported in the English literature.
Vol. 10, no. 1 (S3), 27-29 (2012)
frequently seen: one, in which the antihelix is quite well
Significant ear malformations are prevalent in today’s
formed but there is marked increase in size and convexity
society and they affect more than 5% of population (1).
of the cavum concha, these are the so called “cat ear”,
The anomalies derive from a combination of defects
MUCOCELE IN PEDIATRIC
PATIENTS:
second, these in which the cavum concha is normal about
attending the antihelix and the concha. They can include
CASE SERIES ANALYSIS
the size but there is an incomplete development of the
underdevelopment or absent antihelix conchal, hyperplasia
antihelix, especially of the crura (2).
or excessively deep chonca, increased concho-scaphal angle
1
1
2
A. increased
FRANCHELLA
, S. PELLEGRINELLI
CARINCI
, the psychological effect
(more than 90 degrees), and
cephaloauricular
During the, F.
past
twenty years,
2
2
2
I.
ZOLLINO
,
G.
CARNEVALI
,
V.
CANDOTTO
,
distances (as superior, medial, inferior) (1, 2).
of deformities of the ear has received ever increasing
2
3
3
, V. PINTO
, G.P MORSELLI
FRANCHELLA
consideration,
with corresponding
improvement in
The formation of the externalS.ear
begins about during
the sixth week of intrauterine life, from the first or the
surgical procedures used to correct these abnormalities
1
second brachial arches
and it becomes
definitive
from University
(2). The of
most
important
effect Italy
of this disease on a child
Department
of Pediatric
Surgery,
Ferrara,
Ferrara,
2
the
third month.
this aspect,
the deformity
usually and Plastic
is psychological
may be of
expressed
in feelings
Department
ofAbout
D.M.C.C.C.,
Section
of Maxillofacial
Surgery, and
University
Ferrara,either
Ferrara,
Italy
is 3considered
congenital,
even
if
which
is
the
biological
of
inferiority
which
may
cause
the
child
to
avoid
personal
contact, or perhaps to develop a super abundance of self
factor is still unknown (2).
Two types of abnormalities predominant ear are most
expression in an effort to compensate an injured ego.
The mucocele, a mucus accumulation from the salivary gland, represents a common lesion of the oral cavity.
From 44 % to 79 % of mucoceles occur
on the
lip. malformation,
There is no gender
predilection
and it can arise at any age.
Key words:
Ear,lower
anomaly,
cartilage,
flap
Mucoceles do not cause direct obstruction of salivary flow, and the amount of secretion that can be extravasated is
limited by the
elasticity
of the surround
Corresponding
author:
Prof. Francesco
Carinci, M.Dtissues. In the period between January 2001 December 2010, 21 patients
Department
of to
D.M.C.C.C.
underwent
ulcer treatments at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 9
Section Maxillofacial and Plastic Surgery,
0393-974X
(2012)
females and 12 males. Age ranged from 5 months to 13 years with a mean value of 7 years. All were
located in
the
lower
lip.
Mucocele
were
treated
with
surgical
excision,
13
under
general
anesthesia
and
the
remaining
under
local
anesthesia.
Several
have been proposed: initial cryosurgical approach,
CO2
laser,
marsupialization
and
reproduced without
written
permission
from the copyright holder.
E-mail:
[email protected]
Web:techniques
www.carinci.org
23 (S3)
Phone:
+39.0532.455874
complete
resection: Fax:
this+39.0532.455876
last is in most cases the best option.
The mucocele, a mucus accumulation from the
salivary gland, represents a common lesion of the oral
cavity. There are two mechanisms for the development of
these lesions: mucus extravasation and mucus retention
(1, 2).
According to several studies, the lower lip is the region
most affected by mucoceles (2-4). However, rare cases of
mucoceles involving the upper lip, palate, retromolar
region, buccal mucosa, lingual frenum, and dorsal tongue
have been reported (4-6). In particular, “ranula” designates
mucoceles located on the floor of the mouth (7). Ranulas
of salivary flow, and the amount of secretion that can be
extravasated is limited by the elasticity of the surround
tissues. As a result, although these lesions can become
quite large, they are usually of small size (10).
The primary cause of mucocele formation involves
mucus extravasation from accessory salivary glands
and is generally regarded as being of traumatic origin,
particularly related to lip biting (9).
Mucus extravasation triggers a secondary inflammatory
reaction predominantly consisting of mononuclear cells in
surrounding connective tissue, followed by agranulation
Vol. 10, no. 1 (S3), 31-33 (2012)
CONGENITAL MELANOCYTIC NEVI:
A CASE SERIES
3
1
2
Nevi represent benign melanocytic neoplasms that have importance as facultative precursors and predictors
of cutaneous melanoma. In daily clinical practice high nevus counts help to identify person at risk. In the period
between January 2008 and December 2010, 141 patients underwent to nevi excision at the Pediatric Surgery Unit, S
Anna Hospital, Ferrara, Italy. Patients included 64 (45.4%) females and 77 (54,6%) males. Age ranged from 1.5 to
18 years with a mean value of 12.4 years at the time of admission. 29, 46, 75 and 19 nevi where located in arms, legs,
trunk and head and neck, respectively. 19, 121 and 29 nevi were junctional, compound and dermal nevi, respectively.
Nevi were treated with surgical excision: 35 under general anesthesia, 4 under sedation and the remaining under
local anesthesia. Melanocytic nevi during the past have been treated with several techniques such as cauterization
with carbon dioxide, snow, a heated platinum loop and even by x-ray. Most of these treatments result unsatisfactory
because these cause scars whereas leaving few intact melanocytes in the derma. Surgical excision is the method of
choice. If the lesion has been injured or infected antibiotic treatment could facilitate healing.
promotion, senescence and involution. Initiation occurs
The generic term “nevus” originates from the
Vol. 10, no. 1 (S3), 35-38 (2012)
when nevus progenitor cell acquires
a mutation that will
Latin word “naevus”, possibly indicated the maternal
permit future growth, promotion occurs when the mutated
imprinting and still, is primarily used in dermatology for
cell is activated and proliferation begins. This proliferation
signifier, even if not always in the proper manner, isolated
MALFORMATIONS
OF THE by
EAR
is likely investigated
a change in local environmental
or multiple different clinicalCONGENITAL
entities. Furthermore,
the
factors that melanocytic growth on the sustained by the
confusion about the meaning of the nevus term is derived
1
1
2 After a period of growth
previously acquired
mutation.
from the habit of its widespread
use without an adjective,
A. FRANCHELLA
, S. PELLEGRINELLI
, F. CARINCI
,
2
2
2
nevi stop
proliferating trough
i.e. without a qualification (1). I. ZOLLINO , G. CARNEVALI
, V. CANDOTTO
, the activation of senescence
2 a
3
pathways
Nevogenesis is a multifactorial
that involves
S. process
FRANCHELLA
, V. PINTO
, G.P(2).
MORSELLI3
In children like in adults pigmented lesions can
complex interplay of genetics and environmental factors.
pose significant diagnostic and therapeutic challenges.
Current models of nevogenesis
propose that melanocytic
1
Fortunately, malignant melanoma is exceedingly rare in
neoplasm
arises
from
a
single
cell
of
origin.
However,
2
of D.M.C.C.C.,
Section
Surgery,
University
of Ferrara,
Italy
childhood
and many
pigmented
lesions Ferrara,
can be followed
the3Department
differentiation
state of this cell
has of
notMaxillofacial
been clearly and Plastic
University
of
Bologna,
School
of
Plastic
Surgery,
Plastic
Surgery
Unit
S.
Orsola
Hospital,
Bologna,
Italy
safety without surgical management. In the past
established. It is already not determined if the progenitor
decade several non invasive techniques allowing more
cell is located in the dermis or epidermis or both. One
accurate
clinical
diagnosis
of pigmented
lesionsanotia
have
possibility
could beofthat
immature
Malformations
thean
external
earmelanocytic
can involve stem
orientation,
position,
size and
relief pattern
of the pinna,
been must
developed.
Dermoscopy
suchshape
no invasive
cell serves
as the nevus
progenitor
cell (1, 2).of ear malformations
may
also occur.
To make
a classification
be considered:
size is
of one
auricle,
of the
vivo
technique.
Usually
alcohol
oil is of
applied
in
benign
melanocytic
follow anstudy in
earUsually
and position
of the
ear. Aim of lesions
this retrospective
is to
assess
the clinical
outcome
in or
a series
patients
theIn
surface
of thebetween
dermatoscope
improve
the clarity
archetypal
thatand
consists
in fourthe
stages:
initiation,
affected
bylife
earcircle
defects
discusses
pertinent
literature.
the period
Januaryto2001
and December
2010, 35 patients underwent to surgical correction of external ear malformations at the Pediatric Surgery Unit,
Key words:
Nevi,included
melanocytic,
tumor, skin,
S Anna Hospital, Ferrara, Italy.
Patients
23 neoplasm,
(66%) females
andmelanoma.
12 (34%) males. Age ranged from 1
months to 14.5 years with a mean value of 2.6 years at the time of admission. All cases were surgically corrected
Corresponding
author:
Prof. Francesco
Carinci, M.D
under general
anesthesia.
Successful
correction of prominent ears and of all others kind of ear malformations
Department of D.M.C.C.C.
requires a precise understanding of the normal anatomy and relationships of the external ear with the face. The
Section Maxillofacial and Plastic Surgery,
0393-974X
surgeon of
should
tissue
features (2012)
of the
University
Ferrarabe familiar with the normal anatomy of the cartilaginous skeleton and the soft Copyright
© by BIOLIFE, s.a.s.
external
ear. 203
Abnormalities
in ear dimensions will reveal themselves
at
an
early
age.
The
rapid
development
of
the
Corso
Giovecca
44100 Ferrara Italy
without written
permission from the
holder.
E-mail:
Web: www.carinci.org
ear to [email protected]
approximately
90% of adult dimensions by age 3 years allows forreproduced
early surgical
intervention
forcopyright
auricular
31 (S3)
Phone: +39.0532.455874 Fax: +39.0532.455876
anomalies. Many surgeons recommend performing surgical correction of prominent ears when children are aged
3 to 6 years, before the start of school. The goal is to minimize the malformation before the period of socialization
to avoid ridicule by other children.
The external ear consists in auricle and external
acoustic meatus. The auricle arises from a series of
elevations termed “auricular hillocks” around the first
pharyngeal cleft. Three elevations on the first pharyngeal
arch (i.e. the mandibular arch) and three elevations on the
second pharyngeal arch are seen at six weeks. The hillocks
are transitory and soon lose their identity to contribute to
the various part of the external ear. Early first auricle is
secretion factors, growth factors and cell adhesion
proteins have been identified as being responsible (2, 3).
However, in all genetically determined malformations
one can assume a high frequency of spontaneous genetic
mutation. Among the congenital malformations about
30% are associated with syndromes involving additional
malformations and functional losses of organs and organ
systems. Examples are Threacher-Collins Syndrome or
Vol. 10, no. 1 (S3), 39-42 (2012)
BRANCHIAL ANOMALIES
3
1
2
Branchial anomalies are masses located in children’ neck. They are composed of an heterogeneous group of
congenital malformations mainly fistulae, cysts, sinus tracts and cartilaginous remnants. Females and males are
affected equally and many lesions are diagnosed before child reaches adulthood. Aim of this retrospective study
is to asses the clinical outcome in a series of patients affected by branchial anomalies and discuss the pertinent
literature. In the period between January 2001 and December 2010, 31 patients underwent to surgical correction
of branchial anomalies at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 15 (48.4%)
females and 16 (51.6%) males. Age ranged from 5 months to 15.6 years with a mean value of 5.1 years at the time
of admission. There were 16 fistulae 5 cysts and 10 branchial remnants All cases were surgically corrected under
general anesthesia. Cervical cysts occur in children and adolescents as a mass situated anterior to the sterno-cleid
muscle and near the angle of the mandible. Cervical symptoms may consist of drainage from a pit –like depression
at the angle of mandible. The definitive treatment of all branchial anomalies is the surgical for a complete excision.
Complete surgical resection through a wide transverse cervicotomy results in good prognosis. Identification
during operation, of the internal and external carotid arteries and of the vagus, hypoglossal, glossopharingeal and
superior laryngeal nerves will avoid injury of these structures.
Vol. 10, no. 1 (S3), 43-47 (2012)
typically appears in the lateral neck. Particularly, cysts
Branchial anomalies are masses located in children’
and fistulas of the neck are believed to derive from the
neck. They are composed of an heterogeneous group of
second
branchial arch. Second arch abnormalities can
congenital malformations mainly fistulae,CLEFT
cysts, sinus
LIP AND
PALATE:
sub-classified into four types of lesions by using their
tracts and cartilaginous remnants. Females and males are
A CASE SERIES ANALYSIS
anatomical location (4): 1 - lesions which are anterior
affected equally and many lesions are diagnosed before
to the sternocleidomastoid
muscle
(SMC) and are not in
child reaches adulthood (1).
1
1
2
A. FRANCHELLA
, S. PELLEGRINELLI
F. CARINCI
Several theories have been
proposed regarding
the
contact with ,carotid
artery; 2, - lesions which are deep in
2
2
2
ZOLLINOobliteration
,G. CARNEVALI
, V. CANDOTTO
,
origin of anomalies such as theI. incomplete
the SCM
and either are anterior
or posterior to the carotid
2
3
3
V. PINTO
, G.P
artery;
3 - MORSELLI
lesions which pass between the internal and
of branchial mucosa, persistenceS.ofFRANCHELLA
vestige of the preexternal carotid arteries and are adjacent to pharynx; 4
cervical sinus, thymopharingeal ductal origin and cystic
1 The brachial apparatus, that begin
lymphnode origin (2).
- lesionsofwhich
are medial
to the
Department of Pediatric Surgery, University
Ferrara,
Ferrara,
Italycarotid sheed and are
to 2form
in
the
second
week
of
fetal
life
and
is
completed
in
close
proximity
to
the
pharynx
adjacent
to the tonsillar
Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara,
Ferrara,
Italy
by3University
the sixth orofseventh
week,
is
probably
the
structure
fossa.
Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy
Cysts and fistulae usually present as a non tender mass
most widely believed to be the source of brachial cysts,
however, definitive data remain elusive (3).
in the neck, which may actually increase in size after un
Orofacial
commonlymphoephitelial
birth defects of complex
resulting
in disruptions
ofifnormal
facial
Branchial clefts
cleft (OFC)
cyst orarecervical
upperaetiology
respiratory
tract infection.
However,
large enough
structure.
They
represent
one
of
the
most
usual
birth
defects
and
occur
in
1
per
500
to
2,500
births
depending
on
the anomalies can cause asymmetry of the neck as well
cyst represents a unilateral soft tissue swelling that
ancestry, geographic residential location, maternal age and prenatal exposures, and socioeconomic status. Aim of this
retrospective study is to assess the clinical outcome in a series of patients affected cleft lip and palate and discuss the
Key words:
Branchial,
anomaly,
fistulae,
cysts, neck,
malformation
pertinent literature. In the period
between
January
2001 and
December
2010,
56 patients underwent to cleft lip and/
or palate correction at the Pediatric Surgery Unit, S. Anna Hospital, Ferrara, Italy. Patients included 25 females and
23
males. There were 7 cleft lip, 24 cleft palate and 17 cleft lip and palate. All patients were surgically corrected under
general
anesthesia.
and Skoog techniques were used for cleft lip anomalies, whereas Langebeck, VidmayerSection Maxillofacial
andMillard
Plastic Surgery,
0393-974X (2012)
University
of Ferrara
Perko
and
Furlow techniques were used for cleft palate defects. In our series a multidisciplinary
approach
was used
Copyright
© by BIOLIFE,
s.a.s.
Corso
Giovecca
203
44100
Ferrara
Italy
publication
and/or article
individual use only
and maycases.
not be further
and several surgical techniques were performed. Functional and This
aesthetic
results
wereis for
satisfactory
in most
The
need
of a specific dedicated team is mandatory for treating
this group of
patients.
39 (S3)
Unauthorized
reproduction may result in financial and other penalties
Phone: +39.0532.455874 Fax: +39.0532.455876
Orofacial clefts (OFC) are common birth defects of
complex etiology resulting in disruptions of normal facial
structure (1). They represent one of the most usual birth
defects and occur in 1 per 500 to 2,500 births depending
on ancestry, geographic residential location, maternal age
and prenatal exposures, and socioeconomic status (2, 3).
The common forms of OFC involve disruption of
tissue planes above the lip extending into the nares and/
or the palate (hard and/or soft). Thus, OFC can occur in
three main types: cleft lip only (CL), cleft lip with palate
(CLP), and cleft palate only (CP). More than 60% of cases
of morphogenesis of the primary and secondary palates
toward a threshold of abnormality at which clefting can
occur (6).
Approximately 70% of cases with cleft lip with/
without cleft palate (CL/P) occur in isolation i.e. in
isolated entities with no other major birth defects,
developmental disabilities, apparent cognitive and
structural abnormalities, commonly termed “isolated,
non-syndromic OFC” (7, 8). However, they can still occur
as part of a broad range of chromosomal, Mendelian, or
teratogenic syndromes (1) including other anomalies
Vol. 10, no. 1 (S3), 49-54 (2012)
ORTHODONTIC TOOTH MOVEMENT
AND DISTRACTION OSTEOGENESIS
A. LUCCHESE1, F. CARINCI2, V. SAGGESE3, D. LAURITANO3
3
Dental Clinic,Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy
1
2
The purpose of this preliminary study was to compare the rate of orthodontic tooth movement into bone
regenerate created after mandibular DO with the rate of orthodontic tooth movement in patients in which
extraction was performed and followed by traditional orthodontic treatment. The rate of orthodontic tooth
movement into bone regenerate created after mandibular DO in 14 Class II subjects (5 males and 9 females, mean
age 25.0±1.1years) treated with Distraction Osteogenesis appliance was compared with the rate of orthodontic
tooth movement in 20 subjects (mean age 19.9±3.8 years), in which extraction was performed and followed by
traditional orthodontic treatment for space closure. Teeth movements (amount and rate) were evaluated by
measuring the distance between the distal wing of the canine and the mesial wing of the first premolar bracket
with Vernier callipers (Dentaurum). Readings were noted every 2 weeks until space closure was completed. In the
present study the mean duration of the Post-distraction orthodontic treatment (orthodontic tooth movements,
finishing) was 10±.5 months. The mandibular posterior teeth were moved into the edentulous segment created by
distraction using active tieback in 8±1 months; the average time to complete space closure was 3.34±.94 months in
the traditional orthodontic treatment. The average space closure was 4.24±1.32mm in the traditional orthodontic
treatment and 5.46 ±0.35 mm in the patients treated with DO. The mean rate of tooth movement was 1.27±0.23
mm/month in the in the traditional orthodontic treatment and 0.68±0.20mm/month in the in the patients treated
with DO (Table I). Unpaired t test showed a significant difference between tooth movement in the study sample
and in the control group (p>.05). As suggested by most scientific literature, in our sample, dental movement was
started at the end of the latency and consolidation time. However, the amount and rate of space closure in the
distraction area were higher than with traditional orthodontic treatment. In conclusion, the purpose of this study
was to highlight the need for careful assessment of working time on patients undergoing distraction osteogenesis.
Undoubtedly, this approach can be used for treatment of very severe skeletal malocclusions and maxillofacial
deformities, but it cannot be considered an alternative to traditional orthodontic surgery to speed up treatment
since the process of tooth movement requires its time.
Distraction osteogenesis (DO) is the process of
generating new bone in a gap between two bone segments
in response to the application of graduated tensile stress
across the bone gap. Originally this approach was
developed as a tool for long bone lengthening and fracture
healing. The principles of mechanical manipulation of
bone segments in orthopedics date back to ancient times.
Around 400 B.C. Hippocrates described the application of
traction to fractured bones, although this was done more
to improve the realignment of bone stumps than to induce
a real distraction osteogenesis (1). Codivilla (1905) was
the first to combine the techniques of osteotomy and
skeletal distraction to achieve lower limb lengthening
(2). He developed a “continuous extension” procedure for
the treatment of lower limb fractures. Later on, in 1951,
Ilizarov applied the principles of distraction osteogenesis
to orthopaedic practice, and he discovered two biological
principles that are still known as the “Ilizarov effects”:
Key words: distraction osteogenesis, space closure, orthodontic tooth movement.
Corresponding Author: Alessandra Lucchese, D.D.S.
School of Dental Hygiene,
University of Ferrara, Corso Giovecca 203
44100 Ferrara Italy
E-mail: [email protected] Phone: +39.0532.455874
Fax: +39.0532.455876
0393-974X (2012)
49 (S3)
Vol. 10, no. 1 (S3), 55-58 (2012)
IMMEDIATE LOADING VERSUS TRADITIONAL APPROACH
IN FUNCTIONAL IMPLANTOLOGY
A. LUCCHESE1, F. CARINCI2, V. SAGGESE3, D. LAURITANO3
3
Dental Clinic, Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy
1
2
Immediate loading in implantology brings various benefits to the patient both esthetical and functional. The aim
of this study was to evaluate the efficiency of the Nobel Replace® implant while applying a functionalization implant
protocol with fixed prostheses immediately loaded after their placement and to compare the results of this technique
with the traditional loading. The study sample consisted of 202 subjects who had 198 delayed-loaded dental implants
and 187 immediate-loaded implants. A total of n.385 implants were placed in the study sample. The primary stability
was evaluated through the measurement of the insertion torque values. The torque value at 35 N was considered the
key factor while choosing whether or not to perform an immediate load procedure. A resonance frequency analysis
(RFA) was used for measuring implant stability quotient (ISQ).Throughout the first year 10 implants failed, thus
the cumulative success rate of all the implants was 97.04%. Six of the failed implants (3%) were of the immediate
load type (placed 1 in the antero-superior, 3 in the postero-superior, and 2 in the postero-inferior area) while the
remaining 4 (2.1%) were of the non-immediate load type. The 2-year prosthetic survival rate was equal to 100%.
Three of the six immediate load implants that had failed had a torque value slightly above the crucial value (35
N) at the moment of the implantation. Amongst the implants that survived the first year there was no significant
statistic difference between the immediate-loaded implants (ISQ 60.95±0.26) and the traditional delayed-loaded
implants (ISQ 61.01±0.29). As well as no significant statistical difference was registered in the rate of the marginal
bone reabsorption between the immediate-loaded implants (0.46±0.20 mm/1 year) and the traditional delayed-loaded
implants (0.50±0.23mm/1year). No implants placed using bone grafting technique failed. These results suggest that
the immediate loading protocol implant is to be considered a predictable and safe treatment choice, as long as the
implant presents an appropriate primary stability and are strongly stabilized together.
at implant-bone interface (5-16) The aim of this study was
Immediate loading in implantology brings various
Vol. 10, no. 1 (S3), ®
(2012)
to evaluate the efficiency of the Nobel
Replace59-64
benefits to the patient both esthetical and functional (1implant
5). Reliable and easy to apply immediate loading implant
while applying a functionalization implant protocol
procedures are the solution to the increasing request of
with fixed prostheses immediately loaded after their
®
OF ALGIPORE
comfortable esthetic rehabilitation. MoreoverEFFECT
the problem
placement and
to compare the results of this technique
with immediate loadingON
is that
the implants
will notSTEM
have CELLS:
with theAN
traditional
loading.
Torque values and resonance
BONE
MARROW
IN VITRO
STUDY
healed and so, have not fused with the jawbone. This
frequency analysis were used for measuring dental
1 Implant stability
1
increases the risk ofA.
implant
failure.
is CURA
implant
stability. 2, I. ZOLLINO2,
GIRARDI
, A. PALMIERI2, F.
, F. CARINCI
essential for aA.
good
outcome.
The
clinical
assessment
2
3 of
4
HASSANIPOUR , V. SAGGESE , A. PIRAS , P. ZAMBONI5, G. BRUNELLI4,6
osseointegration is based on mechanical stability, rather
MATERIALS AND METHODS
than1 histological criteria, considering primary stability
Department of Histology, Embryology and Applied Biology,
Centre of Molecular Genetics, CARISBO
The study sample consisted of 202 subjects who had 198
(absence of mobility in bone bed after implant insertion)
Foundation,
University
of
Bologna,
Bologna,
delayed-loaded
dental Italy
implants (3 to 6 month after placement)
and
secondary stability (bone formation and remodeling
2
3
Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy
Key
4 words: Implant, Immediate loading, delayed-loaded
Dental Clinic, University of Cagliari, Italy
5
Department
of Radiology,
Anesthesiology and Surgery, University of Ferrara, Ferrara, Italy
Corresponding
Author: Alessandra
Lucchese, D.D.S.
6
Department
of
D.M.C.C.C.
Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italy
School of Dental Hygiene,
0393-974X (2012)
University of Ferrara,
publicationaiming
and/or article
for individual
use only of
and craniofacial
may not be further
Cell-based bone and cartilage replacement is an evolvingThis
therapy
atis the
treatment
E-mail: [email protected] Phone: +39.0532.455874
and+39.0532.455876
orthopedic defects
(limb amputation, damaged
and cartilage-related
disorders
and
55tissues,
(S3) bone Unauthorized
reproduction may result
in financial and
otherdental
penalties
Fax:
Fax: +39.0532.455876
and maxillofacial reconstructive surgery). Autologous cell transplantation in combination with a biodegradable
scaffold is a useful and safe option Algipore, a hydroxyapatite ceramic obtained from red alga, is largely employed
as scaffolds in bone regeneration. Here we studied how this biomaterial promote osteoblast differentiation in
stem cells derived from bone marrow, measuring the expression levels of bone related genes and mesenchymal
stem cells marker by Real Time Reverse Transcription-Polymerase Chain Reaction. Algipore induces osteoblast
differentiation in stem cells derived from bone marrow, as indicated by the activation of osteoblast related genes
SPP1, ALPL, RUNX2 and SP7.
Synthetic resorbable scaffold is a useful and safe
option (1) in bone regeneration to repair bone defects in
orthopedics and maxillofacial surgery.
Research in regenerative medicine is developing at a
the most promising bone regeneration techniques.
Stem cells are undifferentiated cells with the
capability to regenerate into one or more committed cell
lineages. Stem cells isolated from multiple sources have
Vol. 10, no. 1 (S3), 65-70 (2012)
ALLOGRO® INDUCES OSTEOBLAST DIFFERENTIATION
IN HUMAN BONE MARROW STEM CELLS
A. GIRARDI1, A. PALMIERI2, F. CURA1, F. CARINCI2, I. ZOLLINO2,
A. HASSANIPOUR2, V. SAGGESE3, A. PIRAS4, P. ZAMBONI5, G. BRUNELLI4,6
Department of Histology, Embryology and Applied Biology, Centre of Molecular Genetics, CARISBO
Foundation, University of Bologna, Bologna, Italy
2
3
4
5
Department of Radiology, Anesthesiology and Surgery, University of Ferrara, Ferrara, Italy
6
1
Synthetic and biological materials are increasingly used to provide temporary or permanent scaffolds for bone
regeneration. Allogro, a demineralized freeze-dried bone allograft is an optimal scaffold used worldwide to fill bone
defects and to restore bone loss in orthopedic and maxillofacial surgery. To study how Allogro can induce osteoblast
differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells
marker were analyzed, using real time Reverse Transcription-Polymerase Chain Reaction. The obtained results
demonstrated that Allogro influences the osteo-differentiation of stem cells as demonstrated by the activation of
osteoblast related genes RUNX2, ALPL and SPP1.
with osteoprogenitor cells from bone marrow may
Autogenous bone graft has been the “gold standard”
potentially deliver the advantages of autogenous bone
in orthopedic and dental prosthetic surgery to restore the
EUROPEAN
OF INFLAMMATION
Vol. 10, no. 1 (S3), 71-76 (2012)
grafts without the procurement morbidity.
bone loss JOURNAL
subsequent
prosthetic failure and osteolysis
Stem cells are undifferentiated cells with the
(1). Moreover also in spinal and maxillofacial surgery is
capability to regenerate into one or more committed cell
frequently necessary to restore bone stock and enhance
lineages.
Stem cells
isolated from multiple
sources have
bone
healing® ACTS
for spinal
fusion and
maxillaryDERIVED
sinus
BIO-OSS
ON BONE
MARROW
STEM CELLS
PROMOTING
OSTEOBLAST
been finding widespread use to advance the field of tissue
augmentation.
DIFFERENTIATION
repair (5).
However, bone graft harvest may lead to complications,
few reports
analyze the
such as chronic pain, numbness, and
poor cosmesis 2(2).
1
2
2
A. GIRARDI , A. PALMIERI , F. CURA1Because
, F. CARINCI
, I. ZOLLINO
, effects of Allogro
(6-8)4 and none of those
studies focus 4,6on the genetic
For this reason synthetic and biological
materials 3are
2
5
A. HASSANIPOUR , V. SAGGESE , A. PIRAS
, P. ZAMBONI , G. BRUNELLI
effects on stem cells, the expression of genes related to
increasingly used to provide temporary or permanent
scaffolds for bone regeneration (3).
the osteoblast differentiation were analyzed using cultures
1
Department
of Histology,
Embryology
and Applied
Biology,
of Molecular
Genetics,
of stem Centre
cells derived
from bone
marrow CARISBO
BMSC treated
Tissue
engineering
for bone grafting
may emerge
as an
Foundation,
University
of
Bologna,
Bologna,
Italy
alternative to autogenous bone grafts (4).
with Allogro.
2
Department
of D.M.C.C.C.,
Section
Surgery, University
of Ferrara,
Ferrara,
Italy
Allogro (Ceramed,
Lakewood,
CO),ofa Maxillofacial
demineralized and Plastic
To investigate
the osteogenic
differentiation
of BMSC,
3
freeze-dried
bone allograft,
is a promising
for Technologies,
the quantitative
expressionMilano
of the mRNA
of specific
Department
of Neurosciences
andmaterial
Biomedical
University
Bicocca,
Italy genes,
bone grafting, useful as a scaffold4Dental
to fill bone
defects
likeof transcriptional
Clinic,
University
Cagliari, Italy factors (RUNX2 and SP7), bone
5
and to restore
bone lossofinRadiology,
orthopedicAnesthesiology
and maxillofacial
related University
genes (SPP1,
COL1A1,Ferrara,
COL3A1,Italy
ALPL, and
Department
and Surgery,
of Ferrara,
surgery
(6).
FOSL1)
and
mesenchymal
stem
cells
marker
(ENG)
6
Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italywere
examined by means of real time Reverse TranscriptionA composite graft that combines a synthetic scaffold
Bio-Oss® a deproteinized
bovine
is widely
used
scaffold for
autologous cells in several bone
Key anorganic
words: Allogro,
stembone
cell, bone
marrow,
geneasexpression,
osteoblasts
regeneration procedures. To study how Bio-Oss® can induce osteoblast differentiation in mesenchymal stem cells,
Corresponding
author:
Prof.of
Francesco
Carinci, M.D
the
expression
levels
bone related
genes and mesenchymal stem cells marker were analyzed, using real time
Department Transcription-Polymerase
of D.M.C.C.C.
Reverse
Chain Reaction. Bio-Oss® caused an induction of osteoblast related genes
(2012)
ALPL,
FOSL1 and SPP1. The obtained results can be relevant to better understand the molecular0393-974X
mechanism
by
®
wich
Bio-Oss203
induce
osteoblast
Corso Giovecca
44100 Ferrara
Italy differentiation and bone regeneration.
Phone: +39.0532.455874 Fax: +39.0532.455876
65 (S3)
Bio-Oss® (Geistlich, Wolhusen, Switzerland) is a
deproteinized sterilized bovine bone constituted by a
calcium-deficient carbonate apatite.
This biomaterial promotes osteogenesis, has a very
low resorption rate and a very little degradation. For this
reason it is largely employed as scaffold for maxillary
sinus floor elevation as confirmed in a long-term study
(1-3).
Bio-Oss® is identical to human bone from a chemical
and physical point of view (4, 5). Its particles were
surrounded by newly formed mature, compact bone with
well-organized osteons (5, 6). This surface area provides
that under the appropriate stimuli can be expanded and
differentiate into a variety of tissue lineages including
osteoblasts, adipocytes, chondrocytes, myoblasts,
hepatocytes, and possibly even neural tissue in vitro (911). There is much interest in their utilization for tissue
repair and gene therapy because BMSC maintain their
differentiation capacity in vivo on reimplantation (9).
Since Bio-Oss® is always fixed onto bone and
the mechanism by which Bio-Oss® promote osteodifferentiation in stem cells is incompletely known, we
therefore attempted to get more inside by using human
stem cells isolated from bone marrow.
Vol. 10, no. 1 (S3), 77-82 (2012)
OSTEOBLAST® DIFFERENTIATION IN BONE MARROW STEM CELLS AFTER CALCIUM
SULFATE TREATMENT
A. GIRARDI1, A. PALMIERI2, F. CURA1, F. CARINCI2, I. ZOLLINO2,
A. HASSANIPOUR2, V. SAGGESE3, A. PIRAS4, P. ZAMBONI5, G. BRUNELLI4,6
2
3
4
5
6
1
Calcium Sulfate is a highly biocompatible material largely employed to treating periodontal disease, alveolar
bone loss, and maxillary sinus augmentation. It is completely biodegradable, osteoconductive, cheap, easy to handle,
and able to support the defect area until bone growth. However, how Calcium Sulfate acts on osteoblast promoting
bone formation is poorly understood. To study how Calcium Sulfate can induce osteoblast differentiation in
mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells marker were
compared in Normal Osteoblasts and Bone Marrow Stem Cells, using real time Reverse Transcription-Polymerase
Chain Reaction. The obtained results demonstrated that Calcium Sulfate strongly influences the behavior of Bone
Marrow Stem Cells in vitro enhancing proliferation, differentiation and deposition of matrix.
Bone Marrow Stem Cells (BMSC) not only create a
Among graft material used in implant dentistry,
Vol. 10, no. 1 (S3), 83-88 (2012)
microenvironment for the normal
reproduction and
Calcium Sulfate (CaS) is one of the synthetic grafts with
differentiation of blood cells but also are a “reservoir” for
the longest clinical history (1), due to its biocompatibility
bone regeneration (14). Indeed, BMSC are a good model
(1-8) and properties (resorbable, able to maintain space,
®
OSTEOBIOL
ENHANCES OSTEOGENIC DIFFERENTIATION
IN BONE
MARROWand
DERIVED
for studying the formation,
mineralization
maturation
and
cheap) (9, 10).
of bone tissue (15).
In vivo CaS dissolves in body fluids and formsSTEM
ions CELLS
In order to detect if CaS stimulates BMSC towards
that re-precipitates on the surface forming an osteoblast
2
1 carried out.
osteoblast
differentiation, a2,specific
study was
compatibly environment.
D. LAURITANO1, F. CARINCI2, I. ZOLLINO
, A. HASSANIPOUR
V. SAGGESE
,
The
of
mRNA
It has been
utilized
in
treating
periodontal
disease,
2
3
3
4quantitative expression
5
4,6 of specific
A. PALMIERI , A. GIRARDI , F. CURA , A. PIRAS , P. ZAMBONI , G. BRUNELLI
genes, like transcriptional factors (RUNX2 and SP7),
endodontic lesions, alveolar bone loss, and maxillary
bone related genes (SPP1, COL1A1, COL3A1, ALPL,
sinus augmentation
(11). CaS has been used to facilitate
1
healing
and
to
prevent
the
loss
of
other
grafting
materials
and FOSL1) and mesenchymal stem cells marker
2
Department
of D.M.C.C.C.,
Section
Maxillofacial
Plastic was
Surgery,
University
of Ferrara,
Italy
(12).
When associated
with other
boneofgrafts
it seems and (ENG)
examined
by means
of RealFerrara,
Time Reverse
3
Department
of
Histology,
Embryology
and
Applied
Biology,
Centre
of
Molecular
Genetics,
CARISBO
to have a favorable effect on osteogenesis. CaS rapidly
Transcription-Polymerase Chain Reaction (Real Time RTUniversity
Bologna,
Italy
resorbs and leaves a calcium Foundation,
phosphate lattice
which of Bologna,
PCR). Gene
expression
in BMSC was then compared with
4
Cagliari,
Italyin Human Osteoblast (HOb) treated
promotes osteogenic activity (13). Dental Clinic, University
theofgene
expression
Stem 5Department
cells are a promising
tool Anesthesiology
for tissue repair.
with CaS,
to evaluate
potential
effect ofItaly
this material
of Radiology,
and Surgery,
University
of the
Ferrara,
Ferrara,
6
Key words: CaS; bone marrow; stem cells; gene expression; osteoblast differentiation;
OsteoBiol® (OsteoBiol, Tecnoss Dental, Turin, Italy) a cortical collagenated porcine bone is largely employed
in oral implant techniques for bone regeneration thanks to its biocompatibility and osteoconductivity To study the
mechanism author:
by which
bone promotes osteoblast differentiation and bone regeneration, changes in
Corresponding
Prof.cortical
Francescoporcine
Carinci, M.D
Department
of level
D.M.C.C.C.
expression
of bone related genes were investigated by real time RT–PCR, in bone marrow derived stem cells
and human osteoblasts cultivated with OsteoBiol®.
0393-974X (2012)
Autologous bone grafts are the first
Phone: +39.0532.455874 Fax: +39.0532.455876
choice in oral
77
implant techniques for bone regeneration of osseous
defects (1). However a number of negative aspects such
as the limited availability, tendency to partially resorption,
the need for an additional surgery, and the increased
morbidity, have prompted clinicians to test a new range
of biomaterials.
Xenografts are considered valid alternatives to
autografts, given that they represent an unlimited supply
of available material, reduce disease transmission or
infection and have good osteoconductive properties (2).
The most frequent sources of xenograft for bone
regeneration are materials of porcine or bovine origin (3)
(S3)
Bone Unauthorized
Marrow Stem
Cells
(BMSC)
a penalties
good
reproduction
may result
in financialhave
and other
osteogenic potential, simplicity in harvesting and without
ethical problems. (5). Bone Marrow Stem Cells (BMSC)
are pluripotent cell that under the appropriate stimuli can be
expanded and differentiate into a variety of tissue lineages
including osteoblasts, adipocytes, chondrocytes, myoblasts,
hepatocytes, and possibly even neural tissue in vitro (6-8)
To study how cortical porcine bone can induce
osteoblast
differentiation
and
proliferation
in
mesenchymal stem cells, the expression levels of bone
related genes (RUNX2, SP7, ALPL, SPP1, COL1A1,
COL3A1 and FOSL1) and mesenchymal stem cells
marker (ENG) were measured in BMSC and Human
Vol. 10, no. 1 (S3), 89-94 (2012)
OSTEOPLANT® ACTS ON STEM CELLS DERIVED FROM BONE MARROW INDUCING
OSTEOBLASTS DIFFERENTIATION
D. LAURITANO1, F. CARINCI2, I. ZOLLINO2, A. HASSANIPOUR2, V. SAGGESE1,
A. PALMIERI2, A. GIRARDI3, F. CURA3, A. PIRAS4, P. ZAMBONI5, G. BRUNELLI4,6
3
4
5
6
1
2
Osteoplant, an equine flexible cortical and spongy bone tissue, is a promising material for bone grafting in
orthopedic, maxillofacial and dental surgery. Osteoplant is completely resorbable, inducing oteoclast activation
and promoting the substitution of the scaffold with new bone. To study how Osteoplant can induce osteoblast
differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem
cells marker were analyzed, using real time Reverse Transcription-Polymerase Chain Reaction. Osteoplant is an
inducer of osteogenesis on human stem cells, as showed by the activation of bone related genes ALPL, SPP1 and
RUNX2, and by the down-regulation of the mesenchymal stem cells marker ENG.
defects in orthopedic, maxillofacial and dental surgery.
Large bone defects still represent a major problem
Once hydrated, this scaffold isVol.flexible
and95-100
therefore
in
orthopedics
and
maxillofacial
surgery.
Autogenous
10, no. 1 (S3),
(2012)
precisely adaptable to defect that needs to be filled.
bone grafts are traditionally employed in bone-repair
Osteoplant is a completely resorbable biomaterial that
treatments. However, bone graft is associated with an
induces oteoclast activation promoting the substitution of
unacceptably high ®incidence of complications such
P15 INDUCES RUNX2 IN BONE MARROW DERIVED STEM CELLS
the scaffold with new bone (5).
as chronic pain, numbness, and poor cosmesis (1).
Here we investigated2 the mechanism
by which
Furthermore, operative time and1 length of hospitalization
2
1
D. LAURITANO
, F. CARINCI2, I. ZOLLINO
, A. HASSANIPOUR
, V. SAGGESE
, and bone
Osteoplant
promotes osteoblast
differentiation
are often increased
(2).
2
3
3
4
5
4,6
A. PALMIERI
, A. GIRARDI
, F. CURA
, P. ZAMBONI
, G. derived
BRUNELLI
regeneration,
in bone marrow
stem cells (BMSC)
A composite
graft that combines
a synthetic
scaffold , A. PIRAS
and Human Osteoblasts (HOb).
with osteoprogenitor cells from bone marrow aspirate
1
Department
of Neurosciences
Biomedical Technologies,
University
MilanoofBicocca,
Italy
The quantitative
expression
the mRNA
of specific
may potentially
deliver
the advantages and
of autogenous
2
genes, like
transcriptional
factors
(RUNX2Ferrara,
and SP7),
bone
bone
grafts without
the procurement
morbidity
(3).
Department
of D.M.C.C.C.,
Section
of Maxillofacial
and Plastic
Surgery,
University
of Ferrara,
Italy
3
related
genes
(SPP1,
COL1A1,
COL3A1,
ALPL,
Biomaterials
used
in
bone
regeneration
are
designed
Department of Histology, Embryology and Applied Biology, Centre of Molecular Genetics, CARISBO and
FOSL1) and
mesenchymal
to be gradually resorbed by the osteoclast
and replaced
by of Bologna,
Foundation,
University
Bologna,
Italy stem cells marker (ENG) were
examined
by
means
new bone formed through osteoblastic
4 activity (4).
Dental Clinic, University of Cagliari, Italy of real time Reverse TranscriptionPolymerase Chain Reaction (real time RT-PCR) in treted
A new
promising
material
for
bone grafting is
5
BMSC and HOb.
Osteoplant,
an
equine
flexible
heterologous
deantigenic
6
Department of Dentistry and Maxillofacial and Plastic Surgery,
Don Orione Institute, Bergamo, Italy
Gene expression in BMSC was then compared with
cortical and spongy bone tissue.
the gene expression in Human Osteoblasts (HOb) treated
Osteoplant is osteoconductive and useful to fill bone
Peptide-15 (P-15) is. P-15 an analog of the cell binding domain of collagen, has been shown to facilitate
physiological process in a way
to collagen,
to marrow,
serve as
anchorage
cells, and to promote the binding,
Keysimilar
words: Osteoplant,
bone
stem
cells, genefor
expression
migration and differentiation of cells. However, how P-15 alters osteoblast activity to promote bone formation is
poorly understood. In this study we investigated the osteo-inductives properties of P15 on stem cells derived from
bone marrow. In Real Time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR) we quantified
the mRNA
expression
of specific
Section
of Maxillofacial
and Plastic
Surgerygenes, like transcriptional factors (RUNX2 and SP7), bone related genes (SPP1,
0393-974X (2012)
University
of COL3A1,
Ferrara
COL1A1,
ALPL, and FOSL1) and mesenchymal stem cells marker (ENG). Gene expression
in BMSC
Copyright © by BIOLIFE,
s.a.s.
Corso
Giovecca
203
44100
Ferrara
Italy
This publication
and/or article
is for individual
use onlyto
andevaluate
may not be further
was then compared with the gene expression in Human Osteoblasts
(HOb)
treated
with P15,
the
potential
effect
of
this
biomaterial
in
osteoblasts
differentiation.
89 (S3)
Phone: +39.0532.455874 Fax: +39.0532.455876
The discovery of new biomaterials useful for bone
regeneration is a very important field in maxillofacial
surgery and orthopedics.
An important step has been made with the discovery
of specific cell-binding domain of type I collagen (1). P15 (Ceramed, Lakewood, CO) is a highly conserved linear
peptide with a 15-amino acid sequence identical to the
sequence contained in the residues 766-780 of the alpha
chain of type I collagen (1).
Has been shown that this biomaterial facilitate
physiological processes to facilitate the exchange of
Tissue replacement by culturing autologous cells onto
three-dimensional matrixes that facilitate cell progenitor
migration, proliferation and differentiation (10) is one of
the most promising bone regeneration techniques.
The use of stem cells in association with biomaterials
that stimulate osteoblast differentiation is one of the most
promising bone regeneration techniques (10).
Bone Marrow Stem Cells (BMSC) are pluripotent cell
that under the appropriate stimuli can be expanded and
differentiate into a variety of tissue lineages including
osteoblasts, adipocytes, chondrocytes, myoblasts,
Vol. 10, no. 1 (S3), 101-104 (2012)
BISPHOSPHONATES-RELATED OSTEONECROSIS
OF THE JAW: MULTICENTRE STUDY
V. PIRAS1, G. BRUNELLI1,2, F. CARINCI3, A. PIRAS2, C. BRUGNATI3,
L. ORANI1, M. MARINI1, V. GARAU1, G. DENOTTI1
Dental Clinic, University of Cagliari, Cagliari, Italy
3
1
2
Bisphosphonate-related osteonecrosis of the jaw is defined as an ‘exposure of necrotic bone in maxillofacial
region, which persists more than 8 weeks in patients treated or, in course of treatment with bisphosphonates, not
been subjected to radiation therapy of the jaw. Bisphosphonates are compounds used to treat osteoporosis and
malignant bone metastasis. Despite the benefits related to the use of these medications, osteonecrosis of the jaws is a
significant complication in a subset of patients receiving these drugs. This complication occurs either spontaneously
or after a simple dento-alveolar surgery. This study was conducted to evaluate the correlation between the onset
of ONJ and bisphosphonate treatment, through descriptive and statistical data analysis, extracted from our study
population, and correlation with data offered by literature.
Bisphosphonates are a class of drugs that inhibit bone
resorption. This name derived from the two phosphate
groups that characterize them at molecular level. They are
used in treatment of bone diseases such as osteoporosis,
Paget disease and treatment of secondary cancer (multiple
myeloma, breast cancer, prostate cancer); are specifically
derivatives of pyrophosphate POP in which the bridge
was replaced by hydrolysable PCP (1). At this bridge, two
side chains are attached:
•
The long side chain that determines chemical
properties, action mode and potency of the drug.
•
The short side chain is responsible for chemical
properties and pharmacokinetics of the compound.
Bisphosphonates are classified into 2 major groups with
different mechanism of action:
a) Amino-Bisphosphonates, molecules containing
an amino group (alendronate, pamidronate,
Neridronate). The final effect is osteoclast apoptosis
(Generation II-III).
b) Not Amino-Bisphosphonates molecules synthesized
first, such as etidronate, clodronate and tiludronic.
This class of BP due to necrosis osteoclast
(Generation I).
Bisphosphonates bind preferentially bone surface
at sites of active remodeling and are incorporated in
osteoclasts (1). The first bisphosphonates generation
inhibits bone resorption, resulting in a toxic analogue
of adenosine triphosphate, which interferes with
mitochondrial function and leads to apoptosis of
osteoclasts. Second bisphosponates generation, inhibit
farnesyl diphosphate synthase, the enzyme responsible
of prenylation of proteins involved in the osteoclast.
Recruitment and differentiation of osteoclast precursors
are inhibited, the adhesion of osteoclasts to bone is limited
and the unit will deplete bone remodeling. The apoptosis of
osteoclasts result predominantly from not-bone resorption
(1). As was previously stated by, bisphosphonate related
osteonecrosis of the jaw is an exposure of necrotic
bone in maxillofacial region, which persists more than
8 weeks, in patients treated or, in course of treatment
with bisphosphonates, which have not been subjected to
radiation therapy of the jaw (2). From historical point
of view is not the first time that a compound containing
phosphorus is associated with osteonecrosis. Phosphorus
necrosis, also called “Phossy Jaw” (3) was found by some
physicians in the nineteenth century in the match-factory
Key words: Bisphosphonate, osteonecrosisi, jaw
Phone: +39.0532.455874 Fax: +39.0532.455876
0393-974X (2012)
101 (S3)

breast reduction

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