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 EUROPEAN JOURNAL OF INFLAMMATION 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 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 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. Corso Giovecca 203 44100 Ferrara Italy 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 EUROPEAN JOURNAL OF INFLAMMATION 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 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 3 University of Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy 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. EUROPEAN JOURNAL OF INFLAMMATION 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 University of Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy 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 University of Ferrara Copyright © by BIOLIFE, s.a.s. lower lip. Mucocele were treated with surgical excision, 13 under general anesthesia and the remaining under local Corso Giovecca 203 44100 Ferrara Italy This publication and/or article is for individual use only and may not be further 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) Unauthorized reproduction may result in financial and other penalties 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 EUROPEAN JOURNAL OF INFLAMMATION Vol. 10, no. 1 (S3), 31-33 (2012) CONGENITAL MELANOCYTIC NEVI: A CASE SERIES 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 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 3 University of Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy 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 Department of Pediatric Surgery, University of Ferrara, Ferrara, Italy 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 This publication and/or article is for individual use only and may not be further 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) Unauthorized reproduction may result in financial and other penalties 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. EUROPEAN JOURNAL OF INFLAMMATION 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 EUROPEAN JOURNAL OF INFLAMMATION Vol. 10, no. 1 (S3), 39-42 (2012) BRANCHIAL ANOMALIES 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 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 3 University of Bologna, School of Plastic Surgery, Plastic Surgery Unit S. Orsola Hospital, Bologna, Italy 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. EUROPEAN JOURNAL OF INFLAMMATION 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 Corresponding author: Prof. Francesco Carinci, M.D 23 males. There were 7 cleft lip, 24 cleft palate and 17 cleft lip and palate. All patients were surgically corrected under Department of D.M.C.C.C. 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 reproduced without written permission from the copyright holder. E-mail: [email protected] Web: www.carinci.org 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 EUROPEAN JOURNAL OF INFLAMMATION Vol. 10, no. 1 (S3), 49-54 (2012) ORTHODONTIC TOOTH MOVEMENT AND DISTRACTION OSTEOGENESIS A. LUCCHESE1, F. CARINCI2, V. SAGGESE3, D. LAURITANO3 Department of D.M.C.C.C., School of Dental Hygiene, University of Ferrara, Ferrara Italy Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 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. Department of D.M.C.C.C. 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) Copyright © by BIOLIFE, s.a.s. This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties EUROPEAN JOURNAL OF INFLAMMATION Vol. 10, no. 1 (S3), 55-58 (2012) IMMEDIATE LOADING VERSUS TRADITIONAL APPROACH IN FUNCTIONAL IMPLANTOLOGY A. LUCCHESE1, F. CARINCI2, V. SAGGESE3, D. LAURITANO3 Department of D.M.C.C.C., School of Dental Hygiene, University of Ferrara, Ferrara Italy Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 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 EUROPEAN JOURNAL OF INFLAMMATION Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 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, Copyright © by BIOLIFE, s.a.s. Corso Giovecca 203 44100 Ferrara Italy 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 reproduced without written permission from the copyright holder. 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 EUROPEAN JOURNAL OF INFLAMMATION 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 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 3 Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy 4 Dental Clinic, University of Cagliari, Italy 5 Department of Radiology, Anesthesiology and Surgery, University of Ferrara, Ferrara, Italy 6 Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italy 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 Section of Maxillofacial and Plastic Surgery (2012) ALPL, FOSL1 and SPP1. The obtained results can be relevant to better understand the molecular0393-974X mechanism by University of Ferrara Copyright © by BIOLIFE, s.a.s. ® wich Bio-Oss203 induce osteoblast Corso Giovecca 44100 Ferrara Italy differentiation and bone regeneration. This publication and/or article is for individual use only and may not be further E-mail: [email protected] Web: www.carinci.org 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 reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties 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. EUROPEAN JOURNAL OF INFLAMMATION 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 Department of Histology, Embryology and Applied Biology, Centre of Molecular Genetics, CARISBO Foundation, University of Bologna, Bologna, Italy 2 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 3 Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy 4 Dental Clinic, University of Cagliari, Italy 5 Department of Radiology, Anesthesiology and Surgery, University of Ferrara, Ferrara, Italy 6 Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italy 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 Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy 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, EUROPEAN JOURNAL OF INFLAMMATION Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italy 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 Section of Maxillofacial and Plastic Surgery and human osteoblasts cultivated with OsteoBiol®. 0393-974X (2012) University of Ferrara Corso Giovecca 203 44100 Ferrara Italy E-mail: [email protected] Web: www.carinci.org 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) Copyright © by BIOLIFE, s.a.s. This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. 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 EUROPEAN JOURNAL OF INFLAMMATION 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 Department of Neurosciences and Biomedical Technologies, University Milano Bicocca, Italy Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 3 Department of Histology, Embryology and Applied Biology, Centre of Molecular Genetics, CARISBO Foundation, University of Bologna, Bologna, Italy 4 Dental Clinic, University of Cagliari, Italy 5 Department of Radiology, Anesthesiology and Surgery, University of Ferrara, Ferrara, Italy 6 Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italy 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 EUROPEAN JOURNAL OF INFLAMMATION 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 Department of Radiology, Anesthesiology and Surgery, University of Ferrara, Ferrara, Italy 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 Corresponding author: Prof. Francesco Carinci, M.D bone marrow. In Real Time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR) we quantified Department of D.M.C.C.C. 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 reproduced without written permission from the copyright holder. E-mail: [email protected] Web: www.carinci.org potential effect of this biomaterial in osteoblasts differentiation. 89 (S3) Unauthorized reproduction may result in financial and other penalties 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, EUROPEAN JOURNAL OF INFLAMMATION 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 Department of Dentistry and Maxillofacial and Plastic Surgery, Don Orione Institute, Bergamo, Italy 3 Department of D.M.C.C.C., Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy 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 Corresponding author: Prof. Francesco Carinci, M.D Department of D.M.C.C.C. Section of Maxillofacial and Plastic Surgery University of Ferrara Corso Giovecca 203 44100 Ferrara Italy E-mail: [email protected] Web: www.carinci.org Phone: +39.0532.455874 Fax: +39.0532.455876 0393-974X (2012) 101 (S3) Copyright © by BIOLIFE, s.a.s. This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties