Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

Breast cancer is the most common malignant disease among women, with a lifetime risk of approximately 10%. Frequent and well-known locations of metastases are bone, liver, lung, skin and brain, but tumour repetition has been seen in almost any anatomic site. Orbital involvement is quite rare, or perhaps underestimated. Orbit metastases (OMs) represent 1–13% of all orbital cancers, and are difficult to discriminate with other differential diagnoses, such as a simple blepharitis, or orbital pseudotumor, up to more complex forms of cancer such as lymphoma. The prevalence of OMs is calculated to occur in 2–4.7% of primitive cancer patients. Typical manifestations of orbital metastases include overall regional inflammation, mass effect causing displacement or ocular globe proptosis, pain, bone infiltration, chemosis and eyelid swelling. Infiltration of soft tissue leads to ptosis, diplopia or enophthalmos. We report the case of a 70-year-old female patient who developed chronic inflammatory process of both orbital regions due to orbital metastases, without evidence of other systemic disease after 8 years from primary breast cancer diagnosis. The diagnostic pathway as well as the differential diagnosis are discussed.

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction that occurs in a very different ways and affects patients with complex medical histories. The objective of this study is to evaluate the prognosis of surgically treated drug-related osteonecrotic lesions and to verify whether the platelet concentrates used during the surgical procedure can improve the prognosis. The study was performed by analyzing a sample of 64 patients with medication-related osteonecrosis of the maxillary bones, in which 79 lesions were diagnosed and surgically treated at the S. Orsola-Malpighi Polyclinic in Bologna. The lesions treated with PRP showed a lower tendency to relapse compared to its non-use, the probability of recurrence. In conclusion, this study demonstrates that treatment with PRP may have positive effects in the therapy of Medication-Related Osteonecrosis of the Jaw (MRONJ).